Central And Eastern Europe Region Research Articles

Continental lowlands face rising crop vulnerability: structural change in regional climate sensitivity of crop yields, Hungary (Central and Eastern Europe), 1921–2010

Central and Eastern Europe (CEE) is a pillar of global wheat and maize production. However, certain areas within the CEE region have become climate change hotspots, experiencing intensifying water deficits and drought pressure, rising mean and maximum temperatures. This study focuses on the long-term statistical relationships between climatic factors and rain-fed wheat and maize yields for different landscape types in Hungary over 30-year time windows between 1921 and 2010. The relationship between the variances of the detrended climatic parameters and crop yields was tested employing both simple and multifactorial linear models according to landscape types and periods. The sensitivity of wheat yields to spring–summer mean temperature shifted dynamically from the western part of the country to east (from cooler and wetter hilly landscapes to plains) between the periods 1921–1950 and 1981–2010. The cooling observed in summer temperature between the periods 1921–1950 and 1951–1980 supported an increase in wheat yields by an estimated 0.11–0.43 t ha−1 year−1, while the 0.9–1.2 °C warming of May–July temperature may have cut wheat yields by an estimated 0.44–0.56 t ha−1 year−1 in various regions over 1981–2010. That being said, the regional sensitivity of wheat yields to May–July mean temperature did not display substantial differences between the periods 1921–1950 and 1981–2010. Besides negative effects, climate change had a positive impact on wheat yields, since increasing January–March mean temperatures mitigated the negative impact of warming summer temperatures on wheat yields by an estimated 16–34% over 1981–2010. In this 30-year period, increasing mean temperature together with decreasing precipitation explained 46–75% of the variances in maize yields reducing annual maize harvests by an estimated 11.1–12.4% year−1.

Uncertainty in Central and Eastern European markets. Evidence from Twitter-based uncertainty measures

ABSTRACT Purpose Increasing uncertainty has frequently been associated with alterations in investor behaviour in scientific discourse. Central and Eastern Europe (CEE) despite generating 10% of the EU’s GDP, has largely been overlooked in investigations into the relationship between socialmedia uncertainty and its impact on the stock markets. The purpose of this article is to examine the dependence between the largest stock indices of the CEE markets and Twitter uncertainty measures. Design/methodology/approach The Vector Autoregressive (VAR) methodology, specifically bivariate Granger causality is applied to investigate the relationship between social media messages and market behaviour reflected in returns of the main stock indices for Croatian CROBEX, Czech PX, Hungarian BUX, Polish WIG and Romanian BET indices. Findings The author discovers substantial evidence indicating that the CEE region exhibits heterogeneity concerning its relationship with uncertainty in stock markets, with measures related to recession, political events, and natural disasters being of utmost relevance. Originality/value­ While the VAR model and Granger causality have been studied in relation to many markets, there is a lack of studies on the effect of Twitter-based wider spectrum of uncertainty measures on the CEE region. Twitter-based uncertainty measures on the CEE region represent a significant knowledge gap, that when addressed, could offer valuable insight into the region’s financial dynamics, thus potentially affecting hedging strategies, enhancing investor’s awareness and informing policy-making decisions.

Do R&D intensity and capacity utilisation matter for SMEs' innovations within the CEE region? Testing moderating roles of different ownership structures.

Existing innovation literature has assumed that the relationship between firms' R&D intensity and innovation take place without the interplay of other organizational factors. However, the reality differs, and research to date has shown that other factors affecting firms' innovation need to be considered. This is important especially in Central and Eastern Europe (CEE) countries, which are highly dependent on both internal and external R&D and are associated with an inability to use R&D resources effectively. This study therefore responds to calls for further analysis, especially within the CEE region, and focuses on the role of two factors affecting SMEs' innovativeness and their effects, which have been mixed so far. First, we investigate the effects of SMEs' R&D intensity and capacity utilisation on product innovation. Second, we reveal the moderating role of SMEs' different ownership structures (ownership concentration; private/public ownership; family/non-family ownership) in the relationship between R&D intensity and product innovation. We confirm that CEE SMEs' ownership concentration and private ownership moderate the relationship between R&D intensity and product innovation. In contrast, we reject our hypothesis expecting that family ownership of SMEs can significantly moderate the relationship between R&D intensity and product innovation. Interestingly, we also show that the relationship between capacity utilisation and innovation is non-linear (inverted U-shaped). This study makes a significant contribution in the form of analysis within the CEE region, whose innovation systems are seen to be weak, and it is therefore necessary to bring new knowledge and recommendations to managers and public policymakers.

