Health care provider payment schemes consist of a complex set of arrangements used to influence provider behavior towards specific health policy objectives. The study aimed at: 1) providing a structured, comparative overview of current payment schemes within the public health system in selected Central and Eastern European (CEE) countries for different health care providers; 2) identifying and comparing major changes in payment schemes since 2010. Methods included: 1) data collection form development; 2) desk research; 3) national experts' consultations; 4) comparative analysis. The results indicate that the nine CEE countries (Bulgaria, Croatia, Czechia, Estonia, Latvia, Lithuania, Hungary, Poland, and Romania) show numerous similarities in provider payment method mix and in the general direction of the recent changes conducted in this field. Output-based payment methods prevail across all countries and types of providers. Primary health care (PHC) providers are characterized by the most diverse payment method mix. PHC and hospital inpatient care have experienced the most frequent changes in their payment schemes within the last 13 years. These focused mostly on modifying existing payment methods (e.g. detailing payment categories), and applying additional methods to pay for specific services or performance (e.g. fee-for-service, bonus payments). The objectives of conducted change were often similar, thus, there is high potential for a shared, cross-country learning.

Advance Healthcare Management Institute Prague Czech Republic

Data Driven Health Division of the National Laboratory for Health Security Health Services Management Training Centre Semmelweis University Budapest Hungary

Data Driven Health Division of the National Laboratory for Health Security Health Services Management Training Centre Semmelweis University Budapest Hungary; Department of Applied Social Sciences Faculty of Technical and Human Sciences Sapientia Hungarian University of Transylvania Târgu Mureș Romania

Department of Public Health Institute of Health Sciences Faculty of Medicine Vilnius University Lithuania

Faculty of Public Health Medical University Varna Bulgaria

Institute of Economic Studies Faculty of Social Sciences Charles University Prague Czech Republic

Institute of Public Health Faculty of Health Sciences Jagiellonian University Medical College Krakow Poland

Institute of Public Health Faculty of Health Sciences Jagiellonian University Medical College Krakow Poland; Doctoral School of Medical and Health Sciences Jagiellonian University Medical College Krakow Poland

National Institute of Health Services Management Bucharest Romania

National Institute of Health Services Management Bucharest Romania; Faculty of Medicine University Titu Maiorescu Romania

Riga Stradiņš University Riga Latvia

School of Medicine University of Zagreb Croatia

World Health Organization Barcelona Office for Health Systems Financing Barcelona Spain

Zobrazit více v PubMed

Rechel B., McKee M. Health reform in central and eastern Europe and the former Soviet Union. Lancet. 2009;374(9696):1186–1195. doi: 10.1016/S0140-6736(09)61334-9. PubMed DOI

Romaniuk P., Szromek A.R. The evolution of the health system outcomes in Central and Eastern Europe and their association with social, economic and political factors: an analysis of 25 years of transition. BMC Health Serv Res. 2016;16(95):1–12. doi: 10.1186/s12913-016-1344-3. PubMed DOI PMC

Tambor M., Klich J., Domagała A. Financing healthcare in central and eastern European countries: how far are we from universal health coverage? Int J Environ Res Public Health. 2021;18(4):1382. doi: 10.3390/ijerph18041382. PubMed DOI PMC

Kutzin J., Jakab M., Cashin C. Lessons from health financing reform in central and eastern Europe and the former Soviet Union. Heal Econ Policy Law. 2010;5(2):135–147. doi: 10.1017/S1744133110000010. PubMed DOI

Healy J., McKee M. Implementing hospital reform in central and eastern Europe. Health Policy (New York) 2002;61(1):1–19. doi: 10.1016/S0168-8510(01)00213-5. PubMed DOI

Semánová C., et al. Primary care behind the former ‘Iron Curtain’: changes and development of primary healthcare provision in the Eastern part of the European Union. Prim Health Care Res Dev. 2019;20(e121):1–9. doi: 10.1017/S1463423619000410. PubMed DOI PMC

Dubas-Jakóbczyk K., et al. Hospital reforms in 11 Central and Eastern European countries between 2008 and 2019: a comparative analysis. Health Policy (New York) 2020;124(4):368–379. doi: 10.1016/j.healthpol.2020.02.003. PubMed DOI

Csanádi M., et al. Prioritization of implementation barriers related to integrated care models in Central and Eastern European countries. Health Policy (New York) 2022;126(11):1173–1179. doi: 10.1016/j.healthpol.2022.08.012. Nov. PubMed DOI

Eurostat, “Eurostat Database,” 2024. https://ec.europa.eu/eurostat/data/database (accessed Sep. 11, 2024).

