Health care funding reforms in Croatia: A case of mistaken priorities

Vončina, Luka; Mastilica, Miroslav

doi:10.1016/j.healthpol.2006.02.016

Cited by 18 publications

(11 citation statements)

References 13 publications

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“…They focus mainly on the impact of out-of-pocket payments (formal and informal). A study by Voncina and colleagues (32) describes developments in the Croatian health care financing system from 1999 to 2002. It suggests an overly strong bias toward private spending and an increase in its proportion of total health care expenditure.…”

Section: Provision Of Servicesmentioning

confidence: 99%

The Effects of Health Care Reforms on Health Inequalities: A Review and Analysis of the European Evidence Base

Gelormino¹,

Bambra²,

Spadea³

et al. 2011

Int J Health Serv

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Health care is widely considered to be an important determinant of health. The health care systems of Western Europe have recently experienced significant reforms, under pressure from economic globalization. Similarly, in Eastern Europe, health care reforms have been undertaken in response to the demands of the new market economy. Both of these changes may influence equality in health outcomes. This article aims to identify the mechanisms through which health care may affect inequalities. The authors conducted a literature review of the effects on health inequalities of European health care reforms. Particular reference was paid to interventions in the fields of financing and pooling, allocation, purchasing, and provision of services. The majority of studies were from Western Europe, and the outcomes most often examined were access to services or income distribution. Overall, the quality of research was poor, confirming the need to develop an appropriate impact assessment methodology. Few studies were related to pooling, allocation, or purchasing. For financing and purchasing, the studies showed that publicly funded universal health care reduces the impact of ill health on income distribution, while insurance systems can increase inequalities in access to care. Out-of-pocket payments increase inequalities in access to care and contribute to impoverishment. Decentralizing health services can lead to geographic inequalities in health care access. Nationalized, publicly funded health care systems are most effective at reducing inequalities in access and reducing the effects on health of income distribution.

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Section: Provision Of Servicesmentioning

confidence: 99%

The Effects of Health Care Reforms on Health Inequalities: A Review and Analysis of the European Evidence Base

Gelormino¹,

Bambra²,

Spadea³

et al. 2011

Int J Health Serv

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“…To date, it is the only country in the region to have a formal HTA agency. Its health care funding experienced the pattern seen throughout Eastern Europe-a shifting of health expenditure from public to out-of-pocket citizens' contributions in order to cover financial deficits [9]. Since 2002, significant attention has been paid to diversification of the basis of revenue collection, although payroll taxes remain the biggest single contributor.…”

Section: Croatiamentioning

confidence: 99%

Resource allocation strategies in Southeastern European health policy

2012

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The past 23 years of post-socialist restructuring of health system funding and management patterns has brought many changes to small Balkan markets, putting them under increasing pressure to keep pace with advancing globalization. Socioeconomic inequalities in healthcare access are still growing across the region. This uneven development is marked by the substantial difficulties encountered by local governments in delivering medical services to broad sectors of the population. This paper presents the results of a systematic review of the following evidence: published reports on health system reforms in the region commissioned by WHO, IMF, World Bank, OECD, European Commission; all available published evidence on health economics, funding, reimbursement in world/local languages since 1989 indexed at Medline, Excerpta Medica and Google Scholar; in depth analysis of official website data on medical care financing related legislation among key public institutions such as national Ministries of health, Health Insurance Funds, Professional Associations were applicable, in local languages; correspondence with key opinion leaders in the field in their respective communities. Contributors were asked to answer a particular set of questions related to the issue, thus enlightening fresh legislative developments and hidden patterns of policy maker's behavior. Cost awareness is slowly expanding in regional management, academic and industrial establishment. The study provides an exact and comprehensive description of its current extent and legislative framework. Western Balkans policy makers would profit substantially from health-economics-based decision-making to cope with increasing difficulties in funding and delivering medical care in emerging markets with a rapidly growing demand for health services.

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“…Under the FFS system, hospitals had an incentive to maintain a high level of bed occupancy and extend length of stay, since this high occupancy resulted in stable funding through per diem payments, while the majority of costs tend to be concentrated in the first few days of hospital stays. Low occupancy rates also increased the risk that the HZZO would lower the global budget ceiling (22). …”

Section: The Croatian Health Care System Until 2008mentioning

confidence: 99%