Navigating Technological Change: The Role of Passive Social Policies in Central and Eastern European Labour Markets

How Not to Get Stuck in the Middle Lessons for the Commonwealth of Independent States from Central and Eastern Europe

The presented study analyzes the specific features of economic cooperation of Russia and China with the countries of Central and Eastern Europe (CEE). In recent years, China has begun to actively cooperate with the former socialist republics of Central and Eastern Europe, offering them new institutional projects, such as the Belt and Road and 16+1 initiatives. At the same time, the CEE region has been distancing itself from Russia — it's once main economic partner — for a number of political reasons. Russia needs to maintain its standing in the region of its traditional external interests. This makes the analysis of the specific features of China and Russia's strategies for cooperation with the CEE countries relevant and practical. Aim . The study aims to analyze the specific features of economic cooperation of the People's Republic of China (PRC) and Russia with the countries of Central and Eastern Europe, assess the efficiency of their cooperation, and examine the existing problems. Tasks . The authors determine historical and strategic prerequisites for the development of Russia and China's cooperation with the countries of Central and Eastern Europe; examine the institutional framework of interaction between the countries under study; assess the dynamics of changes in the volume and structure of Russia and China's trade with the CEE countries; analyze the dynamics, priority sectors, and regional structure of direct Chinese investment in the countries of Central and Eastern Europe; assess the problems in Russia and China's cooperation with the CEE countries and prospects for further development of their interaction. Methods . This study uses such research methods as verbal and statistical analysis, observation, synthesis, generalization, description, graphical modeling, and data classification. Results . Central and Eastern Europe currently occupies one of the leading positions in China's foreign policy. After a long period of stagnating economic cooperation, relations between China and the CEE countries have entered a new stage within the framework of established institutional formats. The 16+1 strategy has been proposed, and the CEE countries have been included in China's Belt and Road Initiative. The pattern of economic interaction between Russia and the countries of Central and Eastern Europe in 2005-2018 is cyclical. Political factors have a significant impact on Russia's cooperation with the CEE. Conclusions . The lack of diverse tools for economic cooperation between Russia and Central and Eastern Europe, combined with Russia's low investment opportunities, prevents this cooperation from fulfilling its potential. Russia needs new institutional formats of interaction with the countries in this region, similar to those introduced by China.

The countries of Central and Eastern Europe (CEE) have much to gain from implementing policies that increase investment, support the development of human capital, and promote the legal, regulatory, and policy framework needed for market mechanisms to function. The faster they implement such changes, the faster they will bridge the income gap between them and the countries of the European Union - and the more likely their chances of successful integration. Joining the European Union (EU) is perhaps the key political and economic objective of Central and Eastern European (CEE) countries as they approach the 21st century. But how successful the CEE countries are in achieving this goal depends not only on how well and quickly they adapt their legal and regulatory systems to EU requirements but on how well and quickly they bridge the wide income gaps between CEE and EU countries. Using a model and cross-section data to develop estimates, Barbone and Zalduendo investigate how appropriate structural policies adopted before and after accession to the EU can help CEE countries bridge this income gap. They have much to gain from implementing policies that increase investment, support the development of human capital, and promote the legal, regulatory, and policy framework needed for market mechanisms to function. The faster they implement such changes, the faster they will bridge the income gap between them and the EU countries - and the more likely their accession to the EU will be successful. This paper - a product of Country Department II, Europe and Central Asia - is part of a larger effort in the department to examine issues related to accession to EU by Central and Eastern European countries. Luca Barbone may be contacted at lbarbone@worldbank.org.

BackgroundAccording to the conventional point of view, compulsory health insurance (CHI) models in the Central and Eastern European (CEE) countries are classified as Social Health Insurance (SHI) schemes. However, the absolute dominance of the state in their regulation in many CEE countries calls into question such a qualification. The existing approaches to the definition of SHI are insufficient to clearly distinguish existing CHI models from government health financing schemes as well as to identify their exact similarities and differences with SHI models in Western Europe (WE).MethodsThe new conceptual framework is used to compare the similarities and differences between the SHI models in CEE and WE countries. The characteristics of financial flows regulation are considered to distinguish SHI from government healthcare financing schemes. Different CHI models are compared by using three different types of regulation (state, societal, market) of the three main functions of health financing system (collection, pooling, purchasing), and by types of financing agents. A qualitative, cross-country analysis is implemented with use the data from the WHO Health system reviews Health Systems in Transition.ResultsIn almost all countries considered, state regulation is dominant in the implementation of collection and pooling functions. A variety of combinations of state, societal, and market regulation is observed in the purchasing of medical services. State regulation dominates in most CEE countries, societal regulation dominates in some of them and in almost all WE countries. In most CEE countries and in some WE countries state regulation of purchasing is complemented by market regulation. Based on these characteristics, four types of SHI models are identified (State, Etatist, Bismarckian, and Quasi-Market).ConclusionThe dominance of state regulation in the CHI models in almost all CEE countries is not a sufficient reason to qualify these models as hybrid financing systems. They retain fundamental differences from government financing schemes: the systems of financial flows are separated from state budgets and operate according to the rules set specifically for these systems.