K. Hirose and Z. Czepulis-Rutkowska, “Challenges in long-term care of the elderly in Central and Eastern Europe,” Geneva, Switzerland, 2016.

Sowa P.M. 1st ed. Springer; Singapore: 2016. Governance of hospitals in central and eastern europe.

Sagan A., Kowalska-Bobko I., Bryndová L., Smatana M., Chaklosh I., Gaál P. What is being done to respond to the rise of chronic diseases and multi-morbidity in Czechia, Hungary, Poland, and Slovakia? Front Public Heal. 2023;10:1–8. doi: 10.3389/fpubh.2022.1082164. PubMed DOI PMC

Langenbrunner J., Cashin C., O'Dougherty S. World Bank Publications; 2009. Designing and implementing health care provider payment systems: how-to manuals.

Cashin C., et al. Joint Learning Network for Universal Health Coverage; 2015. Assessing health provider payment systems: a practical guide for countries working toward universal health coverage.

Kutzin J. A descriptive framework for country-level analysis of health care financing arrangements. Health Policy (New York) 2001;56(3):171–204. doi: 10.1016/S0168-8510(00)00149-4. PubMed DOI

OECD . OECD Health Policy Studies; Paris: 2016. Better ways to pay for health care.

Callenbach M.H.E., Ádám L., Vreman R.A., Németh B., Kaló Z., Goettsch W.G. Reimbursement and payment models in Central and Eastern european as well as Middle Eastern countries: a survey of their current use and future outlook. Drug Discov Today. 2023;28(1):1–9. doi: 10.1016/j.drudis.2022.103433. PubMed DOI

Moreno-Serra R., Wagstaff A. System-wide impacts of hospital payment reforms: evidence from Central and Eastern Europe and Central Asia. J Health Econ. 2010;29(4):585–602. doi: 10.1016/j.jhealeco.2010.05.007. PubMed DOI

Waitzberg R., et al. Balancing financial incentives during COVID-19: a comparison of provider payment adjustments across 20 countries. Health Policy (New York) 2022;126(5):398–407. doi: 10.1016/j.healthpol.2021.09.015. PubMed DOI PMC

Barber S.L., Lorenzoni L., Ong P. Health Organization, Organisation for Economic Co-operation and Development; Geneva, Switzerland: 2019. Price setting and price regulation in health care: lessons for advancing universal health coverage, no. WHO/WKC-OECD/K18014.

European Observatory on Health Systems and Policies, “Health system reviews (HiT series),” 2023. https://eurohealthobservatory.who.int/publications/health-systems-reviews (accessed May 25, 2023).

European Observatory on Health Systems and Policies, “Health Systems and Policy monitor (HSPM),” 2023. https://eurohealthobservatory.who.int/monitors/health-systems-monitor (accessed May 25, 2023).

European Observatory on Health Systems and Policies, “Country health profiles - State of health in the EU,” 2023. https://eurohealthobservatory.who.int/publications/country-health-profiles (accessed May 25, 2023).

European Observatory on Health Systems and Policies, “The HSPM network,” 2023. https://eurohealthobservatory.who.int/monitors/health-systems-monitor/network (accessed May 25, 2023).

Ministry of Health, Vyhláška č. 315/2022 Sb. o stanovení hodnot bodu, výše úhrad za hrazené služby a regulačních omezení pro rok 2023 [Decree No. 315/2022 Coll. on the determination of point values, the amount of reimbursement for paid services and regulatory restrictions]. Czech Republic, 2022.

Bryndová L., Šlegerová L., Votápková J., Hroboň P., Shuftan N., Spranger A. Czechia: health system review. Health Syst Transit. 2023;25(1):183. i–. PubMed

Dimova A., Rohova M. Changes in GPs payment target wider population coverage for prophylactic examinations. HSPM Policy analysis. 2023 Jul.

