Building new university hospital--what citizens know and policy makers should be aware of

Survey of citizens' attitudes in the process of strategic decision making is one of the most important methods for determining health care priorities. We describe the results of a survey carried out in December 2001, with an aim to collect and analyze the attitudes of the citizens and health care professionals toward the possibilities and strategies of construction of the University Hospital in Blato, Zagreb. The first referendum on the construction of the new hospital was conducted among Zagreb citizens in 1982, when they agreed that the new University Hospital was much needed. Zagreb citizens confirmed once again their attitudes toward and opinions on the need to continue the construction of new hospital in the city outskirts. By 1992, when the construction of the hospital was halted due to insufficient financial means, Zagreb citizens had already invested over 150 epsilon million in the project. It is interesting that today, 89.4% of the citizens and 74.5% of physicians agree that the new hospital building should be completed. Also, 66.7% of the citizens and 88% of physicians think that this hospital should be a University hospital that could offer the most complex treatments and medical education. To finish the construction of the new hospital further 200 epsilon million needs to be invested. Survey showed that 71% of citizens and 82.2% of physicians think that funds should be raised from some form of credit or budget rather than by special local tax, additional tax or voluntary tax. This project will significantly determine the future of hospital and health care system in Croatia due to its capacities in terms of space, technology, and staff. Before the decision to continue with the new hospital construction be made, the expected future needs, demands, and supply of the health care services in hospital sector in Zagreb and Croatia should be provided using SWOT analysis for each of existing the facilities.

The Croatian health survey--patient's satisfaction with medical service in primary health care in Croatia

The aim of the study was to investigate patient satisfaction with nurses and general practice organization in Croatia. A total of 2,252 patients 18 years of age and over from 47 randomly selected general practices were included in the study. 72.1% of patients were satisfied with nurses and general practice organization. Older and less educated patients were generally more satisfied. Patients were more pleased with nurses' behavior (81.9%) than with practice organization (62.3%). Factor analysis revealed two underlying discriminates of patient satisfaction--"positive attitude towards the nurse" and "inaccessibility of practice". The former discriminate emphasized a great potential of nursing, which should be taken into consideration in the transformation of health care system in Croatia.

Patients' views on the professional behaviour of family physicians

BACKGROUND

Patient satisfaction is an important part and a measure of the quality of health care. Patient satisfaction with family physicians was studied within the project 'Analysis of Transition of Health Care System in Croatia'.

OBJECTIVES

The aim of this study was to explore patient satisfaction with family physicians through evaluation of some characteristics of physician behaviour. The specific goals of this study were to determine whether there were differences in the evaluation of patient satisfaction with physician behaviour with regard to some sociodemographic characteristics of the respondents.

METHODS

The study group consisted of 1217 respondents: 479 (39.4%) men and 738 (60.6%) women. Medical students interviewed the respondents 'face-to-face' immediately after their consultation with the physician. An anonymous questionnaire was created providing answers to 10 questions on patient satisfaction. Data on sociodemographic characteristics and the reason for encounter of the respondents were also collected.

RESULTS

The average positive rating over 10 questions on patient satisfaction was 85.3%. There was a statistically significant difference in age distribution between geographic areas (P < 0.001). Differences in answers were found regarding sex, age, educational level (P < 0.001) and reason for encounter (P < 0.01). Two factors were obtained by factor analysis: the first could be called physician's competence/expertise estimated by respondents, and the other physician's empathy evaluated by respondents. The respondents were divided into two groups based on the reason for encounter as a criterion for discriminant analysis: acute (symptoms and complaints, injuries; n = 553) and other reasons (n = 664). The discriminant function obtained was statistically significant (P < 0.01). Younger respondents, regardless of sex, whose reason for encounter was an acute condition, were less satisfied with the physician's expertise, agreeableness during the consultation, physician's interest in what they were saying and physician's friendliness.

CONCLUSION

Considering the difficulties present in the health systems of countries in transition, the results of our study were surprisingly encouraging, showing that the respondents were satisfied with the physician's behaviour and that the physicians fulfilled the basic elements of professional behaviour.

