Primary care behind the former "Iron Curtain": changes and development of primary healthcare provision in the Eastern part of the European Union.

BACKGROUND: The Alma-Ata Declaration was a big step in the development of primary care, defining the main tasks and populations' expectation. Celebrating the 40th year's anniversary is a good opportunity to make an analysis. Development of primary care was not parallel in the Eastern and Western part of Europe. AIM: To provide an overview on the societal and economic situation, structural and financial changes of healthcare systems in the former 'Soviet bloc' countries, to present an analysis of the primary healthcare (PHC) provision and to find relationships between economic development and epidemiological changes of the respective countries. METHOD: Epidemiological data, healthcare expenditures and structure, and financing schemes were compared; systematic literature search was performed. RESULTS: Visible improvements in population health, in the national economic condition, structural changes in healthcare and more focus to primary care were experienced everywhere. Higher life expectancies with high inter-country variation were observed in the former 'Soviet bloc' countries, although it could not be clearly linked to the development of healthcare system. PHC provision improved while structural changes were rarely initiated, often only as a project or model initiation. Single-handed practices are yet predominant. The gate-keeping system is usually weak; there were no effective initiatives to improve the education of nurses and to widen their competences. Migrations of workforce to Western countries become a real threat for the Central-East European countries. CONCLUSION: Lack of coordination between practices and interdisciplinary cooperation were recognized as the main barriers for further improvement in the structure.

Expenditures Of Metabolic Diseases - An Estimation on National Health Care Expenditures of Diabetes and Obesity, Hungary 2013.

BACKGROUND: Obesity could be considered as the main consequence of unhealthy nutrition, responsible for many pathological alterations in human. Obese patients usually need more health care services. The aim of the study was to estimate the financial expenditures of health care provisions in Hungary, related to obesity and diabetes, as its main pathological consequence. METHODS: Data of the Hungarian National Health Insurance Fund (NHIF) were collected for 2013, regarding finances of secondary care, hospital services, reimbursement for medications and healing aids of diabetic patients together with selected morbidities linked to obesity, based on the codes of the International Classification of Diseases (ICD) and calculated their population prevalence on the population-attributable fraction (PAF). RESULTS: Financial data regarding diabetes care resulted in a 40,311 Million HUF (129 Million EUR) national fund expenses, beside a 7,173 Million HUF (23 Million EUR) contribution from patients. Estimated total health care expenditures related to obesity were 58,986 Million HUF (188 Million EUR) and the financial contribution of patients was calculated as 25,316 Million HUF (81 Million EUR). These data represent a 5.2% and 9.3% of the whole national health services, 16% and 30% of the whole drug-reimbursement budgets, respectively. CONCLUSIONS: Although expenditures for some obesity related pathologies analyzed in this paper represent 0.28% of the national GDP, considering other morbidities and other patient's expenses, the real ratio could be between 0.5-1%. The increasing number of overweight and obese persons requires more focus in public health, higher awareness in the society and more governmental support.