| Abstract | Sustav zdravstvene zaštite u Hrvatskoj kroz proteklih dvadesetak godina prošao je brojne reforme kojima je temeljni cilj bio optimizirati razinu pružanja zdravstvenih usluga sa stvarnim financijskim mogućnostima hrvatskoga gospodarstva. Ciljevi reformskih zahvata samo su djelomično ostvareni, kako zbog nekonzistentnosti poduzetih mjera, tako i zbog objektivnih problema koji su se često nalazili izvan zdravstvenog sustava (npr. sve veći udio starijeg stanovništva), a uz to su stalno prisutni i problemi slabe interne učinkovitosti zdravstvenog sustava. U Republici Hrvatskoj na privatni zdravstveni sektor otpada otprilike 10% ukupne zdravstvene potrošnje te se razvoj ovog sektora tek očekuje. Za to je potrebna trajna i ciljano usmjerena podrška nadležnih institucija, posebice Ministarstva zdravlja, čiji je angažman potreban u uklanjanju niza problema kako bi došlo do integracije privatnog sektora u ukupni sektor javnog zdravstva. Jer, sustav zdravstvene zaštite mora biti efikasan i koliko je moguće pravičan i solidaran – to je zadatak javnog dijela sustava zdravstva dok istovremeno privatno zdravstvo mora doprinijeti dizanju efikasnosti zdravstvenog sustava i kvaliteti zdravstvene zaštite te racionalizaciji troškova. Republika Hrvatska, kao tranzicijska zemlja, treba sagledati dobre prakse onih koji su to ostvarili. Stoga su u ovoj doktorskoj disertaciji analizirani sustavi zdravstvene zaštite Slovenije, Austrije, Češke, Nizozemske, Velike Britanije, Švedske i Bugarske, sagledani pozitivni i negativni aspekti tih sustava te odnos javnog i privatnog zdravstvenog sektora.
Doktorska disertacija, analizirajući trendove i zdravstvene sustave u ovih sedam europskih zemalja kao i trenutno stanje u Hrvatskoj, predlaže odgovarajuće koncepcijske okvire i strateška rješenja za hrvatski sustav zdravstvene zaštite imajući u vidu aktualnu ekonomsku situaciju i članstvo Republike Hrvatske u EU. U disertaciji prijedlog modela suradnje javnog i privatnog sektora prikazan je u kontekstu deset strateških problema zdravstvenog sustava. Naime, potrebno je postaviti zdravstveni sustav koji će moći odgovoriti na troškovne pritiske kojeg donose demografske promjene i medicinsko-tehnološki napredak. Tako je u disertaciji, ispitana mogućnost uključenja privatne inicijative koja doprinosi racionalizaciji troškova zdravstvene zaštite i dugoročnoj financijskoj održivosti hrvatskog zdravstvenog sustava. Isto tako je pokazano da javno i privatno zdravstvo u Hrvatskoj čini cjelovit i učinkovit zdravstveni sustav, gdje veća privatna inicijativa doprinosi racionalizaciji troškova zdravstvene zaštite uz istovremeno osiguranje kvalitetne zdravstvene skrbi. U disertaciji su analizirani resursi kao i potencijali hrvatskog privatnog zdravstvenog sektora te trendovi na tržištu privatnih zdravstvenih usluga 2011.-2014. Empirijsko istraživanje pokazuje da su pacijenti, unatoč velikom opsegu prava iz obveznog zdravstvenog osiguranja, spremni na dodatno plaćanje za dobivanje brze, pravovremene i kvalitetne zdravstvene usluge. Isto tako su zadovoljniji dobivenim uslugama u privatnom sektoru, a najviše odlaze kod privatnika radi uštede vremena (manje čekanja, kako radi dolaska na red za uslugu tako i radi fleksibilnog radnog vremena i organizacije tj. naručivanja dolazaka).
Ulazak Hrvatske u Europsku uniju nosi sa sobom niz mogućnosti, ali nas suočava i sa nekim negativnim trendovima, kao što je migracija zdravstvenih radnika. Kroz partnerstvo privatnog i javnog sektora moguće je najracionalnije iskoristiti sve postojeće kadrovske resurse, ali i ući u održive investicije koje će unaprijediti kvalitetu zdravstvene skrbi za sve naše građane. U većini zemalja, suradnja s privatnim sektorom smatra se oblikom reformske mjere u zdravstvenim sustavima te novim mogućnostima da se prikupe dodatna financijska sredstva te poboljša produktivnost i upravljanje resursima. U Hrvatskoj, pak, na tu se suradnju gleda s još dosta sumnjičavosti i podozrenja. Postoje različiti modeli, odnosno oblici suradnje javnog i privatnog sektora na području zdravstva, ali sklapanje bilo koje vrste javno-privatnih partnerstava treba omogućiti pružanje kvalitetnijih zdravstvenih usluga, unaprijediti infrastrukturu te povećati mobilizaciju svih resursa u zdravstvu. Prijedloge za navedene inovacije u sustavu se predlaže u ovoj disertaciji. Razvoj javno-privatnih partnerstava u hrvatskome zdravstvenom sektoru (pogotovo vezano uz bolje korištenje viška zdravstvene infrastrukture te razvoj zdravstvenog turizma) jedno je od rješenja za osiguranje održivosti financiranja sustava javnog zdravstva, iako je praksa ovakve suradnje tek u svojim začecima.