Supply Chain Interconnectedness in Times of Crises: A Gravity Model with DiD Analysis of COVID-19 Effects on Central and Eastern European Trade

This paper explores the impact of COVID-19-induced disruptions on supply chains, specifically focusing on the interconnectedness of supply chains and the transmission effects they cause. The gravity model framework, together with difference-in-differences analysis, is employed to analyze monthly trade patterns among Central and Eastern European (CEE) countries, Western European countries, and other trading partner countries. The model presented accounts for the country’s roles in global value chains (GVCs) by incorporating data related to exports, imports of intermediate and capital goods, and imports of final consumption goods. CEE countries have demonstrated a certain resilience during the COVID-19 pandemic. Yet, they were not immune to adverse consequences due to disrupted supply chains, primarily in the imports of intermediate and capital goods. We find that the countries that suffered from the COVID-19 pandemic the least demonstrated remarkable resilience against disrupted GVCs. The findings of our study enrich the literature on the effects of the COVID-19 pandemic, specifically for the CEE region, by providing a framework for understanding the pandemic’s impact on international trade. The results show that supply shock might be greater than demand shocks on production and trade dynamics. Furthermore, our results suggest that policymakers seek adaptability to changing supply and demand patterns, while enterprises should consider broader diversification both within the region and locally.

Right-Wing Leftists, Left-Wing Rightists, and Traditionalist Liberals: Core Political Values and Ideological Inconsistency at the Party-Elite Level in Bulgaria

The growth of heterodox ideological configurations, or ideological inconsistencies, among the electorate of Western countries, has been offered as one explanation for recent momentous political events, such as Brexit or the election of Donald Trump as US President. Previous research, however, suggests that ideological inconsistency has been typical for Central and Eastern European (CEE) states for the past thirty years after the fall of the Socialist regimes there. Based on a survey of 102 active members of local and national party structures in Bulgaria, followed by in-depth interviews with the same respondents, I develop a conceptual and methodological approach aimed at objectively measuring Bulgarians’ political values and ideological orientations. Building on previous research on the statistical independence of the social and economic dimensions of ideology, this study identifies three main models of ideological inconsistency at the party-elite level in Bulgaria, offering evidence of the “homogeneity in ideological inconsistency” in this post-Socialist country, with party elites and electorate following the same patterns of inconsistency. The existence of a conservative value complex, integrating traditionalist, statist, and nationalist attitudes regarding the social sphere, is another major finding of the study. I discuss the specific historical and socio-cultural background contributing to ideological inconsistency in Bulgaria and potential implications for the wider CEE region.

Interdependencies between international innovation partnerships: the case of Central and Eastern Europe

Purpose Competitively multipolar international system demands bilateral and multilateral partnerships. Joint innovation signals close partnerships. Regional proximity of Central and Eastern Europe (CEE) to the European Union (EU) defines its research and development objectives. These objectives are additionally subjected to the USA’s geopolitical strategy in this geographical area. Hence, CEE’s limited resources require limited resources make international innovation cooperation. This paper aims to analyse whether and how CEE countries make international innovation cooperation decisions. Design/methodology/approach This paper used Organisation for Economic Co-operation and Development (OECD) database of total patent applications filed to the patent cooperation treaty (PCT) with co-applicants from abroad, where co-patents with at least one foreign inventor present a measure of international innovation partnership. A vector autoregression analysis and impulse response function were used to analyse international innovation partnership choices of eight CEE OECD countries for the period 1990–2018. Findings Innovation with the EU is of collaborative nature, commonly displaying complementary properties with the rest of the examined innovation partners, while co-patenting with the Russia and China act as substitutes or complements. Co-patenting with Russia is the most versatile, displaying both properties of collaboration and competition. Some countries exhibit complementarity in co-patenting activities with multiple partners. The significance levels of these relationships vary, indicating varying degrees of impact. Overall, these findings highlight the complex dynamics of co-patenting activities and the influence of different partners on countries’ collaborative innovation strategies. Research limitations/implications In addition to significant relationships, insignificant relationships as well as those that could bring about greater synergy are flagged in the paper. Those relationships portray possible direction into which national funds could be channelled to incite cooperation between different sectors and countries, especially as innovation partnerships are not always successful and require a long time period to materialise. Originality/value By examining bilateral innovation partnerships, this study provides an insight into the strategic political and economic spheres of influence in the CEE region.