This paper presents an attempt at establishing an association between crime levels and prison populations across European countries. We observe that the situation in Central and Eastern European countries differs distinctly from the rest of Europe. Building on this, we offer justification that is methodologically based on correlations and regressions of country incarceration rates on crime rates, with reference to governance indicators. Our cross-sectional analysis uses data on crime and prisoner rates by offence from Eurostat and SPACE for the year 2018. The paper’s empirical analysis is preceded by a discussion of the challenges faced when attempting to compare crime between countries in Europe. A review of research focused on relationships between incarceration and crime follows, with the emphasis on the deterrence effect and the prison paradox. Typically, this stream of research uses microdata covering a single country or limited to a smaller geographic area. International comparisons are rare, and are usually based on time series and trend analyses. The quantitative approach applied here is based on recognizing two clusters of countries: the Central and Eastern European (CEE) cluster and the Western European (WE) cluster. We show that the observation of higher prisoner rates and lower crime rates for CEE countries is confirmed with regression analysis. Our study encompasses four types of offences: assault, rape, robbery, and theft. The final section of the paper presents an attempt to incorporate Worldwide Governance Indicators into the analysis of the association between incarceration and crime rates. The results confirm that crime rates in WE countries are distinctly higher than in CEE countries, while incarceration rates in WE are significantly lower than in CEE countries. We think this is due to a higher percentage of crimes being reported and the greater accuracy of police statistics in WE countries. The prison population in each country is largely determined by its criminal and penal policies, which differ substantially between CEE and WE countries (e.g., in terms of frequency of imposing prison sentences and the length of imprisonment). These tendencies result in higher incarceration rates in CEE countries, despite lower crime rates when compared to WE countries.

Despite better accessibility of the effective lipid-lowering therapies, only about 20% of patients at very high cardiovascular risk achieve the low-density lipoprotein cholesterol (LDL-C) goals. There is a large disparity between European countries with worse results observed for the Central and Eastern Europe (CEE) patients. One of the main reasons for this ineffectiveness is therapeutic inertia related to the limited access to appropriate therapy and suitable dosage intensity. Thus, we aimed to compare the differences in physicians' therapeutic decisions on alirocumab dose selection, and factors affecting these in CEE countries vs. other countries included in the ODYSSEY APPRISE study. ODYSSEY APPRISE was a prospective, single-arm, phase 3b open-label (≥12 weeks to ≤30 months) study with alirocumab. Patients received 75 or 150 mg of alirocumab every 2 weeks, with dose adjustment during the study based on physician's judgment. The CEE group in the study included Czechia, Greece, Hungary, Poland, Romania, Slovakia, and Slovenia, which we compared with the other nine European countries (Austria, Belgium, Denmark, Finland, France, Germany, Italy, Spain, and Switzerland) plus Canada. A total of 921 patients on alirocumab were involved [modified intention-to-treat (mITT) analysis], including 114 (12.4%) subjects from CEE countries. Therapy in CEE vs. other countries was numerically more frequently started with lower alirocumab dose (75 mg) at the first visit (74.6 vs. 68%, p = 0.16). Since week 36, the higher dose was predominantly used in CEE patients (150 mg dose in 51.6% patients), which was maintained by the end of the study. Altogether, alirocumab dose was significantly more often increased by CEE physicians (54.1 vs. 39.9%, p = 0.013). Therefore, more patients achieved LDL-C goal at the end of the study (<55 mg/dl/1.4 mmol/L and 50% reduction of LDL-C: 32.5% vs. 28.8%). The only factor significantly influencing the decision on dose of alirocumab was LDL-C level for both countries' groups (CEE: 199.2 vs. 175.3 mg/dl; p = 0.019; other: 205.9 vs. 171.6 mg/dl; p < 0.001, for 150 and 75 mg of alirocumab, respectively) which was also confirmed in multivariable analysis (OR = 1.10; 95% CI: 1.07-1.13). Despite larger unmet needs and regional disparities in LDL-C targets achievement in CEE countries, more physicians in this region tend to use the higher dose of alirocumab, they are more prone to increase the dose, which is associated with a higher proportion of patients reaching LDL-C goals. The only factor that significantly influences decision whether to increase or decrease the dose of alirocumab is LDL-C level.

