Croatian medical journal
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Croatian medical journal · Sep 1998
Priority setting and scarce resources: case of the Federation of Bosnia and Herzegovina.
The priority setting within the context of scarce resources in the Federation of Bosnia and Herzegovina (BH) can be divided into priorities within the health care services provision and priorities within the reconstruction process. Facing the resource scarcity, the Federation of BH has chosen to increase health insurance contribution rate to establish cost-sharing arrangements (co-payments) and priority setting to ration access to certain services funded by the compulsory health insurance ("basic package" of the health care services). Reconstruction process of the health care facilities is conducted on the federal level through the effective managerial infrastructure ("project implementation units"). This study reports on the consequences of the war in BH as a peculiar context of the overall reform objectives and priority setting.
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The introduction of health insurance system has been the core of the Russian health care reform. It has coincided with the decentralization of the state administration. ⋯ Meanwhile, the reform has had a positive stabilizing influence on financing of health care under conditions of continued economic crisis. The new priorities of the reform should be to balance the financial flows and the state's obligations, and to increase the efficiency of the use of resources through encouragement of competition, assurance of transparency of public funding, development of health care planning, and shift from inpatient to outpatient care.
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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. ⋯ 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.