Moving towards or away from universal health coverage in the EU-8 countries

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.