European Observatory on Health Systems and Policies, “Croatia health Systems in transition (HiT) profile,” HSPM Country Updates 20 March 2023, 2022. https://eurohealthobservatory.who.int/monitors/health-systems-monitor/countries-hspm/hspm/croatia-2022/principal-health-reforms/analysis-of-recent-reforms/(accessed May 25, 2023).

A. Dimova et al., “Bulgaria: health system summary,” WHO Regional Office for Europe on behalf of the European Observatory on Health Systems and Policies, Copenhagen, 2022.

Gaal P., Velkey Z., Szerencses V., Webb E. The 2020 reform of the employment status of Hungarian health workers: will it eliminate informal payments and separate the public and private sectors from each other? Health Policy (New York) 2021;125(7):833–840. doi: 10.1016/j.healthpol.2021.04.014. PubMed DOI

Kotherová Z., Caithamlová M., Nemec J., Dolejšová K. The use of diagnosis-related group-based reimbursement in the Czech Hospital care system. Int J Environ Res Public Health. 2021;18(10):5463. doi: 10.3390/ijerph18105463. PubMed DOI PMC

Sagan A., Rogala M., Buszman P.P., Kowalska-Bobko I. Improved coordination of care after acute myocardial infarction in Poland since 2017: promising early results. Health Policy (New York) 2021;125(5):587–592. doi: 10.1016/j.healthpol.2021.03.010. PubMed DOI

Basińska E. Program KOS-Zawał wymaga odświeżenia [Coordinate Care program for Stroke Patients – new adjustments needed] Polityka Zdrowotna. 2023 https://politykazdrowotna.com/artykul/program-kos-zawal-wymaga/969414 accessed Nov. 19, 2023.

K. Kasekamp, “New payment model for stroke treatment,” HSPM Country Updates 23 November 2020. https://eurohealthobservatory.who.int/monitors/health-systems-monitor/analyses/hspm/estonia-2018/new-payment-model-for-stroke-treatment (accessed Nov. 19, 2023).

S.G. Scintee and C. Vladescu, “Improving Romania's DRGs system,” HSPM Country Updates 30 April 2020, 2020. https://eurohealthobservatory.who.int/monitors/health-systems-monitor/updates/hspm/romania-2016/improving-romania-s-drg-system (accessed May 25, 2023).

AOTMiT - agency for health technology assessment and tariff system 2023, “Tariff system description.” https://www.aotm.gov.pl/en/tariff-system/(accessed Nov. 19, 2023).

Kancelaria Sejmu, Ustawa 2017 Ustawa z dnia 8 czerwca 2017 r. o sposobie ustalania najniższego wynagrodzenia zasadniczego pracowników wykonujących zawody medyczne zatrudnionych w podmiotach leczniczych (Dz.U.2017poz. 1473) [Law on minimal wages for helathcare profession]. Poland, 2017.

Dubas-Jakóbczyk K., Kowalska-Bobko I., Sowada C. The 2017 reform of the hospital sector in Poland – The challenge of consistent design. Health Policy (New York) 2019;123(6):538–543. doi: 10.1016/j.healthpol.2019.03.013. PubMed DOI

M. Rohova, “Disputed budget of the NHIF for 2018,” HSPM Country Updates 20 December 2017. https://eurohealthobservatory.who.int/monitors/health-systems-monitor/updates/hspm/bulgaria-2018/disputed-budget-of-the-nhif-for-2018 (accessed May 25, 2023).

Vlaanderen F.P., et al. Design and effects of outcome-based payment models in healthcare: a systematic review. Eur J Heal Econ. 2019;20(2):217–232. doi: 10.1007/s10198-018-0989-8. PubMed DOI PMC

Michelsen S., Nachi S., Van Dyck W., Simoens S., Huys I. Barriers and opportunities for implementation of outcome-based spread payments for high-cost, one-shot curative therapies. Front Pharmacol. 2020;11(594446):1–18. doi: 10.3389/fphar.2020.594446. PubMed DOI PMC

Leao D.L.L., Cremers H.-P., van Veghel D., Pavlova M., Hafkamp F.J., Groot W.N.J. Facilitating and inhibiting factors in the design, implementation, and applicability of value-based payment models: a systematic literature review. Med Care Res Rev. 2023;80(5):467–483. doi: 10.1177/10775587231160920. PubMed DOI PMC

National Audit Office, “Outcome-based payments schemes: government's use of payment by results,” London, 2015.

