Wednesday, 2 January 2019

Reduced VAT on OTC Medicines Lowers Their Prices by 18%-19%

ZAGREB, January 2, 2019 - The enactment of the law lowering the standard Value Added rate of 25% to 5% on non-prescription medicines will pave the way for the reduction of retail prices of OTC medicines by 18-19 percent as of the start of 2019, the Croatian Chamber of Pharmacists (HLJK) has stated.

The Croatian government has recently proposed that all medicines, including prescription and non-prescription drugs, should be taxed by a 5% rate as of 1 January 2019.

This would lead to a marked lowering of prices of non-prescription medicines as of the new year, which means that medicines for influenza and cold, nose drops, painkillers and about 500 kinds of other OTC drugs will be 18% cheaper, HLJK chairwoman Ana Soldo has said.

Prices of painkillers and anti-inflammatory drugs are currently between 25 and 40 kuna and will further drop to between 20-30 kuna. Drugs for cold symptoms and nose drops will be 10 kuna cheaper.

The most frequently sold OTC drugs in Croatia are painkillers and anti-inflammatory drugs as well as drugs for cold symptoms.

Spending on OTC drugs in Croatia is currently twice as high as it was five years ago. However, Soldo has warned that some of the drug companies have in the meantime already risen prices of their products that the lower VAT would only offset that increase, which means that the prices of such products would not be changed as of the new year.

In this context, the HLJK chamber points out the German Berlin-Chemie as the only one that has increased the prices of its products to such extent that buyers cannot see the effect of the lower VAT on its products in 2019.

Soldo hopes that other producers will not follow the example of that company. She criticises Berlin-Chemie for its ill-considered decision that will neutralise the good effects of the lower VAT rate on OTC drugs.

The Croatian Health Insurance Fund (HZZO) has recently stated that it expects an additional 1.3 billion kuna in revenues in 2019 after the increase of the standard health insurance contribution rate from 15% to 16.5%.

All that should facilitate efforts to reduce the overall debt of kuna 8.2 billion in the public healthcare system.

More news on the healthcare in Croatia can be found in our Lifestyle section.

Sunday, 30 December 2018

Health Minister: Spinraza to Be Given to Patients if Efficacy is Proven

ZAGREB, December 30, 2018 - Health Minister Milan Kujundžić said on Saturday that all medicines, including Spinraza, were put on the essential medicines list by the Croatian Health Insurance Agency (HZZO) Medicines Commission, stressing that patients aged over 18 and those on a respirator would be given the drug if its efficacy in such cases was proven.

"The main criterion (for putting a drug on the essential medicines list) are indications cited by the company making the drug. As soon as the relevant company reports that the drug should also be given to patients on a respirator and if there is evidence that it is a useful method, the Commission will decide that Spinraza should be given to those patients as well," Kujundžić told the RTL commercial broadcaster when asked when spinal muscular atrophy patients older than 18 or on a respirator would be able to use Spinraza.

More news on the healthcare in Croatia can be found in our Lifestyle section.

Saturday, 29 December 2018

Split Hospital Receives 10,000th Blood Donation in Ten Years

ZAGREB, December 29, 2018 - The Clinical Hospital Centre in the southern coastal city of Split on Friday received the ten thousandth blood donation in the last ten years. The donor at the Split hospital was Mario Roguljić (27), who has donated his blood for the sixth time.

Mayor Andro Krstulović Opara thanked all the donors for the noble deed of saving human lives, while the head of the municipal Red Cross, Tomislav Gojo, emphasised the importance of raising awareness among young people as potential new blood donors.

With 10,000 doses of blood donated in the last decade, residents of Split have saved or helped over 30,000 people, given that one dose can be used for three patients.

More news on Croatia’s health system can be found in our Lifestyle section.

Friday, 28 December 2018

St. Catherine Hospital to Launch Genetic Screening of Footballers

The St. Catherine Hospital, the official hospital of the Croatian national football team, and the Croatian Football Federation have begun, for the first time in Europe, a project of systematic screening of risk groups of football players to determine frequency of the most common genetic mutations that can lead to sudden cardiac death of athletes, announced the Croatian Football Federation on December 28, 2018.

The sudden cardiac death is a tragic event which occasionally happens at sports venue which opens up a series of questions among both the general public and professionals, such as "How can this happen to seemingly healthy and successful athletes" and "How to prevent such sudden events?"

