ear-long service in primary health care will not be obligatory for young doctors upon graduation, the Croatian Health Ministry has decided after that proposal triggered an avalanche of criticism among medical students and young doctors.

The system of specialist medical training will be promoted, young doctors will have mentors and higher salaries, but they will not have to work in primary health care, Minister Vili Beros said while presenting reform measures after three-week public consultation on two key healthcare system reform bills.

Beros said that after graduation, young doctors would not have to work in primary health care for one year but that a set of incentives would be introduced to encourage them to specialise in less attractive fields of medicine.

Considering the number of objections submitted, the Ministry has also given up on the proposal to make five-year long work in a primary health centre a condition for doctors to open a private practice. Year-long work in a primary health centre will continue to be a condition for those wishing to start their own practice in primary health care.

“Nobody likes change, but it is necessary,” the minister said in reference to criticisms in the media and opposition to the proposed measures that mostly refer to the situation in primary health care and specialist training for young doctors.

Beros said that the two key bills – on healthcare and mandatory health insurance – on which public consultation ended on Tuesday, would go through two readings in the parliament and that they were expected to be adopted by the end of this year or the beginning of the next.

He repeated that the key reform goals were the financial viability of the system, stronger public health care and prevention, reorganisation of hospitals and investment in human resources.

The ministry did not accept demands that the share of primary health care offices in primary health centres be limited to a maximum 25% so their number is expected to increase at the expense of private primary health care practices.

Patients to rate medical services

Beros said, however, that family doctors would not have to provide emergency medical services outside their place of work and that the burden of administrative work they now do would be reduced by hiring administrators to deal with excess administrative work.

The healthcare bill will retain the proposal for each county to have one primary health centre, which will be able to have branch offices in case of islands or other demanding geographical situations. Primary health centres will significantly expand the range of their services, and they are also expected to provide psychological, speech therapy and other specialist services.

The minister also welcomed the proposal for physical medicine to be treated as part of primary health care.

He stressed that the pay grades of doctors in primary health care and hospital specialists would be made equal and that doctors with private primary health care practices would be able to work until the age of 68.

Even though there was a proposal that each county should have only one general hospital, Beros said that it would not be obligatory but was just a proposal.

The transfer of founding rights from counties to the state, in the case of general hospitals, will enable a single public procurement system, there will be a new system for the categorisation of hospitals and excellence centres will be established, he said.

The minister also said that one of the changes in the bills was the possibility for patients to rate the medical service they have been given.

A register of providers of medical services is being worked on and work has also been underway on reducing waiting lists for specialist examinations, the minister said, calling again for the political and social consensus on the proposed reform.