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Background: Improving the quality of hospital care is an important policy objective. Hospitals operate under pressure to contain costs and might face challenges related to financial deficits. The objective of this paper was to identify and map the available evidence on the association between hospital financial performance (FP) and quality of care (Q). Methods: A scoping review was performed. Searches were conducted in 7 databases: Medline via PubMed, EMBASE, Web of Science, Scopus, EconLit, ABI/INFORM, and Business Source Complete. The search strategy combined multiple terms from 3 topics: hospital AND FP AND Q. The collected data were analysed using both quantitative and qualitative methods. Results: 10 503 records were screened and 151 full text papers analysed. A total of 69 papers were included (60 empirical, 2 theoretical, 5 literature reviews, and 2 dissertations). The majority of identified studies were published within the last decade (2010-2021). Most empirical studies had been conducted in the United States (55/60), used cross-sectional approaches (32/60) and applied diverse regression models with FP measures as dependent variables, thus measuring the impact of Q on hospitals FP (34/60). The comparability of the studies’ results is limited due to differences in applied methods and settings. Yet, the general overview shows that in almost half of the cases the association between hospital FP and Q was positive, while no study showed a clear negative association. Conclusion: This scoping review provides an overview of the available literature on the association between hospital FP and Q. The results highlight numerous research gaps: (1) systematic reviews and meta-analyses of existing studies with similar measures of FP and Q are unavailable, (2) further methodological/conceptual work is needed on the metrics measuring hospital FP and Q, and (3) more empirical studies should analyse the association between FP and Q in nonUS healthcare settings.

Yemen has been facing political, economic and social challenges since 1990. The fragility of Yemen’s situation has led to a widespread conflict in 2015, resulting in the world’s largest humanitarian crisis. Amid the humanitarian catastrophe and the collapsing health system, a platform for coordinating humanitarian health response, called the National Health Cluster, has expanded its operations across the country. The study aims to evaluate the performance of the National Health Cluster in Yemen between 2015 and 2019. A qualitative research design was employed, and ten semi-structured interviews with key Health Cluster stakeholders were conducted. The study applied the Active Learning Network for Accountability and Performance in Humanitarian Action (ALNAP) guide to evaluating humanitarian action using the Development Assistance Committee (DAC) criteria. Six evaluation criteria were selected: relevance, effectiveness, efficiency, effects, connectedness and participation. Inputs from interviews were manually transcribed and then analysed using NVivo 12 software. The study results indicate that the Health Cluster in Yemen has contributed to saving lives and strengthening the local health capacities in diseases surveillance. In addition, its positive effect was evident in improving the humanitarian health response coordination.Nevertheless, engaging health stakeholders, especially national organisations, was suboptimal. Exit strategies were lacking, while services to address mental health, non-communicable diseases, senior citizens and people with disabilities were not prioritised in the Health Cluster strategic plans and partners’ response. To ameliorate Health Cluster performance, revising its objectives and establishing a cluster-specific rapid response funding mechanism are pivotal. Furthermore, preparing the national health system for recovery and actively engaging all stakeholders in the Health Cluster’ response and strategic decisions would maximise its positive impact on Yemen’s health system and population.

The future of long-term care in ten European countries: Review of policy reports and qualitative study among country experts

After the fall of communism, the healthcare systems of Central and Eastern European countries underwent enormous transformation, resulting in departure from publicly financed healthcare. This had significant adverse effects on equity in healthcare, which are still evident. In this paper, we analyzed the role of government and households in financing healthcare in eight countries (EU-8): Czechia, Estonia, Hungary, Latvia, Lithuania, Poland, Slovakia, and Slovenia. A desk research method was applied to collect quantitative data on healthcare expenditures and qualitative data on gaps in universal health coverage. A linear regression analysis was used to analyze a trend in health expenditure over the years 2000–2018. Our results indicate that a high reliance on out-of-pocket payments persists in many EU-8 countries, and only a few countries have shown a significant downward trend over time. The gaps in universal coverage in the EU-8 countries are due to explicit rationing (a limited benefit package, patient cost sharing) and implicit mechanisms (wait times). There is need to increase the role of public financing in CEE countries through budget prioritization, reducing patient co-payments for medical products and medicines, and extending the benefit package for these goods, as well as improving the quality of care.

