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The financial burden of out-of-pocket patient payments in the European Union and accession countries: Results of a systematic literature review

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Moser K., Pavlova M., Groot W.
Zdrowie Publiczne i Zarządzanie
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2014
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vol. 12
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issue 3
PL
A major issue for public health policy is to reduce the poverty and catastrophic effects of out-of-pocket payments. This paper reviews empirical studies that analyze the financial burden of out-of-pocket payments and factors that are associated with this burden for households in the EU and accession countries. The method of systematic literature review is applied. Poverty effects appear to be independent of geographical area. Catastrophic healthcare expenditure ranges from a bit less than 0.05% to nearly 4%, and the impoverishment due to out-of-pocket payments is also up to 4%. Analyses carried out in single countries reveal that living in a household with a pensioner contributes most to high payments for health care. The results support calls for health policy to prevent the burden of out-of-pocket payments, especially for pharmaceutical expenditure. Special attention should be paid to risk groups such as pensioners, female headed households and low income households.
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The opinions of the key health care stakeholders towards patient payments in Lithuania

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Murauskiene L., Veniute M., Pavlova M.
Zdrowie Publiczne i Zarządzanie
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2010
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vol. 8
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issue 1
PL
Patient payments are considered to be a significant issue in health policy in Lithuania. Despite the unclear legislative framework, health care institutions are asking patients to co-pay (contribute) for services provided to them. Thus, patients and providers are facing challenging situation in legal, ethical and financial terms. The aim of the study was to evaluate the opinions and attitudes towards patient payments in Lithuania. Qualitative and quantitative research methods were applied in the study – focus group discussions and in-depth interviews combined with a self-administrated questionnaire filled in by each participant. The results suggest that there is no consistent policy on patient payments in Lithuania. Health care consumers are rather resistant towards the introduction of payments (they support fees only in case of services with better quality). Health care providers sustain patient payments considering the needs of health professionals and health care institutions. Health policy makers and health insurance representatives remain dispersal in their opinions. More conceptual and strategic thinking in defining the aims of patient payment policies in Lithuania and its governance is needed.
3

Patient payments and the problems in medical services provision in Bulgaria

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Atanasova E., Moutafovа E., Kostadinova T., Pavlova M.
Zdrowie Publiczne i Zarządzanie
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2010
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vol. 8
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issue 1
PL
During the past decade, the reform in the Bulgarian health care sector was in the focus of policy and research discussions at national and international level. In spite of the great expectations after the introduction of social health insurance in 2000, efficiency, equity and quality problems in health care provision in Bulgaria continue to exist. The unequal start of the reform in outpatient and hospital care (namely the delay in restructuring the hospital sector) is one of the causes of these problems. Among other issues, the reform also included the implementation of formal patient charges. At present, formal patient charges are applied to all levels of medical services with the exception of emergency care. Nevertheless, informal patient payments continue to exist. The aim of this paper is to present the attitudes of health care stakeholders toward patient charges from the perspective of the state of the Bulgarian health care system. The data are collected via focus group discussions and in-depth interviews carried out in Bulgaria in May-June 2009. The results are used to out-line recommendations for policy related to patient payments
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Are patient charges an effective policy tool? Review of theoretical and empirical evidence

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Pavlova M., Tambor M., van Merode G. G.
Zdrowie Publiczne i Zarządzanie
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2010
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vol. 8
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issue 1
PL
Policy-makers assign various objectives to the implementation of patient charges for public health care services. These charges impose prices on health care consumption and as such, they are expected to affect the quantities of health care service demanded, and to generate revenues. The actual ability of patient charges to achieve these objectives depends to a great extent on the patient payment mechanism implemented in a country, as well as on the health care system and context-specific factors. This paper reviews and discusses the theoretical and empirical evidence on the effectiveness of patient payment policies. The paper suggests that patient charges can be a successful policy tool for controlling the pattern of health care utilisation and improving the quality of health care provision. However, an additional condition for success is the appropriateness of the design of patient charges with respect to efficiency and equity in the public health care sector
5
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The future of long-term care in ten European countries:  Review of policy reports and qualitative study among country experts

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Praznovszky L., Pavlova M., Tambor M., Groot W.
Zdrowie Publiczne i Zarządzanie
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2019
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vol. 17
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issue 3
146-158
EN
The provision of good quality long-term care to citizens represents a challenge for many European countries due to tight public budgets and ongoing societal transitions. To gain insights on the future of long-term care in Europe, an explorative study was conducted consisting of a review of policy reports and qualitative study among country experts from Albania, Bulgaria, France, Germany, Lithuania, the Netherlands, Poland, Portugal, Ukraine, and the United Kingdom. For the purpose of the analysis, a conceptual framework was developed. Based on this framework, the method of qualitative directed content analysis was applied to extract and analyze information from the reports and study transcripts. The results suggest four key directions for long-term care development: a) integration, coordination and cooperation across structures and actors for better service quality; b) increased scope and scale of formal service provision; c) improved workforce planning and capacity building; d) use of e-health and information technologies. The exact direction is however dependent on the country-specific guiding principles, governance capacity and funding constraints. To adequately respond to current challenges, policy-makers need to acknowledge the interconnectedness of long-term care issues and approach them from a more holistic perspective.
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Introduction. Challenges in long-term care in Europe

