Thank you Neil for opening the door for our further discussion regarding national commitment of increasing quality of care. In Croatia, the in-depth analyses (like I have noted previously) have been continuously prompted by the European Commission and European Observatory on Health Systems and Policies, and they actually do draw on a range of stakeholders. In short, they have shown that the geographical distribution of health care infrastructure and human resources is uneven in the country, with the largest number of hospitals and health workers located in central Croatia (mainly in Zagreb). This is also accompanied with a shortage of physicians and nurses (due to 'brain drain' and other reasons), most notably in rural areas and the country's islands, as well as an oversupply of some other types of health professionals (i.e., there is an evident lack of balance).
This is why in recent years Croatia has started to address these issues head on by increasing motivation and enrolment quotas to health-related disciplines (primarily medicine and nursing), as well as providing salary increases. The government has also adopted the Strategic Plan for Human Resources in Healthcare with the aim to establish a human resources management system. There was also an implementation of case-based provider payment reforms in hospitals, initially starting with broad-based categories according to treatment procedures.
And indeed, one of the principal points for health reforms in Croatia has been the hospital sector, with several efforts to improve the strategic planning of hospital infrastructure and the overall efficiency of the hospital sector. Nonetheless, the results have thus far been mixed, with progress made on a new provider (DRG) payment system, but inadequate implementation of hospital reorganisation plans and continued accumulation of debts. Now, the problem is further compounded with the ongoing COVID-19 pandemic and some reforms have stopped, but there is definitely a need for further in-depth analyses that will inform subsequent steps in quality of care improvement efforts on the country level.
HIFA profile: Tomislav Mestrovic is a medical doctor and a clinical microbiologist with a PhD in biomedical sciences, and an Assistant Professor at Croatia's youngest public university, University North. He is also passionately invested in global health communication, health literacy, science journalism and science diplomacy. Tomislav was appointed by the Ministry of Science and Education of the Republic of Croatia as a Managing Committee Member to COST Action on evidence-based medicine run by the European Union. He holds several positions in international societies that resulted in many volunteering initiatives. Tomislav is the current holder of the HIFA Country Representative of the Year award (2020) and is also the European coordinator for HIFA Country Representatives. He is also a member of the HIFA-WHO working group on Learning for quality health services.
tomislav.mestrovic AT gmail.com