1. CROATIAN HEALTH INSURANCE FUND
Croatian pilot from the NHI perspective Tatjana Bekić MD

2. Role of GPs I 2.339 GP partner teams with contract
2 types of status (private practitioners 66% and medical centres employees 34%)
2 ways of earning assets for contractual health care (private practitioners – contracted funding, medical centres - salary)
Specialists 60%
Medical centres : 60% younger than 50, 30% specialists
Private practitioners : 80% older than 50, 70% specialists

3. Role of GPs II
Working in chronical panels (diabetes, hypertension, chronic obstructive pulmonary disease/asthma) is the indicator of work quality (QI), and it is paid by NHI
30,88 % of GPs satisfy quality indicator if they worked in at least one chronical panel a day/ one month
Panel covers 5,5% of population of patients with diabetes (CIPH Report for 2016)

4. Panels and QI
It is necessary to improve quality indicators (QI); NHI in collaboration with experts identified new indicator of diabetes care which has to be implemented in NHI official records:
Total number of diabetic patients with fulfilled diabetes panel versus total number of registered diabetic patients in a single contractual GP team
QI fulfilment criteria: 30% of diabetic patients per team has to have at least 1 panel fulfilled (per year)

5. Following table describes in detail QI structure after 1. 4
Following table describes in detail QI structure after : Agency for quality assurance criteria (model not realised) QI
(7,5% of total income; poll tax + DTP)
Assessment
(according to number of patients randomly chosen age groups)
1. 70% of diabetic patients with HbA1c value in last 12 months:
Verified yearly;
Adjusted monitoring in G2 applications
15% sum of money QI
Possible revenue:
Team 1297 = 210,00 Kn per month
Team 1488 = 219,90 Kn per month
Team 1658 = 247,50 Kn per month
Team 1880 = 285,00 Kn per month
Team 2294 = 365,10 Kn per month
2. 70% of diabetic patients in care with HbA1c value lower than 8,0 %:
10% sum of money QI
Team 1297 = 140,00 Kn per month
Team 1488 = 146,60 Kn per month
Team 1658 = 165,00 Kn per month
Team 1880 = 190,00 Kn per month
Team 2294 = 243,40 Kn per month
3. 70% of patients with hypertension in care with blood pressure value in last 12 months:
20% sum of money QI
Team 1297 = 280,00 Kn per month
Team 1488 = 293,20 Kn per month
Team 1658 = 330,00 Kn per month
Team 1880 = 380,00 Kn per month
Team 2294 = 486,60 Kn per month
4. 50% of patients with hypertension in care with blood pressure value lower than 150/90 mmHg:

6. Panels
Easy reachable, uniformed, systematised informatical tool for recording relevant data about a patient, showed as series of visits to a doctor
GPs use following panels:
1) preventive 2) chronical (diabetes, hypertension, chronic obstructive pulmonary disease/asthma) 3) cardiovascular risk 4) rational pharmacotherapy 5) anticoagulant therapy 6) body mass index
In women’s health care - gynaecologists: pregnancy panel for early detection of risks (e.g. fasting glucose in 23rd week gestation)

7. GP’s role in care of chronic noncommunicable diseases
The most accessible, knows patients very well, has an insight into entire population in care, the ability for screening the population at risk and opportunity screening
Collaborates with community health nurses
Organizes counselling for small groups of patients (NHI pays for small group counselling which is organized at least once a month, and they are most often organized for diabetic patients)

8. Pilot Project CHORDIS I
Expectations:
NHI is an insurance fund
12% of NHI budget spent on treating diabetes, 80% of that spent on treating complications
Contribution to cost rationalization by developing clinical guidelines and protocols for treating chronic noncommunicable diseases
Better collaboration and relationship between primary and specialist health care levels in care of chronic noncommunicable diseases

9. Pilot Project CHORDIS II
We expect the professionals and public to work together in designing panels and other supporting IT solutions
We think that community health nurses should play a bigger role in informing and educating population, and including them in primary and secondary prevention of chronic noncommunicable diseases at their chosen GP (they should also help to choose a physician to those who still do not have one)

10. Pilot Project CHORDIS III
Risks:
Teams are overburdened (old legislative which determines rights and obligations of doctors and patients)
Different legal and labour status of doctors (medical centres employees and private practitioners)
Professional disagreement regarding jurisdiction of care for diabetic patients (primary or secondary healthcare)

11. NHI supports Pilot Project CHORDIS+ and hopes that the results of the project will show us what we have to do to improve the care of patients with chronic noncommunicable diseases. Thank you for your attention!