Subject and purpose of work: The purpose of this study is to assess the economic partnership between China and Central and Eastern Europe (CEE). It evaluates the economic policy since the cooperation in the region began, as the 17+1 process. The study evaluates the success and failure of China’s economic engagement in the 17 CEE countries and the Balkan region. This article explores how the relationship was made stronger in CEE countries for economic development. It looks at diplomatic ties, trade knot and economic initiatives, and it examines China’s relations with other CEE countries. The article aims to examine the geographical distribution of China’s economic influence on the CEE countries. Materials and methods: Content analysis is widely used as a comparative technique by the press, media, think tanks and communication. There are official statistics from a wide range of institutions (The China Observers in Central and Eastern Europe (CHOICE), the IMF, the OECD, the European Commission, the European Union, Statistics CEE countries and the European External Action Service). Results: The latest result indicates that Chinese economic policy is not achieving more success than the expected objectives in CEE countries. Conclusions: China’s economic impact on CEE countries is relatively small. Central and Eastern European countries are highly dependent on trade and investment relations with developed states, mainly EU members, while China accounts for a minor share.

PurposeThe authors’ aim is to establish the variance of youth welfare citizenship regimes in Central and Eastern Europe (CEE) and to revisit the applicability of the regime approach to the emerging welfare regimes (EWRs).Design/methodology/approachThe empirical analysis follows the descriptive case study strategy aiming to discover diversity of youth welfare citizenship patterns. The case selection is made within the CEE country group, which includes countries in Central Europe, the Baltics, Eastern Europe and Southeast Europe, all sharing the communist past. The subdivision of these countries in reference to the welfare states can be made via the European Union (EU) membership based on the assumption that EU social policy frameworks and recommendations have an important effect on domestic policies. We included countries which are in the EU, i.e., with a similar political and economic transition path. There were three waves of accession to the EU in CEE countries. In the first wave (2004), all the Baltic countries, Czech Republic, Slovakia, Poland, Hungary and Slovenia joined. In the second wave (2007), Romania and Bulgaria joined. Finally, Croatia joined the EU in 2013. Altogether 11 CEE countries are the EU members today, the remaining CEE countries are non-EU members and thus are excluded from the current research. Those countries which are part of the EU share similarities in social and economic reforms during the pre-accession period and after in order to reach a comparatively similar system with other member states. So, in terms of casing strategy these six countries can be named as emerging welfare regimes (EWRs) evolving transformations across different public policy areas. Handpicking of six countries out of 11 relies on the assumption that the Anglo-Saxon welfare system characteristics are more evident in the Baltic countries (Aidukaite, 2019; Aidukaite et al., 2020; Ainsaar et al., 2020; Rajevska and Rajevska, 2020) and Slovenia, while in Bulgaria and Croatia certain outcomes reflect the Bismarckian principles of social security (Hrast and Rakar, 2020; Stoilova and Krasteva, 2020; Dobrotić, 2020). This brings important variety into our analysis logic. Last but not least, we juxtapose six CEE EWR countries under analysis with six mature welfare regime countries representing different welfare regime types. Those mature welfare regime countries (Finland, Sweden, France, Germany, Italy, UK) are not an explicit object of the study but help to put analysed CEE EWR cases into larger context and thus, reflect upon theoretical claims of the welfare regime literature.FindingsThe authors can confirm that the EWR countries can be rather well explained by the welfare citizenship typology and complement the existing knowledge on youth welfare regime typology clusters in the Western Europe. Estonia is clustered close to the Nordic countries, whereas Latvia, Lithuania, Croatia and Slovenia are close to the Bismarckian welfare model despite rather flexible, non-restricted educational path, universal child and student support. Bulgaria is an outlier; however, it is clustered together with mature Mediterranean welfare regimes. Former intact welfare regime clusters are becoming more diverse. The authors’ findings confirm that there is no any intact cluster of the “post-communist” welfare regime and Eastern European countries are today “on move”.Research limitations/implicationsAltogether 11 CEE countries are the EU members today. The remaining CEE countries are non-EU members and thus are excluded from the current research. Those countries which are part of the EU share similarities in social and economic reforms during the pre-accession period and after in order to reach a comparatively similar system with other member states. At least one CEE country was chosen based on existing theoretical knowledge on the welfare regime typology (Anglo Saxon, Beveridgean, Bismarckian) for the Post-communist country groups.Practical implicationsIn the social citizenship dimension we dropped social assistance schemes and tax-relief indices and included poverty risk and housing measures. Youth poverty together with housing showed rather clear distinction between familialized and individualised countries and thus, made the typology stronger. In the economic dimension the preliminary picture was much fuzzier, mainly due to the comprehensive education in the region and intervention of the EU in domestic ALMPs (and VET) reforms. The authors added a new indicator (pro-youth orientation of ALMP) in order better to capture youth-sensitivity of policy.Social implicationsThe authors included a working poverty measure (in-work poverty rate) in order to reflect labour market insecurity as an increasing concern. Yet, the analysis results were still mixed and new indicators did not help locating the regime types.Originality/valueIn order to improve the validity of the youth welfare citizenship regime economic dimension, Chevalier's (2020) model may also be worth revisiting. The authors argue that this dichotomy is not sufficient, because inclusive type can have orientation towards general skills or occupational skills (i.e. monitored or enabling citizenship clusters), which is currently ignored. Chevalier (2020) furthermore associates inclusive economic citizenship with “coordinated market economies” (referring to Hall and Soskice, 2001), which seems hardly hold validity in the Nordic and at least some CEE countries.

