Croatia : Health Finance Study
The health system in Croatia developed relatively well among the countries in the region: the system has a well-trained health workforce, a well-established system of public health and health delivery programs, and good health outcomes in relation...
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| Format: | Other Health Study |
| Language: | English en_US |
| Published: |
Washington, DC
2013
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| Online Access: | http://documents.worldbank.org/curated/en/2004/04/4291360/croatia-health-finance-study http://hdl.handle.net/10986/15670 |
| Summary: | The health system in Croatia developed
relatively well among the countries in the region: the
system has a well-trained health workforce, a
well-established system of public health and health delivery
programs, and good health outcomes in relation to countries
at comparable income levels. However, these results have
been achieved at a high cost, and the growing deficits in
the social health insurance fund is a major concern.
Croatia's challenge is to channel its already
substantial public spending on health care, towards
cost-effective services, targeting public subsidies to
protect the most vulnerable groups. The Government is
currently engaged in a new round of reforms, aimed at
improving the performance of the health system. The report
reviews the 2000-2002 health reform initiatives, examines
the high cost of care (attributed to its aging population),
and focuses on the 2002 health insurance law and the reforms
in the revenue base for health insurance. Legislation
established the principals of central and local government
responsibilities for subsidizing the premium and co-payments
for special categories of population, such as the
unemployed, war veterans and disabled. Central government
transfers were made retroactively to cover the shortfalls,
or to cover deficits accumulated by the health care
providers. In 2002, actual government transfers to the
Croatian Health Insurance Institute (HZZO) showed a
significant decrease over the previous year, with debt
financing still being used to cover the shortfall in budget.
This suggests that the cost of financing the subsidies, has
not yet been fully evaluated, or included in the budget
plan. The parameters for determining subsidy levels will
need to be defined, for transparency, and for planning
purposes. Recommendations suggested include: improvements to
budget planning and fund management, with full accrual
accounting established at all levels of Government, and the
cost of subsidies evaluated, and included in the budget;
subsidies and social protection should be targeted, but with
greater administrative simplicity and transparency;
improvements to the quality and efficiency of health
services, strengthened by building on the ongoing reforms in
the provider payment system; decentralization, including
stronger local government capacity building; and,
strengthening policy, planning, and monitoring and evaluation. |
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