Mental Health Financing in Six Eastern European Countries

We describe and compare the current status of mental health financing in Bulgaria, the Czech Republic, the Republic of Moldova, Poland, Romania, and Slovakia. In all six Eastern European countries, the state financed and state organized health system was transformed into a public health insurance scheme, though the implementation thereof differs from country to country. The country-specific information was obtained from a health policy questionnaire that includes both qualitative and quantitative information and covers health financing, purchasing, and provision of services. The compulsory health insurance secures that population has access to mental health services irrespective of their ability to pay. It seems that there is a problem to achieve such universal access in Bulgaria and the Republic of Moldova. The countries spend lower shares of GDP on total health expenditure and from this amount they spent lower shares of total health expenditure on mental health services than Western European countries. The political, social and economic transition in the 1990s initiated the process of mental health policy formulation, adoption of mental health legislation stressing human rights of patients, and a call for a pragmatic balance of community and hospital services. However, not all of this has been successfully realized. Mental health services are underfinanced. Insufficient financing of mental health services leads to absence of financial resources for mental health system development. There were poor investments in mental health services in the past, which led to the situation with a need of renovation of inpatient facilities, and need of improvement of the living conditions in the existing institutions. On the other hand, the national mental health systems need resources for strengthening weak community services. But such additional resources are not available.