Background Protecting people against financial hardship associated with using health care, is crucial for achieving universal health coverage. Despite the significant improvement happening in the last two decades, household out-of-pocket payments in Poland account for 23% of current spending on health, which is more than in many European Union countries. This implies an incased risk of financial hardship for Polish households. Methods The aim of this study was to assess the extent to which people in Poland experience financial hardship when they use health services. The analysis draws on household budget survey data collected annually by the Central Statistical Office of Poland between 2005 and 2014. It focuses on two indicators of financial protection: catastrophic health spending and impoverishing health spending. The study is a part of WHO country-based studies generating new evidence on financial protection in European health systems. Results In 2014, 8.6% of Polish households experienced catastrophic health spending, while 3.8% of households were impoverished or further impoverished due to health spending. Financial hardship is heavily concentrated among the poorest households for whom the incidence of catastrophic spending is 30%. Outpatient medicines are the largest single driver of catastrophic health spending across all consumption quintiles except the richest. For the richest households, payments for medical products and dental care are the main causes of financial hardship. Although financial protection improved between 2005 and 2014, the improvement among the poorest was marginal. Conclusions Policy attention should focus on protecting households against high spending on outpatient medicines, e.g. revising patient cost-sharing for prescribed medicines and strengthen regulation for over-the-counter medicines. The protection mechanisms should be targeted at low-income households (people living on social benefits, disability or survivor's pensioners). Key messages Financial protection is fairly weak in Poland compared to many European Union countries. Out-of-pocket payments for medicines (prescribed and over-the-counter) are the main cause of financial hardship for Polish households.

Background The transformation of health care systems in Central and Eastern European (CEE) countries after the fall of communism resulted in increased household out-of-pocket payments for health and a deterioration of equity in health care. Since then, CEE countries have been struggling to ensure sufficient public resources for health and improve universal health coverage. Methods We evaluated the progress in achieving universal health care coverage made over the last two decades in eight European Union countries (EU-8): Czechia, Estonia, Hungary, Latvia, Lithuania, Poland, Slovakia, and Slovenia. A desk research method was applied (2019) to collect and analyze quantitative data on health care expenditure and qualitative data on health care coverage (population coverage, service coverage, patient cost-sharing, and quality of care). Results The results show an increased priority on the part of governments to fund health care in the EU-8 countries. Nevertheless, public resources have not been sufficient to significantly reduce the role of out-of-pocket expenditure. Out-of-pocket payments in the analyzed countries result from the explicit decision to shift costs to households (patient cost-sharing for medicines, excluding dental care) or implicit rationing (long waiting times for specialist services). Despite some common features, there is a great diversity across the EU-8 with some countries (Latvia) marked with significant gaps in health care coverage, and others (Czechia, Slovenia) providing universal health care with relatively low out-of-pocket payments. Conclusions There is room for reducing out-of-pocket payments in the EU-8 through further budget prioritization. A systematic and evidence-based approach to establish a benefit basket and patient cost-sharing obligations might help to improve universal health coverage in these countries. Key messages In the last two decades, the EU-8 countries have made moderate progress in achieving universal health coverage. Despite governments’ increased priority for health, significant gaps in service and cost coverage, as well as quality of care, persist in some EU-8 countries.

This analysis of the Polish health system reviews recent developments in organization and governance, health financing, health care provision, health reforms and health system performance. In late 2017, the Polish government committed to increase the share of public expenditures on health to 6% of GDP by 2024. If the GDP continues to grow in the years to come, this will present an opportunity to tackle mounting health challenges such as socioeconomic inequalities in health, high rates of obesity, rising burden of mental disorders and population ageing that put strain on health care resources. It is also an opportunity to tackle certain longstanding imbalances in the health sector, including overreliance on acute hospital care compared with other types of care, including ambulatory care and long-term care; shortages of human resources; the negligible role of health promotion and disease prevention vis-a-vis curative care; and poor financial situation in the hospital sector. Finally, the additional resources are much needed to implement important ongoing reforms, including the reform of primary care. The resources have to be spent wisely and waste should be minimized. The introduction, in 2016, of a special system (IOWISZ) of assessing investments in the health sector that require public financing (including from the EU funds) as well as the work undertaken by the Polish health technology assessment (HTA) agency (AOTMiT), which evaluates health technologies and publicly-financed health policy programmes as well as sets prices of goods and services, should help ensure that these goals are achieved. Recent reforms, such as the ongoing reform of primary care that seeks to improve coordination of care and the introduction of the hospital network, go in the right direction; however, a number of longstanding unresolved problems, such as hospital indebtedness, need to be tackled.

BACKGROUND: Health promotion interventions for older adults are important as they can decrease the onset and evolution of diseases and thus can reduce the medical costs related to those diseases. However, there is no comparative evidence on how those interventions are funded in European countries. The aim of this study is to explore the funding of health promotion interventions in general and health promotion interventions for older adults in particular in European countries.METHOD: We use desk research to identify relevant sources of information such as official national documents, international databases and scientific articles. Fora descriptive overview on how health promotion is funded, we focus on three dimensions: who is funding health promotion, what are the contribution mechanisms and who are the collecting agents. In addition to general information on funding of health promotion, we explore how programs on health promotion for older population groups are funded.RESULTS: There is a great diversity in funding of health promotion in European countries. Although public sources (tax and social health insurance revenues) are still most often used, other mechanisms of funding such as private donations or European funds are also common. Furthermore, there is no clear pattern in the funding of health promotion for different population groups. This is of particular importance for health promotion for older adults where information is limited across European countries.CONCLUSIONS: This study provides an overview of funding of health promotion interventions in European countries. The main obstacles for funding health promotion interventions are lack of information and the fragmentation in the funding of health promotion interventions for older adults.

