A reversal of fortune: Comparison of health system responses to COVID-19 in the Visegrad group during the early phases of the pandemic.

This paper analyses the health policy response to the COVID-19 pandemic in the four Visegrad countries - Czechia, Hungary, Poland, and Slovakia - in spring and summer 2020. The four countries implemented harsh transmission prevention measures at the beginning of the pandemic and managed to effectively avoid the first wave of infections during spring. Likewise, all four relaxed most of these measures during the summer and experienced uncontrolled growth of cases since September 2020. Along the way, there has been an erosion of public support for the government measures. This was mainly due to economic considerations taking precedent but also likely due to diminished trust in the government. All four countries have been overly reliant on their relatively high bed capacity, which they managed to further increase at the cost of elective treatments, but this could not always be supported with sufficient health workforce capacity. Finally, none of the four countries developed effective find, test, trace, isolate and support systems over the summer despite having relaxed most of the transmission protection measures since late spring. This left the countries ill-prepared for the rise in the number of COVID-19 infections they have been experiencing since autumn 2020.

What is being done to respond to the rise of chronic diseases and multi-morbidity in Czechia, Hungary, Poland, and Slovakia?

Although countries in central and eastern Europe (CEE) have relatively younger populations compared to the West, their populations are often affected by higher prevalence of chronic conditions and multi-morbidity and this burden will likely increase as their populations age. Relatively little is known about how these countries cater to the needs of complex patients. This Perspective piece identifies key initiatives to improve coordination of care in Czechia, Hungary, Poland, and Slovakia, including some pioneering and far-reaching approaches. Unfortunately, some of them have failed to be implemented, but a recent strategic commitment to care coordination in some of these countries and the dedication to rebuilding stronger health systems after the COVID-19 pandemic offer an opportunity to take stock of these past and ongoing experiences and push for more progress in this area.

Economic aspects of multiple myeloma: real costs associated with disease in the Slovak Republic.

Health care costs are continuously increasing. Multiple myeloma represents approximately 1% of all malignancies and the 5-year prevalence is 230,000 patients on average. In addition, there is an annual incidence of 3.8/100,000 in Slovakia. In total economic burden assessment, it is important to focus not only on direct but also on indirect costs, including the lost productivity due to premature death. Based on the data and information obtained from the key stakeholders the Ministry of Health, the Ministry of Labor, the Social Insurance Agency, and NCZI, we provided the assessment of direct and indirect costs. The total cost of the disease for the model patient represents €409,071 from the diagnosis of MM to death. The major cost burden is associated with the treatment, €155,645 followed by the costs of productivity loss due to premature death, €127,611. Cost-of-illness studies provide an important view on the total burden of the disease in specific areas and are necessary for an adequate decision-making process from the regulatory and reimbursement perspective.

Slovakia: Health System Review.

This analysis of the Slovak health system reviews recent developments in organization and governance, health financing, health-care provision, health reforms and health system performance. The health care system in Slovakia is based on universal coverage, compulsory health insurance, a basic benefit package and a competitive insurance model with selective contracting of health care providers. Containment of health spending became a major policy goal after the 2008 financial crisis. Health spending stabilized after 2010 but remains well below European averages. Some health indicators, such as life expectancy, healthy life years and avoidable deaths are worrisome. Furthermore, weak hospital management, high numbers of unused acute beds, overprescribing pharmaceuticals, and poor gatekeeping of the system all lead to over-utilization of services and system inefficiency. This suggests substantial room for improvement in delivery of care, especially for primary and long-term care. Additionally, there is inequity in the distribution of health providers, resulting in lengthy travelling distances and waiting times for patients. Given the ageing workforce, this trend is likely to continue. Current strategic documents and reform efforts aim to address the lack of efficiency and accountability. There has been a strong will to tackle these challenges but this has often been hindered by a lack of political consensus over issues such as the role of the state, the appropriate role of market mechanisms and profits, as well as the extent of out-of-pocket payments. Successive governments have taken different positions on these issues since the establishment of the current health system in 2002, and major reforms remain to be implemented.

Slovakia: health system review

This analysis of the Slovak health system reviews recent developmentsin organization and governance, health financing, health-care provision,health reforms and health system performance. The health care systemin Slovakia is based on universal coverage, compulsory health insurance, abasic benefit package and a competitive insurance model with selectivecontracting of health care providers. Containment of health spending becamea major policy goal after the 2008 financial crisis. Health spending stabilizedafter 2010 but remains well below European averages. Some health indicators,such as life expectancy, healthy life years and avoidable deaths are worrisome.Furthermore, weak hospital management, high numbers of unused acutebeds, overprescribing pharmaceuticals, and poor gatekeeping of the systemall lead to over-utilization of services and system inefficiency. This suggestssubstantial room for improvement in delivery of care, especially for primaryand long-term care. Additionally, there is inequity in the distribution of healthproviders, resulting in lengthy travelling distances and waiting times forpatients. Given the ageing workforce, this trend is likely to continue. Currentstrategic documents and reform efforts aim to address the lack of efficiencyand accountability. There has been a strong will to tackle these challenges butthis has often been hindered by a lack of political consensus over issues suchas the role of the state, the appropriate role of market mechanisms and profits,as well as the extent of out-of-pocket payments. Successive governments havetaken different positions on these issues since the establishment of the currenthealth system in 2002, and major reforms remain to be implemented.