Postwelfare Indicators and Health Reform in Croatia

Reforme zdravstva u Europi po prvi puta u povijesti vrše se prema određenom stupnju standardiziranih kriterija. Prateći integracijske procese potaknute od strane EU Regionalni ured WHO započeo je intenzivnu interdisciplinarnu znanstvenu i tehničku aktivnost koja podupire stvaranje novih sustava zdravstva. Istovremeno u Hrvatskoj je, u veoma teškim, gotovo nemogućim okolnostima, otpočeta reforma zdravstva. Kako teče integracijski proces sustava zdravstva u Hrvatskoj prema Europskim sustavima i zemljama OECD? Radeći na projektu „Komparativno istraživanje zdravstvenih sustava u Europi i Hrvatskoj“ analizom teorijskih sustava došli smo do postwelfare indikatora značajnih za organizaciju sustava zdravstva: tip organizacije zdravstva, vlasništvo, mehanizmi kontrole i plaćanja. Kriteriji za evaluaciju tih elemenata su: accessibility (pristupačnost), acceptability (prihvatljivost), affordability (upotrebljivost) i equity (jednakost). Kombiniranjem općih i specifičnih postwelfare indikatora dobili smo uvid u sedam bazičnih elemenata pomoću kojih se vrši evaluacija kvalitete zdravstvenih sustava: cost-containment, javno mnijenje o zdravstvenom sustavu, decentralizacija, uloga tržišta, kvaliteta usluga, tip zdravstvenog osiguranja. Metodologija istraživanja zasnivala se na sva tri tipa bihevioral-nih istraživanja zdravstvenih procesa (individualna, agregatna, višeslojna). Kao referentni okvir ciljeva koje treba postići reformom zdravstva koristili smo: ciljeve „Zdravlje za sve do godine 2000“ određene od strane WHO, pokazatelje OECD-a i zdravstvene indikatore objavljene od strane Svjetske banke.Health systems reforms in Europe for the first time in history are faced with the standardization according to the common criteria. Following the integration processes initiated by the European Union (EU), the World Health Organization, Regional Office for Europe (WHO/EURO) started an intensive interdisciplinary technical and scientific activity to enable designing the new health care systems. In the same time, in the very hard circumstances, started health care reform in Croatia. What is happening with the integration processes between the health system in Croatia and the health systems in Europe according the criteria, standards and experience of other countries which was verified by the EU? By the analysis of theoretic systems, the elements were found for system analysis. These general postwelfare indicators are: health system organization (the type of delivering services), ownership (system control), mechanisms for financing and payment of health services. There are three basic theoretic health models: national health services, social (compulsory health) insurance, and private health system. The criteria for evaluation (measurement) of effects of various systems are: accessibility, acceptability, affordability and equality. The aim of this research is to get insight into seven basic components of health system reform Croatia and Europe according to scientific indicators. These components are: cost-containment, public expectations, decentralization, market mechanisms, quality, assurance, vocational training for health manpower in new work conditions. This methodology uses all the three approaches used in behaviouristic researches of health processes (individual, aggregate, cross-level approach). This article which is “work in progress” presents some results of the third stage of project “Comparative study of health care systems in Europe and in Croatia” (5.06-198) answering the question how Croatian health care reform fulfill the following criteria: legitimacy, knowledge and technology, quality and optimum of economic rationality. In analyzing and evaluating the reform processes we are general health indicators (such as targets of the ‘Health for All by the Year 2000’ WHO strategy, OECD health data, The World Bank Health Indicators Report from the year 1993)