Regional features in the treatment of Parkinson’s disease in the Baltic States compared to Germany

Parkinson's Disease (PD) is a progressive neurodegenerative disorder characterized by motor symptoms, alongside non-motor manifestations. In advanced stages, people with PD (PwP) require extensive support to maintain mobility and quality of life, creating substantial demand on healthcare and reimbursement systems. Reported prevalence varies across Europe, with Germany at 350 per 100,000, Estonia at 314 per 100,000, Lithuania at 265 per 100,000, and Latvia at 217 per 100,000. This study applies a structured, qualitative comparative policy mapping approach (a subtype of comparative policy analysis) to describe and compare how national reimbursement and service-delivery rules shape access to PD treatments in Latvia, Lithuania, and Estonia, using Germany as a high-resource comparator. Key constructs, including availability, accessibility, affordability, and reimbursement, were defined a priori and operationalized into extractable indicators (e.g., formulary inclusion, reimbursement rate, cost-sharing, authorization requirements, and service-capacity proxies). Data sources included reimbursement agency databases, national formularies, policy documents, and expert input. Analysis was structured across three domains: pharmacological therapy, device-assisted therapies (DATs), and rehabilitation and supportive therapies. Findings show that Germany ensures broad access to all treatment domains, including newer pharmacological options, reimbursed DATs, and structured multidisciplinary rehabilitation. Estonia and Lithuania provide full reimbursement for standard medications but limited access to DATs and variable rehabilitation services. Latvia remains most constrained, with partial reimbursement for medications, no reimbursed DATs, and underdeveloped supportive therapies. Differences in reimbursement design (including cost-sharing and eligibility rules) and service capacity co-occur with broader system financing differences (total health expenditure: 12.6% of GDP in Germany vs. 7.6% in Latvia, 7.2% in Lithuania, and 7.0% in Estonia; government-funded expenditure: 10.1%, 4.9%, 4.7%, and 5.2%, respectively). These findings are descriptive and intended to clarify where policy design and implementation may plausibly contribute to cross-country variation in access.