Cost Control-Oriented Provisions in Croatian Pharmaceutical Policy
Croatia operates a mandatory health insurance system with a single public health insurance fund, the Croatian Health Insurance Fund (HZZO), acting as the sole public purchaser of health care services for all insured—the entire population of Croatia...
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| Format: | Report |
| Language: | English |
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World Bank, Washington, DC
2020
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| Online Access: | http://documents.worldbank.org/curated/en/595621593099933890/Cost-control-oriented-provisions-in-Croatian-pharmaceutical-policy http://hdl.handle.net/10986/34190 |
| Summary: | Croatia operates a mandatory health
insurance system with a single public health insurance fund,
the Croatian Health Insurance Fund (HZZO), acting as the
sole public purchaser of health care services for all
insured—the entire population of Croatia. The HZZO holds a
monopsony on reimbursement and pricing of publicly funded
medicines. This gives it leverage in negotiations with
pharmaceutical companies. The HZZO implements two (brand
name based) lists of medicines that define: (a) which
products are reimbursed, (b) their wholesale prices, and (c)
reimbursed prices and co-payments—the ‘basic’ list with
medicines dispensed in community pharmacies and hospitals
with no co-payments, and the ‘complementary’ list with
medicines dispensed in community pharmacies covered
partially through mandatory insurance and partially by
co-payments. These out-of-pocket payments are the result of
internal reference pricing procedures, implying that all
medicines with co-payments should have comparable1 parallel
products listed in the ‘basic list’ with no co-payments.
Community pharmacies are reimbursed monthly for the products
they dispense at the listed reimbursed prices. They procure
medicines from wholesalers at the regulated wholesale prices
(a maximum of 8.5 percent of which accounts for wholesale
margins) and are in addition paid by the HZZO linear fees
for dispensing. No retail margins are allowed for HZZO
reimbursed medicines. Hospitals are paid through Diagnosis
Related Groups (DRGs, that account for the cost of medicines
used in treatment) but receive additional funds (100 percent
of listed price) for use of medicines defined by the HZZO as
expensive. Hospitals procure all medicines through public
procurement. HZZO’s lists define the maximal prices they can
pay in the process. Products not reimbursed by the HZZO
(over the counter and prescription medicines) can be freely
priced. Nevertheless, given the breadth of HZZO’s coverage,
sales of non-reimbursed prescription medicines are marginal.
The value-added tax (VAT) on all medicines (including those
reimbursed by the HZZO) is set at 5 percent of the wholesale price. |
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