Primary healthcare in the developing part of Europe: changes and development in the former Eastern Bloc countries that joined the European Union following 2004.

BACKGROUND: Primary care is an important tool to improve global health. This study presents an overview of how targets regarding primary care were realized in ten countries of the former Soviet Bloc that joined the EU since 2004. MATERIAL/
METHODS: Demographic, socioeconomic, and mortality-based statistical data are presented, scientific publications from the countries analyzed, and personal experiences of family physicians of these countries compared.
RESULTS: After the collapse of communism, political changes and healthcare reforms began in these countries. There was economic recession and decline in the first decade. Life expectancies improved and total health expenditures increased to different extents, although governments spent barely more for healthcare. Primary care providers are the main private-sector contributors. The hospital-based structure changed, while the number of outpatient contacts is nearly the same. The ratio between secondary care specialists and family physicians remains too high and there is a shortage of educated nurses. Although new funding systems for primary care were introduced, budgets were mostly redistributed without substantial increases or improvement in outcome. The achievements of reform have rarely been evaluated systematically. Teamwork and praxis communities do not exist. The old style of polyclinics still predominates in some countries. The gate-keeping system is often symbolic or dysfunctional. Health promotion and prevention are rarely supported.
CONCLUSIONS: The implementation of family medicine is not an absolute priority for decision makers. The political situation is often unstable. Despite non-negligible achievements, the health systems in this part of Europe are still in the midst of transition.