Future of Sharing Economy in Medicine in Croatia

FUTURE OF SHARING ECONOMY IN MEDICINE IN CROATIA

Terezija Berlančić J. J. Strossmayer University of Osijek, Faculty of Medicine Osijek E-mail: [email protected]

Ivan Miškulin, Ph. D. J. J. Strossmayer University of Osijek, Faculty of Medicine Osijek E-mail: [email protected]

Abstract Sharing economy (SE) is a new fast-growing economy model and the biggest economy trend of all time. It is based on peer to peer sharing of goods and services and as opposed to previous ownership-based economy it puts focus on the accessibility of a good or service instead of ownership. One of the principles in SE is that unused value is wasted value, therefore, it makes use of unused equipment or possessions and it is estimated that there is over £3,5 trillion worth of unused goods in the world. SE differentiates itself from the classical economy in that it doesn’t have a common hierarchy where one side is the provider of the service and the other is the consumer, in SE everyone can be a provider and a consumer of service at the same time. In the last couple of years, SE has grown in a number of users, companies, start-ups and different fields in which SE has taken the lead. In the past, there have been several attempts of introducing SE in the health profession and some (i.e. COHEALO) were more successful than the others. Health and health services are one of the biggest problems in the world as well as in Croatia. There is a current lack of medical staff in all medical fields and medical devices are very expensive to own. Therefore, there is a need for reduction of medical expenses. In this paper we will analyze the possibility of implementing SE in everyday work in hospitals and other health centers as well as possible places of its implementation and Terezija Berlančić • Ivan Miškulin: FUTURE OF SHARING ECONOMY IN MEDICINE CROATIA Terezija

1758 how could it be used in the near future. SE in medicine will be regarded from a professional, financial, legal, and cultural perspective in Croatia. Keywords: sharing economy, medicine, public health, management JEL Classification: I18, M19

1. INTRODUCTION Sharing economy (SE) is a trend that has taken the world economy by a storm in recent years. It came into the public eye as a result of the success of various companies such as Airbnb and Uber. Even though it is a relatively new trend the concept of sharing, collaborative or peer-to-peer economy exists, in its primitive form, since the beginning of mankind. SE in a way deletes the past strict wall between the producer and the consumer and creates a market where everyone can be a producer and a consumer of the goods and services at the same time. SE has developed in the last fifteen years because increasingly people find that there are some things that they do not need to own to enjoy them, such as vehicles, accommodation and so on. It is a reaction to the ever-growing technological industry and smart tech that allows people to have all of those things just a call or a message away in the palm of their hand. True evidence of SE popularity is the fact that in 2017. The value of SE economy has grown to $2 trillion (BofAML, BIA/Kelsey, 2017). Sharing economy today can be divided into 4 different subgroups: access economy, gig economy, collaborative economy and commoning economy (Ferrer, 2017). There are subtle differences in each subgroup. Access economy refers to access to goods and services through renting them for a period of time and it is not based on ownership of said goods and services. The pivotal part of the access economy is that ownership doesn’t mat- ter just the access to the goods. The gig economy is based on sporadic gigs where the transaction is done through the digital market. The collaborative economy as a subgroup of SE is known as economy inter pares and is more widely known as a peer-to-peer economy. This economy is based on the principle that its own customers help develop the economic activity of said company by participating in the process of developing and designing the production of assets. Finally, we have a commoning economy. “Commoning” is a word developed and popular- ized by the writer Peter Linebaugh and he described it in his book The Magna Carta Manifesto as a word that means people living in close connection to the common people and life. Therefore, the commoning economy means that there INTERDISCIPLINARY MANAGEMENT RESEARCH XV

1759 is a growing need for cooperation in place of competition and that economic growth and market should serve the community. Sharing economy today is a melting pot of all four subgroups and today it gives the opportunity to everyone to develop their business in a different and modern way. Sharing economy is a way to use unused goods and resources that go to waste each year. The aim of this paper is to show the past and present usage of sharing economy in health-related businesses and to propose SE business models that have the potential of developing in Croatian healthcare.

