Voncina Luka, Dzakula Aleksandar, Mastilica Miroslav
Andrija Stampar School of Public Health, Medical School, University of Zagreb, Zagreb, Croatia.
Health Policy. 2007 Jan;80(1):144-57. doi: 10.1016/j.healthpol.2006.02.016. Epub 2006 Apr 18.
This study provides an overview of funding mechanisms in Croatian health care and analyses them in terms of sustainability, efficiency and equity. The study presents an in depth investigation of problems facing funding health care in Croatia: high expenditure, inadequate financial resources, continuous deficits of the state insurance fund, lack of transparency in funding, an aging population, etc. Furthermore, the study provides a critical overview of reforms that have been implemented to counter those issues from 1990 to 2002. The study argues that the implemented reforms over relied on shifting health expenditure from public to private sources in addressing financial deficits in the system. The study argues that, instead, the reforms should have focused more on curbing rising expenditure in health care providers. Emphasis has been put on the extent to which the reforms affected the conceptual-social foundations of the system. Finally, the paper provides recommendations for policy makers in Croatia and presents an overview of Croatian experiences that might be of interest to researchers and policy makers internationally.
本研究概述了克罗地亚医疗保健的筹资机制,并从可持续性、效率和公平性方面对其进行了分析。该研究深入调查了克罗地亚医疗保健筹资面临的问题:高支出、财政资源不足、国家保险基金持续赤字、筹资缺乏透明度、人口老龄化等。此外,该研究对1990年至2002年为应对这些问题而实施的改革进行了批判性概述。该研究认为,已实施的改革在解决系统财政赤字方面过度依赖将医疗支出从公共来源转移到私人来源。该研究认为,相反,改革应更多地侧重于抑制医疗服务提供者不断上升的支出。重点在于改革对该系统概念性社会基础的影响程度。最后,本文为克罗地亚的政策制定者提供了建议,并概述了克罗地亚的经验,这些经验可能会引起国际上研究人员和政策制定者的兴趣。