Croatian healthcare system in transition, from the perspective of users
BMJ 2005; 331 doi: https://doi.org/10.1136/bmj.331.7510.223 (Published 21 July 2005) Cite this as: BMJ 2005;331:223
- Miroslav Mastilica (mmastil@snz.hr), associate professor1,
- Sanja Kušec2, master of science in public health
- Department of Medical Sociology, Andrija Štampar School of Public Health, Medical School, University of Zagreb, Rockefellerova 4, HR-10000 Zagreb, Croatia
- 2 Department of Educational Technology, Andrija Štampar School of Public Health
- Correspondence to: M Mastilica
Introduction
In Croatia, as in other countries in transition, healthcare reform was a necessary process that went alongside general changes in the political system and economy. New objectives and measures were defined in the early 1990s, adopted by the Croatian parliament, and came into force with the new Health Care Act and Health Insurance Act in 1993.
The principal motive for healthcare reform was dissatisfaction with the existing healthcare system: the government was dissatisfied with the economic inefficiency of the system, doctors were dissatisfied with their income, and people were mainly dissatisfied with access (long waiting times), the behaviour of staff, and regular shortages of drugs.1 2 Consequently, healthcare reform primarily focused on financing, rationing of services, and introduction of private incentives in the provision of services.
Healthcare reform—objectives, measures, problems
Centralisation of financing resulted in the establishment of a central insurance fund in 1990, responsible for implementation of health policies and financing and control of health services. New standards of insured rights were established. Compulsory health insurance covered a restricted range of health services, reducing the volume of services covered, and the list of prescribed drugs.3
Financial management of health services was introduced to control expenditure. Health providers were contracted by the state insurance fund and paid only for providing the determined standard of services. Limiting services was thus established as a control mechanism, mainly in primary health care, and doctors became responsible for any overuse of services. Cost sharing (copayments) was introduced for almost all health services and drugs. Exemptions were made for children and students, …