Political Effects on FDI in the CEE Region: Two Cases of Connectivity and Decoupling from the West

The article studies two cases of political impacts on FDI in the Central and Eastern European (CEE) region. The first case covered 15 CEE countries focusing on FDI sensitivity to democracy and elections during their connectivity with the West from 1991–2019. The panel data multi-factor linear regression method gives some arguable results that show that the fall of democracy increases FDI in CEE economies. It is explained by the FDI’s priority of economic scale and growth over the level and direction of democratic development. At the same time, Western connectivity provides an environment for economic growth in the CEE economies. The second case describes the political effects of decoupling from the West on the China–Belarus Industrial Park (CBIP) in 2020–2022. Based on the event study methodology and field survey of 21 residents of the CBIP, the findings show the negative effects of decoupling on the volume of Chinese capital, the number of registered residents, their profit, payback period, and reliance on government support. Both the cases also demonstrate the drop in FDI during election years. JEL Classification F21, P16, O52

Taking stock of responsible management education in Central and Eastern Europe

Corporate social responsibility, business ethics and sustainability – often bracketed under responsible management education (RME) – are topics that are increasingly adopted by universities and business schools across the globe. However, one region where our knowledge regarding the extent of RME is still limited is Central and Eastern Europe (CEE). Bringing together a team of scholars (currently or formerly) based throughout the region, we were able to conduct the largest survey to date of RME practices in the CEE region, covering 13 countries. Our findings suggest that, at a declarative level, RME is very much present at CEE universities and business schools, in particular in terms of teaching. However, a pro-RME rhetoric is not necessarily backed-up with substance; in particular, a lack of financial resources was identified as the major barrier to greater engagement with RME practices. We also observed a gap between commitment to RME in teaching versus in research, which could be a potential source of concern as teaching should be informed by research; otherwise faculty remain dependent on imported teaching materials. We contribute to strengthening the RME agenda in management education by discussing the implications of our findings for individual faculty, business school leaders, governments and international associations of management education.

Public perceptions of CCUS in Central and Eastern Europe – implications for community engagement

Carbon capture, utilization, and storage (CCUS) is emerging as a subject of major interest for EU climate policy due to their potential role in avoiding hard-to-abate CO2 emissions, as well as to lead to “negative emissions” through direct air capture or bioenergy with carbon capture and storage. Despite CCUS technologies being deployed since the 1970s, their widespread implementation is still challenged by a range of factors, including policy inertia, high costs, and relative novelty in the public discourse. In particular, as CCUS emerges slowly into the realm of public and political debate, opinions on these technologies and associated projects are easily changeable and affected by a range of factors, which make concerted public and community engagement extremely important for deploying them where they matter most.The Central and Eastern Europe (CEE) region is characterized by a higher-than-average economic dependence on heavy industry, old assets and infrastructure, and a high occurrence of regions where the transition to climate neutrality will have a significant impact on local economies, employment, and social welfare [1]. CCUS could play an important role in decarbonizing the heavy industry sectors of the region, particularly given the potentially significant storage capabilities of countries such as Romania and Poland, as well as emerging storage potential in the Black Sea and Eastern Mediterranean Sea. However, climate policy in these jurisdictions is sluggish, and there is a general failure to approach CCUS in a systematic way, with targeted application to sectors where it can have the highest impact, such as cement and oil refining. As a result, the public debate around CCUS is practically non-existent, and where public opinions do emerge, they may be significantly influenced by the context of a particular project and generate significant resistance based on the relationship with project developers, the amplification of perceived risks, and the lack of appropriate explanations of costs, benefits and risks. This in turn can lead to a reticence of political stakeholders to commit to deploying CCUS, causing the public debate to further stagnate and creating a vicious circle whereby opportunities to familiarize the public with these technologies (well in advance of their deployment) are missed.In order to deploy CCUS at pace and scale, as part of the catching-up climate policies of CEE countries, public perception of CCUS must be thoroughly researched and developed into appropriate guidelines for community engagement by project developers. There is experience in the region – the feasibility study for Romania’s planned Getica CCS demonstrator (subsequently abandoned) included comprehensive research into the perceptions of local communities, and a toolkit for communications around CCUS by project developers. Similarly, learnings from Poland’s failed Belchatow CCS project can serve to re-assess the state of public opinion on CCS, and how the local and national-level contexts for CCUS perceptions interact. The CEE region has significant potential for deploying CCUS, and public perception must be an integral part of planning as the region moves into the key decade of 2030-2040 for implementing large-scale projects.

