{"?xml":{"@version":"1.0"},"edm:RDF":{"@xmlns:dc":"http://purl.org/dc/elements/1.1/","@xmlns:edm":"http://www.europeana.eu/schemas/edm/","@xmlns:wgs84_pos":"http://www.w3.org/2003/01/geo/wgs84_pos","@xmlns:foaf":"http://xmlns.com/foaf/0.1/","@xmlns:rdaGr2":"http://rdvocab.info/ElementsGr2","@xmlns:oai":"http://www.openarchives.org/OAI/2.0/","@xmlns:owl":"http://www.w3.org/2002/07/owl#","@xmlns:rdf":"http://www.w3.org/1999/02/22-rdf-syntax-ns#","@xmlns:ore":"http://www.openarchives.org/ore/terms/","@xmlns:skos":"http://www.w3.org/2004/02/skos/core#","@xmlns:dcterms":"http://purl.org/dc/terms/","edm:WebResource":[{"@rdf:about":"http://www.dlib.si/stream/URN:NBN:SI:doc-D7UX71DN/5f8336be-c27b-4404-ba5b-8fc07455dd24/PDF","dcterms:extent":"702 KB"},{"@rdf:about":"http://www.dlib.si/stream/URN:NBN:SI:doc-D7UX71DN/44cf6932-e559-4adb-89ee-071cf6df0844/TEXT","dcterms:extent":"0 KB"}],"edm:TimeSpan":{"@rdf:about":"2018-2025","edm:begin":{"@xml:lang":"en","#text":"2018"},"edm:end":{"@xml:lang":"en","#text":"2025"}},"edm:ProvidedCHO":{"@rdf:about":"URN:NBN:SI:doc-D7UX71DN","dcterms:isPartOf":[{"@rdf:resource":"https://www.dlib.si/details/URN:NBN:SI:spr-3NZXSA6F"},{"@xml:lang":"sl","#text":"Central European Public Administration Review"}],"dcterms:issued":"2025","dc:creator":["Bronić, Mihaela","Marijanović, Romario","Prijaković, Simona"],"dc:format":[{"@xml:lang":"sl","#text":"številka:2"},{"@xml:lang":"sl","#text":"letnik:23"},{"@xml:lang":"sl","#text":"str. 191-220"}],"dc:identifier":["DOI:10.17573/cepar.2025.2.07","COBISSID_HOST:257783043","ISSN:2591-2240","URN:URN:NBN:SI:doc-D7UX71DN"],"dc:language":"en","dc:publisher":{"@xml:lang":"sl","#text":"= University of Ljubljana Press"},"dc:subject":[{"@xml:lang":"sl","#text":"analiza ovojnice podatkov (DEA)"},{"@xml:lang":"en","#text":"cost efficiency"},{"@xml:lang":"en","#text":"Croatia"},{"@xml:lang":"en","#text":"Data Envelopment Analysis"},{"@xml:lang":"en","#text":"health"},{"@xml:lang":"sl","#text":"Hrvaška"},{"@xml:lang":"sl","#text":"javne splošne bolnišnice"},{"@xml:lang":"en","#text":"public general hospitals"},{"@xml:lang":"sl","#text":"stroškovna učinkovitost"},{"@xml:lang":"sl","#text":"zdravje"}],"dcterms:temporal":{"@rdf:resource":"2018-2025"},"dc:title":{"@xml:lang":"sl","#text":"Analysis of the cost efficiency of public general hospitals in Croatia|"},"dc:description":[{"@xml:lang":"sl","#text":"Purpose: The Croatian population is rapidly ageing, and if current demographic trends continue, by 2050 one in three Croatians will be over the age of 65. This demographic shift implies that a smaller working-age population will need to support a growing number of elderly individuals, placing considerable strain on economic performance. Simultaneously, increasing demand for public health services has driven up public healthcare expenditures, with general hospitals bearing the majority of accumulating unpaid obligations. In this context, assessing the cost efficiency of general hospitals becomes crucial in minimising resource wastage. Design/Methodology/Approach: Cost efficiency is assessed by analysing how monetary inputs are converted into intermediate outputs. The cost efficiency of 19 Croatian general hospitals is analysed using the most common method—input-oriented Data Envelopment Analysis (DEA)—during the pre-pandemic years of 2015 and 2016, and the pandemic years of 2021 and 2022. One input is used (total expenditures and outlays of general hospitals, excluding investments in facilities) and three outputs (number of inpatient treatment days, beds/chairs occupancy rate in day hospitals, and