- Funding Programme
- Year
- 2022
Enhancing the fiscal sustainability of the healthcare system in Croatia
The Ministry of Health of the Republic of Croatia initiated a comprehensive health care reform with the aim, among other things, of achieving long-term fiscal sustainability of the health care system. The European Commission provided support of this reform via the Technical Support Instrument. The expected outcome was to enhance the capacity of the Ministry of Health to effect improvements to the fiscal sustainability of hospital funding, as well as to strengthen the capacity the the Health Insurance Fund and hospitals to upgrade the DRG system.
Context
The Croatian healthcare system has been experiencing significant problems with its budget management, and since its stability is the prerequisite for the long-term sustainability of the modern welfare state, resolving this issue was highlighted within the Recommendations of the Council of the European Union for Croatia. As a result, the financial sustainability of the healthcare system has been defined as a general objective within the National Recovery and Resilience Plan (RRP), which is further reflected in the National Reform Program for 2022, and in the National Development Strategy until 2030.
Support delivered
The project spanned 24 months, while was implemented by Deloitte and its partners through the delivery of 2 components. Within the first component, the project analysed the revenue and expenditure sides of the national healthcare system, recommended the improvements of the budget accounting and financial reporting within the system, as well as proposed amendments to the legislative framework. At the end of the first component, the project provided training to strengthen the administrative capacity of healthcare institutions and the Ministry of Health. The second project component provided hands-on strategic consultancy to the HZZO regarding the improvement of the current version of DRG system, supported the procurement of a new version, assessed and made recommendations costing and practices, recommended steps for establishment of an effective Activity-Based Funding (ABF) system using DRG classifications etc. Also, a comprehensive training program was delivered on DRG operations for two different groups of hospital personnel: administrative staff (medical coders/billing personnel) and medical staff (physicians).
Results achieved
- Legislative framework improved - Amendments to legislative framework were elaborated upon following MOH request to comment on international practice on earmarked tobacco taxes, and recommendations related to expenditures monitoring for the very expensive drugs were accepted by the Ministry of Finance and included in the Rule Book on Budget Accounting and Chart of Accounts.
- An Action plan created for the Ministry of Health – An action plan for the implementation of recommendations for harmonizing the application of budget accounting in the healthcare system was created.
- An Action Plan developed for the reform of the hospital payment system and the transition to a new model – steps were recommended for gradual transition to the upgraded DRG system, including improvements of the existing system (accuracy of DRG data, methods of calculating costs and the setting of DRG prices that reflect real costs of production) and phased implementation of the newer version of DRG system.
- The DRG v11 system procured - Although the new version of the DRG system should have been procured before the start of this project, as part of component 2 of this project, hands-on support to the Health Insurance Fund was provided in the procurement process, as well as with the translation process to Croatian language.
- Administrative capacities and skills of MOH, HZZO & hospitals strengthened – 35 training sessions were held, attended by around 1600 representatives from various national health system institutions. Its primary goals were to enhance the administrative capacity, to raise awareness about the upcoming regulatory changes, improve the proficiency of staff involved in using the DRG system, as well as to prepare them to the changes with the implementation of the new DRG version. Surveys of training participants indicate that the training program successfully achieved its objectives.
Useful links
The official publications: press release of the Ministry of Health:
More about the project
You can read the documents related to the project here: