HZZO Absurdity, Again: Private Facilities Offer Patient Care, HZZO Says NO

Lauren Simmonds

December the 19th, 2020 – I think just about everyone has an HZZO story, and not a positive one. I myself have quite a few of them in which they sought documents that quite literally do not even exist before they’d agree to give me access to what my employer pays every single month and what I have a fundamental right to – basic healthcare. I know I’m far from the only one, and this article is, as such, unlikely to surprise anyone.

As Poslovni Dnevnik/Marija Crnjak writes, due to the influx of patients who couldn’t go to hospitals to have various tests done because of the ongoing pandemic, private polyclinics asked the Croatian Health Insurance Institute (HZZO) to contract a larger number of procedures for referrals multiple times throughout the year. HZZO said no.

HZZO refused them to perform this act of decency every single time, explaining that the request was unjustified precisely because the contracted capacities of public hospitals apparently remained unused, ie vacant. This primarily regards magnetic resonance imaging (MRI) and PET CT scans, the sort of examinations that are most often needed by cancer patients, and many of them cannot be delayed due to the nature of that disease.

Private institutions that provide some of the services at the expense of HZZO, such as the Medikol polyclinic and the Sveta Katarina Special Hospital, warned that the state hasn’t used the services of private health institutions in other segments during the pandemic, even though they’ve been offering such services readily since back in spring.

HZZO figures confirm that the pandemic has slowed down important diagnostics, but also that public hospitals, even without the presence of the novel coronavirus, have a generally weaker execution of contracted procedures than private ones do. Last year, hospitals performed 95 percent of their planned MRI procedures, and this year only 80 percent were performed, ie 110.3 thousand procedures instead of the contracted 136.5 thousand of them.

About a hundred fewer patients are being treated in hospitals per month than they were in the previous months, and almost 5,000 fewer bedridden patients were treated than last year, equal to about 12 percent less on a monthly basis. In the case of PET CT this year, the number of examinations at the University Hospital Centre Zagreb is similar to last year (3174), but last year and this year, about a third fewer procedures were performed than agreed.

In 2020, 4620 procedures were contracted at Rebro, and 3174 of them were performed. Back in pre-pandemic 2019, 29,516 magnetic resonance procedures were contracted in private polyclinics, and 25 percent more were performed.

For the same money, 30,208 procedures were contracted during the first 11 months of this year, and 15 percent more were performed. Polyclinic Medikol, the only private institution that performs PET CT, performed 99 percent of its contracted examinations last year, as was the case during the first 11 months of this year.

The Medikol Polyclinic has an agreed number of services with HZZO, which mostly involve radiological and nuclear diagnostics, at the level of 40 percent of the capacity utilisation that the polyclinic actually has at its disposal. During 2020, Medikol has repeatedly asked HZZO to increase its services at the expense of the Institute, and as stated, HZZO said no, despite the dire situation we’re all in.

”Unfortunately, HZZO keeps on giving us negative answers to all of our inquiries about the possibility of increasing this contractual limit, with the explanation that we’re not the only contracted health institution,” stated a rightfully annoyed Trstenjak Rajkovic of Medikol.

This year, the number of patients who paid for services themselves because they couldn’t have them performed normally in public health institutions increased, and due to the limited contracted number, they couldn’t provide the service based on a referral.

At the same time, due to the ongoing crisis, they had a large number of appointments. When it comes to PET/CT, they have a fixed contractual number of tests for a total of 7380 procedures per year, which is why a good part of oncology patients were literally forced to pay for this test out of their own pockets, and it costs about 10 thousand kuna. When it comes to MRI devices, about 10 thousand procedures are contracted per year.

As has since been found out, HZZO does indeed plan to extend the contract period, and after a comprehensive analysis of how things were executed this year, and in accordance with available funds, it will plan as well as possible. Medikol expects that the number of procedures will increase in 2021, because the pandemic hasn’t simply annulled the existence all other, often very serious diseases.

At Medikol, they believe that the low level of cooperation between public and private healthcare in Croatia is still a question of stigmatisation of the private sector. The director of the aforementioned polyclinic pointed out that in a situation where the public health system is overloaded, enviable human and material resources boasted private healthcare facilities remain unused.

HZZO confirmed that during the contracted period there were no changes in the contracts they hold with private facilities, meaning there were no changes in the scope of work despite the need for that obviously being stronger than ever before.

Jadranka Primorac, a member of the Management Board of the St. Catherine’s Special Hospital, pointed out that HZZO’s cooperation with private institutions could only represent savings for the state, and not an extra cost.

“By contracting with private institutions, the state pays only for the service, and we bear the costs of everything else, from the purchase and maintenance of equipment to staffing costs and all other costs. It’s clear to us that the pandemic, along with the reduction of economic activities and the consequent situation with the state budget, caused a loss of revenue and additional costs for public health, but additional contracting in the last quarter of 2020 wouldn’t be a major financial expense for HZZO and would significantly contribute to reducing waiting lists. Through the Croatian Employers’ Association, we offered cooperation to the Ministry of Health way back in March to help during the pandemic,” revealed Jadranka Primorac.

St. Catherine’s Hospital has contracted very little further capacity for radiological examinations with HZZO, which will only further increase the burden on the public healthcare system, especially in the future when even greater pressure is expected from patients who couldn’t get things done because of the virus.

“Our goal isn’t for HZZO to cover all services, but there’s room for expansion and I hope that it will be considered,” concluded Primorac.

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