Background To motivate people to lead a healthier life and to engage in disease prevention, explicit financial incentives, such as monetary rewards for attaining health-related targets (e.g. smoking cessation, weight loss or increased physical activity) or disincentives for reverting to unhealthy habits, are applied. A review focused on financial incentives for health promotion among older people is lacking. Attention to this group is necessary because older people may respond differently to financial incentives, e.g. because of differences in opportunity costs and health perceptions. To outline how explicit financial incentives for healthy lifestyle and disease prevention work among older persons, this study reviews the recent evidence on this topic. Methods We applied the method of systematic literature review and we searched in PUBMED, ECONLIT and COCHRANE LIBRARY for studies focused on explicit financial incentives targeted at older adults to promote health and stimulate primary prevention as well as screening. The publications selected as relevant were analyzed based on directed (relational) content analysis. The results are presented in a narrative manner complemented with an appendix table that describes the study details. We assessed the design of the studies reported in the publications in a qualitative manner. We also checked the quality of our review using the PRISMA 2009 checklist. Results We identified 15 studies on the role of explicit financial incentives in changing health-related behavior of older people. They include both, quantitative studies on the effectiveness of financial rewards as well as qualitative studies on the acceptability of financial incentives. The quantitative studies are characterized by a great diversity of designs and provide mixed results on the effects of explicit financial incentives. The results of the qualitative studies indicate limited trust of older people in the use of explicit financial incentives for health promotion and prevention. Conclusions More research is needed on the effects of explicit financial incentives for prevention and promotion among older people before their broader use can be recommended. Overall, the design of the financial incentive system may be a crucial element in their acceptability. Electronic supplementary material The online version of this article (doi:10.1186/s12913-016-1517-0) contains supplementary material, which is available to authorized users.

The lack of systematic research on the assessment of patient payment policies emphasizes the need to evaluate the mechanisms of official patient charges. This paper aims to contribute to this research area by outlining a comprehensive framework for the assessment of patient payment policies, and by validating it on data for six CEE countries (Bulgaria, Hungary, Lithuania, Poland, Romania and Ukraine). Three broad groups of assessment criteria are included in the framework: policy context, policy content and policy effects. Within each of these groups, several sub-groups of criteria are defined. Our application of the assessment framework to the six CEE countries shows its relevance for the comparison of patient payment policy across countries, and for outlining common policy options. At the same time, it also reveals the need of collecting data on other relevant indicators that are not included in this paper, as well as for updating indicators already included. Research on patient payments will be essential for a continuous monitoring of patient payment policies (e.g. those in CEE) and their prompt adjustment.

In Poland, the low level of health care financing from public funds is becoming increasingly voiced and accepted as an argument not only for increasing health insurance contributions, but also for extending the scope of private funding. The objective of this paper is to analyze the level and structure of out-of-pocket expenditure in Poland as well as health care consumer characteristics influencing payments for health care and willingness to pay. The analysis relies on two main sources of micro data: the household budget surveys of the Central Statistical Office of Poland and a representative survey carried out in Poland in 2010. The results indicate that in the structure of out-of-pocket expenditure, spending on pharmaceuticals dominates (up to 80% of total out-of-pocket expenditure on health). The out-of-pocket expenditure on services most often refers to paying for out-patient specialists’ services, rehabilitation services and dental care, often in the private sector. Out-of-pocket expenditures are highest among population groups with high health needs (elderly, disabled, chronically ill) but also among individuals with high income. Polish consumers do not object to co-payments for health services with good quality and quick access. Greater stated willingness to pay characterizes younger people, those with higher income and better health.

Background: During the past decades, many governments have introduced patient cost-sharing in their public health-care system. This trend in health-care reforms affected the European Union (EU) member states as well. This article presents a review of patient cost-sharing for health-care services in the 27 EU countries, and discusses directions for their improvement. Methods: Data are collected based on a review of international data bases, national laws and regulations, as well as scientific and policy reports. The analysis presents a combination of qualitative and quantitative research techniques. Results: Patient cost-sharing arrangements in the EU have been changing considerably over the past two decades (mostly being extended) and are quite diverse at present. There is a relation between patient cost-sharing arrangements and some characteristics of the health-care system in a country. In a few EU countries, a mix of formal and informal charges exists, which creates a double financial burden for health-care consumers. Conclusions: The adequacy of patient cost-sharing arrangements in EU countries needs to be reconsidered. Most importantly, it is essential to deal with informal patient payments (where applicable) and to assure adequate exemption mechanisms to diminish the adverse equity effects of patient cost-sharing. A close communication with the public is needed to clarify the objectives and content of a patient payment policy in a country.