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Country profiles of health system responses to the crisis | Bulgaria 353 the minimum) (2011). The aim of the reform was to reallocate resources according to needs. • The Minister of Health postponed a stimulus policy for acute hospital care because of a lack of resources (2011). Priority setting or protocols to change access to treatments, coordination of care and patterns of use • No response reported. Waiting times • The National Health Insurance Fund introduced monthly ceilings on hospital admissions by clinical pathway, which is expected to increase waiting times (2013). Health promotion and prevention • A smoking ban instituted for indoor public places (2012). • Prices of cigarettes increased by 25% (2009) and 38% (2010). • Additional BGN 2 million allocated to the National Health Insurance Fund for vaccinations against cervical cancer (2012). • BGN 35 million allocated to the National Health Insurance Fund for vaccinations for obligatory immunizations and re-immunizations (2013).

Croatia Martina Bogut Economic trends • Croatia's economy contracted in 2009 and 2010, and while economic growth was positive by 2011, it remained below pre-crisis levels and the European average. By contrast, the unemployment rate failed to recover after 2008. Government health spending as a share of total government expenditure has been stable and high compared with other European countries. • Growth in health spending per capita has been volatile since the early 2000s. All health care financing sources reduced their spending in 2009 and 2010 (Croatia: Fig. 1). • Croatia Fig 2 gives the trends in per capita spending on health. Policy responses Changes to public funding for the health system • Deficits in public spending on health preceded the crisis. • Legislation was introduced to require government departments, including the Ministry of Health, to maintain fiscal balance (2011), with new borrowing only permitted to cover previous liabilities or development projects. • From 2011, the government budget was to be reduced annually by one percentage point of projected GDP. • SHI contributions on pensions were introduced, with varying rates depending on pension income (2011): SHI contributions on wages were reduced from 15% to 13% to reduce labour costs (2012). • Earmarking of tobacco tax revenue for health was introduced (2011). Changes to health coverage Population (entitlement) • No response reported. The benefits package • Addition of 64 new drugs to the positive list achieved through savings from improvements in pharmaceutical pricing and reimbursement (2010). • Introduction of criteria for including drugs in basic and supplementary lists of covered drugs (2012).

Country profiles of <strong>health</strong> system responses to the <strong>crisis</strong> | Bulgaria<br />

353<br />

the minimum) (2011). The aim of the reform was to reallocate resources<br />

according to needs.<br />

• The Minister of Health postponed a stimulus policy for acute hospital<br />

care because of a lack of resources (2011).<br />

Priority setting or protocols to change access to treatments, coordination<br />

of care <strong>and</strong> patterns of use<br />

• No response reported.<br />

Waiting times<br />

• The National Health Insurance Fund introduced monthly ceilings on hospital<br />

admissions by clinical pathway, which is expected to increase waiting times<br />

(2013).<br />

Health promotion <strong>and</strong> prevention<br />

• A smoking ban instituted for indoor public places (2012).<br />

• Prices of cigarettes increased by 25% (2009) <strong>and</strong> 38% (2010).<br />

• Additional BGN 2 million allocated to the National Health Insurance Fund<br />

for vaccinations against cervical cancer (2012).<br />

• BGN 35 million allocated to the National Health Insurance Fund for<br />

vaccinations for obligatory immunizations <strong>and</strong> re-immunizations (2013).

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