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The World in Medicine
September 9, 1998

Unpopular Reforms

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JAMA. 1998;280(10):873. doi:10.1001/jama.280.10.873-JWM80006-3-1

Reforms that are transforming health care in the former Yugoslav republic of Croatia from a universal, state-controlled system to one that is market-based seem to have inherent benefits: a stronger financing mechanism, fewer shortages of medical supplies, and improved allocation of health resources.

Yet researchers from Croatia and the Republic of China wrote in last month's American Journal of Public Health that reforms in Croatia could worsen the health status of middle- and low-income groups. By introducing copayments for almost all health services and prescriptions, additional costs have been shifted onto consumers and undercut their real incomes. The very needy have been exempted from copayments, but the number of exemptions recently has been reduced, the researchers reported.