Health care issues in Croatian elections 2005-2009: series of public opinion surveys

There are various predictors of citizens’ satisfaction with health care system, but there are two main political factors: patient participation and institutional influence of their representative organizations, and political party affiliations (1-4). Some authors concluded that socio-demographic characteristics were only a minor predictor of satisfaction with health care system, but older age appeared to be one of the most consistent positive determinants of health care satisfaction (5-13). Women were found to be less satisfied with care than men because they were more frequent users of care and had higher expectations (14,15). Studies in post-communist states provide mixed evidence in this regard. In a 1991 cross-country survey study, most of the respondents believed that, while the market system was essential to economic development, policies that promoted social and economic egalitarianism were important (16). They also found that women, those with lower educational level, and those with lower income were more likely to be supportive of socialist principles. On the other hand, a study conducted in 1999 showed a change in value systems, with a majority of respondents from Poland and Hungary not favoring further redistribution of income, even at the expense of welfare (17). Furthermore, there was a positive correlation between education and positive attitude to health care competition. Still, in Hungary the older generations were predominantly against increases in health care competition. Since the early 1990s, the public level of satisfaction with the health care system reforms in Croatia has not matched the apparent success of the reform goals. A 1994 consumer survey found that a vast majority of lower- and middle-income Croats was skeptical of health care reforms (18). They attributed this to the legacy of universal access to health care, the view of health care access as a universal right, negative consequences on the patients, and lack of public understanding of the reforms. The same study (18) found the distribution of out-of-pocket payments and co-payment for health care to represent a regressive burden on those in the lower income group. Patient satisfaction was also low: 44% were dissatisfied with the quality of health facilities and 48% with the equipment (18). Similar face-to-face interviews found that citizens of Croatia did not hold a positive view of the health insurance reform (19). Their primary concern were limitations of their rights and the increase in the financial burden related to medical care. A 2005 survey found that during the presidential election campaign period health care was the second most important issue on the voters’ minds, closely following economy (20). Finally, a national survey on patients’ satisfaction with hospital and primary health care in 2006 showed considerable concerns with relations between patients and medical professionals, hospital accommodation, communication between primary and secondary health care, and corruption (21,22). In this study, we present and compare the results of a series of public opinions surveys conducted between 2005 and 2009. This is the first study that targeted public experiences and voters’ opinion as an evaluation of the health care sector in Croatia.