According to the United Nations estimate, there are about one billion persons with disabilities in the world, accounting for some 15% of the world’s population. In Croatia, relevant parameters on ...individuals with disabilities have been collected through the Register of Persons with Disabilities. The aim of this study was to compare the pattern of disability prevalence and causes of disability between the Republic of Croatia and the City of Zagreb during the 2008–2013 period, with the understanding that information on the national and regional level can be used in the process of planning care for people with disabilities, but also as indicators in the evaluation of implemented measures and programs. Data obtained from the Croatian Register of Persons with Disabilities distributed according to age, sex, and type of disability were used in a comparison of the Republic of Croatia and the City of Zagreb. Data from the Register of Persons with Disabilities revealed that the prevalence of disability in the Republic of Croatia rose continuously from 11.0% in 2008 to 12.1% in 2012, and then fell to 11.9% in 2013. In the City of Zagreb, an increase in the prevalence of disability was recorded from 2008 (11.4%) to 2010 (11.9%), followed by a slight fall in 2011 and 2013 (11.5% in both years), with 11.6% recorded in 2012. In 2010, the same prevalence of disability – 11.9% – was recorded in the Republic of Croatia and the City of Zagreb.In conclusion, the prevalence of disability was recorded in the Republic of Croatia and the City of Zagreb, with comparable sex and age distribution according to the causes of disability. Some differences should probably be attributed to the fact that, in the Republic of Croatia, disability validation is performed by six different disability boards and based on different legislation. Establishment of a unique disability board using uniform criteria on disability evaluation will certainly contribute to standardized presentation of the causes of disability and to the development of epidemiology in this particular field of medical science.
•Timing is key in responding to a pandemic.•An effective response needs high levels of accountability and trust.•There is a need for an appropriate legal framework.•Health workers are central to ...well-functioning health systems and an effective pandemic response.•More efforts should have been undertaken to maintain the provision of essential health services.
This article compares the health system responses to COVID-19 in Bulgaria, Croatia and Romania from February 2020 until the end of 2020. It explores similarities and differences between the three countries, building primarily on the methodology and content compiled in the COVID-19 Health System Response Monitor (HSRM). We find that all three countries entered the COVID-19 crisis with common problems, including workforce shortages and underdeveloped and underutilized preventive and primary care. The countries reacted swiftly to the first wave of the COVID-19 pandemic, declaring a state of emergency in March 2020 and setting up new governance mechanisms. The initial response benefited from a centralized approach and high levels of public trust but proved to be only a short-term solution. Over time, governance became dominated by political and economic considerations, communication to the public became contradictory, and levels of public trust declined dramatically. The three countries created additional bed capacity for the treatment of COVID-19 patients in the first wave, but a greater challenge was to ensure a sufficient supply of qualified health workers. New digital and remote tools for the provision of non-COVID-19 health services were introduced or used more widely, with an increase in telephone or online consultations and a simplification of administrative procedures. However, the provision and uptake of non-COVID-19 health services was still affected negatively by the pandemic. Overall, the COVID-19 pandemic has exposed pre-existing health system and governance challenges in the three countries, leading to a large number of preventable deaths.
Outcome-based reimbursement models can effectively reduce the financial risk to health care payers in cases when there is important uncertainty or heterogeneity regarding the clinical value of health ...technologies. Still, health care payers in lower income countries rely mainly on financial based agreements to manage uncertainties associated with new therapies. We performed a survey, an exploratory literature review and an iterative brainstorming in parallel about potential barriers and solutions to outcome-based agreements in Central and Eastern Europe (CEE) and in the Middle East (ME). A draft list of recommendations deriving from these steps was validated in a follow-up workshop with payer experts from these regions. 20 different barriers were identified in five groups, including transaction costs and administrative burden, measurement issues, information technology and data infrastructure, governance, and perverse policy outcomes. Though implementing outcome-based reimbursement models is challenging, especially in lower income countries, those challenges can be mitigated by conducting pilot agreements and preparing for predictable barriers. Our guidance paper provides an initial step in this process. The generalizability of our recommendations can be improved by monitoring experiences from pilot reimbursement models in CEE and ME countries and continuing the multistakeholder dialogue at national levels.
