Factors Influencing Health Care Providers Payment Reforms in Central and Eastern European Countries

Central and Eastern European (CEE) countries have recently implemented reforms to health care provider payment systems, which include changing payment methods and related systems such as contracting, management information systems, and accountability mechanisms. This study examines factors influenci...

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Main Authors: Costase Ndayishimiye, Marzena Tambor, Daiga Behmane, Antoniya Dimova, Alina Dūdele, Aleksandar Džakula, Barbora Erasti, Péter Gaál, Triin Habicht, Pavel Hroboň, Liubove Murauskienė, Tamás Palicz, Silvia Gabriela Scîntee, Lenka Šlegerová, Cristian Vladescu, Katarzyna Dubas-Jakóbczyk
Format: Article
Language:English
Published: SAGE Publishing 2024-09-01
Series:Inquiry: The Journal of Health Care Organization, Provision, and Financing
Online Access:https://doi.org/10.1177/00469580241287626
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author Costase Ndayishimiye
Marzena Tambor
Daiga Behmane
Antoniya Dimova
Alina Dūdele
Aleksandar Džakula
Barbora Erasti
Péter Gaál
Triin Habicht
Pavel Hroboň
Liubove Murauskienė
Tamás Palicz
Silvia Gabriela Scîntee
Lenka Šlegerová
Cristian Vladescu
Katarzyna Dubas-Jakóbczyk
author_facet Costase Ndayishimiye
Marzena Tambor
Daiga Behmane
Antoniya Dimova
Alina Dūdele
Aleksandar Džakula
Barbora Erasti
Péter Gaál
Triin Habicht
Pavel Hroboň
Liubove Murauskienė
Tamás Palicz
Silvia Gabriela Scîntee
Lenka Šlegerová
Cristian Vladescu
Katarzyna Dubas-Jakóbczyk
author_sort Costase Ndayishimiye
collection DOAJ
description Central and Eastern European (CEE) countries have recently implemented reforms to health care provider payment systems, which include changing payment methods and related systems such as contracting, management information systems, and accountability mechanisms. This study examines factors influencing provider payment reforms implemented since 2010 in Bulgaria, Croatia, Czechia, Estonia, Latvia, Lithuania, Hungary, Poland, and Romania. A four-stage mixed methods approach was used: developing a theoretical framework and data collection form using existing literature, mapping payment reforms, consulting with national health policy experts, and conducting a comparative analysis. Qualitative analysis included inductive thematic analysis and deductive approaches based on an existing health policy model, distinguishing context, content, process, and actors. We analyzed 27 payment reforms that focus mainly on hospitals and primary health care. We identified 14 major factor themes influencing those reforms. These factors primarily related to the policy process (pilot study, coordination of implementation systems, availability of funds, IT systems, training for providers, reform management) and content (availability of performance indicators, use of clinical guidelines, favorability of the payment system for providers, tariff valuation). Two factors concerned the reform context (political willingness or support, regulatory framework, and bureaucracy) and two were in the actors’ dimension (engagement of stakeholders, capacity of stakeholders). This study highlights that the content and manner of implementation (process) of a reform are crucial. Stakeholder involvement and their capacities could influence every dimension of the reform cycle. The nine countries analyzed share similarities in barriers and facilitators, suggesting the potential for cross-country learning.
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spelling doaj-art-6a4e1297c01343eeb787d0a9900dae6b2025-08-20T02:18:47ZengSAGE PublishingInquiry: The Journal of Health Care Organization, Provision, and Financing0046-95801945-72432024-09-016110.1177/00469580241287626Factors Influencing Health Care Providers Payment Reforms in Central and Eastern European CountriesCostase Ndayishimiye0Marzena Tambor1Daiga Behmane2Antoniya Dimova3Alina Dūdele4Aleksandar Džakula5Barbora Erasti6Péter Gaál7Triin Habicht8Pavel Hroboň9Liubove Murauskienė10Tamás Palicz11Silvia Gabriela Scîntee12Lenka Šlegerová13Cristian Vladescu14Katarzyna Dubas-Jakóbczyk15Jagiellonian University Medical College, Krakow, PolandJagiellonian University Medical College, Krakow, PolandRiga Stradiņš University, Riga, LatviaMedical University - Varna, BulgariaRiga Stradiņš University, Riga, LatviaUniversity of Zagreb, CroatiaVilnius University, LithuaniaSapientia Hungarian University of Transylvania, Târgu-Mureș, RomaniaWorld Health Organization Barcelona Office for Health Systems Financing, Barcelona, SpainAdvance Healthcare Management Institute, Prague, CzechiaVilnius University, LithuaniaSemmelweis University, Budapest, HungaryNational Institute of Health Services Management, Bucharest, RomaniaCharles University, Prague, CzechiaUniversity Titu Maiorescu, Bucharest, RomaniaJagiellonian University Medical College, Krakow, PolandCentral and Eastern European (CEE) countries have recently implemented reforms to health care provider payment systems, which include changing payment methods and related systems such as contracting, management information systems, and accountability mechanisms. This study examines factors influencing provider payment reforms implemented since 2010 in Bulgaria, Croatia, Czechia, Estonia, Latvia, Lithuania, Hungary, Poland, and Romania. A four-stage mixed methods approach was used: developing a theoretical framework and data collection form using existing literature, mapping payment reforms, consulting with national health policy experts, and conducting a comparative analysis. Qualitative analysis included inductive thematic analysis and deductive approaches based on an existing health policy model, distinguishing context, content, process, and actors. We analyzed 27 payment reforms that focus mainly on hospitals and primary health care. We identified 14 major factor themes influencing those reforms. These factors primarily related to the policy process (pilot study, coordination of implementation systems, availability of funds, IT systems, training for providers, reform management) and content (availability of performance indicators, use of clinical guidelines, favorability of the payment system for providers, tariff valuation). Two factors concerned the reform context (political willingness or support, regulatory framework, and bureaucracy) and two were in the actors’ dimension (engagement of stakeholders, capacity of stakeholders). This study highlights that the content and manner of implementation (process) of a reform are crucial. Stakeholder involvement and their capacities could influence every dimension of the reform cycle. The nine countries analyzed share similarities in barriers and facilitators, suggesting the potential for cross-country learning.https://doi.org/10.1177/00469580241287626
spellingShingle Costase Ndayishimiye
Marzena Tambor
Daiga Behmane
Antoniya Dimova
Alina Dūdele
Aleksandar Džakula
Barbora Erasti
Péter Gaál
Triin Habicht
Pavel Hroboň
Liubove Murauskienė
Tamás Palicz
Silvia Gabriela Scîntee
Lenka Šlegerová
Cristian Vladescu
Katarzyna Dubas-Jakóbczyk
Factors Influencing Health Care Providers Payment Reforms in Central and Eastern European Countries
Inquiry: The Journal of Health Care Organization, Provision, and Financing
title Factors Influencing Health Care Providers Payment Reforms in Central and Eastern European Countries
title_full Factors Influencing Health Care Providers Payment Reforms in Central and Eastern European Countries
title_fullStr Factors Influencing Health Care Providers Payment Reforms in Central and Eastern European Countries
title_full_unstemmed Factors Influencing Health Care Providers Payment Reforms in Central and Eastern European Countries
title_short Factors Influencing Health Care Providers Payment Reforms in Central and Eastern European Countries
title_sort factors influencing health care providers payment reforms in central and eastern european countries
url https://doi.org/10.1177/00469580241287626
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