2018年-世界发展银行全球_Universal_Health_Coverage_in_Croatia___Reforms_to_Revitalize_Primary_Health_Care_40页_1mb

Summary of "Universal Health Coverage in Croatia: Reforms to Revitalize Primary Health Care"

Core Content

This document provides an in-depth analysis of the Universal Health Coverage (UHC) reforms in Croatia, focusing on revitalizing the primary health care (PHC) system. It outlines the current structure of Croatia's health system, the role of the Croatian Health Insurance Fund (HZZO), and the financial and organizational reforms implemented since 2008 to improve the efficiency, quality, and affordability of health services.

Key Information

• Health System Overview:
  Croatia's health system is organized around a social health insurance model, with the HZZO as the sole purchaser of health services. Primary care is predominantly private, while hospitals are mostly publicly owned.

  • Primary Care: Organized under the family medicine model, where patients must register with a chosen doctor.
  • Financing: Mandatory health insurance contributions from employers and individuals are the main source of financing, accounting for 76% of total health financing.
  • Health Expenditure: In 2013, Croatia spent approximately US$4.31 billion on health, with the HZZO managing over 97% of public health financing.

• Financial Sustainability:
  The health system faces financial pressures due to an aging population and increasing demand for services, especially for chronic and noncommunicable diseases. The share of contributors to the mandatory health insurance system is shrinking, with only 34% of the insured population making full contributions.

• Out-of-Pocket (OOP) Spending:
  OOP spending is relatively low in Croatia, at around 12% of household spending, below both the WHO threshold for "good" financial protection and the EU average. The poorest quintile spends 3.9% of their income on health, while the richest spend 2.9%.

• Primary Care Reforms (2008 onwards):
  A series of supply-side reforms were introduced to improve the efficiency and impact of primary care. These reforms included:

  • Organizational changes: Transition from individual to team-based delivery of primary care services.
  • Payment reforms: Introduction of capitation, fee-for-service (DTP), and performance-based bonuses.
  • IT investments: Development of a centralized IT system to support better patient care and real-time monitoring of health service utilization.
  • Pharmaceutical pricing and reimbursement: Reforms aimed at reducing drug costs and improving access to outpatient medications.

• Impact of Reforms:

  • Primary care service delivery has improved, including the delivery of preventive services.
  • Prescribing volumes have increased, indicating better patient coverage.
  • Drug costs have declined due to effective pricing regulations.
  • Hospitalizations have decreased, while outpatient services have increased, possibly due to better management of ambulatory-sensitive conditions.

• Access and Equity:
  The poor benefit significantly from public health spending, with equal or better access to care compared to the non-poor. This is largely due to the absence of copayments for the poor, allowing them to access services without financial barriers.

Main Views

• UHC Challenges:
  Croatia faces the challenge of improving the value of public health spending by enhancing the quality and efficiency of care while ensuring financial sustainability.

• Policy Mechanisms:
  The reforms have been effective in revitalizing primary care, and the lack of copayments for the poor has contributed to greater access and utilization of health services.

• Future Directions:
  The health system needs to broaden its financing base, manage the integration of modern technologies, and improve purchasing, oversight, and coordination among stakeholders to ensure long-term sustainability.

Key Reforms and Their Outcomes

• Primary Care Reforms:

  • Transition to team-based care.
  • Introduction of performance-based payment models.
  • IT investments for better data management and service monitoring.
  • Pharmaceutical pricing reforms leading to cost reductions.

• Hospital Reforms:

  • Standardized procurement processes for medicines, devices, and other services.
  • Improved quality and reduced costs through joint purchasing bodies.

• Financial Reforms:

  • Strengthening the contribution base through better targeting and registration.
  • Increasing transparency and efficiency in the pricing and reimbursement of services.

Conclusion and Looking Ahead

The reforms have had a positive impact on primary care in Croatia, improving service delivery and access for vulnerable populations. However, the system must continue to evolve to ensure financial sustainability and better value from public spending. This includes enhancing the efficiency of care delivery, integrating modern technologies, and improving the information systems that support health purchasing and management.

Appendices and Supporting Data

• Annex 1: Distribution of all insured nationally in 2013-15.
• Annex 2: Information environment for primary care, including the role of IT systems and data exchange.

References

• Abbreviations:

  • CEZIH: Central Health Information System of the Republic of Croatia
  • DTP: Diagnostic Therapeutic Procedures
  • EU: European Union
  • GPs: General Practitioners
  • HTA: Health Technology Assessment
  • HZZO: Croatian Health Insurance Fund
  • IT: Information Technology
  • OOP: Out-of-Pocket

• Citation:
  Vončina, L., Arur, A., Dorcić, F., Pezelj-Duliba, D. 2018. "Universal Health Coverage in Croatia: Reforms to Revitalize Primary Health Care". Universal Health Care Coverage Series 29, World Bank Group, Washington, DC.