Central Eastern European Countries Research Articles

Health care provider payment schemes in Central and Eastern European countries

Abstract Background Health care provider payment schemes are key elements of the health care system that influence providers behavior, quality of care, and efficient use of resources. In recent decades, Central and Eastern European (CEE) counties have implemented various reforms that have changed payments methods and other elements of the purchasing process. The aim of the study was to provide an overview of the current provider payment schemes within the public health system in selected CEE countries and identify the main directions of their reforming. Methods Based on existing literature, a theoretical framework and data collection form were first developed. Next, desk research was conducted to collect data on provider payment methods and other elements of the purchasing process in primary care, outpatient specialized care, hospital care, and long-term care. The collected information was verified and supplemented though consultations with national experts. Nine countries were included: Bulgaria, Croatia, Czechia, Estonia, Latvia, Lithuania, Hungary, Poland, and Romania. The study was conducted in 2023. Results Capitation, fee-for-service, and case-based payments are the most commonly used methods in the analyzed countries. The countries are increasingly using blended payment methods. Primary and hospital care have the most diverse payment method mix and have experienced the most substantial changes in their payment schemes since 2010. The most common changes focused on modifying existing methods (detailing payment categories, changing the principles of tariff valuation), and introducing additional methods to pay for specific services or performance (fee-for-service, bonus payments). Conclusions CEE countries are following similar directions in reforming provider payment systems, with the goal of strengthening primary health care, shifting emphasis from inpatient to outpatient care and improving cooperation between health care providers. Key messages • CEE countries largely use output-based methods to pay for health care services. • Provider payment systems are becoming more blended as countries look for the most effective payment method mix to meet policy objectives.

Disinformation challenges facing the Three Seas Initiative – frame analysis of the key narratives

By exploiting the potential of social media, disinformation has become an important element of warfare. The region of Central and Eastern Europe (CEE) is particularly vulnerable to disinformation, primarily from Russia. One of the reasons for Russia’s activities in this region’s infosphere is that most CEE countries are members of the European Union and the North Atlantic Treaty Organization (NATO). In this context, Russian disinformation activities aimed at the Three Seas Initiative (3SI) are particularly interesting. The image of the 3SI created in the media is crucial, for it translates into how the public understands, perceives and recalls this format of cooperation. The article aims to reconstruct the image of the 3SI in cases of Russian disinformation identified by the European External Action Service within the EUvsDisinfo project. The article’s methodology is based on a qualitative content analysis of disinformation cases identified by EUvsDisinfo. The article identifies four main frames of disinformation targeting the 3SI, showing that Russian disinformation is focused on undermining the credibility and integrity of this cooperation, both among Initiative countries and between them and their international partners.

Happiness and all-cause mortality: the HAPIEE study

Abstract Background The evidence on the association between happiness and mortality is mixed. Similarly, the role of covariates in this association is not clear. Almost no evidence on the topic comes from the Central and Eastern Europe (CEE). This analysis aims to evaluate such association in longitudinal data from three CEE countries, and to investigate the role of other variables in this association. Methods The analysis is based on data from 18,362 men and women from the longitudinal Health, Alcohol and Psychosocial factors In Eastern Europe (HAPIEE) study conducted in the Czech Republic, Lithuania and Poland who were 45-70 years old at the start of the study. Happiness was based on 4-points Likert scale answers ‘Very happy’, ‘Quite happy’, ‘Not very happy’, and ‘Not at all happy’ to the question ‘Taking all things together, would you say you are ...’. All-cause mortality was obtained from local or national mortality registers. Cox proportional hazards regression was used to estimate the hazard ratios (HRs). Results 2,718 deaths have been observed during the 11 years of follow-up. The mortality rates were 13.0, 14.1 and 20.7/1000 person years in very happy, quite happy and unhappy groups. After adjustment for country and age the HR comparing very happy and unhappy was 0.53 (95%CI: 0.43-0.67) in men and 0.66 (0.48-0.91) in women. This association was reduced after adjusting for socioeconomic characteristics, health behaviours and conventional risk factors (HR 0.78 in men and 0.84 in women); and was further reduced after controlling for health conditions at baseline. No strong evidence for country interaction was identified although the association was slightly stronger in Polish men than in other two countries. Conclusions Happiness has been shown to predict all-cause mortality in these three countries from CEE although it may be (at least partly) explained by established risk factors and underlying health conditions. This work was supported by the NPO SYRI (LX22NPO5101). #NGEU Key messages • Happiness is shown to predict all-cause mortality in this CEE population. • The association seems stronger in men than in women.

