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Photograph: Freeimages.com/Jelle Boontje

The Croatian association of health system employers HUPUZ on Tuesday called on Prime Minister-Designate Tihomir Oreskovic to ensure financial stability for the health system but without cuts and privatisation of the public health system.

In an open letter to Oreskovic, HUPUZ recalls that Croatia invests around EUR 700 per capita in the health system annually, which is half the amount invested in Slovenia, five times less than in Austria and six times less than in Canada, while the quality and availability of health care is almost equal to health care in those countries.

The main problem of the national health system is the economy, with the number of workers being 289,000 below the EU average, which results in a deficit of around HRK 3.5 billion annually in the health system, says HUPUZ.

Such an economy, almost at the very bottom of the EU ranking, must not result in a deterioration of the health system as suggested by "some irresponsible economic analysts," say employers in the health system.

An unsuccessful experiment with cuts in the health system was attempted by the outgoing government, which reduced health contributions from 15% to 13% so as to unburden the economy, however, the result was an additional debt of HRK 2.4 billion that pushed the health system to the brink of collapse, with no positive effects for the economy, HUPUZ says.

The government then rectified its mistake by separating the health system from the state treasury and restored the health contribution rate to 15%, which clearly shows that economic recovery does not require cuts in the health system but other solutions, such as simplifying the process of starting a business, reviewing physical plans, introducing flat-rate taxes, reducing red tape, fighting corruption, etc, said HUPUZ.

HUPUZ is satisfied with initial announcements by the Bridge party and the Croatian Democratic Union (HDZ) party in that regard, and it supports decentralisation of the health system, keeping the current public health system, maintaining the social sensitivity and availability of the system to all citizens, streamlining hospital capacity, determining real prices of health services, reducing prices of drugs, and reviewing the list of medicines that are paid for by the Croatian Health Insurance Institute (HZZO).

The financial sustainability of the health system requires ensuring HRK 24 billion, which is the current amount ensured through health insurance contributions and existing legal solutions, by keeping the HZZO outside the state treasury and respecting legal guidelines that define obligations of the state budget towards the HZZO in the amount of HRK 4.8 billion.

A successful and sustainable health system requires greater autonomy of health institutions, determining real prices of medical services, and ensuring better access to the labour market by liberalising the employment process in the health sector, HUPUZ says, calling also for the continuation of the reform of primary health care system by keeping community health centres in charge of primary health care and as the coordinators of mobile teams and concession-holders operating as part of those centres. It also calls for the functional integration of hospitals.

HUPUZ says the emigration of medical workers should be stopped by introducing a system of financial bonuses and making the wage system much more flexible.

HUPUZ is strongly against the privatisation of the current health system because it believes that it would mean the end of the health system which citizens have had for centuries and which they want. It says this does not mean that it advocates an exclusively public health system but stresses that the Croatian health system is a complementary system of private and public medical care provided under the same conditions.

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