title: Payment systems and incentives in primary care: implications of recent reforms in Estonia and Romania.
abstract: Since the early 1990s, major reform in healthcare has been adopted in former communist countries in Central and Eastern Europe. More than 20 years after, reform in healthcare still draws much interest from policy makers and academics alike. One of the dynamic components of reform has been the reform of payment systems in primary care. This article looks at recent developments in payment systems and financial incentives in Estonia and Romania. We conclude that finding the appropriate mix in paying and incentivizing primary care providers in a transitional context is no easy solution for healthcare policy makers who need to carefully weigh in the advantages and inherent problems of various payment arrangements. In a transitional, rapidly changing healthcare system and society, and a context of financial stringency, the theoretical effects of payment mechanisms may be more difficult to predict and manage than it is expected.
authors.affiliation: Public Management Institute, KU Leuven, Leuven, Belgium.
authors.forename: Sorin
authors.initials: S
authors.lastname: Dan
authors.affiliation: Ragnar Nurkse School of Innovation and Governance, Tallinn University of Technology, Tallinn, Estonia.
authors.forename: Riin
authors.initials: R
authors.lastname: Savi
mesh_terms: D004957:Estonia; D018166:Health Care Reform / Q000191:economics / Q000458:organization & administration*; D006801:Humans; D011320:Primary Health Care / Q000191:economics / Q000458:organization & administration*; D012051:Reimbursement Mechanisms / Q000191:economics / Q000458:organization & administration*; D012052:Reimbursement, Incentive / Q000458:organization & administration*; D012383:Romania
keywords: Estonia; Romania; financial incentives; payment systems; primary care