Hospital reforms in 11 Central and Eastern European countries between 2008 and 2019: a comparative analysis

Area of Science:

• Health Policy and Management
• Comparative Health Systems
• Health Services Research

Background:

• Hospital sectors in Central and Eastern European countries (CEEC) have undergone significant changes.
• Understanding recent hospital reforms is crucial for improving healthcare delivery in the region.

Purpose of the Study:

• To provide an overview of hospital sector characteristics in 11 CEEC.
• To compare hospital reforms implemented between 2008 and 2019.
• To identify common trends, success factors, and challenges in these reforms.

Main Methods:

• Development of a theoretical framework for hospital sector reforms.
• Comparative analysis of quantitative data on hospital sectors.
• Scoping review to identify reforms, followed by standardized questionnaires completed by national researchers and literature validation.

Main Results:

• Reforms were broad, with governance and purchasing/payment system changes being most frequent.
• Governance reforms focused on infrastructure, financial management, and quality of care.
• Purchasing and payment reforms aimed at limiting activities and promoting ambulatory/day care.

Conclusions:

• Hospital reforms in CEEC share common areas and challenges, including lack of comprehensive approach, unclear outcomes, and political influence.
• Despite challenges, there is significant potential for cross-country learning due to similar reform trajectories.