Health reforms in Croatia unlikely to address glaring gaps in coverage and staff shortages: Peoples Dispatch

Doctors demonstrate in Zagreb on March 18. Photo: Photo Maja Sever/Syndicate of Croatian Journalists;

The latest round of health law reforms proposed by Croatian Minister Vili Beroš have been widely criticized, with health workers warning they will do nothing to reduce labor shortages and burnout in workers or to improve access to care.

The ministry has proposed transferring ownership of general hospitals from local authorities to state authorities, increasing the level of centralization of primary health care and reorganizing emergency services, among others.

It seems likely that the proposals will be part of a very long line of so-called health system reforms dating back to the early 1990s, which moved the system towards a financialized and commercialized vision. In the early stages of this process, patients retained access to a basic level of care thanks to the remnants of the Yugoslav health infrastructure. However, the cracks caused by decades of underfunding and mismanagement have begun to widen in previous years, leading to gross violations of people’s right to health.

After the death of journalist Vladimir Matijanić in the summer of 2022, the Association of Croatian Journalists and the Syndicate of Croatian Journalists organized a series of protests warning about the state of the healthcare system. Then, in February this year, lawyer Lina Budak, known for her work on press freedom lawsuits, recounted her own experience with breast cancer. Budak was misinformed of her diagnosis for seven months, jeopardizing her chances of treatment and recovery.

Read | What a journalist’s death from COVID-19 says about the Croatian health system

Matijanić’s death and Budak’s case are strongly linked to the general weakness of the health system. Their experiences resonated because they are public figures, but it is certain that there are hundreds of people in the same situation right now, without access to resources to defend themselves and without life-saving therapy.

Not a reform

The changes announced by Beroš should not improve the situation. While the minister insists on presenting the plan as a path to a stronger health care system, in practice it is just an attempt to mask problems that have persisted for years: an allocation of funds greater than the average for the purchase of pharmaceuticals, long waiting lists and ineffective public health programs, among others. Nor do the ministry’s plans give more meaningful signals about increases in the health budget, or even the reallocation of available financial resources to strengthen primary health care and preventive services.

Another serious problem with the minister’s plans is that they do not concretely address the acute health workforce crisis in Croatia. During the preparation of the parliamentary presentation on the health legislation, the deputies of the green party Možemo! and their coalition partner Nova ljevica have warned that up to 36% of doctors in the primary health care system will reach retirement age in the next five years. Because of this, the system will face almost 800 vacancies among family doctors alone – and only 290 doctors currently specialize in this branch of health care.

Even today, access to primary health care is extremely limited in some regions, particularly on islands and in remote areas. Because the organization of this level of care is formally decentralized, economically disadvantaged areas generally cannot offer adequate measures, such as preschool services or social housing, to retain young health workers in their health centres.

Salaries for health workers in primary health care, especially in state-run community health centers, are also low compared to the real cost of living. In the Rijeka region, a section of primary health care nurses with about 30 years of experience earn a net salary of less than 950 euros (1,010 USD). This is lower than the 2022 global net average of 1,025 euros (1,090 USD), and even far from the 1,370 euros (1,455 USD) union income calculated as necessary to achieve a decent standard of living in 2021.

The crisis spreads to doctors

While the earnings of healthcare workers in the public healthcare system have generally been lower than they should be, physicians would have enjoyed a somewhat better position relative to others. Yet recently, even some of the nation’s largest hospitals have struggled with doctors leaving for other jobs. Zagreb University Hospital, the country’s largest hospital, has reportedly faced an internal exodus of mid-career experts, starting with radiologists and internal medicine specialists. Doctors either left to work in the private sector, with less overtime and likely better pay, or to work from home as contractors for healthcare facilities in other EU countries.

This caused additional problems in the treatment of patients and the implementation of procedures, as unions and professional associations had reported for years. Seemingly reaching breaking point, several medical associations have recently stepped up to try to shape better working conditions. Doctors took to the streets on March 18, demanding among other things a separate collective agreement for their profession and a reform of the specialization system.

Thousands of people took part in the demonstration, with a particularly large number coming from the ranks of young doctors and medical students. Marin Smilović, the young doctors’ representative on the protest’s organizing committee, said during his speech: “Young doctors have been silent for too long. We took care of all the extra work, all the extra hours, all the extra responsibilities. Now the time has come to say enough.

According to Laura Mayer, a medical student who participated in the protest, most Croatian students were eager to join the protest because they are worried about the healthcare system they will be working in in a few years. “The current system is not set up to work for patients or health workers. We need a stronger primary health care system and better working conditions to stop so many people leaving right after college,” she told the People’s Health Dispatch.

People’s Health Dispatch is a bimonthly newsletter published by the People’s Health Movement and Peoples Dispatch. For more articles and to subscribe to People’s Health Dispatch, click here

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