The prevalence, patients characteristics and risk factors of hyper-Lp(a)-emia in the Polish population. The first results from the PMMHRI-Lp(a) Registry

Abstract Background Based on the recent data and existing guidelines Lp(a) is recognized, independent CVD risk factor. However, the knowledge on the prevalence of elevated Lp(a) levels, patients characteristics as well as non-genetic risk factors is scarce from some world regions including from Poland, the largest CEE country. Purpose We aim to present the first results from the Lp(a) registry established in the 2nd largest hospital in Poland - Polish Mother’s Memorial Hospital Research Institute (PMMHRI). Methods The PMMHRI-Lp(a)-Registry was established in 2022. The indications for Lp(a) measurement in the registry are based on the 2021 Polish Lipid Guidelines and new Polish recommendations on the management with elevated Lp(a) (2024). The PMMHRI-Lp(a)-Registry is a part of the being founded Lp(a) National Registry of the Polish Lipid Association. Results Based on the data from 302 consecutive patients (mean age 52.18 years; women 53%) the mean Lp(a) level was 30.3±39.4 mg/dl; it was numerically higher in woman (32.8 mg/dl), but there were no significant sex differences (men: 27.5 mg/dl; p=0.245). There were also no significant differences between those with and without CAD, stroke, HF, cancer, diabetes, kidney disease, and thyroid disease. The significant Lp(a) level difference was observed in those with diagnosed dyslipidemia in comparison to those without (31.9±40.6 vs 17.7±25.8 mg/dl, p=0.044) and in those with the history of myocardial infarction (MI) vs those without (50.1±50.3 vs 28.1±37.5 mg/dl, p=0.004). However, when we divided those with MI on premature vs no premature, no significant difference in Lp(a) level was observed (41,6±41.9 vs 57.6±56.7 mg/dl, p=0.39). Lipid lowering therapy did not significantly affect Lp(a) level, with only significant differences in those treated with ezetimibe (as a part of the combination therapy; 39.5±47.6 vs 27.5±36.3 mg/dl, p=0.027). For selected patients (n=31; 10.3%) with two Lp(a) measurements (mean time distance: 7±5 months) we did not observe any significant visit-to-visit variability (mean difference: 0.81 mg/dl; z=0.256, p=0.262) (Fig. 1). We did not also observe any percentage differences in variables (besides MI history, p=0.017) for different Lp(a) risk groups: 0-30, >30-50, >50-180 and >180 mg/dl. While dividing the population on those with Lp(a) ≤30 mg/dl vs >30 mg/dl, the only differences were seen for dyslipidemia diagnosis (p=0.044) and MI occurrence (6.98 vs 17.24%; p=0.007). Similar pattern was observed while dividing the whole population on those with Lp(a) ≤50 vs >50 mg/dl (Fig. 2). Conclusions These results strongly emphasize that Lp(a) should be measured commonly, as its high level is highly prevalent in patients at the risk both in primary and secondary prevention, what require risk re-stratification and treatment optimization. This is especially important in the regions that characterize of baseline high CVD risk, what refers to most of the CEE countries, including Poland.

The hidden burden of atopic dermatitis in central and Eastern European countries

ABSTRACT Background Atopic dermatitis (AD) imposes a hidden burden through its negative effects on quality of life and productivity. We aim to estimate this hidden burden in adults and adolescents in Central and Eastern European (CEE) countries. Methods We created a burden of disease model to quantify AD’s hidden burden. Humanistic burden was calculated by estimating the monetary value of quality-adjusted life years (QALYs) lost, using prevalence data from the Global Burden of Disease study and gross domestic product (GDP) per capita for each country. Indirect economic burden was estimated based on productivity loss from absenteeism and presenteeism, adjusted for labor force participation and unemployment rates. Total hidden burden was determined by combining productivity losses and QALYs lost. Results QALY loss due to AD ranged from 1,832 to 58,596 annually in CEE countries, equating to 38 million to approximately 1 billion Euros per country. Productivity losses ranged from 3.6 to 148.9 million Euros annually. The total hidden burden of AD represents 0.11% to 0.43% of the GDP. Conclusions Our estimates reflect significant differences in population size, prevalence, and economic strength among CEE countries. Adjusting findings to country-specific GDP provided insights into AD’s true hidden burden, offering valuable information for decision-making.

