HZZO: New more economical model of referrals to hospitals from September 1

The Croatian Health Insurance Fund (HZZO) will introduce a new model for referring patients to specialist examinations, hospitalization, diagnostic tests, and outpatient treatment starting from September 1, aimed at relieving hospitals, reducing waiting lists, and saving budgetary funds.

The diagnosis, treatment of patients, and monitoring of chronic patients will be transferred to primary care physicians, writes HRT. They will no longer act as administrators of hospital doctors, as learned from the Deputy Director of HZZO, Tatjana Prenđa Trupec.

Preoperative tests will be strictly defined, and they will no longer be performed by hospitals, but by health centers. Hospital doctors will be able to recommend therapy or medication, but not for sick leave, while family doctors will decide on further steps.
Sick leaves, which are exclusively under the jurisdiction of primary care, must be substantiated by findings, which, according to HZZO data, has already reduced the number of sick leaves in Croatia.

HZZO also has a solution for the previous irrational consumption of medications, as only the cheapest medications of a certain composition will be prescribed in the future. A patient who wants a more expensive medication will have to pay the difference themselves, says the Deputy Director.

The work of healthcare professionals at all levels will be monitored by the Central Health Information System, which covers all 5,000 primary care practices.

Referrals will have a new method of coding, depending on whether the patient is being sent for a consultative examination in a hospital (A), hospital treatment (B), specialist healthcare (C), or outpatient treatment (D).

Referral A will cover the consultative examination and necessary diagnostics, and the specialist will be able to recommend further tests, medication, or therapy, about which the final decision will be made by the family doctor. However, the specialist based on this referral will not be able to refer the patient for further hospital treatment, schedule a follow-up examination, or issue an opinion on the patient’s work ability.

Internal referrals for further processing can only be issued to the patient by the hospital doctor after hospitalization, and no later than six months after discharge from the hospital. One year after hospitalization, the hospital doctor will be able to schedule the patient for only three follow-up examinations. This should significantly reduce the waiting lists, on which currently about 500,000 scheduled patients, around 300,000 are waiting for a follow-up examination, emphasize HZZO.

A patient referred for emergency hospital admission will be able to undergo all necessary tests in the hospital within seven days based on one referral.

The referral for specialist healthcare (C) will be valid for one year, and with it, the patient will be able to undergo a specialist examination and complete processing in the hospital.

For outpatient treatments and day hospitals, referrals (D) will be valid for one year, with the patient needing to schedule an appointment within 30 days of issuance. HZZO emphasizes that in case of need, as before, one can go to the Emergency Room without a referral.

Family doctors should be familiar with the new patient referral changes this month, when all indications that a patient must have to be sent for further processing will be explained in detail, say HZZO.

The system will be much more convenient for the patient and will bring significant savings, emphasizes the Deputy Director, firmly rejecting fears that waiting room congestion will increase due to greater responsibilities of family doctors.