SEECP Health Ministerial Meeting

Achievements and challenges of strenghtening health system performance through addressing inequalities

in health services in Croatia

Achievements and challenges of strenghtening health system performance through addressing inequalities

in health services in Croatia

Chisinau, November 7, 2008

The Republic of CroatiaMinistry of Health and Social Welfare

The Republic of CroatiaMinistry of Health and Social Welfare

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Basic documents proclaiming Basic documents proclaiming the right to healththe right to health

Constitution of the Republic of Croatia Constitution of the Republic of Croatia Health Care ActHealth Care Act Compulsory Health Insurance ActCompulsory Health Insurance Act Communicable Disease Control ActCommunicable Disease Control Act Occupational Health and Safety Health Occupational Health and Safety Health

Insurance Act Insurance Act

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Basic Basic health rightshealth rightsEvery citizen has health insuranceEvery citizen has health insurance

Average numberAverage number

I.-XII.2006.I.-XII.2006.Active workersActive workers 1.505.5471.505.547 Active farmersActive farmers 63.27063.270 PensionersPensioners 1.015.8231.015.823 UnemployedUnemployed 403.988403.988 OtherOther 138.195138.195 Family membersFamily members 1.227.5691.227.569 RefugeesRefugees 3.1603.160 Total - CroatiaTotal - Croatia 4.357.5524.357.552

Structure Structure of ensureesof ensurees

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Basic Basic health rightshealth rights

Every citizen has: Every citizen has: chosen family physicianchosen family physician chosen stomatologistchosen stomatologist women – chosen gynecologistwomen – chosen gynecologist preschool children – chosen pediatrician preschool children – chosen pediatrician

or family physician or family physician

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BasicBasic health protection rights health protection rights

At population level:At population level: epidemiological care – through the public epidemiological care – through the public

health institutes networkhealth institutes network preventive care of school children and youth - preventive care of school children and youth -

through the public health institutes network through the public health institutes network prevention and treatment of occupational prevention and treatment of occupational

diseases and injuriesdiseases and injuries (according to the Act) (according to the Act) health safety monitoring for foods, other health safety monitoring for foods, other

object of common use and drinking waterobject of common use and drinking water

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Compulsory Health Insurance ActCompulsory Health Insurance Actand regulations based thereon and regulations based thereon

include the rights to:include the rights to:

primary health careprimary health care emergency medical careemergency medical care specialist specialist health health carecare hospital hospital health health carecare ddrugsrugs administration administration dental-dental-proprosstthhetic care and etic care and substitutessubstitutes ortorthhopedic and other opedic and other aidsaids healthhealth care abroad care abroad

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Plan and programPlan and programmeme of health care measures of health care measures resulting from resulting from CCompulsory ompulsory HHealth ealth IInsurancensurance Act Act

includes:includes:

Health care measures provided by:Health care measures provided by:primary health careprimary health carespecialistic specialistic and hospital and hospital carecarecounty public health institutes and Croatian county public health institutes and Croatian National Institute of National Institute of PPublic Healthublic Healthttransfusioransfusion medicinen medicine

HHealth care measures for priority health ealth care measures for priority health problems (cardiovascular diseases, malignant problems (cardiovascular diseases, malignant diseases,diseases, mental disorders, mental disorders, injuries etc injuries etc..))

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Monitoring the implementation of Monitoring the implementation of Plan and ProgrammePlan and Programme

Example: preventive examinations for age groupeExample: preventive examinations for age groupe 50+ 50+

GOALGOALEarly detection of illnesses and risk factorsEarly detection of illnesses and risk factors

TARGET POPULATIONTARGET POPULATIONIInsurees aged 50+ who had no clinical examination or dg nsurees aged 50+ who had no clinical examination or dg procedure for a minimum of two yearsprocedure for a minimum of two years

METHODOLOGYMETHODOLOGYGeneral check-up and basic diagnostic proceduresGeneral check-up and basic diagnostic procedures

INDICATORINDICATOR% of persons in need covered by preventive examinations% of persons in need covered by preventive examinations

NATIONAL PROGRAMMESNATIONAL PROGRAMMESNATIONAL PROGRAMMESNATIONAL PROGRAMMES

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National Breast Cancer Screening ProgrammeNational Breast Cancer Screening Programme

STARTED:STARTED: OctoberOctober 2006 2006

TARGET POPULATION:TARGET POPULATION: women aged 50-69 women aged 50-69 (covered 586,912 women ni Croatia)(covered 586,912 women ni Croatia)