2. RESEARCH METHODOLOGY Today, the key question is how to redesign health care systems without dam- aging the foundations these were built on. Research has shown that the costs of financing health care will further increase in the near future. Around one-third of this increase will be the consequence of an aging population, and the remain- ing two thirds will refer to the excessive growth of costs, reflecting thus technological changes, income growth, and health policies. It is necessary to point out that the increase in health costs occurs at a time when countries need to undertake significant fiscal adjustments to reduce public debt and state budget deficit in the light of the global financial crisis. The key challenges and problems of Croatian health care can be divided into three groups: functioning of health care systems, health care personnel, and external factors. Research has shown that key challenges related to the functioning of health care are inefficiency, financial unviability, inadequate infrastructure, and the lack of system transparency. Poor governance is another limiting factor. With regard to health care personnel, they face the problems of low salaries, which then lead to migration challenges and a potential shortage of health care personnel. The following external factors are deemed to be among the most significant challenges: an aging population, bad living habits, and an increase in the number of chronic diseases. However, problems caused by the global financial crisis and the consequential macroeconomic situation must not be neglected. Following the above-explained complex situation of Croatian health care system, the authors are proposing the SE model a solution for reducing the inefficiency and financial unviability of the Croatian health care system. Terezija Berlančić • Ivan Miškulin: FUTURE OF SHARING ECONOMY IN MEDICINE CROATIA Terezija

1760 In the course of the research, a considerable number of scientific methods was used, among which the following should be highlighted: the method of de- duction, the method of analysis and synthesis, the method of causal inference, the method of abstraction, the method of composition, the method of analogy, the historical method as well as the method of descriptive inference.

3. SHARING ECONOMY IN DIFFERENT BUSSINES ENVIRONMENT

3.1. Sharing economy sectors According to the report by the European Commission, we can divide the sharing economy into five key sectors (Vaughan & Daverio, 2016): 1. Peer-to-peer accommodation: households sharing access to unused space in their home or renting out a holiday home to travelers through digital platforms. Some of the platforms include Airbnb, LoveHome- Swap and HomeAway. 2. Peer-to-peer transportation: individuals sharing a ride, car or parking space with others through an app. This includes short-distance and long-distance rides as well as car sharing networks. Platforms in transportation are Uber, Blablacar, GetAround, Zipcar and so on. 3. On-demand household services: freelancer marketplaces enabling households to access on-demand support with household tasks such as food delivery and “Do It Yourself ”, they are online “crowd-based” marketplaces which give access to household task services and deliveries. They include specialized and general delivery services and on-demand household chores platforms like UberRUSH, Instacart, TaskRabbit and Deliverooo. 4. On-demand professional services: freelancer marketplaces enabling businesses to access on-demand support with skills such as administration, consultancy, and accountancy. This differs from the previous sectors since freelancers usually work remotely. Business’ included in this sector are Upwork and HolterWatkin 5. Collaborative finance: individuals and businesses who invest, lend and borrow directly between each other, such as crowd-funding and peer-to- peer (P2P) lending, this is different from traditional intermediaries like INTERDISCIPLINARY MANAGEMENT RESEARCH XV

1761 banks. Crowdfunding platform includes Kickstarter and LendingClub is an example of lending platform. As reported by European Commission (Vaughan & Daverio, 2016) regarding the data from PricewaterhouseCoopers (PwC) UK (Table 1.) - The sharing economy - Sizing the revenue opportunity, these sectors generated revenues of al- most €4 billion and facilitated €28 billion of transactions within Europe in 2015 and to date it includes 275 collaborative economy platforms which are an increase from the previous report (Vaughan & Daverio, 2016). The report shows that the UK and France are the countries with most collaborative economy organizations founded with over 50 organizations; they are followed by Germany, Spain, and the Netherlands with over 25 organizations. Regarding specific sectors in sharing economy most revenue was made by P2P Accommodation and P2P Transporta- tion which cumulatively make around 79% of total revenue from sharing economy in Europe in 2015 (Figure 1.) which was to be expected since not only are they pioneers in the field of sharing economy but they require the least amount of resource. More interesting for us is seeing that just 2% of revenue and 3% of total transactions were done in the field of on-demand professional service where we could categorize medical services as well. The reasons for this could be many but most probable ones could include the stability of the employment where medical staff don’t have needs to provide their service outside of their regular jobs and another reason could be the fact that there aren’t many medical sharing economy platforms and those that exist are not very well known and are not used. Un- fortunately, there haven’t been official reports regarding medical SE platforms in Europe. Either way, the growth in transactions and revenue is fast (Figure 2.) and since there aren’t many medical platforms for SE this could be an unexplored and potentially very profitable future market for SE and medical economy in general. Table 1. Revenues and transaction values facilitated by collaborative economy platforms in Europe (€m, 2015)

