The International Journal of Health Planning and Management vol:30 issue:3 pages:204-218
Since the early 1990s major reform in healthcare has been adopted in former communist countries in Central and Eastern Europe. More than twenty years later, 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 paper looks at recent developments in payment systems for primary care providers in Estonia and Romania. The paper discusses comparatively possible implications of these recent changes on the basis of literature on expected effects of the main existing payment systems - capitation, fee for service and salary. We conclude that finding the appropriate mix in paying and incentivizing primary care providers in a transitional context is not an easy task for healthcare policy makers who need to carefully weigh 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.