Search

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.

Tobacco use continues to be the leading global cause of preventable death. Most of these deaths occur in low and middle-income countries, and this trend is expected to widen further over the next several decades. The overall objective of the study is to describe and analyse the smoking behaviours of adults in Kosova.According to the STEPs methodology, 6,400 respondents, aged 15 - 64 years, are selected randomly within each sex and 10-year age-group. Out of 6,400 participants, 6,117 were selected, which is approximately 95.6%.The prevalence of smoking was higher among males (37.4%) compared with females (19.7%). In all age groups, the prevalence of smoking was higher among males compared with females. Regarding the age group of 15 - 24 years, the prevalence of smoking was 16.0%, but in the age group of 25 - 34 years, it nearly doubled to the rate of 31.9%. We have a smaller increase in the age group of 35 - 44 years, and after the age of 45, it falls gradually.The prevalence of smoking in Kosova is high compared with other countries in Eastern Europe. In future decades, Kosova will face a high probability of an increased burden of smoking-related diseases.Uživanje tobaka je še vedno eden izmed glavnih vzrokov smrti, ki bi jih lahko prepreĉili. Veĉina teh smrti se zgodi v državah z nižjim in srednjim prihodkom, po priĉakovanjih pa se bo ta trend v naslednjih nekaj desetletjih še povečal. Cilj te študije je opis in analiza kadilskega vedenja odraslih na Kosovu.Glede na metodologijo STEPS je bilo nakljuĉno izbranih 6.400 anketirancev obeh spolov, starih med 15 in 64 let; razdeljeni so bili v starostne skupine po10 let. Izmed 6.400 anketirancev jih je bilo v študijo vključenih 6.117, kar je približno 95,6%.Prevalenca kajenja je bila veĉja med odraslimi moškimi (37,4%) v primerjavi z ženskami (19,7%). V vseh starostnih skupinah je bila prevalenca kajenja višja med moškimi kot med ženskami. V starostni skupini med 15 in 24 let je bila prevalenca kajenja 16,9%, v starostni skupini med 25 in 34 let pa se je skoraj podvojila (31,9%). Prav tako je prisotno manjše povišanje v starostni skupini med 35 in 44 let, po 45. letu pa odstotek postopno pada.Prevalenca kajenja na Kosovu je v primerjavi z ostalimi državami v Vzhodni Evropi visoka.V prihodnosti se bo Kosovo sooĉalo z visoko verjetnostjo povišanega bremena zaradi bolezni, povezanih s kajenjem.

The aim of this study is to identify factors that influence the success of the implementation of the primary and secondary prevention programs in Croatia by the visiting/community services. Two main sources of information were used: reports about regular visiting nurse services in Croatia and research about visiting nurse participation in the Croatian Adult Health Cohort Study (CroHort) 2008. Out of the total number 9,070 respondents who participated in CAHS 2003 survey, during CroHort 2008 program 3,229 (35.6%) participants were re-interviewed. The qualitative analysis was done with a sample of 34 visiting nurses, which participated in the CroHort 2008. Results show that there are three key problems which limit preventive programs: inability of the health care system to recognize the importance of the primary prevention; visiting nurses' lack capacity to implement prevention and populations' lack of motivation and education.

Consumption of the pharmaceutical products for both human and veterinary use is constantly increasing. As the consequence considerable amount of pharmaceuticals and its metabolites is released into the environment at therapeutic concentrations. The aim of this article is to describe patient practice and knowledge of unused drugs disposal in some rural areas of Croatia. Results showed that mostly older population live in these areas with considerable co morbidity of various chronic diseases, using considerable number of pharmaceuticals. Educational level and therapy compliance is low, as well as knowledge on how to dispose unused pharmaceuticals. On the other hand, due to the relative geographical isolation there is tendency to stock various pharmaceuticals as well as self-medication. Unused drugs end up improperly disposed in the ecologically delicate environment rich in drinking water supply. Strong support from primary health care is needed as well from pharmacies for returning of unused pharmaceutical when possible or clear advice how to properly dispose them if they cannot be returned.