Sector Revenue 2015 (m) Value 2015 (m) P2P Accommodation € 1150 € 1510 P2P Transportation € 1650 € 5100 On-demand household services € 450 € 1950 On-demand professional services € 100 € 750 Collaborative Finance € 250 € 5200 Total € 3600 € 28100

Terezija Berlančić • Ivan Miškulin: FUTURE OF SHARING ECONOMY IN MEDICINE CROATIA Terezija Source: PwC analysis. Note: Figures may not sum due to rounding. 1762 Figure 1.. Revenues Revenues and and transaction transaction valu valueses facilitated facilitated by collaborative by collaborative economy economy Figureplatforms 1. inRevenuesplatforms Europe and(% in of transactionEurope the total, (% 2015)valu of thees facilitated total, 2015) by collaborative economy platforms in Europe (% of the total, 2015)

Source: PwCPwC analysis analysis Source: PwC analysis Figure 2. Revenues and transaction values facilitated by collaborative economy Figureplatforms 2. inRevenues Revenues Europe and(Growth, and transaction transaction 2013-2015) valu valueses facilitated facilitated by collaborative by collaborative economy economy platforms inplatforms Europe (Growth, in Europe 2013-2015) (Growth, 2013-2015)

Source: PwC analysis Source: PwC analysis Source: PwC analysis 3.2. Business in the era of modern social networking 3.2. Business in the era of modern social networking Social networking is a social system that exchanges resources, the interactions 3.2.occur BusinessSocial between networking in organizations the is eraa social of or, symodern stem what that is social exchanges recently networking becomingresources, the more interactions popular, individualsoccur between to achieve organizations the common or, goal what (Kang, is recently2018). Its becomingmain concept more includes popular, the exchangeindividualsSocial andnetworking to achievesharing theof is different commona social products,goalsystem (Kang, thatcapital, 2018). exchanges informatio Its main resources, nc onceptservices includesthe and interac many the - tionsmore.exchange occurIt gives and between asharing basis fororganizationsof developingdifferent products, socialor, what capital, capital, is recently also informatio know becomingn nas services a collective more and popular, manyasset, individualswhichmore. It is gives defined to aachieve basis as an for the assembly developing common of social actualgoal (Kang, capital, or potential 2018). also know resource Its mainn ass a connectedconcept collective includes toasset, the continuouswhich is defined network as ownership an assembly lev ofel. actualSocial orcapital potential promotes resource a specifics connected behavior to the in theregardcontinuous exchange to the network structure and sharing ownership of transactions of different level. Social(Coleman, products, capital 1988). capital,promotes This information h aas s pecificevolved behavior servicesduring the inand manyregardtime and more. to wethe Itcanstructure gives see athe basisof emerging transactions for developing and (Coleman, growth social of 1988).collaborative capital, This also h as owknown evolvednership, as aduringwhere collective the asset,maintime and which point we ofcanis defined the see marketthe emergingas an and assembly business and growth of isn’tactual of justcollaborative or profitpotential but ow resources socnership,ial growth whereconnected andthe developmentmain point ofof thesocial market capital. and This business is resulting isn’t in just the profitdevelop butment soc ofial shared growth values and tobetweendevelopment the continuous the producer of social network andcapital. the ownershipconsumerThis is resulting since, level. in inSocial time,the develop theycapital arement promotesbecoming of shared thea specific valuessame. behaviorTodaybetween social the in producerregard networking to and the isthe structure more consumer approachable of since, transactions in thantime, everthey(Coleman, throughare becoming 1988).different the This socialsame. has evolvednetworksToday social during and development networking the time and isof more technology.we can approachable see the emerging than ever and throughgrowth differentof collaborative social networks and development of technology. ownership, where the main point of the market and business isn’t just profit but INTERDISCIPLINARY MANAGEMENT RESEARCH XV

1763 social growth and development of social capital. This is resulting in the development of shared values between the producer and the consumer since, in time, they are becoming the same. Today social networking is more approachable than ever through different social networks and development of technology.

