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Background <p>Physician and nurse migration, burnout, and uneven workforce distribution remain pressing challenges in Croatia and comparable Central and Eastern European health systems. Croatia’s national referral hospital (“category 0”) carries the heaviest clinical, educational, and research burden, yet operates within the same remuneration framework as lower-level institutions.</p> Methods <p>This perspective draws on national reports and international sources (WHO, OECD, European Commission) to provide a narrative policy analysis of human resources for health (HRH) in Croatia, situated within the broader regional context.</p> Results <p>Findings highlight significant outflow of health professionals, high rates of burnout, and misaligned remuneration. A conceptual monthly team-level workload monitoring model is proposed to enable transparent team-level tracking of clinical, educational, and research duties. Additionally, a 15% salary supplement for staff in the national referral hospital is suggested to improve retention and sustainability.</p> Conclusion <p>Beyond traditional workforce planning, innovative policy measures are needed to address HRH challenges. The proposed workload monitoring model and differentiated remuneration may strengthen retention in Croatia and offer lessons for other European health systems. Given the narrative design, the search was comprehensive and transparent; databases, time frame, and inclusion/exclusion criteria are reported to support reproducibility.</p>

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From overload to equity: rethinking Croatia’s national referral hospital and health workforce through workload monitoring and fair remuneration

  • 期刊论文

  • 出版模式：

    开放获取

  • 发表日期：

    2026年4月5日

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  • Mislav Puljević

摘要

Background

Physician and nurse migration, burnout, and uneven workforce distribution remain pressing challenges in Croatia and comparable Central and Eastern European health systems. Croatia’s national referral hospital (“category 0”) carries the heaviest clinical, educational, and research burden, yet operates within the same remuneration framework as lower-level institutions.

Methods

This perspective draws on national reports and international sources (WHO, OECD, European Commission) to provide a narrative policy analysis of human resources for health (HRH) in Croatia, situated within the broader regional context.

Results

Findings highlight significant outflow of health professionals, high rates of burnout, and misaligned remuneration. A conceptual monthly team-level workload monitoring model is proposed to enable transparent team-level tracking of clinical, educational, and research duties. Additionally, a 15% salary supplement for staff in the national referral hospital is suggested to improve retention and sustainability.

Conclusion

Beyond traditional workforce planning, innovative policy measures are needed to address HRH challenges. The proposed workload monitoring model and differentiated remuneration may strengthen retention in Croatia and offer lessons for other European health systems. Given the narrative design, the search was comprehensive and transparent; databases, time frame, and inclusion/exclusion criteria are reported to support reproducibility.