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Patient payments have not been studied systematically in Lithuania. This limits the use of empirical evidence in policy making. More systematic and detailed evidence on the patient payments phenomena in Lithuania are needed to clarify who is seeking and paying for health care services, why, and how. This paper presents the main findings from a quantitative representative population survey on patient payments in Lithuania. The study results confirm the significant scope of the patient payment practices as well as the complexity of the issue. Overall attitudes towards informal cash payments are negative but there is a rather tolerant view on gifts-in-kind. In case of health problems, access to proper (good quality) treatment is crucial. When treatment is needed, Lithuanian patients are ready to pay irrespective of the legitimacy of the payments and despite of the significant financial burden that these payments may cause. Priorities for the quality of care and the protection of vulnerable groups against financial risks are important and should be addressed when discussing the design of patient payment policies in Lithuania. The lack of a transparent political and organizational arrangements and the failure to communicate properly with the general public are the main challenges for future policy.

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Az alapellátásban az általános orvosi gyakorlat optimális munkamódszere a családorvoslás, mely jól képzett szakembereket és az orvos és a család korrekt viszonyát feltételezi, illetve melyben érvényesülhet a betegségmegelőzés és a gondozás jó gyakorlata, a kedvezőbb forrásfelhasználás. A hazai egészségügyi reform része volt egy nemzetközi színvonalú családorvosi szisztéma kialakítása. Az 1967-ben alapított Magyar Általános Orvosok Tudományos Egyesületének szorgalmazására már 1974-től volt Magyarországon általános orvostani szakvizsga; a szakképzést a 6/1993. számú NM-rendelet indította el, mely a szolgálatban dolgozó orvosoknak felzárkóztató képzést és szakvizsgát írt elő. Segítette a hazai alapellátás fejlődését, hogy a szaktárca Európában egyedülállóan létrehozta 1998-ban az Országos Alapellátási Intézetet. Ezzel egy tudományos szervezet, az akadémiai szektor és országos intézet összefogása kezdődött a szakember-utánpótlásban, szakmapolitikai és népegészségügyi célok megvalósításában és a kutatás-fejlesztésben. A jelen munka visszatekint a kezdetekre, számot ad átfogó, lakossági szintű tudományos kutatások eredményeiről, bemutatja a családorvoslás munkájának eredményeit, alapot ad a jövőbeli fejlesztés irányaihoz, használható megállapításokat és a belőlük levonható következtetéseket mutat be. Orv Hetil. 2018; 159(32): 1310–1316.

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): Getting Health Reform Right . Oxford: Oxford University Press. Reich M. R. Getting Health Reform Right 2003

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the Hungarian Health Reform . In: Kornai , J. – Haggard , S. – Kaufman , R. (eds): Reforming the State: Fiscal and Welfare Reform in Post-Socialist Countries . Cambridge : Cambridge University Press . pp. 181 – 209

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Central Committee of the Chinese Communist Party, State Council: Concerning public health reform and development. 1997. http://www.chinalawedu.com/news/23223/23228/23258.htm Su, Y., Wang, J. (ed

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Health Sector into Balance. Health Policy Institute (1): 1. Rechel, B. — McKee, M. (2009): Health Reform in Central and Eastern Europe and the Former Soviet Union. Lancet 374(9696): 1186

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://www.unesco.org/culture/ich/doc/download.php?versionID=07331 [retrieved: 2014. 01. 11.] Central Committee of the Chinese Communist Party, State Council: Concerning public health reform and development, Section V. 1997. http://www.chinalawedu.com/news/23223

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J Sylvester DE Low 2011 In an era of health reform: defining cost differences in current esophageal cancer management strategies and assessing the

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In the last decade’s literature it has become clear that in order to adequately understand people’s quality of life it is necessary to use a set of indicators as different as possible. They have to include not only the global indicators, but also aspects that concern households, families and personal life, including the subjective dimension of current conditions, the degree of satisfaction felt as well as dissatisfaction and frustration. The idea of approaching health as a social phenomenon is on the ascendancy. One should not forget the fact that the social welfare of the population is often a precondition of somatic health. Neglecting or ignoring the social pathology aspects inherent to a society (unemployment, poverty, high crime rate, different family dysfunctions, alcoholism, etc.) or treating them in isolation, any health strategy shall only partially reach its major objective, the improvement of the population’s health status. Although health reforms aim to increase the quality of health services, to raise the health status of the population, to reduce health disparities, Rumania had the lowest life expectancy among the ten East and Central European countries that applied for EU membership before 2004. The incidence of tuberculosis decreased until the mid-80s and then started to increase again. More than a decade after starting the reforms in the economic and social areas, and five years after beginning experimenting with the social health insurance system, Rumanians are most afraid of disease.

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Edelényi, M. (2008): Government Performs Unexpected U-turn on Health Reform Bill. Eurofound document . Available 2 nd July 2009 at http://www.eurofound.europa.eu/eiro/2008/06/articles/hu0806029i.htm Edelényi, M

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