Technological progress in central and eastern Europe: Digitalization and business innovation leaders and outsiders

Innovation and the associated digitization of the global economy are becoming the foundation of competitiveness and development. This state of affairs affects all regions and countries of the world, especially enterprises, which need to adapt to stay in the market. The situation is particularly challenging in developing countries, whose economic potential is lower than that of developed economies. Addressing this issue, the article presents the results of a study on the degree of digitization and innovation of enterprises in the countries of Central and Eastern Europe (CEE), which are among the group of developing economies. The research included independent assessments of innovation and digitization in these countries, as well as a combined assessment of both processes. It was based on a set of 17 selected indicators characterizing the processes of digitization (9) and innovation (8). The CRITIC method was used to calculate the weights of these indicators, and the TOPSIS method was used to determine the digitization and innovation indices, as well as the final digitization and innovation index. Using the results of this analysis, relationships were determined between the digitization and innovation indices, as well as between the final index (innovation and digitization) and selected economic parameters of the countries under study (CEE). The results show that companies in the studied countries are highly differentiated in terms of their digitization and innovation. The best results in both dimensions were obtained by the Czech Republic and Slovenia, while the weakest were by Latvia and Romania. In terms of business innovation, the Czech Republic and Slovenia are the best performers, while Latvia and Romania are the weakest. On the other hand, Slovenia and the Czech Republic are the leaders in business digitization, while Romania and Bulgaria are the worst performers. The remaining countries fell within the area of average development in these dimensions. The obtained results should be a valuable source of knowledge for assessing the measures taken to date in CEE countries in the field of innovation and digitization. It would also be advisable to use them in the development and implementation of economic policy and the targeting of investment activities in the EU. A major opportunity, especially for improving the innovativeness of CEE countries, could be the Open Innovation concept. Its wider implementation in these countries should improve their performance in this regard.

The impact of renewable energy consumption and energy poverty on pollution in Central and Eastern European countries

Considering the actual climate challenges, pollution should be reduced in Central and Eastern European countries (CEECs) from the European Union (EU). The main objective of this paper is to assess the impact of energy poverty and renewable energy consumption (REC) on pollution in 10 CEE countries, EU member states, during 2005–2022. The results based on the synthetic control method suggested that Renewable Energy Directive implemented in 2009 contributed to the decrease in the level of CO2 emissions in each CEEC compared to the states in this region that are not EU member states (Albania, Serbia, Moldova, North Macedonia, Georgia, Montenegro, Belarus, Ukraine). The panel regression analysis based on MG estimator showed that energy poverty enhanced CO2 emissions, while renewable energy consumption reduced it and had a mediating effect on the impact of energy poverty on pollution in the CEECs. The population unable to keep home warm, foreign direct investment and value added in industry had an asymmetric effect on CO2 emissions in the CEECs as method of moments quantile regressions suggest. These results are subject to policy proposals to tackle both pollution and energy poverty in the region.

Dynamic Analysis of CO2 Emissions and Their Determinants in the Countries of Central and Eastern Europe

This study addresses the problem of the relationship between the adopted development path and the emission levels of greenhouse gases. The analysis includes the countries of Central and Eastern Europe that joined the EU in 2004–2018. This study used a dynamic analysis due to the nature of the changes taking place, which cannot be assessed in static terms. The results of the research conducted so far for this group of countries have been inconclusive. The countries studied have the aim of accelerating economic growth in order to reduce their distance from other EU countries on the one hand, while attempting to pursue a policy favoring the reduction of greenhouse gas emissions, on the other. The aim of this evaluation was to determine the relationship between GDPs per capita and CO2 emissions and to establish the factors determining this relationship. The results for the whole group showed the presence of N-shaped EKCs. This study showed the importance of energy productivity and demographic factors as well as the pace of GDP growth. This research extended the scope of research on CO2 emissions and their determinants through the use of dynamic methods, as well as the complex course of their relation to GDP per capita in Central Eastern European Countries.

Debt management strategies in the countries of Centraland Eastern Europe – an instrument of debt managementor just increasing transparency of public finances?

The paper investigates the contents of public debt management strategies in Central and Eastern European countries.The fundamental research problem of the research is to determine the role that formal debt managementstrategies play in contemporary public financial processes. Do they – as their name suggests – constitute a realtool for strategic debt management, i.e. strategies that set specific measurable objectives and actions that are tolead to the achievement of these objective over a certain period of time, or – contrary to their name – are theymerely an instrument for informing about the structure of the debt portfolio and seeking legitimacy for past decisionsregarding this structure addressed primarily to rating agencies and secondarily to investors and the public.

