Concentrating complex care in centres of excellence makes sense in terms of quality and health outcomes. In addition, it increases health system efficiency and favourably impacts costs. This is common knowledge today, even though it is not yet vigorously implemented in a number of countries. Measuring and publishing health outcomes will contribute to faster implementation of health system reforms by providing additional arguments on why and how they should be undertaken. International centres of excellence for very rare conditions will play an important role in this process if we want to improve the way in which we care for these patients.

In Croatia currently not, due to both administrative and technical obstacles. However, current plans for the development of the national health care IT system do foresee improved communication between health system stakeholders so should allow for this feature also.

Many European countries are initiating telemedicine projects to improve care and access to care, and the Covid-19 epidemic has in particular demonstrated their potential in this regard. While most of these initiatives are national, there are plenty of examples involving international cooperation also, some funded through EU funds.

Indeed, these factors have a profound impact on quality of life and should not be overlooked. Their collection and reporting will allow for better informed patient participation in deciding on treatment options and planning therapy.

Joint public procurement is a reform that can bring about substantial savings through standardization and bundling of purchasing and subsequent economies of scale without negatively affecting health care benefits provided to citizens or jeopardizing the quality of care. During implementation, it is important to keep in mind not to narrow the therapeutic options so that all patients can receive those products and medications that will help them in the best way. The anti-corruptive element of the reform should also not be overlooked. As centralized procurement increases, the transparency of purchases by making them more visible and easier to monitor and control, it lowers the risk of misconduct. Croatian legislation (based on the relevant EU directive) foresees the use of the economically most advantageous criterion as mandatory in awarding contracts.

The Covid-19 epidemic has negatively impacted economies across Europe, but it has also very clearly demonstrated the importance of adequately financing health care systems. Most of us will agree that health budgets should be the last ones to be reduced, including those used for ensuring access to effective innovative medicines. On the other hand, we can expect greater scrutiny in the health technology assessment of new treatments to ensure value for money. Monitoring real world evidence (including on outcomes) should be a way forward.

Currently these data are not available in Croatia, and this should be urgently addressed to allow for informed decision making and planning meaningful health reforms.

There is wide consensus in the country that measuring and publishing health outcomes in Croatia is a critical step in improving our health system. Health system decisionmakers will have accurate and timely information on performance. Doctors will receive feedback on their treatment results and patients will be better informed about their options and prospects.

Patients should, of course, be actively encouraged to participate in these decisions. We need more research to better understand to what extent this really occurs in Croatia and what we need to do to improve. Recent research shows that it is necessary to work on health literacy in Croatia and empowering patients, which will give them the knowledge and strength to actively participate in treatment with their medical team and shift from an object of treatment to a subject.

EU Commissioner Kyriakides (responsible for Health and Food Safety) has on December 2019, at the European Parliament, stated the following: It is unacceptable in a European Union that seeks to represent all of its citizens, wherever they live in the EU, whatever their age, gender, or socio-economic background, that access to care is not equal for all. Member States, the pharmaceutical industry, payers and healthcare providers, patient advocates all have a huge role to play here. This provides hope that the EU will swiftly act in this direction.

Care and nursing are crucial to achieving high-quality treatment outcomes for patients, families, and communities. As nurses are an integral part of healthcare teams, they must be included in all efforts aimed at improving treatment outcomes. Effective healthcare today requires a multidisciplinary approach and the involvement of professionals from various fields, which of course includes nursing.