Recommendations for patient involvement in health technology assessment in Central and Eastern European countries.

Meaningful 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. Built 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. A 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. In 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.

How competitive is SRI in developing financial markets: The case of Central and Eastern Europe

This study investigates the competitiveness of sustainable and responsible investment (SRI) in Central and Eastern European (CEE) financial markets. Specifically, we examined whether a statistically significant measurable difference in the return and volatility between an SRI index and two conventional benchmark indices in the CEE region exists. To test whether the market volatility may affect the results, we applied a Markov regime-switching model to examine the performance in high and low volatility environments. We also used the Fama-French three-factor model to analyse the potential sources of outperformance and verify the initial analysis results. The analysis covered an eleven-year period (January 2011–December 2021) and was based on monthly returns of indices available on the Vienna Stock Exchange: CECE SRI, CECE Composite and CECE MID. Our findings showed that the SRI phenomenon in developing financial markets of the CEE countries followed performance patterns similar to ones in developed financial markets. Sustainable and responsible investment is competitive with conventional investment in the CEE region. However, the differences in returns between the SRI index and conventional benchmarks were statistically insignificant. Although a statistically significant difference in volatility between the SRI index and the large-cap CECE Composite index was reported, we did not find any evidence of exposure to the SRI factor regarding the analysed returns of the CECE SRI index. Our analysis of SRI returns pointed to the statistical significance of the common risk factors, such as the market and the size, which is similar to the analysed conventional benchmarks, with alpha not being statistically significant.

A new algorithm for the management of diabetic foot ulcer: recommendations from Central and Eastern Europe

There is wide regional variation in clinical practice and access to treatment for patients with diabetic foot ulcer (DFU) from countries in Central and Eastern Europe (CEE). A treatment algorithm that reflects current treatment practices while providing a common framework may facilitate best practice in DFU management and improve outcomes across the CEE region. Following a series of regional advisory board meetings with experts from Poland, the Czech Republic, Hungary and Croatia, we present consensus recommendations for the management of DFU and outline the key features of a unified algorithm for dissemination and use as a quick tool in clinical practice in CEE. The algorithm should be accessible to specialists as well as non-specialist clinicians and should incorporate: patient screening; checkpoints for assessment and referral; triggers of treatment change; and strategies for infection control, wound bed preparation and offloading. Among adjunctive treatments in DFU, there is a clear role for topical oxygen therapy, which can be used concomitantly with most existing treatment regimens in hard-to-heal wounds following standard of care. Countries from CEE face a number of challenges in the management of DFU. It is hoped that such an algorithm will help standardise the approach to DFU management and overcome some of these challenges. Ultimately, a regionwide treatment algorithm in CEE has the potential to improve clinical outcomes and save limbs.

‘Not fighting corruption, but defeating it’: the populism of Zelensky’s Servant of the People in comparative perspective

ABSTRACT Research on populism is more abundant than ever, but the Ukrainian case is usually neglected in the comparative literature. This article fills this gap by providing a systematic analysis of the populism of Zelensky’s Servant of the People (SN) at the time of its electoral breakthrough in 2019, and it does so by adopting a broader European perspective. We argue that the success of Zelensky’s SN in 2019 should not be interpreted as something idiosyncratic or country-specific. On the contrary, we show that Zelensky’s SN is the Ukrainian manifestation of valence populism, a populism variety typically found in Central and Eastern Europe (CEE). By combining qualitative and quantitative evidence, the analysis reveals that Zelensky’s SN, like the other valence populists in the CEE region, focused its agenda on non-positional topics, such as anti-corruption appeals, political transparency and moral integrity. At the same time, similarly to the other valence populist parties, the positions of Zelensky’s SN on economic and socio-cultural issues were intentionally blurry and elusive, to reach a broader group of voters. The conceptualization of SN suggested in the article allows for a better integration of the Ukrainian case into future comparative research on populism.