3.3. Laws, regulations, and policies affecting the sharing economy in the European Union Since its start sharing economy has encountered problems with regulations worldwide. With its disruption of previous business concepts, there were no laws that covered the sharing economy. Many traditional businesses that provided similar services were found at a sudden disadvantage. Most of them require either special permission, additional tax fees or extra courses or tests. We present several cases of these changes (Vaughan & Daverio, 2016). Italy has recently proposed a ‘sharing economy act’ which includes definition of the sharing economy as well as its platforms, requires all platforms to sign up to a sharing economy registry and provide documents for the Autorità Garante della Concorrenza e del Mercato (AGCM) (competition authority) approval all that with addition of extra taxes according to income rate. In Germany Uber has stopped operations in three Ger- man cities citing a ‘difficult regulatory environment’. Drivers were required to register as a private rental car enterprise, which made the registration process too costly and lengthy for many. Another example is France where Airbnb started collecting ‘tourist tax’ of €0.83 per room night. In Spain Uber has been banned nationally in December 2014 and is now trying to re-enter the Spanish market by only working with drivers who carry a valid professional VTC license which is required by all professional drivers. This is similar to the law passed in Croatia in 2018. where Uber drivers were required to pass same programs and licensing as regular taxi drivers (Zakon o prijevozu u cestovnom prometu, 2018).

3.4. Sharing economy prototypes

3.4.1. Uber Today Uber is the most recognized and arguably the most successful SE business in the world (Gabel, 2016). Uber has been a star in SE. It was first started in 2009 by Garrett Camp and Travis Kalanick in San Francisco. The idea was to make affordable driving service where both the driver and the pas- Terezija Berlančić • Ivan Miškulin: FUTURE OF SHARING ECONOMY IN MEDICINE CROATIA Terezija

1764 senger could have an easy to access driving service at a lower cost. The company operates on a mobile app principle. Users can sign in as either a driver or a pas- senger in two separate apps. The drivers go under background check and have a registration requirement and car standards. The passengers have to download the Uber app register and simply order their drive. The main problem for Uber is the opposition of traditional Taxi drivers to this form of taxi service. Since Uber is more available through digital platforms, usually faster, more accessible and affordable for the driver and the consumer since the only thing it requires is for the driver to register through the Uber app as a driver and for him to own a car it is much easier for a person to become an Uber driver rather than a Taxi driver. Following this, since Uber was developed as a form of SE the laws and legislation that applied to traditional taxi drivers didn’t and couldn’t be applied to Uber drivers and consumers. There are many examples of this throughout the world from London, Toronto, Melbourne to New York. In recent years there have also been lawsuits against Uber regarding their working policy and driver exploitation since in the beginning there were no working hour limitations and many drivers for example in the USA drove from their home town to the big cities for the weekdays or the weekends and lived inside their cars to maximize their working hours. In Croatia, a new Law on Transportation in Road Traffic passed in 2018 (Zakon o prijevozu u cestovnom prometu, 2018) which enabled every driver who has a B category driver’s license to take an additional test and, if they pass, provide driving services. This law legalized Uber driving service in Croatia but resulted in a reduction of Uber drivers across Croatia because it required a lot of additional registration and additional examination.

3.4.2. Airbnb Airbnb is another extraordinary SE business. As opposed to Uber which is more of an example for the gig economy, Airbnb is based first and foremost in access economy. While Uber has just one digital transaction per person for a very short time, Airbnb offers a longer service and connects people who want to rent their accommodation to those who are looking for accommodation. There are several benefits of this kind of business such as free listings, hosts being able to set their own price, additional services and protection for guests and hosts (Folger, 2019). Unfortunately, much like Uber, Airbnb has faced legal problems. INTERDISCIPLINARY MANAGEMENT RESEARCH XV

1765 Since both Uber and Airbnb can be classified as disruptive innovation, they also created disruption in legal regulations in different countries which were never introduced to this form of market making these businesses basically illegal.

3.5. Sharing economy in the worldwide healthcare

3.5.1. Cohealo Cohealo was developed in 2011 in Boston, Massachusetts. It was developed as a platform to use unused surgery equipment, such as surgical tables, from one hospital in another. This would activate unused capital from one hospital that had extra equipment and use it to create profit. This was created to lower the cost of everyday hospital management.

