Central and Eastern European (CEE) health systems have made progress but remain significantly under-invested compared to EU4 countries (Germany, France, Italy, and Spain), with a persistent gap in financing, health outcomes, and access to innovative medicines.
Investment Gap: In 2023, CEE public health care investment averaged 5.47% of GDP (vs. 8.17% in EU4), with a minimal narrowing 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 investment (vs. 15% in EU4), masking significant cross-country variations.
Health Outcomes: CEE health outcomes mirror the investment gap, with ~41% higher Disability-Adjusted Life Years (DALYs) and ~137% higher treatable mortality compared to EU4. Life expectancy in CEE has increased by ~14% since 1960 (vs. ~20% in EU4), with a 5-year gap persisting in 2024 (78.2 vs. 83.2 years). Within CEE, Slovenia and Czechia are closest to EU4, while Bulgaria and Serbia lag far behind.
Access to Innovation: Between 2020 and 2023, CEE patients gained reimbursed access to only 31% of new EMA-authorized medicines (vs. 76% in EU4), with an average time from EMA authorization to reimbursement of 705 days (vs. 445 days in EU4). Delays are most pronounced in Lithuania and Romania.
Demographic Challenges: By 2050, the working-age population in CEE is projected to fall by 12.9 million (20%), reducing annual income-tax revenue by €14.6 billion. Age-related per-capita health spending rises sharply after age 55, straining public finances.
GLOBSEC Healthcare Readiness Index (HRI) 2024: 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.
Convergence Trends: While CEE public health and pharmaceutical spending is growing faster than in EU4, several markets could reach today’s EU4 levels within the next two decades if current trends are maintained. However, countries like Latvia, Lithuania, Bulgaria, and Romania, with some of the lowest health investments in Europe, risk further demographic decline and economic disadvantages.
Policy Recommendations:
- Strengthen health financing: Increase efficiency and effectiveness of health spending, enhance predictability of pharmaceutical financing, and reduce distortionary payback mechanisms.
- Reduce barriers to innovation: Align financing with long-term value, strengthen Health Technology Assessment (HTA) frameworks, and leverage Joint Clinical Assessment (JCA) outputs.
- Prioritize prevention: Scale up tobacco control, obesity and nutrition strategies, alcohol harm reduction, and early detection programs.
Without significant investment increases, CEE countries risk further demographic decline, brain drain, and systemic decline. Addressing these gaps requires strategic healthcare investments and a shift from reactive clawbacks to predictable, sustainable funding frameworks.