Governance and Development of Tourism in Rural Areas through the Lens of Media in South Bukovina (Romania)

Agritourism and rural tourism represent an essential growing sector in certain EU regions, particularly in restructured and rebranded Central and Eastern European countries (CEECs) like Romania that display important rural areas and face important societal and economic changes. The rapid growth of rural tourism activities in the South Bukovina region (historically overlapping most of Suceava County) led, in the new legislative frame, to the establishment of the first regional Destination Management Organization (DMO) in Romania. By an exploratory qualitative, mixed-method case study approach, this study underscores important factors for tourism development in the region, outlining rural and agritourism variables integrated into the public authorities’ discourse. The paper innovatively focuses on the semantic analysis of online newspaper media texts and videos, complementarily analyzed by appropriate software solutions. The main results emphasize the factors for tourism development in the area through a dual cluster centered around the multilevel governance and tourism management structures represented by public authorities on the one hand and the projects, investments, and EU funding on the other. Key stakeholders’ opinion underscored public–private partnerships, supportive administrative structures, tourism events and various natural and cultural resources as sustainable elements that contribute to the successful development of tourism in the region.

Effects of European funding on the convergence of central and eastern European countries

This study aims to analyze the effects of European funding for Central and Eastern European countries (CEE) on the degree of convergence. The model for measuring the real β-convergence and the standard regression equation when working with a general population were mainly used as part of the analysis methodology. The results confirm the tested neoclassical hypothesis that less developed countries record faster growth rates relative to stronger developed countries. The analysis finds that only in Bulgaria of the studied countries is an independent impact of EU financing on real convergence expressed in the inflation rate. When examining the unemployment rate, a relationship is found in three of the CEE countries: Lithuania, Latvia and Bulgaria. Indicators from the analysis of the relationship between EU funding and convergence through the Gini index are found only in Slovenia while the same observed relationship expressed through GDP per capita shows a negligible independent influence on real convergence in all CEE countries. The study in its entirety demonstrates the relationship between the real effects of European funding on the convergence of CEE countries through four independent variables and raises discussion questions about the approaches to measure the real effect of the budgetary resources allocated at the European level.

Performance of Family Businesses in the Specific Conditions of CEE Countries: The Case of the Czech Republic

Performance of Family Businesses in the Specific Conditions of CEE Countries: The Case of the Czech Republic

A comparative analysis on how much individuals are left behind in the former state socialist countries of the European Union

This paper examines the extent to which individuals from the former state socialist countries of the EU’s Central and Eastern European (CEE) countries have been left behind compared to the rest of EU individuals from Western European (WE) countries and across countries within the CEE bloc. To this end, a fuzzy approach is applied to a multidimensional setting made up of income, material deprivation, and work intensity to measure the ‘Leaving no one behind’ (LNOB) principle of the 2030 Sustainable Development Agenda. A certain process of convergence is found between both blocs of countries over the period 2007–2019 due to a decrease in the level individuals were left behind in the CEE countries, as well as an increase in the level individuals were left behind in the WE countries in the years following the 2007–2008 financial crisis. Significant cross-country disparities in the degree individuals lag behind are also revealed among the CEE countries related to the different models of post-socialist capitalism established in these countries and their subsequent development after joining the EU.

The North-South divide and everything that gets left out in-between: conceptualizing Central and Eastern Europe to explain its positioning on climate change

The North-South divide forms the central axis along which scholars study the contemporary global order. Yet many countries fall in-between the cracks of a world divided into core and periphery. This paper develops a structural account to understand the position of countries in this space of in-betweenness. The focus is on Central and Eastern Europe. I draw on already existing scholarship on liminalities, the varieties of capitalism and transition studies to argue that a liminal identity of in-betweenness goes hand-in-glove with a domestic logic of transitioning, as the state seeks to move somewhere else. Furthermore transitioning dynamics position the state in the semi-periphery, as the transition to the civilizational core requires capital and know-how from abroad. The resulting semi-peripheral position further underlines the liminal identity. The paper uses this apparatus to understand why CEE countries are typically climate change laggards within the EU. Their continuing liminal identity results in frustration over and resistance against the schooling tendencies of Brussels and Western European capitals. The dynamics of a sense of imposition of climate change mitigation policies stem from CEE’s liminal positioning as apprentices, but the reasons for the perceived alienness of such policies are located in domestic societal dynamics, and CEE countries’ economic structure. The specific political structures of communism and the communist transition have strengthened particularistic personal ties of friendship and family between individuals and the localities they live in, while simultaneously weakening general and abstract conceptions of the public good. Accordingly initiatives for preserving specific localities can be strong, but conceptions of protecting an abstract, global climate, are not well developed. Additionally, the material costs of protecting the climate are higher in post-communist economies due to their comparative advantage in resource and labour intensive industries, their reliance on foreign capital, and a lack of domestic innovations.

