Croatian 2008-2010 health insurance reform: hard choices toward financial sustainability and efficiency

Over the past two decades, Croatian social health insurance system has undergone a number of reforms that were aimed at addressing the rising financial gap between the demand for health care and available public resources. The single most important observation regarding its development until 2008 is that, while attempting to provide quick fix solutions to worrying financial performance, the implemented reforms did not adequately take into account some of the root causes of the system’s sustainability issues, such as high public spending, a narrow base of financial contributors, generous benefits, and system inefficiencies that resulted in unnecessary expenditures and in low financial discipline. This text provides an overview of the segments of the reform of the Croatian social health insurance system that was implemented from 2008 to 2010 with two primary goals: financial stabilization and increasing system efficiency. These include changes introduced to the revenue collection mechanism, copayment levels, hospital and primary care payment models, introduction of a comprehensive primary health care information technology (IT) system, improved control of sick leave compensations, and advanced regulation of the pharmaceutical market. In order to properly review these measures, it is necessary to understand the context in which the social health insurance system existed until 2008.