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CROATIAN HEALTH CARE SYSTEM IN TRANSITION

CROATIAN HEALTH CARE SYSTEM IN TRANSITION. Miroslav Mastilica ‘Andrija Stampar’ School of Public Health Medical School, University of Zagreb, Croatia. CROATIAN HEALTH CARE REFORM: PRIVATISATION RATIONING MARKETISATION. 1. PHASE - PROVIDERS ORIENTED

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CROATIAN HEALTH CARE SYSTEM IN TRANSITION

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  1. CROATIAN HEALTH CARE SYSTEMIN TRANSITION Miroslav Mastilica ‘Andrija Stampar’ School of Public Health Medical School, University of Zagreb, Croatia

  2. CROATIAN HEALTH CARE REFORM: • PRIVATISATION • RATIONING • MARKETISATION

  3. 1. PHASE - PROVIDERS ORIENTED • Centralization of financing ("Croatian Institute for Health Insurance ") • Control of provision of services

  4. 2. PHASE - CONSUMERS ORIENTED • Voluntary health insurance • supplementary insurance • private insurance • Co-payments • Private practice • a) full private • - with or without contract with • insurance fund • b) in PHC in rented offices / contracted

  5. DEVELOPMENT OF MARKET • PROVIDERS • public (still dominant) • private (growing) • SERVICES OFFERED • public providers - services covered by compulsory health insurance (all what is available) • private providers – services covered by supplemental insurance • amenities • OTC medicaments • alternative medicine

  6. CONSUMERS • GDP per capita 5000 US$ (2002) • Average income 480 US$ • HCE per capita 400 US$ • THIRD PARTY - 2002 • COMPULSORY BASIC HEALTH INSURANCE • covers 85% - 25% of total price of services or drugs • co-payments from the insured 15% - 75% of the cost for most health care services or drugs

  7. VOLUNTARY HEALTH INSURANCE • 50% of the population • SUPPLEMENTARY HEALTH INSURANCE • covers the difference between the basic insurance and the total service or drug cost • greater scope of rights or standard for contracted health services • amenities PRIVATE HEALTH INSURANCE • full coverage of contracted health care services

  8. Health care providers in public (or state owned) institutions and in private sector (Croatia 2000-2004)

  9. … in percentages (2000-2004)

  10. CURRENT SITUATION • reductions in the right to health care within the mandatory health insurance system • introduction of market mechanisms into the health care and health insurance system • citizens as patients are paying a growing share of health services transforming them into consumers

  11. INCREASE OF DIRECT PAYMENTS • reduced access / utilization of services and medicaments • PRIVATISATION AND MARKETISATION • two-tiered system for necessary health services • new inequalities / inequities in access / utilization / quality of services • low income persons in disadvantaged position in access to quality services

  12. HEALTH CARE REFORM IN CROATIA transformation of health services from SOCIAL GOODS to COMMODITIES from PUBLIC to MARKET

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