The fact is that extremely intense physical activity can temporarily increase the risk of sudden cardiac death in predisposed athletes. Medical literature suggests that due to increased physical activity, athletes have a 2.8 times higher risk of sudden cardiac death compared to the general population which does not take part in sports activities. Particularly significant is the fact that genetically-based illnesses can cause such a dramatic event. Because of this, the medical professionals, in addition to introducing thorough clinical exams of athletes, have recently started recommending the introduction of targeted genetic testing, primarily because they can point to an existing genetic predisposition on time.

With the Cardio Screen "multi-gene panel testing" during the pilot project, 77 genes and related mutations that can lead to sudden cardiac death of athletes will be analysed simultaneously. These conditions include, among others, various disorders of the heart's electrical activity, including inherited disorders of the ionic heart canals (e.g., prolonged QT interval syndrome) or, on the other hand, structural changes in the heart, such as cardiomyopathy (most often hypertrophic cardiomyopathy), as well as many other conditions. When it comes to cardiomyopathies, sudden cardiac death unfortunately often occurs before any previous symptoms appear, so any diagnostic data that can reduce the frequency of such incidents is highly important.

The Croatian Society for Sports Medicine of the Croatian Medical Association, in connection with the systematic exams of athletes and in line with the views of the American Heart Association, the European Society of Cardiology and the International Olympic Committee, has issued guidelines for the scope of athletes’ examinations and have emphasised that "it is of particular concern that most athletes with undetected cardiac issues have no symptoms, and the only way to prevent sudden cardiac death is primary prevention involving an electrocardiogram. If there is any suspicion about heart disease, further examinations should be performed, including heart ultrasound, ergometry, 24h Holter monitoring, heart MRI etc.” It goes on to say that “today, genetic testing of deceased athletes is becoming more common so that we can get more information about these disorders in order to prevent sudden deaths in the future better.”

The goal of the St. Catherine Hospital and the Croatian Football Federation’s project is to use the genetic screening of athletes belonging to risk groups (athletes with a concerning personal or family medical history, athletes with specific findings after a clinical examination, athletes with previous episodes of weakness or excessive fatigue, athletes with unexplained loss of consciousness and chest pains, etc.) to find athletes with specific genotypes that contain typical mutations responsible for the emergence of these unexpected and tragic events. On the other hand, according to the guidelines of the Croatian Society of Human Genetics of the Croatian Medical Association, all persons who have been determined to be persons with higher risk will be provided with information as part of their genetic counselling process, in identifying the risk and after further examinations. This will provide the basis for optimal treatment and, if necessary, exclusion from the sports of under risk athletes all with the aim of reducing the incidence of sudden cardiac deaths.


“It is my pleasure to cooperate with our official hospital, the St. Catherine Hospital, the European centre of excellence, and to carry out for the first time in Europe a systematic genetic screening of football players. With this, we demonstrate that we can be leaders in a number of processes, like introducing new diagnostic tests, all with the aim of providing our athletes with the best possible health care,” said Davor Šuker, the president of the Croatian Football Federation.

“The sudden cardiac death is the leading cause of death in athletes, and every new diagnostic step is significant in preventing such unexpected and tragic events that leave a deep mark in every society. A large number of cardiovascular diseases that can lead to sudden cardiac death, such as hypertrophic cardiomyopathy or various heart electrical activity disorders, have a genetic basis. This naturally suggests the need for timely genetic screenings, especially with risky groups of athletes, which will lead, together with standard clinical treatments according to the guidelines of the European Society of Cardiology, to optimisation of treatment and providing recommendations related to further sports activities,” said Dragan Primorac, the president of the St. Catherine Hospital’s management council.

More news about the St. Catherine Hospital can be found in our Lifestyle section.

Thursday, 27 December 2018

MOST Party Presents Health Care Bill Proposal

ZAGREB, December 27, 2018 - The opposition MOST party on Thursday presented a draft law on preventing chronic non-communicable diseases (NCD), saying their health care bill was revolutionary and that it would raise the quality of life in Croatia.

The bill regulates measures of preventive health care as well as the responsibilities of those in charge of its implementation – the state, health system employees and patients, Ivan Bekavac told a news conference, adding it was critical for citizens to accept responsibility for themselves.