Povećanje učinkovitosti i uspostavljanje financijske održivosti bolničkog zdravstvenog sustava u Republici Hrvatskoj temeljne su odrednice Nacionalnog plana razvoja bolnica. Cilj je rada prikazati ...aktivnosti bolničke mreže u Republici Hrvatskoj između 2017. i 2021. godine u odnosu na specifične modele plaćanja zdravstvenih usluga i zahtjeve za bolničkim uslugama na temelju tipa upućivanja. Potencijal sekundarne upotrebe prikupljenih podataka za unapređenje efikasnosti i kvalitete bolničkog zdravstvenog sustava analiziran je na temelju podataka za pet specifičnih indikatora. Istraživanje je retrospektivno, a analizom su obuhvaćeni podaci iz baze računa Hrvatskog zavoda za zdravstveno osiguranje. Odabrani vremenski okvir kvantificirao je smanjenje aktivnosti bolnica za sve aspekte liječenja tijekom trajanja COVID-19 pandemije uz manje zahtjeva za bolničkim uslugama na temelju upućivanja iz primarne zdravstvene zaštite. Specifičnost i upotrebljivost dostupnih podataka u reformi bolničkog zdravstvenog sustava nužno je iskoristiti za izgradnju analitičkih alata koji će određivati ne samo smjer razvoja mreže bolnica, već i cjelokupnog zdravstvenog sustava u Republici Hrvatskoj.
Croatia: Health System Review Dzakula, Aleksandar; Vočanec, Dorja; Banadinovic, Maja ...
Health systems in transition
23, Številka:
2
Journal Article
This analysis of the Croatian health system reviews developments in its organization and governance, financing, provision of services, health reforms and health system performance. Croatia has a ...mandatory social health insurance system with nearly universal population coverage and a generous benefits package. Although per capita spending is low when compared to other EU countries, the share of public spending as a proportion of current health expenditure is high and out-of-pocket payments are low. There are sufficient physical and human resources overall, but some more remote areas, such as the islands off the Adriatic coast and rural areas in central and eastern Croatia, face shortages. While the Croatian health system provides a high degree of financial protection, more can be achieved in terms of improving health outcomes. Several mortality rates are among the highest in the EU, including mortality from cancer, preventable causes (including lung cancer, alcohol-related causes and road traffic deaths) and air pollution. Quality monitoring systems are underdeveloped, but available indicators on quality of care suggest much scope for improvement. Another challenge is waiting times, which were already long in the years before 2020 and are bound to have increased as a result of the COVID-19 pandemic.
According to the United Nations estimate, there are about one billion persons with disabilities in the world, accounting for some 15% of the world's population. In Croatia, relevant parameters on ...individuals with disabilities have been collected through the Register of Persons with Disabilities. The aim of this study was to compare the pattern of disability prevalence and causes of disability between the Republic of Croatia and the City of Zagreb during the 2008-2013 period, with the understanding that information on the national and regional level can be used in the process of planning care for people with disabilities, but also as indicators in the evaluation of implemented measures and programs. Data obtained from the Croatian Register of Persons with Disabilities distributed according to age, sex, and type of disability were used in a comparison of the Republic of Croatia and the City of Zagreb. Data from the Register of Persons with Disabilities revealed that the prevalence of disability in the Republic of Croatia rose continuously from 11.0% in 2008 to 12.1% in 2012, and then fell to 11.9% in 2013. In the City of Zagreb, an increase in the prevalence of disability was recorded from 2008 (11.4%) to 2010 (11.9%), followed by a slight fall in 2011 and 2013 (11.5% in both years), with 11.6% recorded in 2012. In 2010, the same prevalence of disability-- 11.9%--was recorded in the Republic of Croatia and the City of Zagreb. In conclusion, the prevalence of disability was recorded in the Republic of Croatia and the City of Zagreb, with comparable sex and age distribution according to the causes of disability. Some differences should probably be attributed to the fact that, in the Republic of Croatia, disability validation is performed by six different disability boards and based on different legislation. Establishment of a unique disability board using uniform criteria on disability evaluation will certainly