3.5.2. “Šestar” “Šestar” is an internet platform on which scientists can exchange diagnostic machines that are not in use at the moment in their laboratory. This type of SE offers a highly effective and complete usage of all machines and at the same time saves money to the laboratories so that they don’t have to buy them and therefore they can use their money on other needed materials. The way the site works is that there are different machines listed, they have a contact person and the location of the machine available (Šestar, 2019).

3.5.3. Telehealth platforms - Teladoc Modern telehealth platforms present a variety of unique benefits to both consumers and physicians. Patients may seek telemedicine services for episodic care, specialty management of chronic illnesses, and primary care. Consumers stand to experience increased convenience in accessing medical services and en- countering a variety of connection services platforms, choosing the modality they prefer based on their own unique characteristics as consumers. In contrast to traditional, office-based services, patients may access medical services in an “on-demand” fashion, engaging in instant message exchanges, video chats, and remote exams. Lastly, clinicians will also benefit from the improved work-life balance due to flexible practice hours and location, in addition to potential increased earnings. Terezija Berlančić • Ivan Miškulin: FUTURE OF SHARING ECONOMY IN MEDICINE CROATIA Terezija

1766 Both consumers and physicians will also benefit from the system’s innova- tions that will accompany the increased use of telehealth platforms. For example, in order to mitigate malpractice risk, telehealth platforms will need to differentiate between, and then route, patients requiring higher-acuity or more specialized care to the right point and service provider. Telehealth platforms may also innovate in how they regulate quality and safety standards and screen and select providers, and in how consumers rate service providers—a common feature of many platforms in the sharing economy. By facilitating information collection and making it transparent, telehealth platforms have the potential to protect and empower consumers. Telehealth platforms can further expand access to general medical services by reaching out to consumers in underserved areas and providing access to highly specialized consultancy services. Currently, medical care delivery is highly lo- cal, with physicians practicing in their towns or cities and patient interaction occurring primarily in person in an office or hospital setting. Highly localized delivery, coupled with state-based licensure systems, potentially restricts the supply of physicians and limits consumer access to, and price competition for, telemedicine services. Telehealth platforms offer an opportunity to expand access without major financial investment, in addition to increased price competition for some medical services. Early market evidence supports the conclusion that telehealth platforms yield substantial consumer and clinician benefits. Teladoc, a publicly traded telehealth platform company, had 576,000 visits in 2015 with 95% consumer satisfaction, 5 while physician hourly income increased 50%. These and other benefits will power market growth, with estimates of the current telemedicine market ranging from $1.9 billion to $30 billion. Despite this rapid growth, some have raised concerns regarding the safety of telehealth platforms as a rationale for restricting the market entry and growth of telehealth platforms. In address- ing this concern, one must note that physicians have successfully practiced telemedicine for over 100 years by using the telephone to conduct physician- to-physician consults, diagnose and treat patients, prescribe medications, and order diagnostic tests. Like the taxi industry’s move from telephone dispatch to matching through GPS-enabled smartphones, modern telehealth platforms represent a natural outgrowth of the practice of medicine, using modern technology to grow a systems approach to safety and quality (Miller et al.; 2016). INTERDISCIPLINARY MANAGEMENT RESEARCH XV

1767 3.6. Possibilities of future use of sharing economy in healthcare in Croatia

3.6.1. Developing tech exchange between hospitals Even though hospitals are usually overcrowded with patients and patient waiting lists are a couple of months-long there are occasions in which not all facilities and diagnostic machines are adequately used. The reasons for this vary from too few patients in that town or region which is usually a result of low population in that area to the lack of specialists and other experts who work in the specific medical field. Reason for the lack of experts can be found in higher immigration rates and older population of doctors in some areas who then re- tire. As a result, we have on one side overcrowded waiting lists in larger hospital centers, and on the other hand unused, expensive and highly sophisticated diagnostic machinery. A solution for this could be found in an app that enables all hospitals to list their devices and when they are not in usage offer them to those institutions with long waiting lists. This is similar to previously presented “Cohealo” and “Šestar”. Problem with this is that the larger machines would be very expensive to transfer from one hospital to another so profitability would be a limiting factor, another problem is potential damage to the machines that could occur to the machines. From the medical point of view, the main problem would be “What to do when there is an emergency and those machines are needed?” this is solvable since most of the hospitals have more than one machine of one kind and it could be used in an emergency. The overall technological exchange between hospitals is possible and achiev- able but with smaller devices and with the calculation of the profitability of this exchange.