PrEP Scale-Up and PEP in Central and Eastern Europe: Changes in Time and the Challenges We Face with No Expected HIV Vaccine in the near Future.

With no expected vaccine for HIV in the near future, we aimed to define the current situation and challenges for pre- and post-exposure prophylaxis (PrEP and PEP) in Central and Eastern Europe (CEE). The Euroguidelines CEE Network Group members were invited to respond to a 27-item survey including questions on PrEP (response rate 91.6%). PrEP was licensed in 68.2%; 95 centers offered PrEP and the estimated number on PrEP was around 9000. It was available in daily (40.1%), on-demand (13.3%), or both forms (33.3%). The access rate was <1-80%. Three major barriers for access were lack of knowledge/awareness among people who are in need (59.1%), not being reimbursed (50.0%), and low perception of HIV risk (45.5%). Non-occupational PEP was available in 86.4% and was recommended in the guidelines in 54.5%. It was fully reimbursed in 36.4%, only for accidental exposures in 40.9%, and was not reimbursed in 22.72%. Occupational PEP was available in 95.5% and was reimbursed fully. Although PrEP scale-up in the region has gained momentum, a huge gap exists between those who are in need of and those who can access PrEP. Prompt action is required to address the urgent need for PrEP scale-up in the CEE region.

Развитие вооруженных сил и оборонно-промышленного комплекса Венгрии: стратегия правительства В. Орбана

The article examines Hungary’s modernization of Armed Forces and expansion of the capabilities of the country’s defence-industrial complex (DIC). Using the neorealistic paradigm, the author analyzes the main directions in which the Hungarian army and the MIC developed during the leadership of the Prime Minister Viktor Orbán. The 10-year development program of the Hungarian Defence Forces – Zrínyi – involves a significant increase in their capabilities by 2026. Official plans to expand and modernize the DIC include the target to make the Hungarian state one of the leaders of the defense industry in the Central and Eastern Europe (CEE) by 2030. The main partners in this area are going to be companies not only from the member states of the European Union (Germany, France and the Czech Republic), but also from Turkey and Israel. Reforming the army and increasing the technological level of the DIC are primarily aimed at strengthening the country’s economy and protecting the state borders and Hungarian citizens both in Hungary itself and in Ukraine, in Transcarpathia. At the same time, the Prime Minister V. Orbán is confident that NATO’s actions can only be aimed at self-defense. This is related to the refusal of the Hungarian authorities to supply weapons to Kiev. However, Hungary is not only strengthening mechanized troops (German Lynx infantry fighting vehicles, Turkish Gidrán armored personnel carriers), the country’s Air Force (Swedish Saab JAS 39 Gripen aircraft) and Air Defense (Norwegian–American NASAMS anti-aircraft missile complex), but also, reflecting on the experience of the conflict in Ukraine, returns to the use of artillery, considers the possibility of producing drones and more ammunition on its territory, and also wants to increase the offensive potential of its Armed Forces thanks to modern multiple rocket launchers like HIMARS. Despite the fact that Hungary, according to V. Orbán, is on the side of the ‘peace party’, in the future, as part of NATO in the CEE region, there will be a modernized army with a proper defence-industrial complex, ready for a ‘new generation’ conflict. The Hungarian political opposition in turn advocates for military assistance to Ukraine and curtailing relations with Russia, while being actively encouraged by the United States.

110 Characteristics and management of generalized pustular psoriasis (GPP): experience from the Central and Eastern Europe (CEE) GPP Expert Network

This study was conducted to determine the characteristics of GPP flares and current treatment landscape among patients with GPP in the CEE region. Eligible cases (N=57) that met GPP diagnosis criteria (centre of excellence or ERASPEN) and had follow-up/treatment in the last 10 years were collected from 10 centres. Case report forms were used to collect patient demographics; characteristics of last and most severe flares; treatment and outcomes. Median age at disease onset was 57 years (range 0–84); 59.6% were female.