CEEC stock markets in the post-communist era: evolutions and convergences

ABSTRACT The political regimes that emerged from the 1989–1990 transitions needed a strong financial market system to support the economic transformation of previously -centralized communist regimes. In this way, the banking system had to attract foreign investment to build a strong system that was able to lend and create a resilient economy for its private and public sectors. To understand the important role that stock markets play in modelling countries’ economic functioning, this paper explores and reviews the effects of stock market reopening in CEE countries. The data analysis shows that indeed, if referring to financial indicators, the economies of communist countries reached those in Western Europe. Nonetheless, the effects of the equal distribution of financial success remain unclear.

Economic Growth and Income Inequality: The Challenge in Ex-Communist EU Countries

ABSTRACT This paper explores the relationship between economic growth and income inequality by observing a set of 11 Central and Eastern European (CEE) countries during the period 1994 to 2020. We employ panel cointegration techniques in order to capture the common long-term dynamics of the CEE countries while not imposing equality on the short-run coefficients. Generally, it is found that there exists a monotonically decreasing growth-inequality link, contradicting Kuznets’ theory for emerging economies. However, in the short-run, several heterogeneities are found at the cross-country level, inferring the diffuse pattern of this association: inverted-U-shaped or linear (insignificant).

Trust in president – a different case? Individual-level patterns of trust in political executives in Central and Eastern Europe

ABSTRACT People seem to trust the president more than other national political institutions. In the context of semi-presidential regimes, it is plausible that the role of the president being “above party politics” is an explanatory factor behind this pattern. This study challenges the argument by analysing the impact of citizens' party preferences and attitudes towards the political system on trust in president in select CEE countries. The results confirm that trust in president is often context specific and cannot be disassociated from partisan factors. In general, similar patterns are found between trust in president and trust in prime minister.

Demand for private health insurance: an empirical study of post-communist countries

The development of voluntary health insurance is characteristic of post-Communist and CEE countries. The aim of the paper is to identify the factors determining the demand for private voluntary health insurance. The main finding of the research is that the most important factor is the demographic factor. Other factors include the factor related to the ineffectiveness of treatment under universal health insurance, the factor related to health condition, the demographic factor related to longevity, and the factor related to insurance awareness and income. The research confirms conclusions from previously published studies. The most important is to confirm that the income factor positively influences the studied phenomenon. However, the results shed new light on the aspect of the demand factor, as this indicates the ageing of society and the consequent increase in private spending on health, which are the key mechanisms in the discussion, with the other factors constituting a complementary element.

A Systematic Literature Review of Income Inequality in Central–Eastern European Countries

AbstractThis review offers a comprehensive perspective on income inequality literature in Central–Eastern European (CEE) nations, with a specific focus on six countries: Bulgaria, Romania, Poland, Hungary, Czechia, and Slovakia. By thoroughly examining existing research, this review uncovers the underlying factors and root causes contributing to varying income inequality levels and trends across CEE countries. The investigation is conducted through a systematic literature review and network analysis, focusing on the literature published since 1990, mainly on recent studies. The review is structured around three thematic frameworks (concept and measures, evidence, and causes). These three strands of the literature review not only offer a comprehensive picture of income inequality in CEE countries but also identify critical research gaps for further studies. The review underscores several critical areas for improvement within CEE studies. These include addressing gaps in geographical and temporal coverage, utilizing alternative measurements of income inequality, and investigating the causes of diverging trends in income inequality among CEE countries. Moreover, there is a pressing need to expand the understanding of the determinants influencing income inequality in these nations, which presents a significant opportunity for future research.

Digitalisation and income inequality in Central and Eastern European countries

The COVID-19 pandemic has highlighted the importance of digital technologies in business and daily life. The paper aims to explore the theoretical and empirical aspects of the relation between digitalisation and income inequality in Central and Eastern European (CEE) countries between the years 2000-2020. It contributes to existing research on determinants of income inequality, focussing on the potential negative role of digitalisation as an unnoticeable driver of income inequality in CEE countries. To investigate the potential impact of digitalisation on income inequality, empirical analysis was performed for the sample of 10 CEE countries, namely Bulgaria, the Czech Republic, Estonia, Hungary, Latvia, Lithuania, Poland, Romania, the Slovak Republic and Slovenia. The results of canonical correlation analysis indicated that the sets of variables related to digitalisation and inequality as a group are significantly related to each other and a strong correlation exists between them. The relative contribution of each indicator to each standardised function showed that the highest values of significant standardised coefficients were observed for income inequality indicators such as the top 10% share, the Gini coefficient, and the top 1% share, while in digitalisation measures, the highest value was observed for Internet users and fixed and mobile broadband subscriptions.