3.6.2. Patient redirection Another way of using SE in medicine is to redirect patients from overcrowded hospitals to those with fewer patients. That way we could completely bypass all the problem with the transport of medical machinery. All patients who are using health insurance in Croatia would have opportunity to download an app that would show all waiting lists of all hospitals, of Terezija Berlančić • Ivan Miškulin: FUTURE OF SHARING ECONOMY IN MEDICINE CROATIA Terezija

1768 course, all patients would have their unique ID which would be shown in the lists and the app could just show when the next available appointment is. An- other possibility for this app would be that when the patient decides in which hospital, he wants to go he could register on their waiting list in the app. This form of admitting patients already exist in Croatia in primary medicine but it is only available to Family medicine specialists who can “save your date” for their patients. This is a problem because if there are sudden open places for new admissions the hospital has to contact the next patient on the waiting list or leave it unused. This is a great waste of medical personnel, money and time. Firstly, because you have an administrator who has to use his time to call other patients to see whether there are patients who are able to come at different time and secondly, because a lot of patients are unable to come on call into hospital, it usually leaves that time unused which results in lost profit for the hospital. This solution is cheaper and easier to carry out in reality. Main problem for this model is that except for Zagreb there are no cities in Croatia with more, large hospitals and hospital centers to which the patients could be rerouted so the patients wouldn’t be able to use the app in an adequate way or they would have to travel larger distances to reach the hospital which would increase patient’s cost. On the other hand, the pilot of this app could be done in Zagreb with great efficiency.

3.6.3. Doctors and nurses on demand With a increasingly aging population, longer lifespan and more people with chronic diseases there is a larger need for in-house care. With the usual population of 2000 patients per family medicine specialist, there is very little room for healthcare workers to visit each patient daily. This would enable the immobile patient’s adequate healthcare. There are several problems. First of all, house call visits already exist, and they are a part of regular healthcare services for a specific kind of patients

3.6.4. Chronic patients Two of the most common chronic diseases that require daily supervision and regulation are hypertension and diabetes. With technical development we now have smart devices that can measure blood pressure and glucose levels in INTERDISCIPLINARY MANAGEMENT RESEARCH XV

1769 the blood, however, while the regulation of hypertension requires just daily consumption of antihypertension drugs, insulin dependent diabetes requires a sometimes-complex administration of insulin. Since diabetes is still consid- ered a disease of older age and taking into consideration the fact that a lot of elderly are still not used to use advanced settings on their smartphones or some of the modern technologies used in diabetes therapy it would be beneficial to have a platform where previously educated personnel (nurses, doctors, and even medicine students) could be employed by family members of diabetic patients to ensure that those diabetic patients regulate their blood sugar levels daily by measuring blood sugar levels and administrating insulin or per oral therapy.

3.6.5. Pharmacology in the palm of a hand Because of the difference in size, location and need for drugs in each location, all pharmacies don’t carry the same drug, and because of the supply orga- nization and management, it can sometimes happen that the specific pharmacy doesn’t carry the required drug. This problem has two solutions either there needs to be peer – to – peer exchange of drugs between pharmacies so that one pharmacy can supply the other with the required drug in between orders. This would require a list of available drugs for each pharmacy as well as a way of in- forming and delivery. Other solution would be to offer a list of other pharmacies that carry the required drug to the patients. Out of these two possibilities we expect the best solution to be the one where a patient is offered a list of pharmacies with available drug because pharmacies are fairly widespread in every city and it wouldn’t require a high increase in patient’s personnel costs to go to another pharmacy, while the first solution would create much larger expenses for the pharmacies, and unnecessarily complicate everyday work.

3.6.6. Doctors and nurses as freelancers With ever-growing lack of medical staff in all hospitals especially in rural areas, there is a need to provide quality health service in those areas. Since urban areas, especially large cities, give a lot of opportunity for medical practice most of the doctors gravitate towards jobs and practices in urban area, leaving the rural area jobs with either short-time practitioners who go from one practice to another, or no doctor at al. A possible way of solving this problem would be

