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Anti-Communist Backlash in Croatian Healthcare Policy

Europe (Central and Eastern)
Institutions
Social Policy
IMF
World Bank
Policy Change
Ante Malinar
Universität Bremen
Ante Malinar
Universität Bremen

Abstract

In most of the CEE countries, the transition from the communist regime which started in 1989 had a profound impact on the health systems as well. The reforms in the healthcare system followed a major paradigm shift from the communist to the liberal type of governance (Lawson, Nemec, 2008; Rechel, McKee, 2009). Large body of literature suggests that early transition created a policy vacuum in the CEE countries with international organisations (most notably WB, WHO, IMF and EU) seizing the opportunity to exert their influence through financing and policy advice (Deacon et al. 1997; Cerami, 2006; Kaasch, 2015 Barr, 1995). In Croatia radical reforms in healthcare started during the early transition period (1990 – 1993). The previous health system, organised on distinct Yugoslav communist values of self-management and Bismarckian blueprints, was decentralised with multiple health funds responsible for financing (Džakula et al. 2014; Parmelee, 1985; Saric, Rodwin 1993). The system was highly inefficient, created large regional disparities and financial deficits. The 1990s reforms centralised the system by establishing one national fund and introduced liberal, market oriented policies into the system (Chen, Mastilica, 1998: 1157; Vončina et al., 2007; Kovačić, Sosić, 1998). The paper will investigate which mechanisms were at play in the early 1990s reform of Croatian healthcare system. It will engage in a dispute with the above literature and show that even though Croatia was an extremely vulnerable country in the early transition period the IOs have had minor or no influence at all in the making of healthcare policy. Instead, paper suggests that the mechanisms of change were explicitly domestic. The first one is punctuated equilibrium in the domestic policy setting (Baumgartner, Jones, 2009). The second one is anti-communist backlash which explains that the prevailing dissatisfaction for communist healthcare policy pushed the reforms towards a new neoliberal agenda.