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Fiscal (un)sustainability of the Croatian healthcare system: additional impact of the COVID-19 crisis*
Article | Year: 2021 | Pages: 495 - 515 | Volume: 45 | Issue: 4 Received: June 8, 2021 | Accepted: July 14, 2021 | Published online: December 6, 2021
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FULL ARTICLE
FIGURES & DATA
REFERENCES
CROSSMARK POLICY
METRICS
LICENCING
PDF
Source: OECD/European Union (2020: 44), for Croatia authors’ calculations.
Source: OECD/European Union (2020).
Source: OECD/European Union (2020).
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2015
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2016
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2017
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2018
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2019
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2020
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Health insurance contributions
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18,121.28
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18,468.68
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19,135.18
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19,904.22
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22,188.02
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21,042.81
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Budgetary income
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2,400.00
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2,588.95
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2,629.76
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3,100.00
|
2,600.00
|
3,769.21
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Income under special Regulations
(mostly supplemental health insurance)
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1,618.17
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2,650.80
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1,867.89
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2,004.79
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2,291.70
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2,451.01
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Property income
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14.52
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14.02
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17.36
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15.19
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12.53
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7.76
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Foreign aid - EU projects
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0.42
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1.45
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0.40
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1.34
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2.87
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0.79
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Income from CES (Croatian Employment Service),
professional training without employment
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0.62
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0.43
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0.91
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0.48
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0.00
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0.00
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Income from services provided
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0.05
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0.37
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0.86
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1.16
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1.30
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1.99
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Income from sale of non - financial assets
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0.75
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0.50
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0.65
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0.72
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1.90
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3.11
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Other income
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0.28
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0.70
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0.34
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0.36
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0.44
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0.25
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Income from financial assets and liabilities
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0.00
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26.14
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0.00
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0.00
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0.00
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1,077.58
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In total
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22,156.10
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23,752.05
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23,653.35
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25,028.27
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27,098.76
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28,354.51
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Budgetary income
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2015
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2016
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2017
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2018
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2019
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2020
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Contributions for the unemployed
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1,305.45
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1,124.94
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937.44
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778.27
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676.65
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851.10
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Contributions for persons deprived of their liberty
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10.71
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11.05
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11.37
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10.18
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12.48
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10.92
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Additional contributions for pension beneficiaries
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361.00
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363.11
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371.06
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393.59
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408.86
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420.53
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Income from special tax on tobacco
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1,339.93
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1,432.09
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1,399.69
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1,540.41
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1,636.71
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1,278.12*
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Premium for supplemental health insurance policy
at the expense of the state budget
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768.83
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683.55
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624.05
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565.62
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509.33
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464.19
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Funds to cover the costs of healthcare of insured
persons
at the expense of the state budget
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1,060.22
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818.00
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939.11*
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939.11*
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939.11*
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939.11*
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Total amount receivable from the
state budget (estimate)
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4,846.13
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4,432.74
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4,282.72
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4,227.19
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4,183.14
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3,963.97
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Budgetary income (paid)
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2,400.00
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2,588.95
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2,629.76
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3,100.00
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2,600.00
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3.769,21
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Difference
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-2,446.13
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-1,843.79
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-1,652.96
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-1,127.19
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-1,583.14
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-194.76
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Note: CHC – Clinical Hospital Center, CH – Clinical Hospital, GH – General Hospital, SH – Special Hospital. Health resorts, health care centers, and institutes are omitted from this part of the analysis. At the time of this analysis (May 2020), the CHC Sestre Milosrdnice and the Clinic for Children’s Diseases did not make public the data on due liabilities for 2020, so the data for 2019 was used in analysis.
Source: Authors’ work according to the Reports on liabilities of individual hospitals, hospital websites.
Note: CHC – Clinical Hospital Center, CH – Clinical Hospital, GH – General Hospital, SH – Special Hospital. Health resorts, health care centers, and institutes are omitted from this part of the analysis. At the time of this analysis (May 2020), the CHC Sestre Milosrdnice and the Clinic for Children’s Diseases did not make public the data on due liabilities for 2020, so the data for 2019 was used in analysis.
Source: Authors’ work according to the Reports on liabilities of individual hospitals, hospital websites.
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Year
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Financial bailouts
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Amount
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1994
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Financial bailout agreement
with health institutions
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214.84
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1994
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Agreement with wholesalers -
paid obligations for medicines
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62.13
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1998
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Settlement of due
obligations towards health care institutions - from the budget
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593.00
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1999
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Commitments of hospital
suppliers
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845.37
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1999
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Budget transfer for
suppliers
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792.02
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1999
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Short-term loan from a bank
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120.00
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1999
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Promissory note issued for
pharmacy debt (debt older than 90 days)
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244.98
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1999
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Pliva takes over CHIF debt
to pharmacies
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375.21
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2000
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CHIF issues bonds
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1,668.67
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2000
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Short-term loan
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115.00
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2001
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Collection of receivables
from CHIF
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750.37
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2001
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Short-term loan
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108.00
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2002
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Loan
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820.00
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2003
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Loan
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410.00
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2004
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Transfer to hospitals from
the Ministry of Finance (state budget) for suppliers
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533.01
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2005
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Agreement with Zagrebačka
banka on taking over overdue receivables for medicines
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808.70
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2007
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Sale of shares owned by CHIF
through the Privatization Fund - paid orthopedic devices and aids
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90.00
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2007
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Obligations to suppliers -
CHIF
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1,200.00
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2008
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Liabilities of hospitals to
suppliers of medicines and medical supplies
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500.00
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2012
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Assignment agreement
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465.03
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2013
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Assignment agreement
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3,062.06
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2014
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Assignment agreement
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3,200.00
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2017
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Budget transfer to hospitals
to settle debt to wholesalers
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200.00
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2019
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Extraordinary payment of
CHIF to wholesalers for overdue debt
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500.00
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2020
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Budget transfer to CHIF for
wholesalers debt
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500.00
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2020
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State budget amendment
(additional revenues for CHIF)
|
1,300.00
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2021
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Budget transfer to CHIF (600
million for pharmacy debt and 300 million for hospitals)
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900.00
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2021
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Budget transfer to CHIF for
pharmacy debt and hospital debt (installments of 900 million in April, May
and June, plus a state budget amendment of an additional 895 million)
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3,595.00
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Total
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23,973.39
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Act on Financial Operations and Pre-Bankruptcy Settlement, OG 108/12, 144/12, 81/13, 112/13, 71/15, 78/15.
