Countries in Central and Eastern Europe (CEE) are currently facing major demographic shifts, workforce shortages and security challenges. These trends affect economic growth, public finances and social stability. Health is central to how the region responds: health investment can return up to four times its cost, create jobs and support long-term growth. [1]

CEE countries have made important progress in reforming their health systems. Life expectancy has increased and health outcomes have improved. Public health and pharmaceutical spending in CEE is growing faster than in EU4 (France, Germany, Italy and Spain). However, the region still lags behind the EU average. In 2023, CEE countries spent 5.47% of GDP on public health, compared with 7.3% across the EU. In many countries, people still live 4–6 years less than the EU average, and the working-age population is expected to shrink by 20% (12.9 million people) by 2050. [2]

Unequal access to essential diagnostic technologies means many patients are diagnosed too late, become sicker, require more intensive treatment and stay out of work longer, driving up costs for both health systems and the wider economy.[3]

Access to innovative medicines is also significantly more limited. On average, CEE countries provide reimbursed access to only 31% of new EMA-authorised medicines, compared to 76% in the EU4. Patients also wait seven months longer from EMA authorisation to reimbursement of innovative medicines.[4]

In addition, limited capacity to implement health reforms and policies, combined short policy cycles and inconsistent follow-through, continue to undermine health outcomes for patients and the performance of health systems in the region. 

These gaps negatively impact productivity and the workforce, lower tax revenues and increase pressure on public budgets, especially as populations age. Continued underinvestment in health will slow growth and weaken resilience. 

As the CEE Patient Engagement Community, representing umbrella patient organisations and national trade associations across 12 countries, we call on governments to treat health expenditure as a strategic investment and a core pillar of economic and security policy.  

Five priority actions to translate health investment into better outcomes, greater workforce productivity and sustained growth.

1. Protect and scale up investment in prevention, diagnosis and primary care.
Early detection and timely, appropriate treatment, particularly among the working-age population, can help reduce late diagnosis and prevent hospitalisations. This approach supports individuals in remaining employed while helping to prevent long-term disability and reduce reliance on social support or caregivers. Examples from within the region, such as the Czech Republic, Slovenia and Croatia, where people live longer and health systems perform in line with the EU average, show that stronger investment in prevention and early intervention is associated with better health outcomes and overall system performance.[5]

We call on CEE Member States to: 

• Safeguard and prioritise dedicated budget lines for prevention and primary care for all citizens. 

• Implement  systematic screening programs, integrated care pathways and timely access to evidence-based interventions, as part of national health reforms 

2. Address inequalities in access to innovation.

Disparities in access between the EU average and CEE countries are driven by structural barriers, including complex pricing and reimbursement processes, lengthy value assessments, limited budget room and system capacity and multiple administrative layers [6]. Without targeted reform, health inequalities will deepen and CEE countries will continue to miss out on the full clinical and economic value of innovation. 

We call on CEE Governments to: 

• Fund innovation based on long-term value, not short-term cost. Increase the budget room for innovative medicines to ensure adequate and sustainable funding for innovative medicines within balanced health system financing frameworks, considering affordability and long-term sustainability.  

• Move beyond siloed annual budgets by adopting multi-year, outcomes-based and integrated financing models that capture savings from avoided hospitalisations, reduced disease burden and improved productivity. 

• Modernise health technology assessment (HTA) to reflect what truly matters to patients by using real-world evidence, patient-reported outcomes and broader societal impact into value assessments, and introduce faster, proportionate pathways for therapies addressing high unmet medical needs while maintaining robust, evidence-based and transparent decision-making processes. 

• Stop duplication — integrate EU Joint Clinical Assessment (JCA) directly into national HTA and reimbursement decisions, and accelerate access through more efficient and predictable processes. 

 3. Ensure EU and national investment instruments effectively support health system infrastructure.

CEE countries face persistent gaps in medical and digital health infrastructure, including diagnostic capacity, hospital and primary care facilities, digital health systems, and data infrastructure, while available national and EU funding remains fragmented  across siloed budgets.

We call on CEE Member States to:

• Prioritize the modernisation of health infrastructure and systems through EU funding instruments, including the next Multiannual Financial Framework (MFF).  

• Where approved, use National and Regional Partnership Plans to channel health investments aligned with the European Semester recommendations. 

• Work with the European Commission to improve coordination across national and EU funding streams to maximise impact and absorption. 
  

4. Invest in health data systems and patient registries to enable people centred value-based decision-making.

Fragmented health data drives inefficient spending, unequal access and avoidable patient safety risks. By contrast, integrated data systems and patient registries enable smarter allocation of resources, supported by real-world data, and better health outcomes. They should be recognised as essential governance tools that enable better prioritisation, accountability and return on investment across the health system, and not simply as IT expenditures.  

We call on CEE Member States to: 

• Strengthen existing national patient registries and data systems, establish new ones where needed - starting with high-burden disease area(s)-, and improve interoperability between health databases, building on the European Reference Networks and the European Health Data Space, to support patient-centric and evidence-based policy and planning.  

• Assign standardised data requirements for registries to ensure interoperability and enable consistent analysis across systems 

• Use data to support people-centred, value-based care models, considering, patients‘ goals, health outcomes and system performance in resource allocation.  

5.Treat the health workforce crisis as a patient-safety and societal well-being priority.

The ongoing health workforce crisis poses significant challenges, leading to increased costs, diminished access to care, and heightened regional inequalities, particularly in underserved areas. [7 ]

To address these critical issues, we call on Member States to: 

• Implement targeted and evidence-based retention strategies focused on improving working conditions and facilitating career development opportunities.   

• Develop and incentivize policies that ensure a fair distribution of healthcare workers.  

• Invest in programmes that enhance workforce capacity, including training, up skilling, and language support to ensure healthcare professionals can work effectively where they are most needed.

A cross-cutting principle: people-centred and participatory health systems 

Across all five priorities, meaningful patient engagement, through the active involvement of patients and caregivers in decision-making and innovation, improves the quality, legitimacy and impact of health investments. As recognised by the WHO resolution on social participation in health [8] and the IAPO Global Patient Charter on Social Participation [9], patient involvement must be institutionalised and rights-based, recognising the role of patients as equal partners and co-creators in health decision-making. Embedding structured patient participation in EU HTA implementation and in pricing and reimbursement processes is therefore essential to ensure value-based decision-making in CEE countries. 

References:

[1] Mckinsey Global Institute, Prioritizing Health: A Prescription for Prosperity, available here.

[2] Healthcare Investment and Outcomes in Central and Eastern Europe, available here.

[3] GLOBSEC, Healthcare Readiness Index 2024, pp. 47–48, available here.

[4] EFPIA, Patients in Europe Waiting Longer for New Medicines ad Inequality Grows between Member States, available here.

[5] GLOBSEC, Healthcare Readiness Index 2024, pp. 33–35, available here.

[6] CRA and EFPIA, The root causes of unavailability of innovative medicines and delay in access, available here.

[7] EP own-initiative report, “An EU health workforce crisis plan: sustainability of healthcare systems and employment and working conditions in the healthcare sector”, https://oeil.europarl.europa.eu/oeil/en/procedure-file?reference=2025/2062(INI); "The health and care workforce in Europe: time to act" (WHO Regional Office for Europe, 2022).

[8] https://www.who.int/news/item/29-05-2024-world-health-assembly-endorses-resolution-on-social-participation

[9] https://www.iapo.org.uk/sites/default/files/files/IAPO_Patient-Charter_2025.pdf