Kako s aspekta održivosti financiranja, tako i s aspekta pružanja kvalitetnije zdravstvene zaštite, doktorska disertacija temeljem teorijskih i empirijskih istraživanja nudi koncepcijski okvir sinergije i komplementarnosti javnog i privatnog zdravstvenog sektora na svim razinama zdravstvene zaštite (od primarne do tercijarne kao i kroničnog liječenja). Kako u Hrvatskoj ne postoji jasno definiran odnos javnog i privatnog zdravstva kao ni dugoročna strategija njegova razvoja, ovo se područje mora i dalje sustavno analizirati, pratiti unapređivati, uzimajući u obzir da je u današnjim globaliziranim uvjetima djelovanja (gdje niti javni niti privatni sektor ne mogu pojedinačno ispuniti sve potrebe stanovništva) sinergijskim djelovanjem moguće razviti inovacije u sustavu zdravstva te povećati efikasnost i učinkovito alociranje svih resursa. Zbog svega navedenog, ova doktorska disertacija doprinos je daljem promišljanju i pronalaženju vrijednih i važnih rješenja na ovom području. |
| Abstract (english) | In the last 20 years the health care system in Croatia has gone through many reforms, whose main goal was to optimize the level of providing health care services within the realistic financial possibilities of Croatian economy. The goals of the reforms have been achieved only partially due to the inconsistency of measures that have been taken, as well as the objective difficulties which were often outside the health care system (e.g. the growing rate of elderly population), and the constant problem of poor internal efficiency of the health care system. In the Republic of Croatia the private health care sector amounts to around 10% of total health care exspenditure and the development of this sector is still to be expected. This requires constant and goal-oriented support of proper institutions, especially the Ministry of Health, whose involvement is necessary in the elimination of a number of problems in order to integrate the private sector into the overall public health care sector. This is because the health care system needs to be efficient and, as much as possible, just and solidary - which is the task of the public part of the health care system, while private health care needs to contribute to the improvement of efficiency of the health care system, the quality of health care and cost rationalization. As a transitional country, the Republic of Croatia needs to consider good practices in countries which have achieved that. That is why this dissertation analyzes health care systems in Slovenia, Austria, the Czech Republic, Holland, the United Kingdom, Sweden and Bulgaria, their positive and negative aspects, as well as the relationship between the public and private health care sectors. By analyzing trends and health care systems in those seven countries, as well as the current situation in the Republic of Croatia, this dissertation puts forward appropriate conceptual frameworks and strategic solutions for Croatian health care system, taking into consideration the current economic situation and Croatia's membership in the EU. The dissertation's suggested model for cooperation between the public and the private sector was presented in the context of ten strategic problems the health care system is facing. In other words, it is necessary to establish a health care system which can respond to cost-related pressure caused by demographic changes and the technological advancements in the field of medicine. That is why the dissertation deals with the possibility of including the private initiative, which contributes to the rationalization of health care costs and long-term financial sustainability of Croatian health care system. Furthermore, it demonstrates that both public and private health care in Croatia constitute an integral and efficient health care system, in which a larger private initiative contributes to the rationalization of health care costs and ensures a high-quality health care. The dissertation analyzes both the resources and the potentials of Croatian private health care sector, as well as the trends in the private health care services between 2011 and 2014. The empiric research demonstrates that, despite the large range of rights they are entitled to within the mandatory health insurance, patients are willing to pay extra and more in order to get a quick, timely and high-quality health care service. Furthermore, they are satisfied with services they have been provided within the private sector, and the main reason they use these services is to save time (shorter waiting time to get the service, flexible working hours and organization, i.e. making an appointment for the service).
Croatia's membership in the EU has offered a range of possibilities, but it has also faced us with certain negative trends, such as the migration of health care professionals. Through partnership between the private and the public sector it is possible to use all existing human resources in the most rational way, as well as to establish sustainable investments which are going to improve the quality of health care for all our citizens. In most countries the cooperation with the private sector is seen as a type of reformist measure in health care systems and as a new way to raise additional funding in order to improve productivity and the management of resources. However, in Croatia, this type of cooperation is still looked upon with a lot of distrustfulness and suspiciousness. There are different models, i.e. forms of cooperation between the public and the private health care sectors, but any type of partnership should improve the quality of health care services and the infrastructure, and utilize all resources in the health care system. Suggestions for these innovations to the system are put forward in this dissertation.The development of partnerships between the public and the private sector within Croatian health care system (especially regarding an improved use of surplus health care infrastructure and the development of health tourism) is one of the solutions how to maintain the sustainability of public health care funding, despite the fact that this kind of cooperation is in its early stage.
Regarding both the sustainability of funding and providing a higher quality of health care, based on theoretical and empiric research, this dissertation offers a conceptual framework of synergy and complementarity of public and private health care sectors on all levels of health care (from primary to tertiary, as well as treating chronic conditions). Since the relationship between the public and private health care sectors in Croatia and the long-term strategy of its development have not been clearly defined, this area needs to be systematically analyzed, monitored and improved, taking into consideration that in today's globalized conditions (where neither the private nor the public sector cannot meet all of the population's needs on their own) a synergy would enable the development of innovations in the health care system and improve the efficacy and effective allocation of all resources.For all of the above stated reasons, this dissertation is a contribution to further consideration, as well as finding valuable and important solutions in this area. |