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Pavlova M., Praznovszky L., Tambor M., Golinowska S., Groot W.
Zdrowie Publiczne i Zarządzanie
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2019
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vol. 17
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issue 3
113-118
7
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Long-term care provision in Europe: Results of a desk research study 

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Manolova S., Pavlova M., Stepurko T., Tambor M., Groot W.
Zdrowie Publiczne i Zarządzanie
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2019
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vol. 17
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issue 3
119-130
EN
This paper describes the provision of long-term care across Europe based on data gathered in a desk research. The aim is: (1) to identify indicators of long-term care provision; and (2) to compare the provision of formal and informal care across the European countries. For this purpose, a narrative literature review was carried out to identify relevant indicators. Subsequently, a descriptive analysis was performed to analyse the indicator-related data. The results suggested that there are important differences in the long-term care provision in Europe. Long-term care is provided both at public and private institutions. The entitlement criteria vary among countries. In general, Western and Northern European countries have more generous provision of residential care compared to Eastern and Southern European countries. At the same time, informal care has different roles and it is extremely important in Eastern and Southern European countries. Among all countries, more than half have quality assurance regulations for residential care. However, most of the Southern and Eastern European countries lack information about the quality assurance regulations. In order to monitor the long-term care provision, it is recommended that European countries establish a reporting system to provide annual data. These annual data should be based on identical measurement mechanisms and standardised reporting structure to allow for comparison and improvements of long-term care systems.
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A Greek tragedy of our time? Institutional and financial dimension of Health Promotion for Older People in Greece

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Pavlova M., Skalkidis Y., Groot W., Sowa A., Golinowska S.
Zdrowie Publiczne i Zarządzanie
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2017
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vol. 15
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issue 1
62-68
EN
Despite the numerous legislative documents and public health institutions in Greece, the country lacks a comprehensive and robust long-term policy perspective in the public health area. The traditionally higher priority attached to curative care than to public health actions, is the major reason of the shortcomings. This country report draws upon several national reports focused on the Greek health system, and other country-specific sources in order to outline the major institutional and financing challenges for health promotion in Greece, and specifically health promotion for older adults. The paper is based on the method of narrative literature review. The findings show that health promotion actions for elderly persons do take place in Greece but mainly in urban areas and/or within the framework of EU-funded projects. Government efforts are required to stimulate coordinated public health interventions at the local level focusing on the positive effects of health promotion. The health promotion programs that are successfully implemented, should receive the necessary government support to assure their long-term sustainability. 
9
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Informal patient payments for health care services: policy challenges and strategies for solutions

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Pavlova M., Stepurko T., Gordeev V. S., Tomini S., Gryga I., Groot W.
Zdrowie Publiczne i Zarządzanie
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2010
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vol. 8
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issue 1
PL
The topic of informal patient payments is rather new in policy discussions although the phenomenon has existed for decades. These payments are a threat to public health since they jeopardise efficiency, equity and quality of health care provision. Most importantly, those who  cannot afford to pay might not seek or delay seeking treatment. Before attempting to deal with informal patient payments, it is necessary to understand the reasons for their existence and their role in health care provision. This could indicate the mechanisms through which these payments can be influenced by policy, as well as relevant strategies for dealing with these payments. This paper outlines a mixture of strategies as a plausible solution to informal patient payments. The successful implementation of these strategies depends on the particular setting and the overall conditions in the country (e.g. prevalence of corruption, and attitudes of health system stakeholders towards informal payments).
10
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Attitudes towards patient payments in Ukraine: is there a place for official patient charges?

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Gryga I., Stepurko T., Danyliv A., Gryga M., Lynnyk O., Pavlova M., Groot W.
Zdrowie Publiczne i Zarządzanie
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2010
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vol. 8
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issue 1
PL
The attitudes of health care system stakeholders towards official patient charges have not been studied in Ukraine although both the central and local governments have several times considered to introduce such charges. Instead, informal patient payments are widespread and wellestablished. Ukrainian patients pay either unofficially or quasi-officially (i.e. charitable contributions) to health care institutions. The reasonable solution for dealing with these types of payments would be the introduction of official patient charges. However, the legal base for such reform in Ukraine is ambiguous. The Constitution declares that health care provision is free-of-charge. Nevertheless, in our study,  representatives of stakeholders groups appear keen not only on discussing official charges but are also favor their introduction. The expectations regarding the possible objectives of these charges expressed by different  stakeholders are the focus of this paper.
11
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Long-term care financing in Europe: An overview

