Paying for hospital care in seven central and Eastern European countries – a comparative analysis

The systems for paying health care providers consist of a complex set of arrangements, including payment methods and supporting elements. A diversity of payment methods exists, and for each of them the administrative process of setting prices (tariffs) plays a pivotal role. It defines the exact amount of money that a purchaser pays a health care provider for delivering a given service, unit of activity, or specific outcome. This study aimed to provide a structured comparison of the systems for setting prices for hospital care services in the public health insurance systems of seven Central and Eastern European countries (Bulgaria, Estonia, Czechia, Hungary, Lithuania, Poland, and Slovakia), as well as identify major challenges. The methods involved three consecutive steps: (1) a conceptual framework and data collection form were developed based on existing literature; (2) national experts identified through purposive, snow-ball sampling were asked to complete the data collection form; and (3) a comparative analysis was performed. All analysed CEE countries use mixed payment methods, with a dominant role of diagnose-related groups, in paying for hospital care provision. The price-setting process follows similar general steps: collecting costing data; calculating tariff weights; setting the price by using a dedicated base rate; conducting negotiations with providers; and applying price adjustments. However, the scope and details of each element may vary significantly between the countries. In Hungary and Bulgaria, there is no structured costs data collection process (historical weights are adjusted). The analysed countries face similar challenges in building effective price-setting systems: (1) incomplete and/or low quality hospital cost data, (2) insufficient institutional capacity; (3) methodological challenges of the costing model; and (4) barriers driven by the overall health system context. These challenges can lead to both under- and over-pricing of hospital services and generate system-level inefficiencies. There is a strong need to support investments in data infrastructure and improvements in system governance across all analysed countries. Digital solutions could enhance the efficiency of the process by limiting the potential trade-off between the timeliness (and accuracy) of reporting cost data and the feasibility constraints.