Ndayishimiye C., Tambor M., Dubas-Jakóbczyk K. Barriers and facilitators to health-care provider payment reform – A scoping literature review. Risk Manag Healthc Policy. 2023;2023(16):1755–1779. doi: 10.2147/RMHP.S420529. PubMed DOI PMC

Feldhaus I., Mathauer I. Effects of mixed provider payment systems and aligned cost sharing practices on expenditure growth management, efficiency, and equity: a structured review of the literature. BMC Health Serv Res. 2018;18:1–14. doi: 10.1186/s12913-018-3779-1. PubMed DOI PMC

I. Mathauer, “Mixed provider payment systems: what are the issues?,” Geneva, 2017.

R. Messerle and J. Schreyögg, “System-wide effects of hospital payment scheme reforms: the German introduction of diagnosis-related groups,” HCHE Research Paper, Hamburg, 2022.

Quentin W., et al. How Denmark, England, Estonia, France, Germany, and the USA pay for variable, specialized and low volume care: a cross-country comparison of In-patient payment systems. Int J Heal Policy Manag. 2022;11(12):2940–2950. doi: 10.34172/ijhpm.2022.6536. PubMed DOI PMC

Mathauer I., Dkhimi F. World Health Organization; Geneva: 2019. Analytical guide to assess a mixed provider payment system.

Milstein R., Schreyögg J. The end of an era? Activity-based funding based on diagnosis-related groups: a review of payment reforms in the inpatient sector in 10 high-income countries. Health Policy (New York) 2024;141 doi: 10.1016/j.healthpol.2023.104990. PubMed DOI

Eckhardt H., Smith P., Quentin W. In: Improving healthcare quality in europe: characteristics, effectiveness and implementation of different strategies. Busse R, Klazinga N, Panteli D, Quentin W, editors. The European Observatory on Health Systems and Policies and OECD; Copenhagen: 2019. Pay for quality: using financial incentives to improve quality of care. Improving healthcare quality in Europe; p. 357. PubMed

Milstein R., Schreyoegg J. Pay for performance in the inpatient sector: a review of 34 P4P programs in 14 OECD countries. Health Policy (New York) 2016;120(10):1125–1140. doi: 10.1016/j.healthpol.2016.08.009. PubMed DOI

Papanicolas I., Milstein R., Ryan A.M., Figueroa J.F. Are alternative payment models the answer to the failures of pay-for-performance? BMJ. 2024;386 doi: 10.1136/bmj-2023-077941. Aug. PubMed DOI

Eijkenaar F., Emmert M., Scheppach M., Schöffski O. Effects of pay for performance in health care: a systematic review of systematic reviews. Health Policy (New York) 2013;110(2–3):115–130. PubMed

Barber S.L., Lorenzoni L., Ong P. Institutions for health care price setting and regulation: a comparative review of eight settings. Int J Health Plann Manage. 2020;35(2):639–648. doi: 10.1002/hpm.2954. PubMed DOI PMC

Minister of Health, Rozporządzenie MINISTRA ZDROWIA z dnia 26 października 2020 r. w sprawie zaleceń dotyczących standardu rachunku kosztów u świadczeniodawców [Minister of Health2022, Regulation on cost accounting standard for health care providers]. Poland, 2022.

Tan S.S., et al. DRG systems in Europe: variations in cost accounting systems among 12 countries. Eur J Public Health. 2014;24(6):1023–1028. doi: 10.1093/eurpub/cku025. Dec. PubMed DOI

Puls Medycyny, “NFZ nie ma pieniędzy na zapłatę za świadczenia nielimitowane? "to problem do rozstrzygnięcia wspólnie z MZ,” 2024. https://pulsmedycyny.pl/nfz-nie-ma-pieniedzy-na-zaplate-za-swiadczenia-nielimitowane-to-problem-do-rozstrzygniecia-wspolnie-z-mz-1217476 (accessed Sep. 20, 2024).

de Vries E.F., Drewes H.W., Struijs J.N., Heijink R., Baan C.A. Barriers to payment reform: experiences from nine Dutch population health management sites. Health Policy (New York) 2019;123(11):1100–1107. doi: 10.1016/j.healthpol.2019.09.006. PubMed DOI