幻灯片：中欧和东欧的医疗保健投资和成果

Dr.SlaveykoDjambazovDr.LukaVoncinaDr.Aleš RodDr.Marcin Czech This report was commissioned and funded by EFPIA-the European Federation of Pharmaceutical Industries and Associations Summary •Health systems in Central and Eastern Europe (CEE) have undergone major reforms in financing, coverage and service delivery anda positive trendis observed regarding investments and outcomes in healthcare. Yet a substantial gap remains compared with the EU4 countries (Germany, France,Italy and Spain). CEE governments still invest a smaller share of GDP on health, populations experience higher levels oftreatablemortality anddisability, and patients wait longer to access innovative medicines. •In 2023, public health care investment in CEE averaged5.47% of GDP, compared with8.17% in EU4. The gap has narrowed only slightly since 2017,from 3 to 2.78 percentage points. In per-capita terms, public health and pharmaceutical spending in CEE remain well below EU4 levels, and OOPpaymentsrepresent22%of total health investment versus15%in EU4,but this masks notableOOPvariation across CEE countries. •CEE health outcomes mirror the investment gap: compared with EU4, the CEE region records~41% higher DALYsand~137% higher treatablemortality. Moreover, CEE is converging more slowly with EU4 in terms of longevity:life expectancy at birth has increased by ~14% since 1960 inCEE on average versus ~20% in EU4, and a 5-year gap persisted in 2024 (78.2 vs 83.2 years). •Access to innovation is another critical gap. Between 2020 and 2023, patients in CEE on average gained reimbursed access to only31% of newEMA-authorized medicines, compared with 76% in the EU4. The average time from EMA authorization to reimbursement was705 days inCEE–260days longer than the EU4 average of 445 days. •Demographic change will further strain health systems and public finances. By 2050, the working-age population (15-64) in CEE is projected to fall by12.9 million people (20%), reducing annual income-tax revenue by an estimated€14.6 billionif current patterns persist. At the same time, age-related per-capita health spending rises steeply after age 55. •The GLOBSECHealthcare Readiness Index (HRI) 2024summarizes these challenges: CEE countries score systematically lower than EU4 on both“readiness today” and “readiness tomorrow”, underlining the need for sustained investment to close the readiness gap. •Despite this, convergence is underway. Public health and pharmaceutical spending in CEE is growing faster than in EU4, and inseveral markets couldreach today’s EU4 levels within the next two decades if current trends are maintained. The central message of this report istherefore thathealthshould be treated as a strategic, long-term investment that supports growth, productivity and fiscal stability, not just a short-term cost. Progress in the CEE region is evident;however, thegapwith the EU4 remainswide and shows no signs of closingrapidly •The EU4 with Germany and France in particular investing above 9.5% of GDPon health (or 4 543€per inhabitant on average) is more than double of whatmany CEE countries devote. At the same time, these Western economiesmaintain GDP per capita above the EU average, reflecting stronger economiccapacity and healthier, more productive populations. In contrast, lower healthinvestment in CEE correlates with weaker GDP per capita, compoundingstructural economic disadvantages. •Latvia, Lithuania, Bulgaria, and Romania all invest between 4.3-4.9% of GDPon health (or 1 300€per inhabitant on average, which isalmost 3.5 timeslowerthan Germany and France’ average), some of the lowest in Europe, whilealso having GDP per capita well below the EU average (<72–77% of EUaverage).This means less economic output per person, lower disposablebudgets for investments into modern technologiesand under-funded healthsystems—a double drag on competitiveness and human capital retention.Without significant investment increases, these countries risk furtherdemographic decline, brain drain and workforce erosion that undermine growth. •Czechia and Slovenia—the CEE countries closest to EU average healthinvestment (~7%)—also exhibit comparatively higher GDP per capita amongCEE peers. This suggests a positive link between social investment andeconomic performance. Targeted increases in public health investment can be alever to strengthen labor participation, reduce disease burden, and enhanceproductivity. Still though the average investment on healthcare per inhabitant is2300€which is more than 2-fold lower than the top European economies. CEE countries are slowly catching up with EU4 on public HC investment as % of GDP. In2017 the difference was 3 percentage points and in 2023 it reached 2.78 percentage points. Rapidgrowth,divergingpaths:CEEhealthcareinvestments’unevenracetoward EU4levels •CEE remains structurally under-invested comparedto EU4:in 2023, public healthcare investment averages€1,618 per capita in CEE vs €3,221 in the EU4(roughlyhalf). •A higher gro