Closing the East-West Divide: Addressing Healthcare Investment Disparities in Central and Eastern Europe

A recent study commissioned by EFPIA and authored by leading CEE academics—Dr. Slaveyko Djambazov, Dr. Luka Voncina, Dr. Aleš Rod, and Dr. Marcin Czech—reveals that despite accelerated public health spending growth in several CEE countries, structural underinvestment persists. This produces markedly worse health outcomes compared with Germany, France, Italy, and Spain (EU4), creating both a human and economic cost that can be addressed through sustained policy action. Treating healthcare financing as a long-term investment rather than a short-term cost is essential for improving population health, strengthening productivity, and ensuring fiscal sustainability.

Investment Gap Fuels Poorer Health Outcomes

The study documents a persistent structural gap, with 2023 public healthcare spending averaging just €1,618 per capita in CEE countries versus €3,221 in the EU4. This lower share of GDP allocated to health directly correlates with inferior outcomes: CEE populations have a life expectancy five years shorter than in the EU4 and experience roughly 137% higher treatable mortality.

Recent growth trends offer hope. If sustained, Slovenia, Poland, Croatia, and Bulgaria could reach current EU4 investment levels by 2040. However, Hungary, Romania, and Latvia will require additional targeted efforts to close healthcare investment disparities.

Geographical Lottery in Access to Innovation

Despite overall spending increases, patient access to innovative medicines in CEE remains markedly inferior. Between 2020 and 2023, CEE patients gained reimbursed access to only 31% of new EMA-authorized medicines, compared with 76% in the EU4. The average delay to reimbursement decision stands at 705 days in CEE—260 days longer than the EU4 average.

To manage budgets, CEE governments have increasingly turned to high clawback schemes and mandatory rebates. In 2023, industry contributions reached 30.4% in Hungary, 25.8% in Romania, 23.5% in Bulgaria, and 22.8% in Croatia. According to the EFPIA analysis, this rising reliance on clawbacks reflects structural underbudgeting that fails to account for economic growth, population ageing, and increasing disease burden.

Demographic Crisis Amplifies the Cost of Inaction

By 2050, the working-age population in CEE is projected to shrink by 12.9 million people (20%), leading to an estimated annual tax revenue loss of €14.6 billion. Healthcare costs rise sharply after age 55, placing additional pressure on already strained systems.

If current spending levels continue, the region faces more than 49 million disability-adjusted life years (DALYs) and over 176,000 preventable deaths annually. Closing the healthcare investment disparities to EU4 levels could save more than 100,000 lives per year and generate approximately €300 billion in broader economic benefits through improved productivity and reduced disease burden.

Policy Pathways Toward Convergence

The report calls for forward-looking budget planning, reduced use of distortionary payback mechanisms, outcomes-based payment models, and stronger Health Technology Assessment (HTA) frameworks. It highlights the opportunity to leverage the Joint Clinical Assessment (JCA) to improve consistency and efficiency in reimbursement decisions across member states.

Several CEE countries already demonstrate good practice examples, showing that targeted reforms can deliver measurable progress. By treating healthcare as a strategic investment that supports economic growth and fiscal stability, Europe can accelerate convergence and reduce unwarranted disparities in care.

Strategic Implications for Sustainable Healthcare Funding

For health economics and market access professionals, the findings emphasize the need for robust, locally relevant evidence that demonstrates the clinical and economic value of innovative therapies in lower-resource settings. The analysis makes clear that moving beyond short-term cost-containment toward sustainable funding models aligned with demographic realities represents both a moral imperative and a high-return economic strategy for the entire European Union.