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Health insurance in Croatia: dynamics and politics of balancing revenues and expenditures.
Eur J Health Econ 2010; 11(2):227-33EJ

Abstract

Since 2002, the Croatian social health insurance system has undergone substantial reforms, initiated for the most part with the aim of addressing the perpetual financial deficits of the state health insurance fund. While the reforms focussed heavily on increasing the inflow of private funds into the health care system, underlying inefficiencies contributing significantly to poor financial performance have been largely ignored. Furthermore, contrary to demographic trends and developments in social health insurance schemes in other countries, funding health care became even more dependent on its main collection mechanism-payroll tax-and consequently on the employment ratio and wage level. Little effort has been made to diversify the revenue base or to increase the efficiency of revenue collection. Like other countries, Croatia is facing difficulties in adjusting its 'Bismarck' system to its changing demographic and socioeconomic context. Instead of targetting a comprehensive effort at improving revenue collection and limitating unnecessary expenditure and system inefficiencies, simplified approaches to balance the budget have been implemented at a high price to users and with limited effect. As a result, the Croatian health insurance system now offers a lower level of financial protection, while still facing the problem of spending more than can be collected through the current mix of revenue collection mechanisms. The authors suggest that, in order to meet the sustainability requirement of the health financing system, measures affecting both revenue and expenditure should be considered and implemented. On the revenue collection side, the Croatian government must make further efforts to improve collection from the informally employed to broaden the base of contributing members; equally important is the diversification of revenue sources by increasing transfers from general taxation revenues. On the expenditure side, exploring inefficiencies of the delivery system can be delayed no longer, and the introduction of effective cost-control mechanisms and financial discipline would seem to be unavoidable.

Authors+Show Affiliations

University of Maastricht, Maastricht, The Netherlands. lvoncina@gmail.comNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

19593629

Citation

Voncina, Luka, et al. "Health Insurance in Croatia: Dynamics and Politics of Balancing Revenues and Expenditures." The European Journal of Health Economics : HEPAC : Health Economics in Prevention and Care, vol. 11, no. 2, 2010, pp. 227-33.
Voncina L, Kehler J, Evetovits T, et al. Health insurance in Croatia: dynamics and politics of balancing revenues and expenditures. Eur J Health Econ. 2010;11(2):227-33.
Voncina, L., Kehler, J., Evetovits, T., & Bagat, M. (2010). Health insurance in Croatia: dynamics and politics of balancing revenues and expenditures. The European Journal of Health Economics : HEPAC : Health Economics in Prevention and Care, 11(2), pp. 227-33. doi:10.1007/s10198-009-0163-4.
Voncina L, et al. Health Insurance in Croatia: Dynamics and Politics of Balancing Revenues and Expenditures. Eur J Health Econ. 2010;11(2):227-33. PubMed PMID: 19593629.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Health insurance in Croatia: dynamics and politics of balancing revenues and expenditures. AU - Voncina,Luka, AU - Kehler,Jenni, AU - Evetovits,Tamas, AU - Bagat,Mario, Y1 - 2009/07/11/ PY - 2009/03/09/received PY - 2009/06/09/accepted PY - 2009/7/14/entrez PY - 2009/7/14/pubmed PY - 2010/8/31/medline SP - 227 EP - 33 JF - The European journal of health economics : HEPAC : health economics in prevention and care JO - Eur J Health Econ VL - 11 IS - 2 N2 - Since 2002, the Croatian social health insurance system has undergone substantial reforms, initiated for the most part with the aim of addressing the perpetual financial deficits of the state health insurance fund. While the reforms focussed heavily on increasing the inflow of private funds into the health care system, underlying inefficiencies contributing significantly to poor financial performance have been largely ignored. Furthermore, contrary to demographic trends and developments in social health insurance schemes in other countries, funding health care became even more dependent on its main collection mechanism-payroll tax-and consequently on the employment ratio and wage level. Little effort has been made to diversify the revenue base or to increase the efficiency of revenue collection. Like other countries, Croatia is facing difficulties in adjusting its 'Bismarck' system to its changing demographic and socioeconomic context. Instead of targetting a comprehensive effort at improving revenue collection and limitating unnecessary expenditure and system inefficiencies, simplified approaches to balance the budget have been implemented at a high price to users and with limited effect. As a result, the Croatian health insurance system now offers a lower level of financial protection, while still facing the problem of spending more than can be collected through the current mix of revenue collection mechanisms. The authors suggest that, in order to meet the sustainability requirement of the health financing system, measures affecting both revenue and expenditure should be considered and implemented. On the revenue collection side, the Croatian government must make further efforts to improve collection from the informally employed to broaden the base of contributing members; equally important is the diversification of revenue sources by increasing transfers from general taxation revenues. On the expenditure side, exploring inefficiencies of the delivery system can be delayed no longer, and the introduction of effective cost-control mechanisms and financial discipline would seem to be unavoidable. SN - 1618-7601 UR - https://www.unboundmedicine.com/medline/citation/19593629/Health_insurance_in_Croatia:_dynamics_and_politics_of_balancing_revenues_and_expenditures_ L2 - https://dx.doi.org/10.1007/s10198-009-0163-4 DB - PRIME DP - Unbound Medicine ER -