number of outpatient services in polyclinic-consultative healthcare). Findings: Cost efficiency scores range from 48% to 100%. On average, hos-pitals could have reduced expenditures by 7% in 2015, 14% in 2016 and 2021, and by 16% in 2022 while maintaining current output levels. During the COVID-19 pandemic, the overall cost efficiency of general hospitals declined. Pula-Pola and Varaždin consistently emerged as benchmark (most efficient) hospitals across all four years. In contrast, Vukovar underperformed, with cost efficiency scores below 70% throughout. For most hospitals, relative efficiency rankings remained stable over time—high performers before the pandemic continued to perform well afterward; low performers remained low. The data also indicate that larger hospitals, in terms of expenditures, generally demonstrate better cost efficiency. Academic contribution to the field: This study contributes to the literature by measuring cost inefficiencies in general hospitals, which are often overlooked in international health economics research, particularly in Central and Eastern European countries. It identifies persistent benchmarks and inefficiencies, offering a data-driven foundation for policy reforms aimed at enhancing financial sustainability and operational efficiency in Croatia’s healthcare system. Research limitations: The model incorporates a limited set of variables due to data constraints. Including additional indicators, such as pharmaceutical expenditures or case-weighted inpatient discharges, could pro-vide a more nuanced cost efficiency assessment. This limitation highlights the need for more comprehensive and standardised healthcare data collection in Croatia, especially from the Ministries of Health and Finance. Practical implications: These findings may assist policymakers, as cost-efficient general hospitals are vital to economic and social prosperity. Benchmark general hospitals can serve as models, sharing best practices in cost management and resource use that could help improve cost efficiency across general hospitals. Less efficient general hospitals should be targeted for audits, managerial training, or support with budgeting and resource allocation. Furthermore, the study provides a foundation for enhancing national hospital performance monitoring systems and data reporting standards. Originality/Value: This is the first study to calculate the cost efficiency of 19 Croatian general hospitals"},{"@xml:lang":"sl","#text":"Namen: Hrvaško prebivalstvo se hitro stara, in če se bodo sedanji demografski trendi nadaljevali, bo do leta 2050 vsak tretji Hrvat starejši od 65 let. Ta demografski premik pomeni, da bo moralo manjše delovno aktivno prebivalstvo podpirati čedalje več starejših, kar bo močno obremenilo gospodarsko uspešnost. Hkrati naraščajoče povpraševanje po javnih zdravstvenih storitvah povečuje javne izdatke za zdravstvo, pri čemer največji delež nakopičenih neporavnanih obveznosti nosijo splošne bolnišnice. V tem kontekstu postane ocenjevanje stroškovne učinkovitosti splošnih bolnišnic ključno za zmanjševanje razsipavanja virov. Zasnova/metodologija/pristop: stroškovna učinkovitost je ocenjena z analizo, kako se denarni vložki pretvorijo v vmesne rezultate. Stroškovna učinkovitost 19 hrvaških splošnih bolnišnic je analizirana z najpogosteje uporabljeno metodo – vhodno usmerjeno analizo ovojnice podatkov (DEA) – v predpandemičnih letih 2015 in 2016 ter v pandemičnih letih 2021 in 2022. Uporabljen je en vhod (skupni izdatki in odhodki splošnih bolnišnic, brez naložb v objekte) in trije izhodi (število bolnišničnih