Commentary on the highlights of the epidemiology of renal replacement therapy in Central and Eastern Europe.

At a relatively early stage in comparison with other Central and Eastern European countries, Hungarian nephrologists together with private investors started a privatization of the dialysis sector, after political and economical revolution in this region. Privatization positively influenced, both quantitatively and qualitatively, this part of renal replacement therapy [1]. Looking at the rest of the region, including my own country Poland, privatization has also had a positive impact on dialysis facilities. I mentioned in my article that many public hospitals have financial problems causing a lack of modern equipment to replace old and worn-out material [2]. In this case, privatization of the dialysis unit is only one way to keep in touch with modern technology and maintain standards of treatment. On the other hand, throughout the Central and Eastern European region, the word ‘privatization’ appears to be very unpopular. In their Letter, our Hungarian colleagues seek to avoid this word, introducing instead two different phrases: ‘private finance initiative’ or ‘public–private partnership’. In my opinion, this is caused by the continued presence of a ‘homo sovieticus’ mindset. It is thus advisable to use simple words and no matter how it is called, privatization means the process by which private investors will provide, nearly all dialysis procedures in Hungary for at least a 15–25 year period. This investment is clearly made on the basis of future profit, and is not a charitable activity. Nevertheless, we should remember the old Polish proverb, which says that ‘harmony is building and discord is damaging’. I would like at the end of this polemic to propose a new term: ‘Functional Privatization’; this term hopefully embraces both points of view.