As Novac/Frenki Lausic writes on the 4th of May, 2019, across 59 hospitals in Croatia, a total of 41,692 workers are employed, out of a total of 65,000 employees in the health care system, and the share of health workers in the total number of hospitals ranges from 70.1 percent in the Lovran Orthopedic Clinic, to 81.2 percent at the Clinical Hospital Centre in Zagreb.
From this data, it could easily be concluded that the hospital in Lovran operates poorly, as it has a large number of administrative staff who aren’t directly involved in the care of patients, while KBC Zagreb is best placed financially because it has the least employees in administration. The reality is exactly the opposite: Lovran is the best Croatian medical institution financially, making it one of the ten major state hospitals operating without any losses, while KBC Zagreb has the biggest losses, the most obligations, and the most outstanding unpaid obligations.
However, data on the positive financial performance of hospitals may be correlated with the fact that the largest share of beds (in total capacity) is boasted by the clinic in Lovran, 82.61 percent, while OB Varaždin, one of the general hospitals with the worst business indicators, has the largest number of beds for long-term and chronic treatment, as well as palliative care (511 beds, or 49.18 percent of the total bed capacity of the hospital) due to the merging of the Novi Marof Hospital for Chronic Disease and the Hospital for Lung Diseases, and TBC Klenovnik OB Varaždin.
Therefore, the status and causes of success and failure in Croatia’s hospitals need not be judged at first impression because each hospital is a special case for itself and requires a deeper analysis. However, there are also common denominators when it comes to the ”bad” side of the Croatian hospital system, ranging from poor financial results, some bad patient outcomes, long waiting lists, and some institutions with literally horrible sanitation facilities.
In response to a survey conducted by Maja Vehovec, Ivana Rašić Bakarić and Sunčana Slijepčević, researchers from the Economics Institute back in 2012, which included one director of the Clinical Hospital Centre, three directors of general hospitals and two directors of special hospitals and representatives of the association of employers in the health system, it can be seen that when finances are in question, “the root cause of the problem with not paying costs is seen by directors as a continuous imbalance between the revenue received and the expense accounted for.”
The basic part of the hospital’s income is, in fact, the income that the hospital receives from HZZO, which are presented as the so-called “limits”, ie, the annual budget funding which was introduced back in 1997.
For this reason, the authors point out that the limits to be allocated to hospitals should be based on objective indicators such as the number and types of surgeries, the number and type of outpatient examinations and the like, ie, the costs of each activity. The second management model in this part, based on the payment of the services provided, began being implemented back in 2015, at the time when Croatia was ruled by an SDP government, but such a practice was later stopped by the HDZ government, which returned the “limits” method the following year.
The Croatian Government and the Ministry of Health have decided to ”repair” the situation this year by increasing their contributions to the healthcare system from 15 to 16.5 percent.
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Click here for the original article by Frenki Lausic for Novac/Jutarnji
