中欧和东欧的医疗保健投资和成果

IN CENTRAL AND EASTERN EUROPE TABLE OF CONTENTS Summary3Public healthcare investment4Rapid growth, diverging paths: CEE healthcare investmentsuneven race toward EU4 levels5CEE countries continue to face worse health outcomes compared to the EU46Poor investment in pharmaceuticals in the CEE is directly correlated with more DALYsand worse quality of life9The innovation gap: access is still uneven in CEE10Out-of-pocket payments play a major role in CEE health financing, leaving patientsfinancially vulnerable12Demographic erosion threatens fiscal sustainability13The pharmaceutical industry is often a “hidden payer” through paybacks15 AuthorsDr. Slaveyko DjambazovDr. Luka VoncinaDr. Aleš Rod SUMMARY Health systems in Central and Eastern Europe (CEE) have undergone major reforms in financing, coverageand service delivery and a positive trend is observed regarding investments and outcomes in healthcare.Yet a substantial gap remains compared with the EU4 countries (Germany, France, Italy and Spain). CEE In 2023, public health care investment in CEE averaged 5.47% of GDP, compared with 8.17% in EU4. Thegap has narrowed only slightly since 2017, from 3 to 2.78 percentage points. In per-capita terms, public healthand pharmaceutical spending in CEE remain well below EU4 levels, and OOP payments represent 22% of total CEE health outcomes mirror the investment gap: compared with EU4, the CEE region records ~41% higherDALYs and ~137% higher treatable mortality. Moreover, CEE is converging more slowly with EU4 in terms oflongevity: life expectancy at birth has increased by ~14% since 1960 in CEE on average versus ~20% in EU4, Access to innovation is another critical gap. Between 2020 and 2023, patients in CEE on average gainedreimbursed access to only 31% of new EMA-authorized medicines, compared with 76% in the EU4. The Demographic change will further strain health systems and public finances. By 2050, the working-agepopulation (15-64) in CEE is projected to fall by 12.9 million people (20%), reducing annual income-taxrevenue by an estimated €14.6 billion if current patterns persist. At the same time, age-related per-capita The GLOBSEC Healthcare Readiness Index (HRI) 2024 summarizes these challenges: CEE countries scoresystematically lower than EU4 on both “readiness today” and “readiness tomorrow”, underlining the needfor sustained investment to close the readiness gap. Despite this, convergence is underway. Public health andpharmaceutical spending in CEE is growing faster than in EU4, and in several markets could reach today’s PUBLIC HEALTHCARE The EU4 with Germany and France in particular investing above 9.5% of GDP on health (or €4,543 perinhabitant on average) is more than double of what many CEE countries devote. At the same time, theseWestern economies maintain GDP per capita above the EU average, reflecting stronger economic capacity andhealthier, more productive populations. In contrast, lower health investment in CEE correlates with weaker GDP Latvia, Lithuania, Bulgaria, and Romania all spend between 4.3 - 4.9% of GDP on health (or €1,300 perinhabitant on average, which is almost 3.5 times lower than the average in Germany and France), some of thelowest in Europe, while also having GDP per capita well below the EU average (<72–77% of EU average). Thismeans less economic output per person, lower disposable budgets for investments systems — a double drag Czechia and Slovenia — the CEE countries closest to EU average health investment (~7%) — also exhibitcomparatively higher GDP per capita among CEE peers. This suggests a positive link between social investmentand economic performance. Targeted increases in health investments can be a lever to strengthen laborparticipation, reduce disease burden, and enhance productivity. Still thoughthe average investment on RAPID GROWTH, DIVERGING PATHS:CEE HEALTHCARE INVESTMENTS CEE countries remain structurally under-invested in healthcare compared to Western Europe.In 2023,public healthcare investments averaged €1,618 per capita in the CEE region versus €3,221 in the The CEE region demonstrates a higher compound annual growth rate (9.2%) compared to the EU4 (4.9%).However, this accelerated growth alone is insufficient to close the investment gap. Current growth rates are Four countries—Slovenia, Poland, Croatia, and Bulgaria—are projected to reach EU4 averageinvestment levels by 2040, but only if current growth rates are sustained.Conversely, Hungary,Romania, and Latvia require accelerated investment to avoid falling further behind. Serbia is projected to Sustained policy commitment and structural reforms are essential to maintain convergence trajectories and CEE COUNTRIES CONTINUE TOFACE WORSE HEALTH OUTCOMES Across CEE, health outcomes continue to lag behind Western Europe in ways that are consistent with long- Life expectancy provides a useful summary of population health, capturing both long-run progress and thepersistence of gaps between CEE and We