Is Croatian Healthcare System Ready To Perform In The Market Conditions Prevailing In The European Union?

As Croatia is nearing its accession to the EU, it is facing a process of implementation of a number of newly introduced legal frameworks which also act to enable access to new market opportunities for certain industries. The most important Directive concerning healthcare providers is Directive 2011/24 on cross-border healthcare, which grants the patients freedom of choice of providers in another EU member state given that the necessary standards of quality and safety are met. A member state is entitled to restrict rights and set rules for reimbursement of the costs of cross-border healthcare with the aim of protecting its own health system. Similarly, prior authorisation by the patient’s insurer is a precondition for reimbursement of costs of certain procedures across the border. We can observe a successful model of cross-border healthcare in Euregio Meuse-Rhine (Belgium, the Netherlands, Germany), which has been active since 1992 and has demonstrated that borders are not obstacles to successful organization of medical experts, hospital and pharmaceutical systems, insurers, patients, local administrative offices, universities and information systems. There is strong emphasis on the need to implement and monitor equal quality standards in all EU member states. For the very purposes of monitoring the effective levels of patient protection, healthcare systems in 34 European countries have undergone assessment. Croatia ranked 17th in regard to 42 indicators of quality (ECHI) in 2012. In the previous year, the level of satisfaction of healthcare consumers with the public health system was monitored by the Croatian Institute for Health Insurance (CIHI), while this year the author conducted a research in patient satisfaction which also included attitudes toward private healthcare. The results of the two researches are in parts almost identical, defining the crucial issues of the Croatian healthcare system: long waiting lists, shortage of finance and corruption. The research, which was conducted by the author and included 386 respondents from several Croatian health institutions, showed that the health insurance system needs to be reformed with the emphasis on the promotion of competitiveness (abolishing CIHI’s monopolistic position and introducing new privately owned insurers) as well as freedom to choose a provider according to service quality and regardless of the ownership (thus supporting privately held providers in their capacity as a welcome competition to the state-owned ones). Croatian legislation will be subject to amendments in order to accommodate and implement this Directive. The amendments should be completed by October this year when the Directive is scheduled to come into eff ect. Privately held health institutions are undoubtedly prepared for the EU market when it comes to the level of safety and quality of the services rendered, but in order to capacitate cross-border health services provided in Croatia and turn them into regular business, support from the national system is also needed. Due to the problems noted in the Croatian national health system, public health institutions shall require substantial financial means and a significant period of time to adopt standards required by the Directive on cross-border healthcare, so it is reasonable to expect that state institutions will recognize the importance of including private healthcare providers in this important new segment of the medical market which will open up with the accession to the EU.