Comparing cost-sharing practices for pharmaceuticals and health care services among four central European countries

The paper reviews the existing cost-sharing practices in four Central European countries namely the Czech Republic, Hungary, Poland and Slovakia focusing on patient co-payments for pharmaceuticals and services covered by the social health insurance. The aim is to examine the role of cost-sharing arrangements and to evaluate them in terms of efficiency, equity and public acceptance to support policy making on patient payments in Central Europe. Our results suggest that the share of out-of-pocket payments in total health care expenditure is relatively high (24–27%) in the countries examined. The main driver of these payments is the expenditure on pharmaceuticals and medical devices, which share exceeds 70% of the household expenditure on health care. The four countries use similar cost-sharing techniques for pharmaceuticals, however there are differences concerning the measure of exemption mechanisms for vulnerable social groups. Patient payment policies for health care services covered by the social health insurance are also converging. All the four countries apply co-payments for dental care, some hotel services or in the case of free choice of physician. Also the countries (except for Poland) tried to extend co-payments for physician services and hospital care. However, their introduction met strong political opposition and unpopularity among public.

The impact of the recession on health care expenditure — How does the Czech Republic, Hungary, Poland and Slovakia compare to other OECD countries?

In the past few years, several papers have been published in the international literature on the impact of the economic crisis on health and health care. However, there is limited knowledge on this topic regarding the Central and Eastern European (CEE) countries. The main aims of this study are to examine the effect of the financial crisis on health care spending in four CEE countries (the Czech Republic, Hungary, Poland and Slovakia) in comparison with the OECD countries. In this paper we also revised the literature for economic crisis related impact on health and health care system in these countries. OECD data released in 2012 were used to examine the differences in growth rates before and after the financial crisis. We examined the ratio of the average yearly growth rates of health expenditure expressed in USD (PPP) between 2008–2010 and 2000–2008. The classification of the OECD countries regarding “development” and “relative growth” resulted in four clusters. A large diversity of “relative growth” was observed across the countries in austerity conditions, however the changes significantly correlate with the average drop of GDP from 2008 to 2010. To conclude, it is difficult to capture visible evidence regarding the impact of the recession on the health and health care systems in the CEE countries due to the absence of the necessary data. For the same reason, governments in this region might have a limited capability to minimize the possible negative effects of the recession on health and health care systems.

The impact of the recession on health care expenditure — How does the Czech Republic, Hungary, Poland and Slovakia compare to other OECD countries?

In the past few years, several papers have been published in the international literature on the impact of the economic crisis on health and health care. However, there is limited knowledge on this topic regarding the Central and Eastern European (CEE) countries. The main aims of this study are to examine the effect of the financial crisis on health care spending in four CEE countries (the Czech Republic, Hungary, Poland and Slovakia) in comparison with the OECD countries. In this paper we also revised the literature for economic crisis related impact on health and health care system in these countries. OECD data released in 2012 were used to examine the differences in growth rates before and after the financial crisis. We examined the ratio of the average yearly growth rates of health expenditure expressed in USD (PPP) between 2008–2010 and 2000–2008. The classification of the OECD countries regarding “development” and “relative growth” resulted in four clusters. A large diversity of “relative growth” was observed across the countries in austerity conditions, however the changes significantly correlate with the average drop of GDP from 2008 to 2010. To conclude, it is difficult to capture visible evidence regarding the impact of the recession on the health and health care systems in the CEE countries due to the absence of the necessary data. For the same reason, governments in this region might have a limited capability to minimize the possible negative effects of the recession on health and health care systems.

A megszokott keretek csapdájában. Gondolatok az Európai Unió 2014-2020 közötti költségvetési kiadásairól (Falling into the trap of usual frameworks. Thoughts on the eu level budgetary expenditures in 2014–2020)

Ebben a cikkben az egész európai integrációs folyamat szempontjából jelentős kérdéskör: az uniós szinten működő közös költségvetés kiadási oldalának 2014–2020 közötti kereteit vizsgálom. Bár kétségtelen, hogy számos megoldatlan probléma a bevételi oldalhoz kapcsolódó ügyek rendezetlenségéből is eredeztethető, ennek elemzésére most terjedelmi okok miatt nem térünk ki. Az uniós szintű költségvetéssel szemben támasztható általános elvi megfontolások elemzése után a 2014–2020 közötti költségvetési keret fő kiadási tételeihez kapcsolódó elmozdulásokat értékelem, rámutatva arra, hogy az új elnevezések mögött alapvetően a régi tartalom húzódik meg, s most is elmaradt a radikális átalakítás. _____ The article examines an important topic from the point of view of the whole integration process: the expenditure side of the union level common budgetary frameworks for 2014–2020. Undoubtedly, several problems are coming from the unsolved issues of the revenue side, however, due to length limits the article doesn’t deal with these issues. The investigation starts with a comprehensive analysis of theoretical background on the main tasks of a union level budget, then the author evaluates shifts among the new expenditure headings in the period 2014–2020. The author points out that the new headings reflect old contents and he concludes that the radical restructuring within the common budget was postponed again.

Az európai villamosenergia-árak központi szabályozásának hatása a fogyasztói árakra (The impacts of the price regulation on the level of retail electricity prices in Europe)

Az Európai Unión belül az elmúlt időszakban megerősödött a vita arról, vajon a Közösség versenyképességének javításához milyen módon és mértékben járulhat hozzá az ipari és lakossági fogyasztók számára kedvező áron elérhető villamos energia. Az uniós testületek elsődlegesen a verseny feltételeinek további javításában látják a versenyképesség javításának fő eszközét, ám egyesek az aktívabb központi szabályozás mellett érvelnek. A jelenleg alkalmazott európai szabályozási gyakorlat áttekintése, a szabályozási modellek és a piaci árak alakulásának vizsgálata hozzásegíthet, hogy következtetéseket vonjunk le a tagállami gyakorlatok tekintetében, vajon sikeresebb-e a központi ármegállapításon alapuló szabályozói mechanizmus, mint a liberalizált piacmodell. ______ There is a strengthening debate within the European Union in recent years about the impact of the affordable industrial and household electricity prices on the general competitiveness of European economies. While the European Institutions argues for the further liberalization of the energy retail sector, there are others who believe in centralization and price control to achieve lower energy prices. Current paper reviews the regulatory models of the European countries and examines the connection between the regulatory regime and consumer price trends. The analysis can help to answer, whether the bureaucratic central regulation or the liberalized market model seems more successful in supporting the competitiveness goals. Although the current regulatory practice is heterogeneous within the EU member states, there is a clear trend to decrease the role of regulated tariffs in the end-user prices. Our study did not find a general causal relationship between the regulatory regime and the level of consumer electricity prices in a country concerned. However, the quantitative analysis of the industrial and household energy prices by various segments detected significant differences between the regulated and free-market countries. The first group of member states tends to decrease the prices in the low-consuming household segments through cross-financing technics, including increased network tariffs and/or taxes for the high-consuming segments and for industrial consumers. One of the major challenges of the regulatory authorities is to find the proper way of sharing these burdens proportionally with minimizing the market-distorting effects of the cross-subsidization between the different stakeholder groups.