contribute to standardized presentation of the causes of disability and to the development of epidemiology in this particular field of medical science. Key words: disability patterns, prevalence of disability, Register of Persons with Disabilities, Zagreb, Croatia Prema procjenama UN-a u svijetu je oko 1 milijarda osoba s invaliditetom sto cini oko 15% svjetske populacije. Hrvatska prikuplja parametre o osobama s invaliditetom putem Registra o osobama s invaliditetom. Cilj rada je usporediti kretanja prevalencija invaliditeta, u periodu od 2008. do 2013. godine, izmedu Republike Hrvatske (RH) i Grada Zagreba, kao i usporediti uzroke invaliditeta izmedu ove dvije teritorijalne jedinice te na taj nacin dati podatke na nacionalnom i regionalnom nivou koji se mogu koristiti u postupcima planiranja skrbi za osobe s invaliditetom na tim razinama, ali i kao pokazatelji u postupku evaluacije provedenih mjera i programa. U istrazivanju su koristeni podaci Hrvatskog registra o osobama s invaliditetom, s podjelom prema spolu, dobi, vrstama ostecenja te su usporedeni podaci izmedu RH i Grada Zagreba. Prema podacima Registra osoba s invaliditetom prevalencija invaliditeta u RH ukazuje na kontinuirani porast u period od 2008. do 2012. godine (od 11,0% do 12,1%) dok se u 2013. godini smanjuje na 11,9%. U Gradu Zagrebu zabiljezen je porast prevalencije invaliditeta od 2008. do 2010. godine (od 11,4% do 11,9%). U 2011. i 2013. godini zamjecuje se blazi pad na 11,5%, dok u 2012. godini iznosi 11,6%. U RH i Gradu Zagrebu je 2010. godine zabiljezena jednaka prevalencija invaliditeta od 11,9%. U periodu od 2008. do 2013, biljezi se podjednaka ucestalost invaliditeta u RH i Gradu Zagrebu s priblizno slicnom distribucijom prema spolnu, dobi te uzrocima invaliditeta. Odredene prisutne razlike potencijalno proizlaze iz cinjenice da se u RH invaliditet vjestaci u sest razlicitih tijela vjestacenja temeljem razlicitih zakonskih osnova. Osnivanje jedinstvenog tijela vjestacenja koje bi koristilo jedinstvene kriterije valorizacije invaliditeta zasigurno bi pridonijelo ujednacavanju nacina prikaza uzroka invaliditeta i razvoju epidemiologije ovoga podrucja. Kljucne rijeci: kretanje invaliditeta, prevalencija invaliditeta, Registar osoba s invaliditetom, Zagreb, Hrvatska UDK: 364.65-056.26(497.5)
Nejednakosti u zdravlju posljedica su nejednakih životnih mogućnosti. Dosadašnja istraživanja pokazuju kako je smanjenje društvenih nejednakosti najuspješniji i najisplativiji put posrednog ...poboljšanja zdravlja populacije, a najveće mogućnosti otvara upravo ulaganje u rani razvoj djece. Postojeći pokazatelji upućuju na to da su i u Republici Hrvatskoj prisutni čimbenici koji uzrokuju nejednakosti u zdravlju od najranije dobi i posljedično tome lošije zdravstvene ishode. Cilj ovog
rada je prikazati metodologiju razvoja javne politike ulaganja u rani razvoj djece u Republici Hrvatskoj. Javna politika čini temelj za daljnje oblikovanje i implementaciju nacionalne strategije u rani razvoj djece. U oblikovanju javne politike korišten je pristup odozdo prema gore. Na taj su način svi zainteresirani dionici dobili priliku iznijeti svoje viđenje problema i predložiti opcije za njegovi rješavanje. U okviru 21. sajma zdravlja u Vinkovcima u travnju 2017. glavna je tema bila „Ulaganje u rani razvoj djece kroz intersektorsku suradnju“. Analizom teksta izlaganja i rasprava prikupljene su informacije za opis postojećeg stanja koje je nadopunjavano u još dva kruga konzultacija sa zainteresiranim dionicima. Dobiveni prikaz sadašnjeg stanja predstavljen je u okviru partnerske konferencije „Ulaganje u rani razvoj djece kroz intersektorsku suradnju“. Tamo su konsenzusom doneseni zaključci prema kojima je kreiran završni dokument – platforma za izradu i
implementaciju nacionalne strategije ulaganja u rani razvoj djece. Izazovi koji su prepoznati u pružanju skrbi i usluga ranog razvoja djece vezani su uz manjak vertikalne i horizontalne suradnje nositelja skrbi i usluga. Osim toga, uočene su razlike u dostupnosti, priuštivosti, kvaliteti te pravičnosti raspodjele skrbi i usluga. No, prepoznate su i neke snage, ponajprije u obliku organizacijskih resursa sa zagovaračkom moći, dobrih praksi koje se provode u svim sektorima na lokalnoj razini i postojeće tehnologije usmjerene prevenciji, ranom otkrivanju i liječenju razvojnih odstupanja. Dobiveni rezultati omogućili su defi niranje ciljeva i ocrtali jasne pravce djelovanja. Naredni koraci su oblikovanje krovnog i operativnih dokumenata za uvođenje ove javne politike u praksu.
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