GOVERNMENT AND COMPULSORY HEALTH FINANCING AND HOUSEHOLD OUT-OF-POCKET PAYMENT IN CENTRAL AND EASTERN EUROPE: A COMPARATIVE ANALYSIS, 2014-2023
Author(s)
Árpád Antal, MSc1, Attila Dénes Orbán, MSc1, Kinga Szentendrey, MD1, Eniko Pap, MD1, Áron Csaba Jakab, MSc1, Eniko Fulop, MSc1, Imre Boncz, MSc, PhD, MD2, István Ágoston, JD, PhD2.
1Doctoral School of Health Sciences, University of Pécs, Pécs, Hungary, 2Institute for Health Insurance, University of Pécs, Faculty of Health Sciences, Pécs, Hungary.
1Doctoral School of Health Sciences, University of Pécs, Pécs, Hungary, 2Institute for Health Insurance, University of Pécs, Faculty of Health Sciences, Pécs, Hungary.
OBJECTIVES: This study examined the relationship between government and compulsory contributory health financing and direct household health expenditures in Romania and Hungary and compared these countries with Central and Eastern European Union (EU) Member States that acceded to the EU after 2004.
METHODS: We conducted a retrospective descriptive comparative analysis using the Eurostat System of Health Accounts (SHA) 2011 database on health care expenditure by financing scheme.The analysis covered 11 Central and Eastern European EU Member States between 2014 and 2023. The main indicators, expressed as percentages of current health expenditure (CHE), were government financing schemes, compulsory contributory health insurance schemes, the combined share of government and compulsory financing, and household out-of-pocket payment. The results are presented in figures showing financing structures, time trends, and changes over the study period.
RESULTS: In 2023, household out-of-pocket (OOP) expenditure accounted for 22.96% of current health expenditure in Romania and 23.06% in Hungary, exceeding the EU27 value of 14.88% in both countries. The highest shares were recorded in Bulgaria (35.50%), Latvia (35.06%), and Lithuania (31.02%), whereas substantially lower values were observed in Croatia (9.38%), Slovenia (12.39%), and Czechia (14.60%). The combined shares of government and compulsory financing schemes were 76.24% in Romania and 73.71% in Hungary. Between 2014 and 2023, the share of OOP expenditure decreased by 5.30 pp in Hungary but increased by 2.65 pp in Romania. Despite relatively high levels of government and compulsory financing, both countries remained above the EU27 average in terms of household OOP expenditure.
CONCLUSIONS: The findings suggest that a high share of government and compulsory health financing alone may not be sufficient to ensure effective financial protection for households. By 2023, Romania and Hungary had reached similar levels of out-of-pocket expenditure but followed contrasting trajectories, with OOP expenditure decreasing in Hungary and increasing in Romania.
METHODS: We conducted a retrospective descriptive comparative analysis using the Eurostat System of Health Accounts (SHA) 2011 database on health care expenditure by financing scheme.The analysis covered 11 Central and Eastern European EU Member States between 2014 and 2023. The main indicators, expressed as percentages of current health expenditure (CHE), were government financing schemes, compulsory contributory health insurance schemes, the combined share of government and compulsory financing, and household out-of-pocket payment. The results are presented in figures showing financing structures, time trends, and changes over the study period.
RESULTS: In 2023, household out-of-pocket (OOP) expenditure accounted for 22.96% of current health expenditure in Romania and 23.06% in Hungary, exceeding the EU27 value of 14.88% in both countries. The highest shares were recorded in Bulgaria (35.50%), Latvia (35.06%), and Lithuania (31.02%), whereas substantially lower values were observed in Croatia (9.38%), Slovenia (12.39%), and Czechia (14.60%). The combined shares of government and compulsory financing schemes were 76.24% in Romania and 73.71% in Hungary. Between 2014 and 2023, the share of OOP expenditure decreased by 5.30 pp in Hungary but increased by 2.65 pp in Romania. Despite relatively high levels of government and compulsory financing, both countries remained above the EU27 average in terms of household OOP expenditure.
CONCLUSIONS: The findings suggest that a high share of government and compulsory health financing alone may not be sufficient to ensure effective financial protection for households. By 2023, Romania and Hungary had reached similar levels of out-of-pocket expenditure but followed contrasting trajectories, with OOP expenditure decreasing in Hungary and increasing in Romania.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
HPR256
Topic
Epidemiology & Public Health, Health Policy & Regulatory
Topic Subcategory
Insurance Systems & National Health Care, Public Spending & National Health Expenditures
Disease
No Additional Disease & Conditions/Specialized Treatment Areas