CEE countries are spending just half the Western European per capita rate on health, with measurable consequences for productivity and public finances. New analysis reveals that Poland and its Central and Eastern European neighbours now face a widening healthcare financing crisis that risks undermining decades of economic convergence.
The scale of the gap is stark. Poland spends just 4.99 per cent of GDP on healthcare, against an average of 8.17 per cent across the EU’s four largest economies – Germany, France, Italy and Spain. Per capita health investment across the CEE region runs at roughly half the Western European rate, a disparity that carries direct consequences for workforce productivity and long-term fiscal sustainability.
“Central and Eastern Europe is catching up in health investment, but the gap with Western Europe remains significant,” said Michał Byliniak, director general of INFARMA, the Polish association of innovative pharmaceutical companies. “Per capita investment in CEE is nearly half that of Western nations, which directly impacts citizen productivity and places significant pressure on public finances.”
The human cost of underinvestment is quantifiable. Treatable mortality in Poland stands at 140 deaths per 100,000 inhabitants – more than double the EU4 average of 67 – a differential that a report by the European Federation of Pharmaceutical Industries and Associations links directly to lower health spending. Aligning CEE investment with EU4 levels could, on the federation’s estimates, save more than 101,000 lives annually across the region from causes that are medically preventable.
Demographic pressure
The urgency of reform is sharpened by an accelerating demographic transition. Poland’s working-age population is projected to shrink by 20 per cent by 2050, potentially removing €6.7 billion from the annual tax base. The fiscal arithmetic turns particularly uncomfortable given that health costs per person rise sharply after the age of 55, meaning that a contracting workforce will be required to finance an expanding bill.
Byliniak offered a cautiously optimistic scenario: Poland could converge with EU4 spending levels by around 2040 if it sustains its current annual growth rate of 8.2 per cent. He was careful to frame this as a best case. “This is an optimistic scenario that does not account for all structural risks,” he said, warning that without sustained reform, Poland faces the prospect of financing growing healthcare needs from a shrinking tax base.
Access to medicines
A parallel gap is opening in patient access to modern therapies. Between 2020 and 2023, patients in CEE gained reimbursed access to only 31 per cent of medicines newly authorised by the European Medicines Agency, compared with 76 per cent in the EU4. Poland currently reimburses 68 out of 173 modern therapies assessed.
The average time from regulatory authorisation to patient availability is 723 days in Poland – some 260 days longer than in Western Europe – with consequences that extend beyond individual patients to the wider economy through higher rates of hospitalisation, complications and early retirement on disability.
The industry as hidden financier
Perhaps the most structurally problematic feature of the current system is the growing burden being transferred to the pharmaceutical industry through payback mechanisms – arrangements under which companies refund a portion of reimbursed medicine costs to the state. In Poland, the industry’s contribution through these mechanisms is growing at an annual rate of nearly 18 per cent.
Byliniak described this trajectory as evidence of “structural underbudgeting” rather than temporary fiscal pressure, warning that the pharmaceutical industry was effectively becoming a de facto hidden payer of public healthcare. The concern is not merely distributional. If payback obligations continue to erode commercial predictability, Poland risks making itself an unattractive market for new drug launches, ultimately restricting the treatments available to its own patients.
Prescription for reform
Byliniak’s recommendations centre on a fundamental shift in how governments conceptualise health expenditure – away from an annual cost to be minimised and toward a multi-year strategic investment in human capital. Specific proposals include outcome-based pricing agreements, multi-year funding frameworks, and a reorientation of the system toward prevention, early diagnosis and primary care to reduce the expensive burden of late-stage disease.
Investment in health data infrastructure – interoperability between systems and the development of medical registries – should be treated as a core element of quality management rather than a peripheral IT function, he argued.
“Health is the foundation of social and economic resilience today,” Byliniak said. “By investing in it, we invest in the security and stability of the state.”
The challenge for Warsaw and its regional peers is one of timing as much as political will. The window to build fiscal capacity before demographic pressures become acute is narrowing. Convergence with Western European health outcomes remains achievable, but the margin for delay is shrinking with each passing year.
[VA, BM]
Source:
www.euractiv.com