What will be the impact of the recession on private healthcare in Eastern Europe? It is already clear that it will be severe and unpleasant, particularly for Romania, Bulgaria and Hungary, who could see savage GNP falls of 10%. Poland, Greece and Turkey could also witness 2-5% falls.

A near 30% currency depreciation is already hitting many healthcare groups hard. If you are equipping new centres with expensive medical equipment then you could easily lose €1m. And some groups have not hedged debts or they have euro-denominated leasing contracts.

I’m also hearing of big drops in discretionary spend. Expect Hungary’s dental healthcare tourism market to be hit hard, and I wouldn’t be surprised to see a 30%-50% drop in cosmetic surgery.

But there is a silver lining to the cloud:

Further hospital privatisation or functional privatisation looks likely across much of the region over the next five years. Regions and municipalities will not be slow to sell off under-performing hospitals – even in countries such as the Czech Republic and Hungary, where there is a lot of hostility to the idea.

It is also quite possible that a lot of Bulgaria’s healthcare will move into the private sector. That could include all healthcare insurance if right wing reformists win the 2009 elections and enact a Netherlands-style healthcare insurance system, creating a market worth nearly €1bn.