This paper aims to assess the economic development and development policies in the Central and Eastern European (CEE) countries in 1990–2005, from the collapse of the USSR to the enlargement of the European Union. A great number of authors have generally seen the transition as a very positive process. They have concluded that the reform policies focusing on macroeconomic and price stability have been the key to success for CEE economies. A reliable economic environment is, of course, instrumental for longer-term economic success, as exemplified by the prolonged crisis in most of the former Soviet Union. Our analysis of the economic development and competitive advantages in the region, however, leads to the conclusion that the specific approach to transition that the Central and Eastern European countries followed came at a rather high cost. Comparative neglect and weakness of a set of policies crucial for longer-term development, such as science, technology and innovation policies, has led to deterioration in the last decade rather than the strengthening of the competitive advantages of Central and Eastern European economies. Furthermore, we argue that, in most cases, CEE countries have unfortunately overlooked or misjudged a number of development challenges, and have thus implemented policies that have generated growth at the cost of rapidly increasing risks. This is how the financial fragility of several Central and Eastern European countries has recently increased drastically, and the region seems to have virtually arrived at the brink of economic collapse. Since the CEE countries joined the European Union, the CEE governments have gradually moved towards acquiring a more active role in economic development. These policies need, however, to be strengthened considerably and reinforced by macroeconomic policies that curb current excessive dependence on foreign-financed growth.

Haemophilia care in Central and Eastern Europe: challenges and ways forward from clinicians' perspective.

IntroductionMeaningful patient involvement in health technology assessment (HTA) is essential in ensuring that the interests of the affected patient population, their families, and the general public are accurately reflected in coverage and reimbursement decisions. Central and Eastern European (CEE) countries are generally at less advanced stages of implementing HTA, which is particularly true for patient involvement activities. As part of the Horizon2020 HTx project, this research aimed to form recommendations for critical barriers to patient involvement in HTA in CEE countries.MethodsBuilt on previous research findings on potential barriers, a prioritisation survey was conducted online with CEE stakeholders. Recommendations for prioritised barriers were formed through a face-to-face workshop by CEE stakeholders and HTx experts.ResultsA total of 105 stakeholders from 13 CEE countries completed the prioritisation survey and identified 12 of the 22 potential barriers as highly important. The workshop had 36 participants representing 9 CEE countries, and 5 Western European countries coming together to discuss solutions in order to form recommendations based on best practices, real-life experience, and transferability aspects. Stakeholder groups involved in both phases included HTA organisation representatives, payers, patients, caregivers, patient organisation representatives, patient experts, health care providers, academic and non-academic researchers, health care consultants and health technology manufacturers/providers. As a result, 12 recommendations were formed specified to the CEE region’s context, but potentially useful for a broader geographic audience.ConclusionIn this paper, we present 12 recommendations for meaningful, systematic, and sustainable patient involvement in HTA in CEE countries. Our hope is that engaging more than a hundred CEE stakeholders in the study helped to spread awareness of the importance and potential of patient involvement and that the resulting recommendations provide tangible steps for the way forward. Future studies shall focus on country-specific case studies of the implemented recommendations.

