Jutarnji brings the lists of understaffed and overstaffed medical centres in Zagreb.
While some Zagreb outpatient clinics are crowded, 65 out of 590 clinics do not meet the 1,275 patient minimum that they should be in charge of, Jutarnji reports on August 23, 2017. One clinic has only 88 patients. It comes as no surprise, then, that concessions granted to outpatient clinic doctors in Zagreb in May are the reason for the dispute between the city authorities and the concessionaires who seek liberalization, i.e. the possibility that all doctors who want a concession can get so that all patients and doctors are equally distributed across medical centres.
That is why they have repeatedly requested a meeting with the Mayor, but to no avail. They have also insisted that the new health care law abolish health care obligations, which dictate that up to 70 percent of primary health care centres can be granted a concession. Namely, they say that everyone who wants to get a concession should be able to do so, because, as they say, doctors will do their jobs better and the network will be better – in the current clinic model in Zagreb, there are clinics with fewer than 200 patients In some parts of the city, while others lack medical teams. A tender for 63 teams has been announced in Zagreb. Doctors claim that there should be 200 teams, but not in all neighbourhoods, because there are surpluses in some.
“The number of concessionaires keeps decreasing, and the number of doctors who are employed in health care centres keeps increasing because, after their colleagues retire, there is no concession, so the office remains part of the health centre,” explains Dr Josipa Rodić, president of the HUKPZZ (Croatian Primary Health Care Concessionaire Association). She adds that according to HZZO’s network of outpatient clinics there are 71 teams missing in Zagreb, namely in Brezovica and Peščenica, one in Vrapče, six in Novi Zagreb, five in Podsljeme, 11 in Donja and Gornja Dubrava, four in Maksimir, 11 in Sesvete, 16 in Stenjevac and 12 in Trešnjevka. Doctors say that, at the same time, there is a surplus of teams in the city centre that not only don’t have enough patients, but their numbers don’t even reach the minimum of 1,275 patients (65 clinics).
“By analysing the teams in different neighbourhoods, we can see that only 20 medical teams are needed in Zagreb Centar, but there are 77, which represents a surplus of 57. The situation is similar in Trnje, where there are 32 instead of 23 teams. In Trešnjevka North neighbourhood, 41 teams have been contracted and 37 are needed, which means that, although some parts of the network are not filled, others have a surplus,” says Dr Rodić. She adds that teams are sometimes in charge of a small number of patients, ranging from only 85 or 142 to 198 or 600, so lower than the minimum of 1,275 patients.
Dr Rodić says that an additional factor was introduced in the Zagreb tender, which was not a deciding factor in earlier concession tender – doctors who work at medical centres and want to bid for the concession tender should get the Management Board’s approval in the Medical centre they work at. This means that no physician working in a medical centre where 30 percent doctors come from their own employees will receive approval from the Management Board, says Dr Rodić.
Moreover, the percentage sometimes does not apply to the entire medical centre, but to a particular neighbourhood, which limits doctors’ abilities to participate in the tender. At the same time, it is possible that some clinics within a single medical centre get only a hundred patients, and the director can’t relocate doctors from the overstaffed to the understaffed clinics. An even more absurd thing is that doctors working in overstaffed and understaffed clinics will have the same paycheck, while dealing with a vastly different number of patients.
Samobor clinic has the lowest number of patients
The first ten medical centres in Zagreb where the number of patients is below the minimum 1,275.
Novi Zagreb East 148
Dugo Selo 198
Novi Zagreb 712
Novi Zagreb 763
Neighbourhoods with too many family medicine teams
– Zagreb center requires 20, has 77 (surplus: 57)
– Trnje requires 23, has 32 (surplus: 9)
– Trešnjevka north requires 37, has 41 (surplus: 4)
A total of 65 teams have fewer than the minimum of 1,275 patients
Neighbourhoods with too few family medicine teams
– Brezovica, Peščenica and Vrapča lack one
– Novi Zagreb: 6
– Podsljeme: 5
– Donja and Gornja Dubrava: 14
– Maksimir: 4
– Sesvete: 11
– Stenjevec: 16
– Tresnjevka: 12
A total of 71 teams is needed in various parts of Zagreb.
Zagreb Medical Centre “Centar” director Dr Antonija Balenović says that some of the clinics have fewer patients because some doctors work part-time, and some of them work in retirement homes. She points out that the Ministry of Health determines what the network will look like based on places of residence, and citizens have the right to choose their doctor wherever they want. As of recently, people have started choosing their doctors based on the location of their workplace, which is also one of the reasons there’s a discrepancy between the official records and real life.
The new Health Insurance Act will have to deal with this disproportion, i.e. paying a lot for nothing in primary health care, leaving medical centre directors helpless. In 2016, HRK 3,075 billion was spent on primary health care, including HRK 3.2 billion in costs for medicines prescribed by family doctors. Spending funds in a more logical manner would undoubtedly increase health care quality for citizens, especially if making it cheaper is not an option.
Translated from Jutarnji list.