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Private sector progressing in Croatian ophthalmology
While public health stagnates due to insufficient funding, private centers offer premium services and develop innovative projects.
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Croatian ophthalmology is fast gaining lost ground, reaching European standards and developing country-tailored key strategic initiatives, but more in the private sector than in the public sector, according to one official.
“Private centers have been able to acquire the most modern technology and offer all kinds of diagnostic and therapeutic services, including premium surgical procedures,” Nikica Gabri, MD, PhD, president of the Croatian Society for Cataract and Refractive Surgery, said.
On the other hand, public hospitals have insufficient funding, cannot keep up with the rapid technological advancements of ophthalmology and, therefore, are unable to meet the demands of patients on both a quantitative and qualitative level.
“Hospitals need restructuring, long-term planning and a more favorable remuneration policy for doctors,” Gabri said.
Continuing education and availability of subspecialty training are also considered unmet needs.
Weaknesses in the public sector
There are currently 415 ophthalmology specialists and around 35 residents in Croatia. Most of them work in public hospitals and the so-called public health centers, delivering most of the primary and secondary care ophthalmology services. Basic ophthalmic exams, such as refraction and IOP measurement, are also performed in optic shops by ophthalmologists who work there in their after hours.
“The number of ophthalmologists that we currently have should cover all needs, but the financial problems and limits that the Croatian health system has been facing in the last decades are causing disservice to patients,” Gabri said.
Waiting lists for cataract surgery are long because the number of lenses provided by hospitals is limited, restricting the number of surgeries that can be performed. In addition, although the number of specialized vitreoretinal surgeons is increasing, this field has relatively insufficient numbers outside of the capital city, Zagreb.
“Tertiary care is centralized in our four big cities, Zagreb, Split, Rijeka and Osijek, and doctors there are under huge pressure. Areas outside cities are underserved. A higher number of specialists for retina, pediatric ophthalmology, oculoplasty and uveitis, as well as a more equal regional distribution, would enable better, faster and wider delivery of ophthalmic care to our patients,” Gabri said.
An expanding private sector
The private sector has been growing considerably in the past decade. Svjetlost Eye Hospital in Zagreb, founded and directed by Gabri, has obtained affiliation with the university and provides all ophthalmic diagnostic and surgical services with the latest equipment. Smaller private clinics, offering basic ophthalmic care or specific eye surgeries such as refractive, cataract and cosmetic procedures, are widespread in the country. Svjetlost Eye Hospital is also certified to perform corneal transplantation.
Basic health insurance covers a significant percentage of costs, and additional state insurance covers all expenses in public hospitals. However, reimbursement for procedures performed in private clinics is still a controversial issue.
“Some private clinics had contracts with state insurance. But all contracts were closed at the end of last year due to financial cuts in the health system. In addition, maximum reimbursement from state insurance is 250 for cataract surgery, which is far from covering the expenses of premium procedures,” Gabri said.
As a result, patients who wish to be treated privately have to pay out of pocket.
“Private enterprise, individual initiatives and efforts fuel progress and economic growth. Ophthalmologists with vision, passion and focus are changing the world of Croatian ophthalmology, and we need more of such people. The system should support them,” he said.
On July 1, 2013, Croatia become a member of the European Union, and there is hope that this will create new opportunities for market development, education and employment.
“It should accelerate the process of education and exchange of knowledge and experiences. It should also give new impulse to the growth of our medical tourism industry, a sector that could potentially have a great impact on employment and the economy in general,” Gabri said.
Croatia has the potential to attract patients from other EU countries, especially from north and central Europe, offering services of similar quality at a lower price, he said.
“[This is] an interesting deal for foreign insurance companies. Plus, patients can benefit of the natural beauties and good climate of our country,” Gabri said.
In the near future, Croatia could become the new Riviera, an ideal winter resort for older people who want to escape from cold climates and at the same time take advantage of first-class medical services.
“Being part of the EU will definitely facilitate the accomplishment of these projects because administrative barriers will no longer exist,” Gabri said. “It will be then up to us to develop good infrastructures and effective marketing strategies.” – by Michela Cimberle
- For more information:
- Nikica Gabri, MD, PhD, can be reached at University Eye Hospital Svjetlost, Heinzelova 39, 10000 Zagreb, Croatia; +385-1-777-5677; fax: +385-1-777-5600; email: nikica.gabric@svjetlost.hr.
Disclosure: No products or companies that would require financial disclosure are mentioned in this article.