The Croatian Health Survey--SF-36: I. General quality of life assessment

The objective of the Croatian Health Survey was the assessment of population health related quality of life in the transitional environment of Croatia. Health status measures incorporate dimensions such as physical, psychological, and social functioning, role performance and perception of wellbeing. In order to assess health status, "The medical outcome study 36-item short-form health survey (SF-36) model" was used. A total sample of 5048 inhabitants (1983 males and 3065 females), 18 years and over, represents approximately 1% of the general population of Croatia. Mean scores were as follows: physical functioning (PF) 69.94, role-physical (RP) 63.01, bodily pain (BP) 64.51, general health (GH) 53.40, vitality (VT) 51.85, social functioning (SF) 72.96, role-emotional (RE) 72.42, mental health (MH) 61.71 and health transition (HT) 44.79. Results of the SF-36 health survey in Croatia are very much like the results in other European countries with indication that general quality of life is lower in Croatia.

Out-of-pocket payments for health care in Croatia: implications for equity

AIM

To assess the distribution of out-of-pocket payments for health care in Croatia by income groups.

METHODS

The study is based on data from 1994 out-of-pocket health expenditure survey carried out through interviews of randomly selected adults in two major cities of Croatia, Zagreb and Split. We analyzed co-payments for public health care services and other payments related to private practice, non-prescription medicaments, or informal payments to health care providers. Spending of each income group was analyzed as a share of its income and as proportion of total payments.

RESULTS

We found an inequitable pattern of out-of-pocket health care payments. Burden of out-of-pocket expenditure was not equally distributed among income groups, with persons from the low income group paying about six times larger share of their income than the high income group. When we compared the proportions of income received by different groups with the proportions of their payments, the results indicated (again) that the low income persons payed proportionally more than those with high income.

CONCLUSION

Distribution of out-of-pocket payments in Croatia is regressive, with a greater burden falling on lower income persons. Possible introduction of the mix of health care financing would need reconsideration of the policy measures to balance equity and efficiency.

Health care reform in Croatia: the consumers' perspective

AIM

Assessment of the Croatian health care system (under the reform) from the perspective of the users of health care services. We analyzed the consumers' satisfaction with health care system, health care expenses and access, and described the consumers' attitudes toward health reform, examining the differences among sociodemographic groups.

METHODS

The study is based on a data set collected in 1994 through the interviews with randomly selected adults in two major cities of Croatia: Zagreb and Split.

RESULTS

A great proportion of respondents were dissatisfied with the current health care services, quality of health care facilities and equipment, and encountered difficulties in access. The elderly, women, and those with lower socioeconomic status were more likely to be dissatisfied and to consider out-of-pocket payments for health services as a problem. A great number of the respondents believed that the reform would either fail or would not achieve significant results. Compared to the younger and higher socio-economic group, the older and lower socioeconomic groups were more likely to evaluate the health care reform negatively.

CONCLUSION

Croatian government decided to rationalize the health care system without taking much account of the impact of health reform on the consumers. Revealed dissatisfaction with the health care services might be linked with the expressed doubts in health care reform and concern that changes could worsen the consumers' position as patients.

Health care reform in Croatia: for better or for worse?

Along with the rest of Central and Eastern Europe, Croatia has begun to dismantle its long-standing socialist health care system and to replace it with a market-based approach. Marketization's advocates maintain that the market will bring efficiency and quality to the Croatian health care system. Nevertheless, data from consumer surveys and official statistics reflect the reform's hidden costs: limited access to care, heightened costs, growing inequality, and the deemphasis of preventive and proactive care in favor of costly therapeutic medicine.

Health and social inequities in Yugoslavia

In Yugoslavia the problem of social inequities comes on the political agenda every time when society is in a crisis. This paper describes the pattern of social inequities in health. Data are mostly used from statistics. The features of health inequalities are shown. The marked inequalities exist regionally, among republics and provinces, in spite of the reallocation of resources. Health inequalities exist also among social classes however they are measured. Individually based measurement shows inequalities in health between all individuals of the population. As Yugoslav society is passing through severe economic crisis when social structure polarizes and becomes rigid--inequalities in health tend to increase.