22 PERSPECTIVES ON BUSINESS AND ECONOMICS | VOL 44 | 2026 system and promoting integration of services via strategic planning; standardization of staffing norms; procurement efficiency; and consistency of quality across regions (OECD, 2023a). Persistent hospital debt and resource constraints at the county level are expected to be addressed through national oversight, which aims to stabilize finances and promote network-wide service integration. As implementation continues, initial analyses suggest that the structural shift may contribute to reduced fragmentation and better alignment of clinical services with population needs, particularly for older adults’ coordinated, multidisciplinary care (OECD, 2023b). In May 2025, Croatia adopted the Operational Plan for the Development of Integrated Long-Term Care. This plan aimed at ensuring accessible LTC across Croatia, at both professional and informal facilities. As part of this plan, members of the Ministry of Health and the Ministry of Labour, Pension System, Family and Social Policy formed an interdepartmental working group. The goals of this group are to update national health and social service plans for 2021–2027 and develop integrated models of home and community care. The group works on collaboration among hospitals, health centers, and social care institutions, ensuring better resource use and holistic patient management. The Operational Plan also outlined a range of actions, such as identifying workforce gaps, training new caregivers, and hiring them through a voucher-based system. Given the recent enactment of the reform, its full impact has not yet been realized or evaluated. Despite the numerous reforms introduced in hopes of improving long-term and geriatric care, their overall effectiveness remains unclear due to the recency of the implementation. Although the Operational Plan for the Development of Integrated Long-Term Care and the Healthcare Act seek coordination between institutional health-care facilities and community care, most hospitals and LTC facilities remain concentrated in urban areas. The Ministry of Health must prioritize reforms that focus on rural communities, earmarking budget items for rural health-care. Funds must be allocated to training health-care workers, building urgent care centers, and equipping expanded telehealth. Both the EU and Croatia should reexamine LTC spending. A large share of health spending, about 22.8%, goes to medical equipment and pharmaceuticals while 37.9% is directed to primary care and specialist outpatient care. LTC makes up only 3.1% (OECD, 2021). Policies should focus on rural regions, increasing the number of facilities to serve the large elderly population living there. Recommendations Improving rural geriatric care will require collaboration among health-care providers, funding tailored for rural areas, and improved availability of facilities. The Ministry of Health, international medical schools, and local governments can collaborate to incentivize health-care personnel to practice in rural areas and create facilities that are easily accessible to elderly individuals. Increasing medical personnel To incentivize foreign health-care personnel, a useful model is medical schools offering international students the opportunity to live with geriatric individuals in rural areas in their homes while attending residency or fellowship programs. At the University of KwaZulu-Natal in South Africa, students in their final year of medical school can opt to live in rural communities and practice in rural hospital environments. Not only are students able to experience medical care in a complex, nonurban clinical environment but also their awareness of the importance of empathy, cultural understanding, and community immersion in medical practice are increased. Rural health demands also became increasingly apparent to the students after working in these areas (Gaede, 2025). A similar model in Croatia would provide older homeowners with free in-home assistance from students and relief from the burden of caregiving that otherwise would fall on family members. Students would acquire experience caring for elderly individuals, medical education abroad, and reduced living expenses, thereby gaining a personal perspective on rural Croatian culture and a deeper understanding of elderly patients’ exigencies. Physicians and nurses likewise would benefit from the students, as responsibilities for social care—coordinating appointments, managing medications, and providing basic preventative care at home—would be shared with the medical students. The addition of physician assistants (PAs) and nurse practitioners (NPs) could be valuable resources in staffing. In contrast to several high-income countries where PAs play a key role in mitigating workforce deficiencies, Croatia does not formally recognize the PA profession (OECD, 2020). The system instead depends on physicians in training or nurses with expanded competencies to fill in staffing gaps; however, incorporating midlevel practitioners such as PAs could take the burden off already overworked practitioners. PA and NP programs are shorter than those for medical doctors,
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