Setting prices for hospital care within public health insurance schemes in seven Central and Eastern European countries – a comparative analysis

Background: The price setting process constitutes the core element of health care providers’ payment schemes, which are used to steer providers’ behaviour towards realisation of pre-defined health policy objectives. Objectives: This study aimed to: 1) describe and compare systems for setting prices for hospital care services in the public health insurance systems of seven Central and Eastern European (CEE) countries (Bulgaria, Estonia, Czechia, Hungary, Lithuania, Poland, and Slovenia) and 2) identify current challenges. Methods: The methods involved three consecutive steps: 1) defining a conceptual framework and developing a data collection form; 2) consultations with national experts, and 3) a comparative analysis. Results: Results show that the process of setting prices for hospital care varies between CEE countries. The main difference is the existence of a structured hospital costing data collection system (present in five out of the seven analysed countries), while there are numerous additional differences in the details of the remaining system elements (e.g. cost standards, scope of reported hospital cost data, the role of provider negotiations, and the objectives and application of final price adjustments). Conclusions: Despite differences, the analysed countries face similar challenges in building effective price setting systems: 1) incomplete and/or low quality cost data collected from hospitals, 2) insufficient institutional capacities on the part of both hospitals and organisations responsible for tariffication; 3) methodological challenges of the costing model; and 4) barriers driven by the overall health system context. Data infrastructure investment and system governance improvement are needed in all analysed countries.