Central and Eastern Europe (CEE) health systems have made positive strides in recent reforms, yet significant gaps persist compared to EU4 countries (Germany, France, Italy, and Spain) in terms of investment, health outcomes, and access to innovative medicines. In 2023, public healthcare investment in CEE averaged 5.47% of GDP, significantly lower than the 8.17% in EU4, with a minimal narrowing of the gap since 2017. Per-capita public health and pharmaceutical spending in CEE remains well below EU4 levels, and out-of-pocket (OOP) payments account for 22% of total health spending, higher than the EU4 average of 15%.
Health outcomes in CEE reflect these investment disparities: the region records ~41% higher DALYs and ~137% higher treatable mortality compared to EU4. Life expectancy in CEE has increased by ~14% since 1960, compared to ~20% in EU4, with a 5-year gap persisting in 2024. Access to innovative medicines is another critical gap, with CEE patients gaining reimbursed access to only 31% of new EMA-authorized medicines, compared to 76% in EU4, and an average 260-day lag in patient access.
Poor investment in pharmaceuticals in CEE is directly correlated with poorer health outcomes, with Bulgaria, Latvia, and Romania having the lowest per-capita pharmaceutical expenditure and the highest DALYs. While CEE countries have been increasing their pharmaceutical investments at a faster rate than EU4, the gap remains substantial, with only Slovenia exceeding the EU4 average.
Demographic challenges further strain health systems, with the working-age population in CEE projected to fall by 12.9 million by 2050, reducing annual income-tax revenue by an estimated €14.6 billion. The pharmaceutical industry often acts as a "hidden payer" through paybacks, with Hungary, Romania, Bulgaria, and Croatia having the highest industry contributions to public pharmaceutical expenditure.
Health investment is crucial for productivity and growth, with the GLOBSEC Healthcare Readiness Index scoring CEE countries significantly lower than EU4. Good practices in CEE include institutional collaboration, sustainable financing, and improved access to innovative medicines, particularly in Poland, Slovenia, and the Czech Republic.
To improve health outcomes and boost economic performance, CEE governments need to strengthen the sustainability and efficiency of health financing, enhance predictability of pharmaceutical financing, reduce distortionary payback mechanisms, and align financing with long-term value. Strengthening prevention and risk-factor reduction, along with embedding these measures as a core complement to health investment, will maximize the net population health and economic gains.