Cilj ovog rada je utvrditi opseg i sadržaj recenziranih znanstvenih publikacija koje donose rezultate istraživanja zdravstvenog sustava u Republici Hrvatskoj u razdoblju od 1990. do 2010. godine. Osnovne odrednice istraživanja usklađene su s metodologijom projektom Health Services Research into European Policy and Practice (HSREPP) koji se provodi s ciljem identifikacije, evaluacije i unaprjeđenja doprinosa istraživanja sustava zdravstva razvoju zdravstvene politike u Europi. Istraživanje u ovom radu obuhvaćalo je znanstvene publikacije indeksirane u bazi PubMed te magisterije i doktorske disertacije objavljenje na medicinskim fakultetima Sveučilišta u Zagrebu, Osijeku, Splitu i Rijeci. Navedenim metodama nađeno je ukupno 536 publikacija indeksiranih u PubMed-u i 22 doktorske disertacije te 70 magisterija koji udovoljavaju nekom od kriterija istraživanja. Za daljnju analizu zasebno su razmatrani magisteriji i doktorske disertacije, te znanstvene publikacije indeksirane na PubMed-u. Baza znanstvenih publikacija indeksiranih u PubMed-u sužena je uz pomoć ključnih riječi podijeljenih u 4 skupine prema uputama HSREPP. Zadane kriterije, nakon analize sažetaka, zadovoljilo je 158 radova. Nakon analize sadržaja sažetaka magisterija i doktorskih disertacija izdvojeno je 6 disertacija i 35 magisterija koji udovoljavaju kriterijima istraživanja. U svim objavljenim publikacijama nije moguće pronaći sustavnost istraživanja zdravstvenog sustava, međutim prepoznat je trend porasta broja radova koji se bave istraživanjima sustava zdravstva u Republici Hrvatskoj tijekom proteklih 20 godina., Aim: The aim of this study was to determine the scope and contents of peer-reviewed scientific publications that bring the results of the Health System Research (HSR) in the Republic of Croatia during the 1990-2010 period. The basic guidelines are in line with the research project, Health Services Research into European Policy and Practice (HSREPP). This project is being implemented with the aim of identifying, evaluating and improving the contribution of Health System Research to the development of Health Policy in Europe. This study included scientific publications indexed in the PubMed database and master theses and doctoral dissertations published at Schools of Medicine in Zagreb, Osijek, Rijeka and Split during the 1990-2010 period. In accordance with the project methodology, scientific publications indexed in PubMed (http://www.ncbi.nlm.nih.gov/pubmed) were searched for by the key words “Croatia AND (Health Care System OR Health System OR Healthcare System)”. Then, the database of scientific publications indexed in PubMed was narrowed by key words divided into 4 groups according to HSREPP instructions. The search for master theses and doctoral dissertations was carried out by direct inspection of the completed works in the library of Andrija Štampar School of Public Health, School of Medicine, University of Zagreb. Access to master theses and doctoral dissertations at the other three medical schools was done by the Internet. We analyzed the collected summaries of all publications, master theses and doctoral dissertations and excluded all those that did not correspond to our research. Results: Using this method, we found a total of 536 publications indexed in PubMed-in, 70 master theses and 22 doctoral dissertations meeting the study criteria. For further analysis, we separately considered master theses and doctoral dissertations on the one side, and scientific publications indexed in PubMed on the other side. All papers were listed by the year of publication, the author and the means of publication. Upon inclusion of the key words, 277 papers met the required criteria. After abstract analysis, 158 PubMed indexed papers were found to meet all the criteria and addressed the Health System Research in Croatia. There was a significant increase in the number of published papers during the 5-year study period. Upon analysis of the summary contents of master theses and doctoral dissertations, we separated 6 doctoral dissertations and 35 master theses that met the criteria of the research. They were divided into four groups: research of macro-, mezzo- and micro-level of Health System and assessment of Health Care System results. The group investigating the organization and delivery of health services (meso-level) and the group investigating health technology assessment (micro/meso-level) predominated. There were only a small number of high quality researches dealing with HSR in Croatia. Descriptive approach to the analysis predominated. Reform interventions require research, but are not part of the designed strategy. Funding of HSR is an important issue. The research in Croatia is financed by the Croatian Ministry of Science, Education and Sports. In the UK and the USA, HSR is funded by the National Health Services. In all publications, we could not find a systematic research of the Health System; however, we recognized a growing trend in the number of articles dealing with HSR in Croatia over the past 20 years. Comparison of the number of papers on the Health Care System in Croatia indicated a significant lag in comparison to Western Europe, and similarity with the countries of Eastern Europe.

