2014年-世界发展银行全球_Croatia_Program-for-Results___Improving_Quality_and_Efficiency_of_Health_Services_39页_826kb

报告摘要

Summary of the Technical Assessment of the Croatia Health Program-for-Results

Core Content

This technical assessment evaluates the Croatia Health Program-for-Results (PforR) operation, focusing on improving the quality and efficiency of health services. It analyzes the current state of the Croatian health system, its challenges, and the strategic priorities outlined in the National Health Care Strategy 2012–2020. The assessment highlights the need for reforms to address rising health expenditures, aging population, and shifting disease burdens.

Main Viewpoints

Health Outcomes: Croatia has achieved reasonably good health outcomes over the past two decades, with improvements in life expectancy, infant mortality, and age-standardized mortality rates. These outcomes are better than several Eastern European countries and are comparable to old EU member states (OMS).
High Costs: Despite good outcomes, the Croatian health system is costly, with overall health spending at 7.8% of GDP and the health sector accounting for 17.7% of public expenditures. This is unsustainable in the context of fiscal constraints.
Demographic Transition: Croatia is experiencing a significant demographic shift towards an aging population, which increases the burden of chronic and non-communicable diseases and the demand for long-term care services.
Health Financing: The system is based on social health insurance principles, managed by the Croatian Health Insurance Fund (HZZO), which covers the majority of the population. However, inefficiencies persist, particularly in hospital services and the lack of effective primary care gatekeeping.
Reforms Implemented: Several reforms have been introduced, including performance-based payment mechanisms, centralized procurement, and pharmaceutical cost rationalization. These reforms have improved regional balance in funding and human resources.
Strategic Priorities: The National Health Care Strategy outlines eight strategic priorities, of which five are supported by the PforR program, focusing on management capacity, reorganization of health care institutions, quality improvement, preventive activities, and financial stability.

Key Information

Current Health System Performance

Life Expectancy: Increased from 72.5 to 76.5 years between 1990 and 2010.
Infant Mortality: Reduced by more than half (from 10.7 to 4.4 deaths per 1,000 live births).
Age-Standardized Mortality Rate: Decreased by 25% (from 1,060 to 790 deaths per 100,000 inhabitants).
Leading Causes of Death: Heart and blood vessel diseases (49%), cancer (26%), injuries and poisoning (11%), digestive system diseases (9%), and respiratory system diseases (8%).
Health Indicators: Croatia performs better than several Eastern European countries and ranks between OMS and new EU member states (NMS).

Health Challenges

Risk Factors: High prevalence of unhealthy behaviors such as poor diet, physical inactivity, smoking, and alcohol consumption contribute to higher mortality rates from specific conditions.
Diabetes: 54.7% higher than NMS.
Cerebrovascular Diseases and Cancer: Higher mortality rates than NMS.
Health Inequalities: Disaggregated data by county is lacking, making it difficult to monitor and address quality and outcome differences.

Health Financing and Expenditures

Public Health Expenditures: Approximately 7.8% of GDP.
HZZO: Covers 4.4 million beneficiaries, including active workers, pensioners, and family members.
Pharmaceutical Reforms: Centralized procurement and promotion of generics have led to cost savings and reduced per prescription expenditures.

Strategic Priorities of the PforR Program

Strengthening Management Capacity in Health Care (Estimated EUR 14M)
Reorganizing the Structure and Activities of Health Care Institutions (Estimated EUR 260M)
Fostering Quality in Health Care (Estimated EUR 40M)
Strengthening Preventive Activities (Estimated EUR 24M)
Preserving Financial Stability of Health Care (Estimated EUR 10M)

Program Implementation and Results Chain

Duration: 2013–2017.
Focus Areas: Rationalizing the health facility network, improving quality of health care services, and promoting financial sustainability.
Interventions: Includes hospital accreditation, HTA implementation, clinical guidelines, performance-based payments, and preventive care strengthening.
Expected Benefits: Direct savings from centralized procurement, improved efficiency in ambulatory services, and indirect benefits through better quality and reduced readmissions.

Institutional Involvement

Ministry of Health (MoH): Leading the policy and strategy implementation, especially in hospital reforms.
Croatian Health Insurance Fund (HZZO): Supporting interventions and ensuring financial sustainability.
Agency for Quality and Accreditation in Health Care and Social Welfare: Involved in accreditation and technical audits.

Strategic Relevance and Technical Soundness

The program is aligned with the National Health Care Strategy and the EU’s policy frameworks.
It addresses key reform challenges, including inefficiencies in service delivery, financial sustainability, and quality improvement.
The PforR instrument is expected to strengthen political commitment and align incentives for achieving results.
It will also help Croatia leverage future EU funding for health sector development.

Conclusion

The Croatia Health Program-for-Results is a critical initiative aimed at improving the quality and efficiency of the health system in a context of high costs, an aging population, and shifting disease patterns. The program supports five of the eight strategic priorities outlined in the National Health Care Strategy and is technically sound, with interventions based on international best practices and aligned with EU policy frameworks. It aims to enhance service delivery, reduce inefficiencies, and promote financial sustainability, ultimately contributing to better health outcomes and more equitable access to care.

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