How far on the road? The role of family medicine/general practice in 10 Central and Eastern European countries: A mixed-method study

Central and Eastern European (CEE) countries began healthcare reforms in the late twentieth century, adopting Family Medicine/General Practice (FM/GP) models. The FATMEE (Family Medicine After Transformation in Middle and Eastern Europe) study in 2012 found this process advanced but incomplete. This study (FATMEE-2) examines current FM/GP development in the CEE region that follows recent social changes and healthcare challenges. A mixed-methods approach combined literature and dataset review with a Key Informant-based survey using the updated FATMEE questionnaire, exploring the FM/GP role in primary care. FM/GP is recognised as a separate medical speciality in all countries with robust legal frameworks. Care comprehensiveness varies, with some systems maintaining separate paediatric and adult services, and a lack of gynaecology and obstetrics services in many. Weighted capitation remains the dominant funding model, supplemented by pay-for-performance and fee-for-service schemes. Electronic medical records and teleconsultations are common. Compared to the previous FATMEE study, changes include increased use of digital tools and diversified financing. Primary care structure and professional roles changed little. While the legal and technological foundations of family medicine in CEE countries have strengthened, comprehensiveness and service integration have limitations. There is a visible progress in infrastructure and digitalisation, but the structural and organisational challenges identified in 2012 largely remain. This may indicate that sustained political commitment and systemic reform – beyond legal acknowledgement and technological improvements – are essential for successful transformation. However, the examples of Estonia and Slovenia prove that under a supportive policy, such a transformation is achievable.