Table 3 The description of consequences of OOP healthcare payments’ introduction

1 Czech Rep

Introduction of formal fees

Until the end of 2007, outpatient and inpatient services were free of charge. Since 2008, formal OOPs exists; a flat fee of 30 CZK (€1.2) per doctor visit, 60 CZK (€2.4) per hospital day as well as spa hotels, 90 CZK (€3.6) per ambulatory visit outside of working hours. An annual ceiling of CZK 5000 (€200) for expenses related to doctor visits and drug costs was introduced. Since 2009, a new ceiling of CZK 2500 (€100) for those below 18 and above 65 was launched. A flat fee per doctor visit for children was eliminated. Since 2012, a flat fee for hospital and spa stay was reduced to 100 CZK per stay (€3.92 EUR). The dental care is paid by OOPs too. Some groups such as poor, pregnant woman, chronically ill children, patients with infectious diseases are exempted from formal OOPs.

(Exchange rate used; 1 EUR = 250 CZK)

Until 2008, some form of co-payments existed. A prescription fee of 30 CZK (1.18 EUR) per item was introduced in 2008. Since 2009, a difference between actual and reimbursement price is paid out of pocket if it is higher than prescription fee.

[3, 22]

2 Estonia

Introduction of formal fees

Since 1995, a fee of €0.30 (EEK 5) per first initial outpatient consultation at public hospitals and/or health centers exists, a free price setting for specialists. Since 2002, no fees for GP visits (except for home GP visit which is €3.2) but ambulatory specialist care at maximum fee of €3.20 (EEK 50) unless a referral within the same institution or specialty is granted. Hospital fees are implemented at 1.6 EUR per day, for up to 10 days per episode of illness. Some exemptions for children, pregnant woman and emergency care apply. (Exchange rate used; 1 EUR = 15.6 EEK)

Co-payment consist of a prescription fee of €1.30 plus the difference between actual price and reimbursement level. The general reimbursement rate is 50 % of the pharmaceutical price up to a maximum reimbursement of €12.00 (EEK 200) per prescription. The reimbursement of drugs for chronic disease, children, seniors and disabled is higher, up to 100 % .

[40, 41]

3 Hungary

Introduction of formal fees

To limited extend, some form of copayments already existed since 1989 (medical devices, spas, specialist treatment outside of standard patient’s pathway etc.). Since 2007 formal co-payments were introduced; app €1 per ambulatory visit and per hospital day. After the referendum held in 2008, they were abolished.

Since 2007 reimbursement rates have been decreased from 50 to 25 %; from 70 to 55 %; and from 90 to 85 %. For drugs with a special reimbursement of 90 %, three levels of coverage was established: 50, 70 and 90 %. For drugs fully reimbursed, a minimum €1 (300 HUF) fee per prescription was introduced. For special attentionpatients eligible for free of charge drugs, a monthly limit of 40 EUR was established. OOPs apply above that sum. Eligibility for special attention is defined by GP. (Exchange rate used; 1 EUR = 250 HUF)

[21, 34]

4 Slovakia

Introduction of formal fees

The formal copayments were introduced in 2003. Since then, app. €0.66 is paid per doctor visit and app. 1.66 EUR per hospital day, app €1.99 per emergency care visit,€0.07 per km for ambulance transport and between €4.98 and 7.30 per food and accommodation in spas. In 2006, user fees for a doctor’s visit and daily hospital stay were abolished. (Exchange rate used; 1 EUR = 40.03 SKK)

Until 2003, some form of co-payments existed. Since then €0.5 EUR prescription fee has to be paid. It was reduced to €0.17in 2006. If there is a difference between the price of the drug and the reimbursement level, patient has to cover it as well.

[11, 42]