A recent report by the Health Department of the London School of Economics and Institut des Sciences de la Santé offers an extensive study of health status in the new EU Member States. The report focuses on three main areas: the overall health trends in the new member states, the impact of health system financing in the CEE countries and the consequences of joining the European Union. EPHA members can read a report of the Report launch.
Lagging behind the "old" Member States
Of the ten new Member States, the two Mediterranean countries Cyprus and Malta appear quite similar to the "old" Member States in terms of health status: life expectancy at birth is almost equal to the EU average for women and actually surpasses it for men. The Central and Eastern European (CEE) states on the other hand, although diverse among themselves, significantly lag behind Western European countries in most health indicators. The levels of life expectancy are well below those in the old member states and gender differences in life expectancy are much wider.
Why does such a significant health divide exist between the old and new (CEE) member states? The authors of the report point to significantly higher levels of cardiovascular disease, road traffic accidents and other injuries (including homicide and suicide), as well as some cancers (notably lung and cervical cancer) in the CEE countries. These in turn have been triggered by risk factors such as smoking, alcohol consumption and diets high in saturated fats and low in antioxidants. The political and economic transition has also played a role, raising the levels of poverty and exacerbating social inequalities.
Financing still a problem
The political and economic transition that took place in the CEE region stimulated extensive health system reforms. During the Soviet era health systems in the CEE countries were highly centralised, health care was predominantly funded from state revenue and health services were delivered by state-owned institutions and salaried state employees.
Following the fall of communism, the health system in the CEE region have seen decentralisation in financing and the introduction of two new sources of funding: social health insurance contributions and out-of-pocket payments. Some countries have adopted elements of competition and performance-based contracting to control expenditure on health carei. However, as the report points out, all these reforms have not yet succeeded in bringing total expenditure on health (as a percentage of GDP) up to EU levels.
Mixed implications of joining the EU
The process of accession has already brought some benefits to health and health systems in the new Member States. Further improvements are expected to include targeting infectious diseases in the CEE countries and reducing health inequalities.
On the other hand, the accession to the EU may pose a challenge with regard to the alcohol and tobacco laws. All the newcomers must align their legislation with that of the EU. Therefore, in cases where alcohol and tobacco control policies are strong (like in Poland), it is possible that sacrifices will have to be made with accession.
The free movement of health professionals within the EU may also affect the new Member States. There have already been signs of a "brain drain" of physicians and nurses out of CEE countries. Given the income gap between health professionals in the old and new Member States, it is possible that further loss of skilled workers, particularly among the young and qualified personnel, will take place.