Prikazane su najvažnije sastavnice programa „Rukovođenje i upravljanje za zdravlje“ kao važnog dijela u razvoju decentraliziranog modela planiranja za zdravlje u Republici Hrvatskoj. U radu je prikazana usporedba ishoda radionica provedenih za predstavnike županijskih timova za zdravlje u razdoblju od 2002. do 2008. godine. Usporedba matrice temeljnih funkcija između županija prvog i drugog vala nije pokazala statistički značajne razlike (P=0,183). Rezultati su ukazali na nisku stopu samostalnog korištenja materijala i spontanog učenja (bez organizirane edukacijske podrške). Zaključak je da decentralizirani model rukovođenja i upravljanja za zdravlje nije moguće razviti samom promjenom legislative. Nižoj razini upravljanja potrebna je edukacijska podrška koja će joj omogućiti usvajanje vještina oblikovanja javnozdravstvene politike., Aim: Based on the results of the first phase of the County Public Health Capacity Building Program named Health-Plan for It, implemented in the Republic of Croatia during the 2002-2008 period, this article analyzes the relationship between training of the county teams and their ability to develop health policy. Our hypothesis was that decentralized model of health planning and management would not occur just by changing legislation alone. Counties in Croatia needed educational support (learning-bydoing training) in order to improve public health practices at the county level. Sample and Methods: During the 2002-2005 period, the first 15 county teams (so-called first cycle counties) completed their training. The teams consisted of 12 to 15 members, representatives of political and executive component, technical component (public health professionals, representatives of health and social welfare institutions) and community members (non-government sector and media). Teams were trained in cohorts. Three counties passed together through the six-month process of modular training (four education modules, with four days of intensive training and “homework” between modules) at the time. The remaining 5 counties (second-cycle counties) completed the same kind of training in 2007-2008. The Public Health Performance Matrix (the Local Public Health Practice Performance Measures instrument developed by the US CDC Public Health Practice Program Office) was used as an evaluation instrument. Each county team had to fill it out at the beginning of education. Results: Comparison of the Public Health Performance Matrices of first cycle counties (training in 2002-2005) with those of the second cycle counties (trained several years later) yielded no differences. Although training materials were publicly available (accessible through the Croatian Healthy Cities web pages) for years, the second cycle counties did not spontaneously (without training) increase their county-level capacities for participative health needs assessment, health planning, and provision of health services tailored to the local needs. Conclusion: Results of this study showed that decentralized model of health planning and management in Croatia could not be developed without educational support given to the lower level of administration. Only through the training process (the Health-Plan for It County Public Health Capacity Building Program), county teams had managed to develop policy function and create County Health Profiles and Strategic Framework of the County Health Plan

This article provides a review of hazardous medical waste production and its management in Croatia. Even though Croatian regulations define all steps in the waste management chain, implementation of those steps is one of the country's greatest issues. Improper practice is evident from the point of waste production to final disposal. The biggest producers of hazardous medical waste are hospitals that do not implement existing legislation, due to the lack of education and funds. Information on quantities, type and flow of medical waste are inadequate, as is sanitary control. We propose an integrated approach to medical waste management based on a hierarchical structure from the point of generation to its disposal. Priority is given to the reduction of the amounts and potential for harm. Where this is not possible, management includes reduction by sorting and separating, pretreatment on site, safe transportation, final treatment and sanitary disposal. Preferred methods should be the least harmful for human health and the environment. Integrated medical waste management could greatly reduce quantities and consequently financial strains. Landfilling is the predominant route of disposal in Croatia, although the authors believe that incineration is the most appropriate method. In a country such as Croatia, a number of small incinerators would be the most economical solution.

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.