oskrbnih dni, zasedenost postelj oziroma stolov v dnevnih bolnišnicah ter število ambulantnih storitev v poliklinično-konzultativni dejavnosti). Ugotovitve: ocene stroškovne učinkovitosti segajo od 48 % do 100 %. Povprečno bi bolnišnice lahko znižale izdatke za 7 % v letu 2015, za 14 % v letih 2016 in 2021 ter za 16 % v letu 2022, ne da bi zmanjšale obstoječe ravni izhodov. Med pandemijo covida-19 se je skupna stroškovna učinkovitost splošnih bolnišnic poslabšala. Bolnišnici Pula-Pola in Varaždin sta v vseh štirih letih dosledno izstopali kot referenčni (najučinkovitejši) enoti. Nasprotno pa je Vukovar dosegal slabše rezultate, s stroškovno učinkovitostjo pod 70 % v celotnem obdobju. Pri večini bolnišnic so relativne uvrstitve po učinkovitosti ostale stabilne skozi čas – visoko učinkovite pred pandemijo so ostale učinkovite tudi po njej; manj učinkovite so ostale nizko uvrščene. Podatki kažejo tudi, da večje bolnišnice, merjeno po izdatkih, praviloma dosegajo boljšo stroškovno učinkovitost. Akademski prispevek k področju: študija prispeva k literaturi z merjenjem stroškovnih neučinkovitosti v splošnih bolnišnicah, ki jih mednarodne raziskave zdravstvene ekonomike pogosto spregledajo, zlasti v državah Srednje in Vzhodne Evrope. Identificira vztrajne referenčne primere in neučinkovitosti ter ponuja podatkovno podlago za politične reforme, usmerjene v izboljšanje finančne vzdržnosti in operativne učinkovitosti hrvaškega zdravstvenega sistema. Omejitve raziskave: model vključuje omejen nabor spremenljivk zaradi podatkovnih omejitev. Vključitev dodatnih kazalnikov, kot so izdatki za zdravila ali po primerih uteženi akutni bolnišnični odpusti, bi lahko omogočila bolj niansirano oceno stroškovne učinkovitosti. Ta omejitev poudarja potrebo po celovitejšem in standardiziranem zbiranju zdravstvenih podatkov na Hrvaškem, zlasti s strani ministrstev za zdravstvo in finance. Praktične implikacije: ugotovitve lahko pomagajo oblikovalcem politik, saj so stroškovno učinkovite splošne bolnišnice ključne za gospodarsko in socialno blaginjo. Referenčne bolnišnice so lahko vzor, delijo dobre prakse upravljanja stroškov in uporabe virov ter s tem pomagajo izboljšati stroškovno učinkovitost v celotnem sklopu splošnih bolnišnic. Manj učinkovite bolnišnice naj bodo cilj revizij, managerskega usposabljanja ali podpore pri proračunskem načrtovanju in načrtovanju virov. Poleg tega je študija podlaga za izboljšanje nacionalnih sistemov spremljanja uspešno-sti bolnišnic in standardov poročanja podatkov. Izvirnost/vrednost: gre za prvo študijo, ki je izračunala stroškovno učinkovitost 19 hrvaških splošnih bolnišnic"}],"edm:type":"TEXT","dc:type":[{"@xml:lang":"sl","#text":"znanstveno časopisje"},{"@xml:lang":"en","#text":"journals"},{"@rdf:resource":"http://www.wikidata.org/entity/Q361785"}]},"ore:Aggregation":{"@rdf:about":"http://www.dlib.si/?URN=URN:NBN:SI:doc-D7UX71DN","edm:aggregatedCHO":{"@rdf:resource":"URN:NBN:SI:doc-D7UX71DN"},"edm:isShownBy":{"@rdf:resource":"http://www.dlib.si/stream/URN:NBN:SI:doc-D7UX71DN/5f8336be-c27b-4404-ba5b-8fc07455dd24/PDF"},"edm:rights":{"@rdf:resource":"http://creativecommons.org/licenses/by-nc-nd/4.0/"},"edm:provider":"Slovenian National E-content Aggregator","edm:intermediateProvider":{"@xml:lang":"en","#text":"National and University Library of Slovenia"},"edm:dataProvider":{"@xml:lang":"sl","#text":"Univerza v Ljubljani, Fakulteta za upravo"},"edm:object":{"@rdf:resource":"http://www.dlib.si/streamdb/URN:NBN:SI:doc-D7UX71DN/maxi/edm"},"edm:isShownAt":{"@rdf:resource":"http://www.dlib.si/details/URN:NBN:SI:doc-D7UX71DN"}}}}