Suchergebnisse

Over the past decade, public opinion surveys have shown that Croats are deeply dissatisfied with their health care system and asses it to be one of the most important issues. However, health care hardly makes it into any political discourse in Croatia. This study analyzes the results of a public opinion survey conducted before the 2007 parliamentary elections to find out what the public sentiment on health care performance in Croatia is and to analyze the reasons why health care is not addressed by political actors. Evidence suggests that while health care is the most salient issue today, the public often understands it poorly. Thus, in a political environment of competing issues, and given the complexity of tacking health care in the policy arena, politicians strategically avoid discussing the issue.

This paper concerns new forms of collective agency in the area of health care in Croatia from 2015 until 2018. These new forms developed in the midst of the growing privatization and commodification of health care and the simultaneous decrease in the accessibility to health care. Privatization has taken place slowly, but continuously over the last 29 years. The traditional civil society organizations in the field of health care used to be characterized by a narrow set of activities, with vertical structures, and were frequently focused on a single-disease approach and collaboration with the pharmaceutical industry. Such practices produced limited results, hence improved forms of activism emerged. In this research, we illustrate their development using the example of three case studies of collective agency. The first case study is looking at the policy analysis and the activist group started by the Organization for Workers' Initiative and Democratization (OWID); the second one focuses on the informal group of medical students called U3 formed at the Andrija Štampar School of Public Health with the aim of developing critical thinking; and the third case study considers the Karika Association, started as an attempt to rethink health care in the community. The main research methods employed included process tracing analysis and research data comparison aimed at showing the differences between the traditional and the new forms of healthcare activism, in addition to the secondary sources of information such as scientific and professional literature. The results show that the new forms of collective agency in the healthcare area include various groups of citizens not necessarily connected with a specific disease, that they have a horizontal structure and are focused on the healthcare system in general. In conclusion, they represent the beginning of a paradigmatic shift in activism from a single-disease approach towards comprehensive health care that has the potential to deal with the growing issue of commercialization, commodification and inequalities in today's healthcare systems.

The work, results, and thoughts of Andrija Štampar are recognized globally as a public health heritage (1). They encompass the vision of health as a state of overall well-being, society as the key responsible health care provider, and a set of values and guiding principles underlining the importance of optimal health. The reasons behind their adoption worldwide lie in the success of public health projects in Croatia (former Yugoslavia) in 1920s promoted by Zagreb School of Public Health (SPH) (later SPH A. Štampar), established in 1927. The key mission of the SPH was to develop further the public health practice and promote Štampar's public health principles (2). Andrija Štampar's principles (Box 1) advocate universal and widely understood values in different social contexts. Apart from their widely understood meaning, the principles also serve as a guideline for policy makers and governments to promote a just and fair society, equality, and equity (3). Whereas these principles illustrate the general determinants of health system organization in some societies, in Croatia they have been acclaimed and accepted in general as a comprehensive and best public health practice. In some way, we have kept the inherited Štampar principles and practice as a professional "dogma" and unquestionable public health business model.

This article compares the health system responses to COVID-19 in Bulgaria, Croatia and Romania from February 2020 until the end of 2020. It explores similarities and differences between the three countries, building primarily on the methodology and content compiled in the COVID-19 Health System Response Monitor (HSRM). We find that all three countries entered the COVID-19 crisis with common problems, including workforce shortages and underdeveloped and underutilized preventive and primary care. The countries reacted swiftly to the first wave of the COVID-19 pandemic, declaring a state of emergency in March 2020 and setting up new governance mechanisms. The initial response benefited from a centralized approach and high levels of public trust but proved to be only a short-term solution. Over time, governance became dominated by political and economic considerations, communication to the public became contradictory, and levels of public trust declined dramatically. The three countries created additional bed capacity for the treatment of COVID-19 patients in the first wave, but a greater challenge was to ensure a sufficient supply of qualified health workers. New digital and remote tools for the provision of non-COVID-19 health services were introduced or used more widely, with an increase in telephone or online consultations and a simplification of administrative procedures. However, the provision and uptake of non-COVID-19 health services was still affected negatively by the pandemic. Overall, the COVID-19 pandemic has exposed pre-existing health system and governance challenges in the three countries, leading to a large number of preventable deaths.