Influence of urbanization level and gross domestic product of counties in Croatia on access to health care.

AIM: To examine the association of counties' urbanization level and gross domestic product (GDP) per capita on the access to health care. METHODS: Counties were divided in two groups according to the urbanization level and GDP per capita in purchasing power standards. The number of physicians per 100,000 inhabitants, the number of physicians in hospitals in four basic specialties, physicians' workload, average duration of working week, the average number of insurants per general practice (GP) team, and the number of inhabitants covered by one internal medicine outpatient clinic were compared between predominantly urban and predominantly rural counties and between richer and poorer counties. Our study included only GP teams and outpatient clinics under the contract with the Croatian Institute for Health Insurance. Data on physicians were collected from the Ministry of Health and Social Welfare, the Croatian Institute for Health Insurance, the Croatian Institute for Public Health, and the Croatian Medical Chamber. Data on the contracts with the Croatian Institute for Health Insurance and health care services provided under these contracts were obtained from the database of the Institute, while population and gross domestic product data were obtained from the Database of the Croatian Institute for Statistics. World Health Organization Health for All Database was used for the international comparison of physician's data. RESULTS: There was no significant difference in the total number of physicians per 100,000 inhabitants between predominantly urban and predominantly rural counties (206.9+/-41.0 vs 175.4+/-30.3; P=0.067, t test) nor between richer and poorer counties (194.5+/-49.8 vs 187.7+/-25.3; P=0.703, t test). However, there were significantly fewer GPs per 100,000 inhabitants in rural than urban counties (49.0+/-5.5 vs 56.7+/-4.6; P=0.003, t test). GPs in rural counties had more insurants than those working in urban counties (1.749.8+/-172.8 vs 1.540.7+/-106.3; P=0.004, t test). The working week of specialists in the four observed specialties in hospitals was longer than the recommended 48 hours a week. CONCLUSION: The lack of physicians, especially in primary health care can lead to a reduced access to health care and increased workload of physicians, predominantly in rural counties, regardless of the counties' GDP.

Present state and possibilities for improvement of cancer prevention and early detection in the Osijek-Baranya county.

Cancer morbidity and mortality are on a steady increase in Croatia. Technologic possibilities for appropriate management are available for four cancer sites, i.e. cancer of the breast, cervix uteri, colorectum and prostate, and include cancer prevention and early detection in individuals yet free from manifest signs of the disease. The magnitude of the problem, the experience acquired to date, health care personnel available, and additional resources required to launch a systematic program of early detection of the disease are presented. The program should be initially launched in a county with greatest experience in early detection of cancer, where health care service is ready to immediately start its implementation. The role of family physician, gynecologic service at primary health care level, and polyclinic-consultation hospital service in program implementation is described. The following three possible options for early detection of cancer are analyzed and proposed: minimal program (early detection every 3 years), medium program (the same individuals examined every 2 years), and optimal program proposed by the American Cancer Society and other national and international organizations.

A model of oncologic care in general medicine.

The problems related to cancer and its control initially manifest in local community, and general practitioners are those who most commonly have to face them there. The aim of the study was to develop a program of comprehensive oncologic care for primary care physicians, which would be highly professional, efficient, economically justified and feasible, with the ultimate goal of upgrading the target population health and quality of life. Opinions on the priorities and intensity of work in particular activities of general practitioners in the field of oncologic care were obtained from 54 Croatian experts in oncologic care. An Expert Opinion was designed to collect oncologists' opinions by use of Delphi method. The study was performed in two runs, yielding a high rate of accordance among the oncologists. 38 of 54 participants responded in the first run, and 40 of 54 (74%) responded in the second run. The results indicated pain therapy and terminal care to be given highest priority, whereas measures of primary prevention ranked first as a group. There was a unanimous agreement that current activities of primary care physicians in the field of oncologic care were not satisfactory, and that they should take the role of a coordinator of the oncologic care of both individual patients and the population at large. The study showed that a model of oncologic care applicable throughout the country could be developed by combining data from a small health care office with the knowledge of renowned experts in the field.