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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| 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 |
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okr-10986-341902021-05-25T09:50:36Z Cost Control-Oriented Provisions in Croatian Pharmaceutical Policy Voncina, Luka PHARMACEUTICAL PRICING HEALTH INSURANCE FUND PUBLIC HEALTH CARE HEALTH SYSTEM 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. 2020-07-24T14:57:45Z 2020-07-24T14:57:45Z 2018-04 Report http://documents.worldbank.org/curated/en/595621593099933890/Cost-control-oriented-provisions-in-Croatian-pharmaceutical-policy http://hdl.handle.net/10986/34190 English CC BY 3.0 IGO http://creativecommons.org/licenses/by/3.0/igo World Bank World Bank, Washington, DC Economic & Sector Work Economic & Sector Work :: Other Health Study Europe and Central Asia Bulgaria |
| repository_type |
Digital Repository |
| institution_category |
Foreign Institution |
| institution |
Digital Repositories |
| building |
World Bank Open Knowledge Repository |
| collection |
World Bank |
| language |
English |
| topic |
PHARMACEUTICAL PRICING HEALTH INSURANCE FUND PUBLIC HEALTH CARE HEALTH SYSTEM |
| spellingShingle |
PHARMACEUTICAL PRICING HEALTH INSURANCE FUND PUBLIC HEALTH CARE HEALTH SYSTEM Voncina, Luka Cost Control-Oriented Provisions in Croatian Pharmaceutical Policy |
| geographic_facet |
Europe and Central Asia Bulgaria |
| description |
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. |
| format |
Report |
| author |
Voncina, Luka |
| author_facet |
Voncina, Luka |
| author_sort |
Voncina, Luka |
| title |
Cost Control-Oriented Provisions in Croatian Pharmaceutical Policy |
| title_short |
Cost Control-Oriented Provisions in Croatian Pharmaceutical Policy |
| title_full |
Cost Control-Oriented Provisions in Croatian Pharmaceutical Policy |
| title_fullStr |
Cost Control-Oriented Provisions in Croatian Pharmaceutical Policy |
| title_full_unstemmed |
Cost Control-Oriented Provisions in Croatian Pharmaceutical Policy |
| title_sort |
cost control-oriented provisions in croatian pharmaceutical policy |
| publisher |
World Bank, Washington, DC |
| publishDate |
2020 |
| url |
http://documents.worldbank.org/curated/en/595621593099933890/Cost-control-oriented-provisions-in-Croatian-pharmaceutical-policy http://hdl.handle.net/10986/34190 |
| _version_ |
1764480284241166336 |