The results show that we have achieved a lot in the past year, like revenue increases, new computerization projects, and the inclusion of new medications in drug lists. We expect positive trends to continue in the future too.
When he sat in ‘the hot seat’ that is acting director of the Croatian Health Insurance Fund (CHIF), Dr Lucian Vukelić was met with divided opinions. Today, with a lot of hard work behind him and positive results ahead of him, Dr Vukelić is optimistic about the future.
1. What is your assessment of the medical treatments available to Croatian citizens in comparison to an average EU citizen in terms of use of innovative medication and medical aids?
In 2005, a fund for new, innovative and by default, exceptionally expensive medication for patient treatment, was established in the Republic of Croatia with the budget of 23 million kunas. In the beginning, the Fund covered only the costs of medication used in the treatment of enzyme diseases in children. Today, the CHIF’s list of exceptionally expensive medication includes the ones that are used in long-term enzyme treatment of hereditary metabolic diseases, haemophilia, inherent lack of growth hormone, some hematologic, malignant, chronic autoimmune diseases and hepatitis C. In the period from 2005 to 2016, the Fund increased its budget several times, reaching over 700 million kunas in 2016, and over 1.4 billion kunas available for treatment of rare and serious illnesses in 2018.
Despite the ever-increasing costs, the CHIF has been constantly coming up with new solutions within its available resources to ensure a continued supply of particularly expensive medication to patients in need and to include new medication on the list of particularly expensive drugs. Medication consumption is growing year-on-year, and this is something that cannot be avoided because new, more modern generations of drugs are emerging in the market and the CHIF must and wants to ensure that insured persons have access to them.
Also, at almost every session of the CHIF’s Managing Council, our departments suggest which new, contemporary medical aids should be included in the list of aids that insured persons can obtain on the account of mandatory health insurance. In 2018, a total of 792,715,469 kunas was spent on orthopaedic appliances and aids, an increase of 1.23% relative to the previous year. Due to the population’s aging and the higher incidence of chronic and other diseases, the funds spent on orthopedic and other aids have been growing, as have the demands for the inclusion of more expensive and innovative aids in the relevant list and more encompassing indications for prescribing and approving the use of aids that are already included in the CHIF’s list of aids.
I believe that all the necessary medication and aids are available to insured persons in Croatia, just like in most European countries. In the future, the CHIF will continue including new medication and aids in its relevant lists. We are constantly in contact with healthcare professionals and we will certainly provide our insurance holders with high-standard medical treatment. People are not even aware that many wealthier countries do not have the scope of health care that we have in Croatia.
2. An issue of availability of therapies and check-ups, as the reason for the growing number of people in Croatia taking sick leave, has been raised recently. Is this the main or additional reason for extending the length and the share of sick leave?
The overall temporary sick leave rate in the period from January to December 2018, compared to the same period the year before that, continued to grow and it currently stands at 3.46% (3.28% in 2017). The total number of days of temporary sick leave increased by 8.61% to 16,942,139 days. On average, 54,128 employees per day take sick leave, with employers covering the costs of sick leave for 26,725 employees, and the CHIF covering the costs for 27,403 employees.
The CHIF implements regular and extraordinary supervision, as well as supervision of temporary sick leave at the request of an employer. In 2018, we came to the conclusion that over 30% of employees who took sick leave were absent from work needlessly long. We are aware of the fact that some of the sick leave is due to long-term illnesses that cannot be treated quickly because the patients have to wait for certain diagnostic procedures for a very long time. But they are in a minority. An additional reason for the increase in the rate of sick leave is the nonfunctioning of the expert body from the Institute for Expertise, Professional Rehabilitation and Employment of Disabled Persons. Specifically, when the forensic evaluation of the ability to work was separated from the Croatian Pension Insurance Fund and formed into a single expert body, the expert evaluation took over a year to do, while the legal deadline is 60 days. This also meant a prolonged sick leave time, which additionally encumbered family doctors and the CHIF.
3. To what extent do sick leave costs burden CHIF’s budget? How much of an additional burden would be to you if the proposition made by employers to reduce their coverage of sick leave costs from 42 to 15 days was accepted?
If we observe the total number of temporary sick leave days and the number of active insured persons, which stands at 1,564,677, we can see that the average length of sick leave per insured person was 11 days in the period from January to December 2018.
The compensation for sickness and disability amounted to 1,232,553,757 kunas in 2018, which is a 7.35% increase relative to the previous year, while their share in the structure of the total CHIF’s expenditure stands at 5.02%.
We do not have projections of how much CHIF’s costs would increase in the event of a reduction in the temporary sick leave days to under 42, which is the number of the sick leave days that employers currently pay for.
4. Since late 2017, when you were appointed CHIF’s director and started making changes, which implemented measures resulted in the biggest positive changes?
The opportunity to become the director of the CHIF, which was given to me by the Government, is important to me as a professional challenge but it also carries a huge responsibility because the CHIF is a large system that covers many health insurance segments. Almost all Croatian citizens are insured with the CHIF, the mandatory health insurance is available to everyone and the scope of our work is huge – from rights to health care and medication to fees, additional health insurance and many other things. The first year of my term in the office, which was 2018, is behind us, and I can say that it was quite successful. There wasn’t much time for adjustment because as soon as I assumed the duties of the director, I put my knowledge and experience to work together with my associates.
The results show that we have achieved a lot in the past year, from revenue increases, new computerization projects, and the inclusion of new medications in drug lists. In 2018, CHIF’s revenue was much higher than in 2017. In the period from January to December 2018, the CHIF generated the total revenue in the amount of 25,028,265,354 kunas, which is 5.7% higher than the total generated revenue in the same period of 2017, which stood at 23,679,490,400 kunas. I think this is a significant indicator!
We expect positive trends to continue in the future too, namely that the number of active insured persons who are paying contributions will increase which will enable us to follow positive trends in technology development and contemporary medical treatment methods. The CHIF will continue to incorporate new medication into the relevant list, as well as expand the list of medical procedures that the CHIF pays for.
5. Digitization is one of the main topics for you. How much can digitization help in managing health care?
Digitization is one of the important elements in improving the functionality of the health care system. All the mentioned e-Health projects deal with digitization. Digitization accelerates work processes, helps with more effective treatment and more accessible health care, and actively involves patients in caring for their health. The timely availability of essential data in treatments expedites, facilitates and rationalizes the treatments, all with the aim of providing a better health care for our patients. The future of health care lies in digitization.