Health Systems in Transition Vol. 8 No. 7 2006 Croatia Health system review Luka Voncina • Nadia Jemiai Sherry Merkur • Christina Golna Akiko Maeda • Shiyan Chao Aleksandar Dzakula Editors: Sherry Merkur • Nadia Jemiai Elias Mossialos Editorial Board Editor in chief Elias Mossialos, London School of Economics and Political Science, United Kingdom and European Observatory on Health Systems and Policies Editors Reinhard Busse, Berlin Technical University, Germany Josep Figueras, European Observatory on Health Systems and Policies Martin McKee, London School of Hygiene and Tropical Medicine, United Kingdom and European Observatory on Health Systems and Policies Richard Saltman, Emory University, United States Editorial team Sara Allin, European Observatory on Health Systems and Policies Olga Avdeeva, European Observatory on Health Systems and Policies Anna Maresso, European Observatory on Health Systems and Policies David McDaid, European Observatory on Health Systems and Policies Sherry Merkur, European Observatory on Health Systems and Policies Bernd Rechel, European Observatory on Health Systems and Policies Erica Richardson, European Observatory on Health Systems and Policies Sarah Thomson, European Observatory on Health Systems and Policies International advisory board Tit Albreht, Institute of Public Health, Slovenia Carlos Alvarez-Dardet Díaz, University of Alicante, Spain Rifat Atun, Imperial College London, United Kingdom Johan Calltorp, Swedish Association of Local Authorities and Regions, Sweden Armin Fidler, The World Bank Colleen Flood, University of Toronto, Canada Péter Gaál, Semmelweis University, Hungary Unto Häkkinen, Centre for Health Economics at Stakes, Finland William Hsiao, Harvard University, United States Alan Krasnik, University of Copenhagen, Denmark Joseph Kutzin, World Health Organization Regional Office for Europe Soonman Kwon, Seoul National University, Korea John Lavis, McMaster University, Canada Vivien Lin, La Trobe University, Australia Greg Marchildon, University of Regina, Canada Alan Maynard, University of York, United Kingdom Nata Menabde, World Health Organization Regional Office for Europe Ellen Nolte, London School of Hygiene and Tropical Medicine, United Kingdom Charles Normand, University of Dublin, Ireland Robin Osborn, The Commonwealth Fund, United States Dominique Polton, National Health Insurance Fund for Salaried Staff (CNAMTS), France Sophia Schlette, Health Policy Monitor, Germany Igor Sheiman, Higher School of Economics, Russia Peter C. Smith, University of York, United Kingdom Wynand P.M.M. van de Ven, Erasmus University, The Netherlands Witold Zatonski, Marie Sklodowska-Curie Memorial Cancer Centre, Poland Health Systems in Transition Written by Luka Voncina, Andrija Stampar School of Public Health Nadia Jemiai, European Observatory on Health Systems and Policies Sherry Merkur, European Observatory on Health Systems and Policies Christina Golna, European Observatory on Health Systems and Policies Akiko Maeda, World Bank Shiyan Chao, World Bank Aleksandar Dzakula, Andrija Stampar School of Public Health Edited by Sherry Merkur, European Observatory on Health Systems and Policies Nadia Jemiai, European Observatory on Health Systems and Policies Elias Mossialos, European Observatory on Health Systems and Policies Croatia: Health System Review 2006 The European Observatory on Health Systems and Policies is a partnership between the World Health Organization Regional Office for Europe, the Governments of Belgium, Finland, Greece, Norway, Slovenia, Spain and Sweden, the Veneto Region of Italy, the European Investment Bank, the Open Society Institute, the World Bank, the London School of Economics and Political Science, and the London School of Hygiene & Tropical Medicine. Keywords: DELIVERY OF HEALTH CARE EVALUATION STUDIES FINANCING, HEALTH HEALTH CARE REFORM HEALTH SYSTEM PLANS – organization and administration CROATIA © World Health Organization 2006, on behalf of the European Observatory on Health Systems and Policies All rights reserved. The European Observatory on Health Systems and Policies welcomes requests for permission to reproduce or translate its publications, in part or in full. Please address requests about this to: Publications WHO Regional Office for Europe Scherfigsvej 8 DK-2100 Copenhagen Ø, Denmark Alternatively, complete an online request form for documentation, health information, or for permission to quote or translate, on the WHO/Europe web site at http://www.euro.who.int/PubRequest The views expressed by authors or editors do not necessarily represent the decisions or the stated policies of the European Observatory on Health Systems and Policies or any of its partners. 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The European Observatory on Health Systems and Policies does not warrant that the information contained in this publication is complete and correct and shall not be liable for any damages incurred as a result of its use. Printed and bound in the United Kingdom by TJ International, Padstow, Cornwall. Suggested citation: Voncina L, Jemiai N, Merkur S, Golna C, Maeda A, Chao S, Dzakula A. Croatia: Health system review. Health Systems in Transition, 2006; 8(7): 1–108. ISSN 1817-6127 Vol. 8 No. 7 Health systems in transition Croatia Contents Preface ............................................................................................................ v Acknowledgements ...................................................................................... vii List of abbreviations...................................................................................... ix List of tables and figures ............................................................................... xi Abstract ....................................................................................................... xiii Executive summary ...................................................................................... xv 1. Introduction and historical background ..................................................... 1 1.1 Introductory overview .................................................................... 1 1.2 Historical background .................................................................. 10 2. Organizational structure and management ............................................... 17 2.1 Organizational structure of the health care system ...................... 17 2.2 Planning, regulation and management ......................................... 20 2.3 Decentralization of the health care system .................................. 22 3. Health care financing and expenditure ..................................................... 23 3.1 Main system of financing and coverage ...................................... 23 3.2 Complementary sources of financing .......................................... 35 3.3 Health care expenditure ............................................................... 40 4. Health care delivery system ..................................................................... 43 4.1 Public health services .................................................................. 43 4.2 Primary health care ...................................................................... 59 4.3 Secondary and tertiary care ......................................................... 64 4.4 Social care .................................................................................... 66 4.5 Mental health ............................................................................... 71 4.6 Human resources and training ..................................................... 73 4.7 Pharmaceuticals ........................................................................... 75 4.8 Health technology assessment ..................................................... 80 iii Health systems in transition Croatia 5. Financial resource allocation ................................................................... 83 5.1 Third-party budget setting and resource allocation ..................... 83 5.2 Payment of secondary and tertiary care providers ....................... 85 5.3 Payment of primary care physicians ............................................ 87 6. Health care reforms .................................................................................. 89 6.1 Health care reform 2002 .............................................................. 89 6.2 2006 National strategy for the development of the health care system ........................................................................ 92 7. Conclusions .............................................................................................