GOAL:GOAL: to reduce breast cancer mortality by 25% withinto reduce breast cancer mortality by 25% within 5 years of 5 years of

the beginning of the programme the beginning of the programme and to increase the and to increase the proportion of breast cancers detected in initial stageproportion of breast cancers detected in initial stage

SCREENING TEST:SCREENING TEST: mammography (double-reading)mammography (double-reading)

SCREENING INTERVAL:SCREENING INTERVAL: 22 yearsyears

SCREEN-DETECTED CANCERS:SCREEN-DETECTED CANCERS: About 900 /October 2008/About 900 /October 2008/

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Colorectal Cancer Screening ProgrammeColorectal Cancer Screening Programme

STARTED:STARTED: NovemberNovember 200 20077

TARGET POPULATION:TARGET POPULATION: men men and women and women aged 50-aged 50-7474 (about 1,200,000 Croatian (about 1,200,000 Croatian

citizens)citizens) GOALGOALSS::

to reduce to reduce colorectalcolorectal cancer mortality by cancer mortality by 115% within5% within 5 years of 5 years of the beginning of the programmethe beginning of the programme

SCREENING TEST:SCREENING TEST: Fecal occult blood testing Fecal occult blood testing ((FOBTFOBT)) followed by colonoscopy followed by colonoscopy

SCREENING INTERVAL:SCREENING INTERVAL: 22 yearsyears

SCREEN-DETECTED CANCERS:SCREEN-DETECTED CANCERS: 77 cancers, 421 polyps /October 2008/77 cancers, 421 polyps /October 2008/

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National Diabetes Programme National Diabetes Programme

STARTED:STARTED: 20082008

TARGET POPULATION:TARGET POPULATION: adults aged 50+ and younger with risk factors, pregnant adults aged 50+ and younger with risk factors, pregnant

womenwomen diabetic patientsdiabetic patients

GOALGOALSS:: increase the numberincrease the number of new diagnosed cases at early stageof new diagnosed cases at early stage reduce the number of complicationsreduce the number of complications

SCREENING TEST:SCREENING TEST: Fasting plasma glucose; OGTTFasting plasma glucose; OGTT

SCREENING INTERVAL:SCREENING INTERVAL: 22 yearsyears / 1year / 1year

ESTIMATED PREVALENCEESTIMATED PREVALENCE:: 8,9% adults (18+) 8,9% adults (18+)

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HIV/AIDS Prevention HIV/AIDS Prevention ProgramProgrammeme 2005-2010 2005-2010..

Diagnostics and treatmentDiagnostics and treatment of HIV positive person and of HIV positive person and AIDS patients free of chargeAIDS patients free of charge,, including HAART therapy including HAART therapy

Educational programmesEducational programmes Widening of Widening of voluntary counselling and HIV testingvoluntary counselling and HIV testing

services (VCT) through the network of centers for services (VCT) through the network of centers for voluntary, anonimous, free of charge testingvoluntary, anonimous, free of charge testing

Second generation surveillanceSecond generation surveillance including not only including not only surveillance of HIV prevalence and AIDS incidence and surveillance of HIV prevalence and AIDS incidence and mortality but also other STDs and risk behaviourmortality but also other STDs and risk behaviour

Seroprevallence investigationSeroprevallence investigation in most at risk in most at risk populations populations

Harm reduction and outreach programHarm reduction and outreach programmemess in in population subgroups with risk behaviourpopulation subgroups with risk behaviour

SPECIAL PROGRAMMESSPECIAL PROGRAMMES

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Prevention of overweight and obesity in childhoodPrevention of overweight and obesity in childhood

CCo-operation project betweeno-operation project between

Flanders, Croatia and SloveniaFlanders, Croatia and Slovenia

““Implementation of a Implementation of a

mmethodologyethodology for thefor the development development

of evidence-based of evidence-based

guidelines in school health care”guidelines in school health care”

Started in 2005Started in 2005

PhasesPhases::• DDeveloping guidelines applicable in daily practiceeveloping guidelines applicable in daily practice • Disemination Disemination of the guidelineof the guideliness to authorities and target to authorities and target

professional groupsprofessional groups• Implementation of the guidelineImplementation of the guidelines at the national levels at the national level

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Thank you for your attentionThank you for your attention!!Thank you for your attentionThank you for your attention!!