[The influence of the economic recession on health care labor market in Croatia]. / Utjecaj ekonomske recesije na trziste rada sustava zdravstva u Hrvatskoj.

Trends in the labor market, as a result of global economic recession, are characterized by reduction of manpower activity, decreased number of employed and increased number of unemployed persons. As the result of economic recession more then million workplaces are expected to be lost in the European Union. The aim of this study was to analyze the influence of economic recession on labor market in general and healthcare labor market in Croatia. In Q1/2009, the number of employed persons in the European Union declined by -1.2% compared to the same quarter of 2008, while in Croatia the number of employed persons declined by -0.4%. The comparison of quarterly employment rate in Croatia and the European Union in the period from Q2/2008 to Q1/2009 was not significantly different (p = 0.169, df = 6, t = 1.564, Student t test). Average unemployment rate in Q1/2009 in the European Union was 8.1% +/- 0.3 and it was increased by 9.4% compared to Q4/2008, while in Croatia the average unemployment rate in Q1/2009 was 8.4% +/- 0.1 and it was increased by 3.3% compared to Q4/2008. Monthly changes of unemployment rates compared between the European Union and Croatia in the six month period (Q4/2008 and Q1/2009) was significantly different (p = 0.001, df = 10, t = 4.425, Student t test). In Croatian health care system in Q1/2009 the number of employed person increased by 0.7% compared to Q1/2008, while the number of unemployed persons in the same period was reduced by -1.0%. Trends in the labor market in Croatia follow the global trends in the labor market in times of economic recession, although the increase in unemployment in Croatia was slower than in the countries of the European Union. As a result of Croatian healthcare system organization, system of financing, supply and demand on healthcare labor market, healthcare workforce in Croatia was less affected by recession than workforce in Croatia in general.

Health insurance in Croatia: dynamics and politics of balancing revenues and expenditures.

Since 2002, the Croatian social health insurance system has undergone substantial reforms, initiated for the most part with the aim of addressing the perpetual financial deficits of the state health insurance fund. While the reforms focussed heavily on increasing the inflow of private funds into the health care system, underlying inefficiencies contributing significantly to poor financial performance have been largely ignored. Furthermore, contrary to demographic trends and developments in social health insurance schemes in other countries, funding health care became even more dependent on its main collection mechanism-payroll tax-and consequently on the employment ratio and wage level. Little effort has been made to diversify the revenue base or to increase the efficiency of revenue collection. Like other countries, Croatia is facing difficulties in adjusting its 'Bismarck' system to its changing demographic and socioeconomic context. Instead of targetting a comprehensive effort at improving revenue collection and limitating unnecessary expenditure and system inefficiencies, simplified approaches to balance the budget have been implemented at a high price to users and with limited effect. As a result, the Croatian health insurance system now offers a lower level of financial protection, while still facing the problem of spending more than can be collected through the current mix of revenue collection mechanisms. The authors suggest that, in order to meet the sustainability requirement of the health financing system, measures affecting both revenue and expenditure should be considered and implemented. On the revenue collection side, the Croatian government must make further efforts to improve collection from the informally employed to broaden the base of contributing members; equally important is the diversification of revenue sources by increasing transfers from general taxation revenues. On the expenditure side, exploring inefficiencies of the delivery system can be delayed no longer, and the introduction of effective cost-control mechanisms and financial discipline would seem to be unavoidable.

[Regional distribution of physicians in Croatia]. / Regionalna raspodjela lijecnika u hrvatskoj.

The aim of this study was to show regional distribution of physicians in Croatia. Number of physicians members of the Croatian medical chamber and number of physicians in the system of mandatory health insurance were compared between the counties. In 2006 in Croatia there were 276 physicians per 100,000 inhabitants, i.e., 215 physicians per 100,000 inhabitants in the system of mandatory health insurance. The fewer number of physicians per 100,000 inhabitants in the system of mandatory health insurance, less then 150, were in Koprivnica-Krizevci County, Lika-Senj County and Vukovar-Srijem County, while the greatest number of physicians, more than 250 per 100,000 inhabitants, were in the City of Zagreb and Zagreb County, and Primorje-Gorski kotar County. There were significant differences in the number of physicians per 100,000 inhabitants between the counties (chi2 = 148.7, DF = 19, P < 0.001, chi2-test). Number of general practitioners (GPs) per 100,000 inhabitants in Croatia were 54.2, with range from 47.1 in Pozega-Slavonia County to 61.8 in Primorje-Gorski kotar County. Number of physician specialties in four basic specialties per 100,000 inhabitants in Croatian hospitals were for internal medicine 19.1, general surgery 11.0, gynecology and obstetrics 6.7 and pediatrics 7.8. There were significant differences in the number of physicians in four specialties (internal medicine, general surgery, gynecology and obstetrics and pediatrics) per 100,000 inhabitants between the counties (chi2 = 76.0, DF = 19, P < 0.001, chi2-test). Apart from the insufficient number of physicians in Croatia, an inadequate allocation of physicians in certain counties is also evident.

[Evaluation of work results in the Department of Neurology Split, University Hospital, in one-year period compared to the national standards]. / Evaluacija rada Klinike za neurologiju Klinicke bolnice Split u jednogodisnjem razdoblju u odnosu na nacionalne standarde.

