European Health Systems
Case study – Croatia
After its turbulent history and independence in early 90s, Croatia has shown its efforts to become a part of the European family and finally joined the EU in the latest enlargement wave on 1st July 2013, becoming the 28th Member State. Five years later, in the series of European Health Systems workshops, the Young Gasteiners met in Zagreb ahead of the country´s first presidency of the Council of the European Union in the beginning of 2020.
Despite the crisis and major fiscal pressures on health expenditure, Croatia has kept publicly funded health services accessible to the entire population, and has made progress in recent years in improving the health status of its population. However, regardless of its accessibility and major medical successes (i.e. organ transplantation), the Croatian health system is currently facing many challenges, especially in the context of smoking, alcohol and obesity, structural issues related to centralization and geographical accessibility, corruption and financing, hospital accreditation and performance measurement, workforce and brain-drain.
From this outline, it is clear that there is a window of opportunity for a discussion in the framework of the Young Forum Gastein activities with the involvement of both Croatian and other European senior experts.
The first day was dedicated to an in-depth analysis of all of the components of a health system, with all the examples being taken from the Croatian health system, facilitated by two appointed lecturers from the European Observatory on Health Systems and Policies, Dr. Anne Spranger and Dr. Bernd Rechel. Croatian Deputy Minister of Health, Dr Mate Car, explained the main challenges detected within the scope of the national system, setting the scene for the interactive part of the workshop.
The Young Gasteiners then split into previously assigned groups and were expected to work on a specific challenge and come up with the tools and recommendations on how to approach it. Each group had a Croatian expert working closely on the topic who provided the background and additional context of the issues. The groups worked on two main topics; health workforce and hospital accreditation, management and performance.
The second day of the workshop was dedicated to the presentation of the group work to an audience of key Croatian stakeholders. An impressive range of policy makers, public health professionals, representatives of national health insurance, the pharmaceutical industry, academia and civil society were present to hear the Young Gasteiners’ ideas.
First, the two groups that had worked on the challenges in the health workforce presented their ideas. Interestingly, the two groups had come up with quite different solutions. The first group presented actions in planning, recruiting and retaining the future health workforce, based on the Framework for Remote Rural Workforce Stability. The second group focused on nurses, presenting a ten-step action plan to improve their status in the Croatian health care system, ending with the Yoda-esque wish ‘May the workforce be with you’.
Next, the two groups that had focused on hospital management came forward with their ideas. The first group started refreshingly by pointing out the things that Croatia does well. Topics that still need to be addressed are trust, vision, accountability and implementation, and the way to do this is to launch a governance framework for vertical collaboration and to ensure continuity of knowledge and expertise retention. The second group presented a three-tiered approach to improve quality and safety, performance monitoring and the use of patient experiences in hospital monitoring.
Both sets of presentations were followed by lively discussions between the Young Gasteiners and the experts. These discussions focussed both on the promisingness of some of the presented solutions as well as the barriers for implementing them, these barriers sometimes being typically Croatian, sometimes universal. How can we uncover and link data? How can we implement actions, what incentives are needed? How can we shift focus from ‘making yourself seem the best’ to actually improving quality? Who is responsible for making the necessary decisions?
This workshop has truly been a thrilling learning experience. The process of diving into a country’s health system and its challenges, coming up with solutions in a short time spam and presenting and discussing these with high-level experts provides an invaluable opportunity to refine skills necessary for our future as public health experts. This concept is unique of its kind, it breaks the silos and helps us better understand different organizations we work in and challenges we face in delivering health care. And hopefully, the diverse perspectives from our different countries and backgrounds gave the Croatian experts new ideas on how to tackle the challenges facing the health workforce and hospital management.
Finally, let us not forget the social part of our stay in Zagreb. Young Forum Gastein is above all a network, and the intervals of leisure time between the hard work is where true connections and friendships are formed and knowledge is shared. Thanks to our host, we also had the opportunity to enjoy a lovely dinner and the beautiful scenery of the city of Zagreb during the light festival season.
Many thanks to YFG, European Observatory on Health Systems and Policies and ‘Andrija Stampar’ School of Public Health for hosting this workshop. We hope the delivered ideas and solutions will be of use and have a positive impact on national health system. We look forward to our next meeting in another country!
Written by Lilian van der Ven and Franjo Caic