Act on the Rights of Croatian Veterans, OG 121/17, 98/19.
Baumol, W.J., 1967. Macroeconomics of Unbalanced Growth: The Anatomy of Urban Crisis, American Economic Review, 57(3), pp. 415-426.
Blazey, A. [et al.], 2021. Adaptive Health Financing: Budgetary and Health System Actions to Combat COVID-19. OECD Journal on Budgeting, 21(1), pp. 1-27 [ CrossRef]
Blecher, M. [et al.], 2015. Fiscal sustainability of health systems – Why is it an issue, what can be done? In: Fiscal Sustainability of Health Systems: Bridging Health and Finance Perspectives. Paris: OECD, pp. 23-44 [ CrossRef]
Broz, T. and Švaljek, S., 2014. Financiranje zdravstva u Hrvatskoj: od reforme do reforme. In: M. Vehovec, ed. O zdravstvu iz ekonomske perspektive. Zagreb: Ekonomski institut, pp. 51-75.
Buljan, A., Deskar-Škrbić, M. and Šimović, H., 2019. Determinants of Public Health Care, Education and Administration Efficiency in Central, Eastern and South Eastern Europe. Hrvatska i komparativna javna uprava, 19(4), pp. 537-563 [ CrossRef]
CHIF (various years). Business Report of the Croatian Health Insurance Institute. Zagreb: Croatian Health Insurance Fund.
CHIF, 2021. Report on the operations of the Croatian Health Insurance Institute for 2020. Zagreb: Croatian Health Insurance Fund.
Jurković, D., 2018. Kvalitetan i održiv zdravstveni sustav u Hrvatskoj. Presentation. 120. Kongres poslodavaca u zdravstvu Hrvatske.
Krnić, I., 2021. Eskalacija troška korone: U 7 tjedana izdaci za liječenje i bolovanja su se udvostručili. Jutarnji.hr, January 25, 2021.
Lorenzoni, L. [et al.], 2019. Health spending projections to 2030: New results based on a revised OECD methodology. OECD Health Working Paper, No. 110 [ CrossRef]
Mandatory Health Insurance Act, OG 80/13, 137/13, 98/19.
Mihaljek, D., 2014. Kako financirati zdravstvo u doba financijske krize? In: M. Vehovec, ed. O zdravstvu iz ekonomske perspektive. Zagreb: Ekonomski institut, pp. 29-50.
Ministry of Health, 2018. National Development Plan for Clinical Hospital Centers, Clinical Hospitals, Clinics and General Hospitals in the Republic of Croatia 2018 - 2020. Zagreb, Ministry of Health.
OECD, 2015. Fiscal Sustainability of Health Systems: Bridging Health and Finance Perspectives. Paris: OECD [ CrossRef]
OECD/European Union, 2020. Health at a Glance: Europe 2020: State of Health in the EU Cycle. Paris: OECD [ CrossRef]
Radin, D., 2019. Health Policy in Croatia: A Case of Free Falling. In: Z. Petak and K. Kotarski, eds. Policy-Making at the European Periphery, New Perspectives on South-East Europe: The Case of Croatia. Cham: Springer International Publishing, pp. 247-264 [ CrossRef]
Šimović, H. and Primorac, M., 2021. Fiskalna održivost hrvatskog zdravstvenog sustava. Fiscus, No. 10.
Smolić, Š., 2016. Zdravstveni sustav. In: A. Obadić and J. Tica, eds. Gospodarstvo Hrvatske. Zagreb: Ekonomski fakultet, pp. 471-508.
Švaljek, S., 2014. The Recent Health Reform in Croatia: True Reforms or Just a Fundraising Exercise? Health Policy, 115(1), pp. 36-43 [ CrossRef]
Vammalle, C. [et al.], 2015. Budgeting practices for health in OECD coun¬tries. In: Fiscal Sustainability of Health Systems: Bridging Health and Finance Perspectives. Paris: OECD, pp. 79-113.
Voluntary Health Insurance Act, OG 85/06, 150/08, 71/10, 53/20.
Vončina, L., Džakula, A. and Mastilica, M., 2007. Health care funding reforms in Croatia: a case of mistaken priorities. Health Policy, 80(1), pp. 144-157 [ CrossRef]
Zrinščak, S., 2007. Zdravstvena politika Hrvatske. U vrtlogu reformi i suvremenih društvenih izazova. Revija za socijalnu politiku, 14(2), pp. 193-220 [ CrossRef]
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December, 2021
IV/2021
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