Impact of hospital payment methods on hospital care performance in Republic of Croatia

Zbog visokih troškova bolničke zdravstvene zaštite, odnosno značajnog udjela troškova za bolnice u troškovima ukupne zdravstvene zaštite, financiranje bolnica je ne samo jedan od najvećih izazova zdravstvene politike i zdravstvene ekonomike, već sustava zdravstva i pojedine države u cijelosti. Kako bi se razjasnilo jesu li i na koji način promjene u načinu - metodama plaćanja bolnica utjecale na poslovanje bolničkog zdravstvenog sustava Republike Hrvatske, analizirane su administrativne i organizacijske promjene bolničkog zdravstvenog sustava, promjene financijskih i naturalnih pokazatelja, te reformske promjene koje su mogle utjecati na poslovanje bolnica. Utvrđeno je da je način plaćanja bolnica utjecao na poslovanje bolnica no ne u značajnoj mjeri osim u dijelu izvan limitnih stavki (transplantacije, eksplantacije, intervencijska kardiologija, intervencijska neurologija), međutim značajan utjecaj imale su administrativne mjere koje nisu bile isključivo usmjerene na bolnice, vezane uz udio sudjelovanja u cijeni bolničke zdravstvene zaštite. Na poslovanje bolnica značajan utjecaj imaju demografske promjene osobito starenje stanovništva koje dovodi do promjene strukture pacijenata u bolnicama, kao i promjene zdravstvene tehnologije. Način plaćanja po slučaju, može se koristiti za usporedbu bolnica, praćenje učinkovitosti i nadzor izvedbe bolnica.Due to the high expenses of hospital health care and the significant share of hospital spending in total health care expenditures, funding hospitals is not only one of the major health care challenges, but of overall health system and state as a whole. In order to clarify whether and how the changes in the way the hospitals are paid, influenced the performance of the hospital health system of the Republic of Croatia, the administrative and organizational changes of the hospital health system, the change of financial and natural indicators, and the reform changes that could have influenced hospital business have been analyzed. It has been found that methods of hospital payment did not significantly affected the hospital's performance, except in the case of targeted activities payed above the hospital budget ceiling e.g. organ transplantation, organ harvesting, interventional cardiology and interventional neurology. Significant impact had administrative measures that were not exclusively directed at hospitals i.e. co-payment in the price of hospital health care. Significant impact on hospital performance have demographic changes, particularly the aging of the population, which results in a change in structure of hospital patients, as well as changes in health technology. The method of payment per case can be used for hospital benchmarking, and for monitor hospital performance

Impact of hospital payment methods on hospital care performance in Republic of Croatia

Zbog visokih troškova bolničke zdravstvene zaštite, odnosno značajnog udjela troškova za bolnice u troškovima ukupne zdravstvene zaštite, financiranje bolnica je ne samo jedan od najvećih izazova zdravstvene politike i zdravstvene ekonomike, već sustava zdravstva i pojedine države u cijelosti. Kako bi se razjasnilo jesu li i na koji način promjene u načinu - metodama plaćanja bolnica utjecale na poslovanje bolničkog zdravstvenog sustava Republike Hrvatske, analizirane su administrativne i organizacijske promjene bolničkog zdravstvenog sustava, promjene financijskih i naturalnih pokazatelja, te reformske promjene koje su mogle utjecati na poslovanje bolnica. Utvrđeno je da je način plaćanja bolnica utjecao na poslovanje bolnica no ne u značajnoj mjeri osim u dijelu izvan limitnih stavki (transplantacije, eksplantacije, intervencijska kardiologija, intervencijska neurologija), međutim značajan utjecaj imale su administrativne mjere koje nisu bile isključivo usmjerene na bolnice, vezane uz udio sudjelovanja u cijeni bolničke zdravstvene zaštite. Na poslovanje bolnica značajan utjecaj imaju demografske promjene osobito starenje stanovništva koje dovodi do promjene strukture pacijenata u bolnicama, kao i promjene zdravstvene tehnologije. Način plaćanja po slučaju, može se koristiti za usporedbu bolnica, praćenje učinkovitosti i nadzor izvedbe bolnica.Due to the high expenses of hospital health care and the significant share of hospital spending in total health care expenditures, funding hospitals is not only one of the major health care challenges, but of overall health system and state as a whole. In order to clarify whether and how the changes in the way the hospitals are paid, influenced the performance of the hospital health system of the Republic of Croatia, the administrative and organizational changes of the hospital health system, the change of financial and natural indicators, and the reform changes that could have influenced hospital business have been analyzed. It has been found that methods of hospital payment did not significantly affected the hospital's performance, except in the case of targeted activities payed above the hospital budget ceiling e.g. organ transplantation, organ harvesting, interventional cardiology and interventional neurology. Significant impact had administrative measures that were not exclusively directed at hospitals i.e. co-payment in the price of hospital health care. Significant impact on hospital performance have demographic changes, particularly the aging of the population, which results in a change in structure of hospital patients, as well as changes in health technology. The method of payment per case can be used for hospital benchmarking, and for monitor hospital performance

Potentially Inappropriate Prescribing in Elderly Outpatients in Croatia

The purpose of this study was to determine the prevalence of inappropriate prescribing to the elderly and to identify possible gender-related differences in prescribing certain potentially inappropriate medications (PIMs) to outpatients by using large administrative prescription database. Medications prescribed for elderly outpatients (≥ 65 years) in Primorsko-Goranska County, Croatia, who received five or more different drugs simultaneously in 2010, were analyzed. The prevalence of potentially inappropriate drugs prescribed to the elderly was assessed using the new comprehensive protocol developed by authors Mimica Matanović and Vlahović-Palčevski. A total of 62.4 % of patients received at least one medication with unfavorable benefit/risk ratio in the elderly. Female patients were given inappropriate medications in a significantly higher percentage than men (69.3 % vs. 50.5 %; p65 years and receiving five or more drugs was potentially inappropriate. Elderly women were prescribed PIMs more often than men. Drugs of concern in female patients were benzodiazepines, antidepressants, and nonsteroidal anti-inflammatory drugs (NSAIDs). In male patients, there was a significantly higher proportion of possible interactions with warfarin, theophylline, and medications affecting the cardiovascular system, such as ACE inhibitors and amiodarone