Before the transition the principal development objective for the animal production sector in the Central and Eastern European (CEE) countries was the attainment of national self-sufficiency, and, is some countries, export orientation. Increasing production costs and the low productivity were compensated through subsides. During the first years of transition, the number of animals declined from 20 to 80 percent, due to the drastic reduction of demand (elimination of subsides and family revenue decrease), disruption of traditional markets, rise of the cost of production. The establishment of a large number of small private farms have led to the creation of specific production systems in a number of countries. Countries which have retained large production units are confronted with needs to update technology in accordance with new requirements (market, environment). Following the request of made by CEE countries, EAAP has established a Task Force on CEE countries. The Task Force has organised seven meetings (round tables, workshops and seminars) in the period 1991-96. Some experts from CEE and Western Europe participated at these events. Over 1400 pages of studies and proceedings have been published. The Task Force has completed its tasks in 1996, when a Contact Group on CEE countries has been established to identify the major policy issues influencing animal production in CEE, to prepare and organise meetings to address these policy questions, and to promote an increase in effectiveness of linkages between CEE and Western European countries.

Core objectives of European common market integration are convergence and economic growth, but these are hampered by redundancy, and value chain asymmetries. The challenge is how to harmonize labor division to reach global competitiveness, meanwhile bridging productivity differences across the EU. We develop a bipartite network approach to trace pairwise co-specialization by applying the revealed comparative advantage method within and between the EU15 and Central and Eastern European (CEE). This approach assesses redundancies and the division of labor in the EU at the level of industries and countries. We find significant co-specialization among CEE countries but a diverging specialization between EU15 and CEE. Productivity increases in those CEE industries that have co-specialized with other CEE countries after EU accession, while co-specialization across CEE and EU15 countries is less related to productivity growth. These results show that a division of sectoral specialization can lead to productivity convergence between EU15 and CEE countries.

In November 2008, the “2nd Summit on Osteoporosis—Central and Eastern Europe (CEE)” was held in Warsaw, Poland. Discussions at this meeting focused on the identification and discussion of diagnostic, preventive, and therapeutic measures used in CEE. Evaluated information was used to identify issues regarding diagnosis and therapy of osteoporosis in these countries to facilitate the subsequent setup of appropriate support and development strategies. The main debate was structured according to the following five subjects: (1) present status and future perspectives for implementation of FRAX® into local (CEE) diagnostic algorithms, (2) principles of drug selection in osteoporosis treatment in CEE countries, (3) nonpharmacological interventions in osteoporosis treatment and prophylaxis in CEE countries, (4) treatment benefit evaluation, and (5) cost–effectiveness and evaluation of reimbursement policies in CEE countries. The most important and substantial comments of the delegates are summarized in the present article. The multinational panel of experts with representatives from many CEE countries as well as Austria and Switzerland made the “2nd Summit on Osteoporosis—CEE” a perfect platform to identify issues and needs regarding diagnosis and therapy of osteoporosis as well as the cost–effectiveness of osteoporosis management in CEE countries. The information gained will serve as a basis for the development of strategies to resolve the identified issues at the “3rd Summit on Osteoporosis—CEE” in November 2009.

Several Central and Eastern European (CEE) countries require cost-utility analyses (CUAs) to support reimbursement formulary listing. However, CUAs informed by local evidence are often unavailable, and the cost-effectiveness of the several currently reimbursed biologicals is unclear. To estimate the cost-effectiveness as multiples of per capita GDP/quality adjusted life years (QALY) of four biologicals (infliximab, etanercept, adalimumab, golimumab) currently reimbursed in six CEE countries in six inflammatory rheumatoid and bowel disease conditions. Systematic literature review of published cost-utility analyses in the selected conditions, using the United Kingdom (UK) as reference country and with study selection criteria set to optimize the transfer of results to the CEEs. Prices in each CEE country were pro-rated against UK prices using purchasing power parity (PPP)-adjusted per capita GDP, and local GDP per capita/QALY ratios estimated. Central and Eastern European countries list prices were 144-333% higher than pro rata prices. Out of 85 CUAs identified by previous systematic literature reviews, 15 were selected as a convenience sample for estimating the cost-effectiveness of biologicals in the CEE countries in terms of per capita GDP/QALY. Per capita GDP/QALY values varied from 0.42 to 6.4 across countries and conditions (Bulgaria: 0.97-6.38; Czech Republic: 0.42-2.76; Hungary: 0.54-3.54; Poland: 0.59-3.90; Romania: 0.77-5.07; Slovakia: 0.55-3.61). While results must be interpreted with caution, calculating pro rata (cost-effective) prices and per capita GDP/QALY ratios based on CUAs can aid reimbursement decision-making in the absence of analyses using local data.