Department of Neurology, Split University Hospital has 77 contracted hospital beds. 70 health professionals were employed in the Department; 17 medical doctors and 53 nurses. Aim was to evaluate work results in the one-year period with emphasis on the number of employed health professionals compared to the standards defined by the Ministry of Health. Age median of medical doctors specialists was 42.0 years. Length of stay median was 8.0 days. Average bed occupation rate in the Department of Neurology in 2005 was 88%. Shortage of nurses in the Department was determined as the result of analyses of required number of nurses for the Department compared with national standards. Despite the shortage of medical professionals in the Department, work results were better than national, displayed with average bed occupation rate and average length of stay. Neurological diseases have growing share in the human pathology, and adequate organization and implementation of out-of-clinic and clinic health services is a priority in the national health strategy.

Influence of urbanization level and gross domestic product of counties in Croatia on access to health care.

AIM: To examine the association of counties' urbanization level and gross domestic product (GDP) per capita on the access to health care. METHODS: Counties were divided in two groups according to the urbanization level and GDP per capita in purchasing power standards. The number of physicians per 100,000 inhabitants, the number of physicians in hospitals in four basic specialties, physicians' workload, average duration of working week, the average number of insurants per general practice (GP) team, and the number of inhabitants covered by one internal medicine outpatient clinic were compared between predominantly urban and predominantly rural counties and between richer and poorer counties. Our study included only GP teams and outpatient clinics under the contract with the Croatian Institute for Health Insurance. Data on physicians were collected from the Ministry of Health and Social Welfare, the Croatian Institute for Health Insurance, the Croatian Institute for Public Health, and the Croatian Medical Chamber. Data on the contracts with the Croatian Institute for Health Insurance and health care services provided under these contracts were obtained from the database of the Institute, while population and gross domestic product data were obtained from the Database of the Croatian Institute for Statistics. World Health Organization Health for All Database was used for the international comparison of physician's data. RESULTS: There was no significant difference in the total number of physicians per 100,000 inhabitants between predominantly urban and predominantly rural counties (206.9+/-41.0 vs 175.4+/-30.3; P=0.067, t test) nor between richer and poorer counties (194.5+/-49.8 vs 187.7+/-25.3; P=0.703, t test). However, there were significantly fewer GPs per 100,000 inhabitants in rural than urban counties (49.0+/-5.5 vs 56.7+/-4.6; P=0.003, t test). GPs in rural counties had more insurants than those working in urban counties (1.749.8+/-172.8 vs 1.540.7+/-106.3; P=0.004, t test). The working week of specialists in the four observed specialties in hospitals was longer than the recommended 48 hours a week. CONCLUSION: The lack of physicians, especially in primary health care can lead to a reduced access to health care and increased workload of physicians, predominantly in rural counties, regardless of the counties' GDP.

Physician labor market in Croatia.

AIM: To analyze the physician labor market in Croatia with respect to the internship and employment opportunities, Croatian needs for physicians and specialists, and trends in physician labor market in the European Union (EU) in the context of EU enlargement. METHODS: Data were collected from the Ministry of Health and Social Welfare, the Croatian Employment Service, and the Croatian Institute for Public Health. We compared the number of physicians waiting for internship before and 14 months after the implementation of the State Program for Intern Employment Stimulation. Also, the number of employed specialists in internal medicine, general surgery, gynecology and obstetrics, and pediatrics was compared with estimated number of specialists that will have been needed by the end of 2007. Average age of hospital physicians in the four specialties was determined and the number of Croatian physicians compared with the number of physicians in EU countries. RESULTS: The number of unemployed physicians waiting for internship decreased from 335 in 2003 to 82 in 2004, while a total number of unemployed physicians decreased from 436 to 379 (chi2=338, P<0.001). In October 2004, 79.3% of unemployed physicians waited for internship <6 months; of them, 89.2% waited for internship <3 months. In February 2005, 365 unemployed physicians were registered at the Croatian Employment Service and that number has been decreasing in the last couple of years. The number of employed specialists was lower than the estimated number of specialists needed in the analyzed specialists, as defined by the prescribed standards. A shortage of 328 internists, 319 surgeons, 209 gynecologists, and 69 pediatricians in Croatian hospitals is expected in 2007. CONCLUSION: The lack of employment incentive seems to be the main reason for the large number of unemployed physicians waiting for internship before the implementation of the Employment Stimulation Program. According to the number of physicians per 100,000 population, Croatia is below the EU average. Croatian labor market will not be able to meet the needs of the health system for physicians by the end of 2007.

Internship workplace preferences of final-year medical students at Zagreb University Medical School, Croatia: all roads lead to Zagreb.

BACKGROUND: Human resources management in health often encounters problems related to workforce geographical distribution. The aim of this study was to investigate the internship workplace preferences of final-year medical students and the reasons associated with their choices. METHOD: A total of 204 out of 240 final-year medical students at Zagreb University Medical School, Croatia, were surveyed a few months before graduation. We collected data on each student's background, workplace preference, academic performance and emigration preferences. Logistic regression was used to analyse the factors underlying internship workplace preference, classified into two categories: Zagreb versus other areas. RESULTS: Only 39 respondents (19.1%) wanted to obtain internships outside Zagreb, the Croatian capital. Gender and age were not significantly associated with internship workplace preference. A single predictor variable significantly contributed to the logistic regression model: students who believed they would not get the desired specialty more often chose Zagreb as a preferred internship workplace (odds ratio 0.32, 95% CI 0.12-0.86). CONCLUSION: A strong preference for Zagreb as an internship workplace was recorded. Uncertainty about getting the desired specialty was associated with choosing Zagreb as a workplace, possibly due to more extensive and diverse job opportunities.