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Neubert A., Baji P., Tambor M., Groot W., Gulácsi L., Pavlova M.
Zdrowie Publiczne i Zarządzanie
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2019
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vol. 17
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issue 3
131-145
EN
Despite the growing interest in the sustainability of long-term care (LTC) systems, only a few studies have investigated the differences in the LTC financing across European countries. The objective of this paper is to describe the financing of LTC in Europe. For this purpose, we use indicators on LTC financing taken from international databases and reports. Desk research was carried out to identify relevant indicators. Hierarchical cluster analysis was used to identify typologies in LTC financing across the EU/EEA countries based on seven indicators selected. We found large differences in LTC financing across the EU/EEA countries in terms of total expenditure, the division of expenditure between the social and health care system, and in the role of in-kind and cash benefits. Four main financial models across the EU/EEA countries could be distinguished. Further, we identified some shortages in data reporting on the financing of LTC services. Some limitations and contradictions related to the indicators of LTC financing are highlighted. In particular, we stress the need for more comprehensive data to enable further cross-country comparisons and to provide valid input for policy.
12
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Health promotion for older people in Lithuania: Between bureaucratic and financial constraints

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Pavlova M., Murauskienė L., Miteniece E., Sowa A., Kowalska-Bobko I., Domagała A., Groot W.
Zdrowie Publiczne i Zarządzanie
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2017
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vol. 15
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issue 1
116-124
EN
The health system in Lithuania has a strong focus on hospital treatment. Overall, there is a lack of sufficient funds explicitly devoted to public health. This country report draws upon several national reports focused on the Lithuanian health system and other country-specific sources in order to outline the major institutional and financing challenges for health promotion in Lithuania, specifically for older adults. As suggested in our review, the key problems in public health services in Lithuania, including health promotion for older persons, are the bureaucratic and financial constraints, a lack of intersectoral cooperation, staff shortages and capacity problems. The implementations of public health initiatives greatly depend on the political will and the government’s ability to implement policies, which are still weak in Lithuania. Moreover, the public health legislation lacks clarity and fails to provide an adequate base for local-level evidence-based interventions. Concrete action plans, as those recently developed in the area of healthy aging and health inequalities, are needed to provide guidance for health promotion among older adults.
13
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Healthy ageing in Germany – common care and insurance funding. Institutional and financial dimension of health promotion for older people

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Golinowska S., Huter K., Sowada C., Pavlova M., Sowa A., Rothgang H.
Zdrowie Publiczne i Zarządzanie
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2017
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vol. 15
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issue 1
20-33
EN
In Germany responsibilities for health promotion and prevention lies with a multitude of different actors and institutions. The institutional arrangement of health promotion is shaped by the German federal structure of the state on the one hand and by a health care system that is characterized by divided responsibilities between governmental organisations, self-administered bodies and non-governmental organisations on the other hand. Although federal-level programs are successfully implemented in the country, the attempt of the Federal government to consolidate and clarify responsibilities in the public health area meets resistance. The Preventive Health Care Act from 2015 is an attempt to strengthen health promotion, its effective impact will be for the future to show. Health promotion activities are initiated and provided by a variety of institutions: governmental, self-administered and voluntary (NGOs) often based on networks form. They cover activities on federal, Länder and local level. The Federal Ministry of Health and federal health agencies (specially BZgA) play an important role in this field. They created a number of health promotion regulation and activities initiatives which added to disease and addiction prevention. In health promotion for older people (HP4OP) programs, there is also a number of regionally and locally oriented initiatives.  In this paper, we outline main features of the HP4OP activities in Germany with regard to institutions and financing mechanism. In addition, we describe health-targeting programmes/projects indicated as good practices:(a) established and developed in Germany and (b) provided by the European Commission with significant participation of German institutions. The multitude and variety of HP4OP programs differentiate positively German health system from other health systems in ageing countries. 
14
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Political will against funds deficiency: Health promotion for older people in Bulgaria

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Pavlova M., Atanasova E., Moutafova E., Sowa A., Kowalska-Bobko I., Domagała A., Golinowska S., Groot W.
Zdrowie Publiczne i Zarządzanie
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2017
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vol. 15
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issue 1
108-115
EN
In Bulgaria, health promotion and health education have received less attention in comparison to other public health areas, which has resulted in a small health promotion budget and consequently, in limited health promotion initiatives. This country report draws upon several national reports focused on the Bulgarian health system, and other country specific sources in order to outline the major institutional and financing challenges for health promotion in Bulgaria, and specifically for health promotion for older adults. As evident from this review, the programs and activities oriented toward health promotion for older adults are inconsistent and incomprehensive. The existing programs are mostly in the form of isolated small-scale projects aimed at enabling older workers to reach the statutory retirement, or supporting retired citizens to maintain their health and well-being. Effective strategic vision, coordination and stable funding in the area of health promotion for older adults is indispensable for helping Bulgarian seniors to live longer and healthier.
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