Health care provider payment schemes across nine Central and Eastern European countries – a comparative analysis

Abstract

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 methods 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) development of a theoretical framework and data collection form; 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 changes conducted in this field since 2010. 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, while both PHC and hospital inpatient care have experienced the most substantial changes in their payment schemes within the last 13 years. The most frequently conducted changes focused 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 conduced change were often similar, thus, there is high potential for a shared, cross-country learning.