Comparison of Recovery and Resilience Facility plans in V4 countries. Czech Republic, Poland and Hungary put emphasis on excellence, digitization and human resources. This is not the case of Slovakia where the focus is on building the standard hospital network.

In April 2021, V4 countries officially submitted their Recovery and Resilience Facility Plans (RRF) to the Commission. Comparing the national plans has turned out to be a bit challenging because each plan has a different structure (e.g., health care and social care often overlaps) fitting the purposes as defined by the Article 3 of the RRF Regulation. Nevertheless, there are interesting findings that can be drawn from submitted papers we would like to describe in this article.  
All the V4 countries are planning to introduce reforms and investment projects in their healthcare system, the share of the total amount of grants and loans required, however, varies considerably. In Hungary, for instance, it accounts for 34.1% of the entire RRF budget. On the contrary, in the Czech Republic only 6.9% of the total volume of financial resources should go to healthcare (Table 1).

Table 1: Recovery and Resilience plan in V4 countries
Country Total amount of requested loans and grants (billion EUR)
Healthcare system
(billion EUR)
Healthcare system / Total amount of loans and grants (%)
Hungary 7.20 2.457 34.1%
Slovakia 6.55 1.524 23.3%
Poland 35.97 4.542 12.6%
Czech Republic 7.07 0.488 6.9%

Healthcare priorities of individual countries reflect the challenges their healthcare systems are facing and are similar to some extent. We have identified three main priorities that are the same in Poland, Hungary and the Czech Republic.
  1. Building excellence - this is evident mainly in the plans of Poland (Table 2) and the Czech Republic (Table 3). Poland is going to invest 2.2 billion EUR for the development of highly specialized care centers (47% of all resources earmarked for health). The Czech Republic, in turn, is launching a comprehensive national plan to strengthen innovative and excellent oncological care in the amount of 319 million EUR (65% of all resources earmarked for healthcare). The Czech Oncology Institute will be established, and innovative and supportive care will be strengthened at the Masaryk Oncology Institute. In addition, the oncology program will be complemented by the establishment of an intensive care simulation center (53 million EUR) and the construction of a cardiovascular and transplant medicine center (39 million EUR).                                                                                                                                                                                                                          
  2. Digitization - very strongly represented in the plans of Poland and Hungary (Table 4). Poland is going to invest one billion EUR in accelerating the digital transformation of healthcare (22%). Hungary is going to give 568 million EUR (23%) to support the digital transition of healthcare and the digitalisation program for the safety and well-being of people with reduced self-sufficiency.
  3. Human resources – are the main priority in Hungary and Poland. Hungary plans to invest 860 million EUR (35%) to balance the income of doctors and the elimination of gratuities and 192 million EUR (8%) to the development of primary care to strengthen the role of GPs. Poland gives 700 mil. EUR (15%) to create suitable conditions for increasing the number of health professionals.
Table 2: Poland: Recovery and Resilience plan, breakdown of resource allocation (only healthcare)
Project million EUR %
Development and modernization of infrastracture of highly specialized care centers and other medical entities 2 119 46.65%
Accelerating the digital transformation of healthcare through further development of services digital healthcare 1 000 22.02%
Creating appropriate conditions for increasing the number of medical staff 700 15.41%
Creation of favourable conditions for the development of the pharmaceuticals and medical devices sector 300 6.61%
Strengthening the research base in the field of medical sciences and health sciences 273 6.01%
Development and modernization of the infrastracture of healh care entities at the poviat level 150 3.30%
Total 4 524 100.00%

Table 3: Czech Republic: Recovery and Resilience plan, breakdown of resource allocation (only healthcare)
Project million EUR %
Establishment of the Czech Oncological Institute 222 45.50%
Development of highly specialized hematooncological and oncological care 65 13.29%
Increasing the availability and development of comprehensive rehabilitation care for patients after critical conditions 62 12.62%
Establishment of a simulation center for intensive care, including optimalization of the education system 53 10.76%
Development of highly specialized care - building a center of cardiovascular and transplant medicine 39 7.97%
Establishment and development ofthe Center for cancer prevention and infractructure for innovative and supportive care at the Masaryk Cancer Institute 32 6.64%
Support and increase the quality of preventive screening programs 16 3.22%
Total 489 100.00%
Table 4: Hungary: Recovery and Resilience plan, breakdown of resource allocation (only healthcare)
Project million EUR %
Settling doctors' income conditions, elimination of gratuities 860 35.00%
Creating the conditions for 21st centurury healthcare 837 34.05%
Supporting the digital transition of healthcare 310 12.62%
Digitalisation programme for the safety and well-being of people with limited self-sufficiency 258 10.50%
Development of primary care to strengthen the role of GPs, axpand near-home services and relieve the burden of specialist care 192 7.83%
Total 2 457 100.00%
Slovak RRF plan puts emphasis on different priority. Basically, 65% of all required financial resources (1 billion EUR) should go to completing the hospital network (the standard) which many would agree falls behind its neighbouring countries. According to calculations of Peter Pažitný and Rudolf Zajac published in the Green Paper (2021), the investment debt of Slovak hospitals is almost 2.9 billion EUR against the level of the Czech Republic. If the RRF plan comes out full (!) it will be able to cover only one third of the total investment debt of Slovak hospitals.
What differs in Slovak RRF plan is total absence of excellence in healthcare and highly specialized centers. Furthermore, also digitalization with only 41 million EUR (3% of all resources earmarked for health) and building human resources in the primary sphere accounting for 11 million EUR (less than 1%) are strongly undercapitalized. This is quite surprising given the situation that all key documents (OECD, European Commission) have long emphasized the importance of primary care and digitalization.

Table 5: Slovakia - Recovery and Resilience plan, breakdown of resources allocation (only healthcare)
Project million EUR %
New hospital network - construction, reconstruction and equipment 998 65.49%
Affordable and quality long-term social and health care 256 16.80%
Humane, modern and affordable mental heath care 105 6.89%
Project preparation and project management of investments 58 3.81%
Construction and renovation of emergency medical service stations, renovation fleet 55 3.61%
Digitalization in healthcare 41 2.69%
Support for the opening of new primary care clinics in short-term careareas 11 0.72%
Total 1 524 100.00%

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