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Assessment of patient payment policies and projection of their efficiency, equity and quality effects. The case of Central and Eastern Europe

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Better health-care provision via improved payment policies

The assessment of patient payment policies is in need of systematic research and analysis. European researchers joined forces to increase relevant knowledge, focusing on mechanisms of official patient payments in Central and Eastern Europe.


The ASSPRO CEE 2007 project set out to identify a comprehensive set of tangible evidence-based criteria suitable for the assessment of patient payment policies. The goal was to analyse the efficiency, equity and quality impacts of these policies. Country comparisons helped establish the extent to which the country context influences the evaluation of patient payment policies. Employing both quantitative and qualitative research methods from a wide range of fields related to socioeconomic science and humanities, the project's particular focus was on evaluation of policy content, its changes and impacts. Following data collection and analyses, research results indicated that formal patient charges represent a rational policy choice in central and eastern Europe (CEE) countries, as a means of improving efficiency in health-care provision and the effectiveness of resource allocation. Also, these will facilitate the generation of additional health-care resources. However, various major health-care system problems need to be resolved before such reforms can be implemented. First, informal payment practices for health-care services need to be eliminated before introducing or increasing formal charges — this will protect patients from duplicated financial burdens. Informal patient payments negatively affect the overall functioning of the health-care system. The ASSPRO CEE 2007 team recommended a mixture of strategies on the demand and supply side of the health-care market as a plausible solution to informal patient payments. Second, the exemption mechanisms accompanying formal patient charges need to be carefully designed (or redesigned) in view of their impact on vulnerable patient groups. It is necessary for new or increased formal charges to be implemented with precautions and in consideration of country-specific contextual factors. Project outcomes are relevant to health policymaking in CEE countries and also help to establish assessment standards for patient payment policies around the world. ASSPRO CEE 2007 results have thus contributed to overall research progress in the methodology of policy evaluation and in the analysis of CEE health-care reforms.

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