Congress report - European Health Forum Gastein

Special Interest Sessions
The last decade was marked by intense changes in health care systems around the globe,
the changes being the most remarkable in the transition (accession) countries. These
changes will be further supplemented by the intense process of accession to the European
Union. Even if there is much more stress on economic and administrative reforms, health
care remains an important issue. Economic constraints, coupled with redefinition of national
priorities and introduction of market forces into health care pose a threat to the further
development of health care as a universal, publicly financed service.
Introduction
Reforms of health systems are a universal process, dealt with in almost all European
countries and in many countries around the world. These processes have reached various
stages – from the early phases when the general ideas are only about to be implemented to
the actual positive or negative experiences with reforms that had been initiated several years
ago. As much as the various countries differ, there is also significant variation in how they
had approached health system reforms. That depended on their historical background or
economic needs or simply the need to change the delivery of health care.
Countries of the Central and Eastern European area share the experience of living in the
same countries (most of them) as well as several aspects of the former political systems.
They have seen the eve of transition at various points of economic and social development,
some have had a more favourable starting point and some much less so.
Current situation from the system's point of view
Bismarckian-type systems have become the most frequent solution for almost all Central and
Eastern European (CEE) countries. They have resorted to them for two important reasons:
1. such systems being part of their historical tradition (for most of these countries)
2. offering more stability in the period of unstable fiscal policies and especially,
unsecure national budgets
Since the role of the State has already become significantly reduced, there is a question
about how to preserve some of the essential functions that the Ministries of Health usually
have. Among those are especially: working towards better and more equitable health
(reducing the differences in both health and disease), maintaining the system and the
adequate infrastructure of the public health system and ensuring a comprehensive package
of rights and other health care entitlements under public funding. Many of these principles
have become challenged over the course of the last few years. On the one hand that was a
direct result of the deregulation processes in many of the CEE countries and on the other
hand, the new system approaches, e.g. privatisation of health care provision and facilities,
insurance system, private and voluntary insurances, fiscal pressures at the level of the State.
For some of the countries, the independence from the former common state also represented
a particular challenge.
Challenges for the accession countries
1. Changing epidemiologic situation
Accession countries face two processes in their epidemiological situation: on the one hand
there is an ongoing process of epidemiological transition coherent with the ageing
population. On the other hand, there are 'regression' processes that contradict the usual
trends in epidemiological transition. Some communicable diseases are becoming more
important again and that poses special challenges on the health care system. There will be a
need for an overall redefinition of priorities in health care that will require a system support,
too. Increased movement of people across borders will definitely need to be supported by a
common and well co-ordinated surveillance system.
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