The largest healthcare insurer in Austria, UNIQA, is building a pan-East European business. We talk to Peter Eichler, Member of the Board of UNIQA Personenversicherung.

HCE: Do you feel there are likely to be major reforms which will enable private healthcare insurance to really grow?

There have been a number of disappointments, such as Hungary, for instance. I believe Bulgaria may privatise its entire system - what are your views on that?

PE: We observe continuous announcements in the different CEE markets about new reforms in the health system, but, in reality, we don’t find any real changes. In fact, protagonists of health politics change even more rapidly than entire governments!

Reforms are, in many cases, subject to political games between the government and opposition parties. In some cases, reforms have then been overthrown by the next government. So health politics lack continuity and stability.

This is not very helpful, but, on the other hand, private sector expectations may have been too high; some expected that private health insurers would be invited to provide basic (=substitutive) insurance - and to be allowed to earn big money in this field.

These expectations have been heavily disappointed (in some cases quite brutally, as in Slovakia, where new entrants were told, after investing, by the next government that insurers would be not-for-profit), because they were politically unrealistic.

Nevertheless, we feel confident, that, in general, private health insurance will really grow in these countries.

The main question is, how is the role of the public health system defined, and what is the function of private health insurance?

There must be clear rules, determined by the state. From our point of view, the business of private health insurance is not 'substitutive health insurance', the mission is rather 'complementary health insurance' - that means to offer differentiated benefits (higher standard, no or lower waiting periods etc).

The state should establish the necessary framework in this field (e.g. allowing for private wards in public hospitals), otherwise it will not work smoothly. If there are no well defined rules, a private health system will be generated anyway, but, in the long run,  parallel to the public one....

HCE: I believe you are initially focusing on providing ambulatory care rather than acute care. How can you expand the package to cover acute care inpatients, when there don’t seem to be good private acute facilities in most regions? Do you feel that private healthcare provision is improving?

PE: Right now we are focusing on packages and coverage for outpatient treatment. As already mentioned, the state has to establish the framework for public and private healthcare. On this basis, attractive packages and coverage for 'private upgrading' will be developed, and private healthcare will definitely improve.

HCE: How fast do you really expect these markets to grow over the next five years? Hasn't healthcare insurance disappointed badly over the last decade in East Europe?

PE: Yes, it has. But now we are awaiting a constant growth in health insurance in the CEE markets, different from country to country - not explosive, but in each case double digit.