The recent health reform in Croatia: true reforms or just a fundraising exercise?

Croatia's most recent reform of the healthcare system was implemented in 2008. The aim of the reform was to enhance financial stability of the system by introducing additional sources of financing, as well as increase the efficiency of the system by reducing sick pay transfers to households, rationalising spending on pharmaceuticals, restructuring hospitals etc. This paper attempts to assess the success of the 2008 healthcare system reform in reaching financial stability and sustainability, and to evaluate the effects of the reform on equity in funding the system. It takes into account the fact that the reform coincided with a severe economic crisis and decline in the overall living standard of Croatian citizens. The paper shows that the reform ended up being expansionary and thus impaired the necessary fiscal adjustment. Finally, it is argued that in circumstances of declining disposable incomes, increased co-payments aimed at the financial stabilisation of the health system made health services less affordable and could have had detrimental effects on equity in the utilisation of health care.