Medical waste management in Croatia is regulated by three fundamental legal acts: Waste Act, Ordinance on Waste Types and Directive on Manipulation of Waste Generated in Health Care. The implementation of these acts and waste management in general are also supported by Transport of Hazardous Materials Act and Toxic Substances Act. Modern trends in waste management promote an integral approach also called "waste chain". This integral approach to medical waste management is based on hierarchical structuring of waste management structure from the point at which the waste is produced to its final disposal. Priority is always given to reducing the amount and the harmfulness of waste by replacing harmful materials with those that are not, but where this is not possible, waste management includes reduction by sorting and separating, pretreatment on site, safe transportation, final treatment and sanitary disposal. Methods of choice for the final treatment should be the least harmful for human health and environment. Integral medical waste management could greatly reduce quantities of medical waste and consequently financial strains. Even though Croatian regulations define and cover all steps in the waste management chain their implementation is one of the country's greatest issues. Improper practice is seen from waste production in healthcare institutions to the final disposal, and includes handling, sorting, use of containers, or treatment in incinerators. Information on quantities, type and flow of medical waste are inadequate, just as sanitary control. In addition, Croatia lacks locations for sanitary landfills. Croatia has signed international conventions on the supervision and control of transfrontier waste shipments. Within the CARDS project, Croatia has started to harmonise its laws with acquis communitaire related to waste management. Although waste management is one of the priorities defined within the National Environment Action Plan, Croatia still has not made a strategy for waste management.

Background Human resources management in health often encounters problems related to workforce geographical distribution. The aim of this study was to investigate the internship workplace preferences of final-year medical students and the reasons associated with their choices. Method A total of 204 out of 240 final-year medical students at Zagreb University Medical School, Croatia, were surveyed a few months before graduation. We collected data on each student's background, workplace preference, academic performance and emigration preferences. Logistic regression was used to analyse the factors underlying internship workplace preference, classified into two categories: Zagreb versus other areas. Results Only 39 respondents (19.1%) wanted to obtain internships outside Zagreb, the Croatian capital. Gender and age were not significantly associated with internship workplace preference. A single predictor variable significantly contributed to the logistic regression model: students who believed they would not get the desired specialty more often chose Zagreb as a preferred internship workplace (odds ratio 0.32, 95% CI 0.12–0.86). Conclusion A strong preference for Zagreb as an internship workplace was recorded. Uncertainty about getting the desired specialty was associated with choosing Zagreb as a workplace, possibly due to more extensive and diverse job opportunities.

Decentralisation of the health system was applied in all transition countries in the 1990s.1-3 In most countries it was encouraged by the necessity to reform the inherited model of health organisation and to achieve the final goal—an efficient and fair health system. Croatia has special experience in decentralisation, primarily because of its geographical, political, and administrative circumstances but also because of its decentralised health system during the socialist regime in the 1980s.Decentralisation is always a challenge in any health system and is mostly looked at as a series of political and organisational measures. Unfortunately, the expectation that decentralisation will ensure successful professional activities is often overlooked in the analyses. Furthermore, the measures and the purpose of decentralisation are often not recognised as important elements of political culture. The primary purpose of decentralisation—health care based on the real priorities and resources—therefore remains marginal.

The aim of this article was to describe the method that Croatian cities have used in the development of the City Health Profile and City Health Plan. Selected as the most appropriate and applied was the Rapid Appraisal to Assess Community Health Needs. Three sources of information were used in this research: panelist essays reflecting local community views on health, problems and potentials of their city, observations about what is diminishing and what is giving beauty of living in their city and information derived from the existing written data sources. A free-text processing program analyzed essays. During the Consensus conference, based on presented data, participants had selected (Healthy City Project) priority areas. Between 1996 and 2002 The Rapid Appraisal was applied in six Croatian cities: Pula, Metković, Rijeka, Karlovac, Varazdin and Zagreb. By applying the method of Rapid Appraisal the cities assessed their health and health needs and created the City Health Profile. They selected their (Healthy City Project) priority areas, established the working groups on priority areas, and developed the City (action) Plan for Health. The method proved that communities have the capacity to recognize and deal with their health problems.