Mental Health Financing and Purchasing in Four Eastern European Countries

The objectives of this international comparison are: a) to describe and analyze the current status of mental health financing and purchasing in Romania, the Czech Republic, Slovakia, Bulgaria; b) to identify common trends as well as national specifics in mental health financing and purchasing and find opportunities for transfer of knowledge and experience among the countries, c) to improve understanding of the attitudes towards mental health services in the countries. Methods: The country-specific information was obtained by a questionnaire that was developed by the research team in the project “Finance and Mental Health Services Training in Czech Republic/Central Europe”, sponsored by the U.S. National Institutes of Health John E. Fogarty International Center. The questionnaire includes both quantitative and qualitative information on the mental health policy, health services, financing and purchasing.Results: In all countries, the tax-financed system was transformed to public health insurance one, though the countries differ in the implementation. The Czech Republic and Slovakia have multiple health insurance funds; Romania has the national unique social health insurance fund administrated by the National Health Insurance House through its district houses and Bulgaria run one national health insurance fund. The compulsory social health insurance system secures that citizens have access to mental health services. The Czech Republic and Slovakia do not have any separate budget for mental health care; mental health care is financially integrated with other services. In Romania is the Mental Health National Program developed by the Health Ministry through the national unique social health insurance fund. Bulgaria is the only country in which inpatient care for the mentally ill is financed from the state budget and outpatient care is financed from health insurance.