Prevalence of potentially inappropriate prescribing in older adults in Central and Eastern Europe: a systematic review and synthesis without meta-analysis

We aimed to systematically review the prevalence of potentially inappropriate prescribing (PIP) in older adults in Central and Eastern Europe (CEE) in all care settings. We searched Embase and MEDLINE (up to June 2019) and checked the reference lists of the included studies and relevant reviews. Eligible studies used validated explicit or implicit tools to assess the PIP prevalence in older adults in CEE. All study designs were considered, except case‒control studies and case series. We assessed the risk of bias using the Joanna Briggs Institute Prevalence Critical Appraisal Tool and the certainty of evidence using the GRADE approach. Meta-analysis was inappropriate due to heterogeneity in the outcome measurements. Therefore, we used the synthesis without meta-analysis approach—summarizing effect estimates method. This review included twenty-seven studies with 139,693 participants. Most studies were cross-sectional and conducted in high-income countries. The data synthesis across 26 studies revealed the PIP prevalence: the median was 34.6%, the interquartile range was 25.9–63.2%, and the range was 6.5–95.8%. The certainty of this evidence was very low due to the risk of bias, imprecision, and inconsistency. These findings show that PIP is a prevalent issue in the CEE region. Further well-designed studies conducted across countries are needed to strengthen the existing evidence and increase the generalizability of findings.

Is There “a Chinese Effect” On EU-15 Foreign Direct Investment in Central and Eastern Europe?

This paper aims to empirically verify the possible existence of “a Chinese effect ”, that is, a substitution effect between the Chinese and the EU-15 investment in the Central and Eastern European (CEE) region, which has been recently involved in the Belt and Road and 17+1 Initiatives. Such an effect can result from the strengthened political orientation of several CEEauthoritarian populist and illiberal elites towards China, which can, in turn, discourage the EU-15 from investing in the CEE region. Despite intensified Sino-CEE political relations, the results of the analysis conducted on 15 CEE countries during 2010–2018 suggest that the Chinese FDI does not substitute for investment from the EU-15 market since the expectations regarding the FDI cooperation between China and the CEE region have not been met. Moreover, most of the Chinese investment has been made via mergers and acquisitions, and not via greenfield FDI, which may lead to exaggerations of the relatively weak Chinese influence in the CEE region.

„Spolupráca 17+1“ v strednej a východnej Európe: analýza európskych a amerických faktorov a trendov

Since the second decade of the 21st century, the world's great powers have increased their attention and investment in Central and Eastern Europe (CEE), and the game between great powers has intensified. This paper aims to understand the interests and concerns of great powers or international organizations such as the United States (US) and the European Union (EU) in CEE, and analyze the positions and impact of great power factors on China- CEE cooperation ("17+1 Cooperation"). Through the analysis using a multidimensional hermeneutic approach, it can be seen that the EU plays a leading role in CEE, the US is deeply involved in CEE by providing military security and energy supply, and the interests pattern and interactions of the above parties in the CEE region are important external variables that directly or indirectly affect China-CEE cooperation. As a "latecomer", China's cooperation with CEE countries coexists with opportunities and challenges in the game of great powers. While there is some potential for cooperation, the road seems bumpy and long.

Potential Barriers of Patient Involvement in Health Technology Assessment in Central and Eastern European Countries.

Patients' perspectives are important to identify preferences, estimate values and appreciate unmet medical needs in the process of research and development and subsequent assessment of new health technologies. Patient and public involvement in health technology assessment (HTA) is essential in understanding and assessing wider implications of coverage and reimbursement decisions for patients, their relatives, caregivers, and the general population. There are two approaches to incorporating the patients' voice in HTA, preferably used in a mix. In the first one, patients, caregivers and/or their representatives directly participate at discussions in different stages of the HTA process, often at the same table with other stakeholders. Secondly, patient involvement activities can be supported by evidence on patient value and experience collected directly from patients, caregivers and/or their representatives often by patient groups Patient involvement practices, however, are limited in Central and Eastern European (CEE) countries without clear methodology or regulatory mechanisms to guide patient involvement in the HTA process. This poses the question of transferability of practices used in other countries, and might call for the development of new CEE-specific guidelines and methods. In this study we aim to map potential barriers of patient involvement in HTA in countries of the CEE region.