Terezija Berlančić • Ivan Miškulin: FUTURE OF SHARING ECONOMY IN MEDICINE CROATIA Terezija to create a platform for doctors and nurses only on which the short-term jobs 1770 (one to two days a week) would be offered. A sort of freelancers in medicine where a doctor or a nurse could fill a spot in a practice and in that way enable quality health service in all areas. The app would have a possibility to apply for a job a month in advance after which a schedule would be formed and sent to the applicants according to the days on which they applied. There would be set payment for each qualification (i.e. those with specialization, sub specialization, and finished courses would get additional increase of payment in set per- centages ) and a grading system and scale for doctors and nurses in accordance to their training and education (i.e. an MD with valid practice license would get 10 points, a specialization would grant another 15 points, Ph.D. another 5 points and every further education such as ultrasound of heart, abdomen or Color Doppler would grant additional 8 points and so on). This way if there are more applicants, they would get an advantage to choose desired jobs according to their qualifications. In addition, at jobs that require certain qualification (i.e. pediatric practice) those with required qualification would get additional points and preference before other applicants. Advantage of this kind of project and platform would enable health care in underdeveloped locations, open more jobs, and create a job for health professionals after they finish their internship or if they want to do more work. Problem with this kind of work would again be focused on the distance from the larger city and the amount of work required since this frequent exchange of doctors can account for them not know- ing regular patients (like their regular family medicine specialist would), and also many doctors and nurses would not be interested in traveling that far so the jobs would probably be filled with younger staff that is still not specialized with some exceptions.

4. CONCLUSION SE will reduce costs and improve healthcare, particularly its accessibility. Our goal should be to help accelerate these changes first by identifying them and driving awareness, and also giving them a context and framework so that new models can be developed more rapidly. The important step to be taken now is to change the way of designing and thinking about our healthcare facilities in light of the emergence of these new models of economies. It is time to stop debating whether the SE will affect our healthcare ecosystem or not, as this is an undeni- able solid fact. It is time instead to discuss what happens after the change occurs INTERDISCIPLINARY MANAGEMENT RESEARCH XV

1771 like community-driven health, and how we can regulate it to ensure quality and privacy. We also need to think about the new data ownership rights and how we can provide our patients with full access to their medical records without ham- pering their privacy. SE is here to stay, it has taken a large and important piece of cake in the economic market and as far as we see it will only keep on growing exponentially. The main problem of SE is that even though it is very adaptable there are usually just recycled versions of the same idea that are not applicable to all fields of the market. SE is an interdisciplinary phenomenon and it requires interdisciplinary solutions. Since healthcare is a highly specialized field of work and science with a lot of highly specialized experts it calls for a more specific and focused problem-solving applications of SE.

5. REFERENCES BofAML, BIA/Kelsey, SIC: Primer on the Sharing Economy, 2017 Coleman, J. (1988). Social Capital in the Creation of Human Capital, American Journal of Sociology 94, 95-120 David, G. (2016). Uber and the Persistence of Market Power, Journal of Economic Issues 50, 527-534 Ferrer, M.A, Quinonero, J. M., Yap, R. & Yeh, X. (2017.). La Economia Colaborativa en Cataluna: Llego para quedarse?. Pompeu Fabra University Folger J. (2019). Airbnb: Advantages and Disadvantages. [available at: https://www.investo- pedia.com/articles/personal-finance/032814/pros-and-cons-using-airbnb.asp , access February 25, 2019] Kang, S. & Na, J.K. (2018). The Effect of the Relationship Characteristics and Social Capital of the Sharing Economy Business on the Social Network, Relationship Competitive Advantage, and Continuance Commitment, Sustainability 10, 1-22 Miller, B.J., Moore, D.W. & Schmidt, C.W. Jr. (2016). Telemedicine and the Sharing Econo- my: The “Uber” for Healthcare, The American Journal of Managed Care 22, e420-e422 PwC UK, (2014). The sharing economy - Sizing the revenue opportunity. [available at http://www.pwc.co.uk/issues/megatrends/collisions/sharingeconomy/the-sharingeconomy-sizing-the-revenue-opportunity.html, access March 1, 2019] Šestar, Baza podataka instrumenata za istraživanje (2019). [available at: https://sestar.irb. hr/ , access March 1, 2019] Vaughan, R. & Daverio, R. (2016.). Assessing the size and presence of the collaborative economy in Europe. European Commission. Zakon o prijevozu u cestovnom prometu. NN 41/2018 Terezija Berlančić • Ivan Miškulin: FUTURE OF SHARING ECONOMY IN MEDICINE CROATIA Terezija

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