The draft law is unique, expert, sustainable, necessary to change the grim statistics according to which Croatia is on the top of European rankings.

The proposed law is based on facts and recommendations written by experts and not politicians and some of the preventing measures include better eating habits, especially for school children, intergenerational solidarity, volunteering.

Croatia has a law on communicable diseases but it does not have a law on chronic non-communicable diseases, of which over 40 million people die each year in the world and 23,000 in Croatia.

MOST MP Ines Strenja Linić stressed that Croatia did not yet have a national plan for fighting cancer, although it is high on the European list of malignant diseases patients.

Croatia today is among the top three countries according to chronic non-communicable diseases risk, namely cardiovascular diseases, tumours, etc.

More news on Croatia’s health system can be found in our Politics section.

Monday, 17 December 2018

Cancer Kills Nearly 1 in 4 Persons in Croatia

ZAGREB, December 17, 2018 - Cancer is the second leading cause of death in Croatia, accounting for nearly one in four deaths, as well as 26% of all deaths in 2017, it was said on Monday at the "Fight & Win" conference, aimed at raising awareness of the importance of preventing and fighting cancer. According to the International Agency for Research on Cancer, cancer kills 164 persons out of 100,000 in the United States and 262 in the European Union.

In 2016, 27 persons out of 100,000 died of breast cancer in the EU and 47 in Croatia, said Croatian member of the European Parliament Dubravka Šuica, also a member of the informal group of MEPs "Members Against Cancer".

"It's evident that in the US they invest more and do more than in the EU. This shows that it's necessary to invest more in research, development and innovation, which is a priority for the European Parliament. Croatia has to become more involved," said Šuica.

"Cancer is a topic that's often not visible enough, yet it's a big social phenomenon endangering families and radically changing their lives. The number of persons with malignancies is constantly on the rise both in Europe and the rest of the world," said Prime Minister Andrej Plenković.

The number of those ill is rising because people live longer and many people reach an age when malignancies appear more frequently because of daily stress, which is one of the psychological triggers contributing to the development of malignancies, and cause of the high number of smokers and obese persons, in which Croatia is near the top of European rankings, he said.

Participants in the conference agreed it is necessary to raise awareness of the fact that cancer does not choose its victims and of the importance of prevention, healthy living, and check-ups for early diagnosis and treatment.

"The turnout for screening programmes is poor," Health Minister Milan Kujundžić said, adding that next year, alongside the three existing national programmes for early diagnosis of breast, colon and cervical cancer, programmes would begin for the early diagnosis of lung and prostate cancer.

A national cancer plan is currently in public consultation and Plenković expects it to be adopted in the first half of next year.

"Funds have been ensured for future screenings as well as for priority lists, which primarily refers to patients suspected of having a malignancy who should undergo diagnosis within seven days. All other big investments we plan to finance from EU funds," said Kujundžić.

More health news can be found in our Lifestyle section.

Sunday, 2 December 2018

Croatian Health Insurance Fund Records Positive Financial Results?

ZAGREB, December 2, 2018 - The Croatian Health Insurance Fund (HZZO) reported recently that it was continuing to achieve good financial results this year and that in the first nine months of the year, it had generated a positive financial result of more than 668 million kuna.

These results are due to positive macroeconomic trends, and in particular due to the 5.4% increase in the average gross wage, HZZO stated.

The Croatian Health Insurance Fund's Jan - Sept revenue was 5.81% higher year-on-year and amounted to 18.5 billion kuna.

The higher contribution rate of 4.08% was conducive to this, as did a 20% increase in revenue from the budget which led to an additional 500 million kuna in contributions increasing from 2.5 kuna billion to 3 billion kuna.

This has resulted in a positive financial result in that period of about 668 million kuna, HZZO said.

The report further added that the average number of total insurees is decreasing, however, the number of active insurees is growing and as of 30 September there was an average of 1,563,452 registered employees, which is an nominal increase of 42,191 employees or 2.77% compared to the same period last year.

The rate of people on sick leave in the period from January to September increased slights and amounted to 3.41% y-on-y (3.22% in 2017) but has fallen compared to the first six months of this year when it amounted to 3.53%.

For more on Croatia’s health system, click here.

Tuesday, 27 November 2018

How to Improve Private Healthcare in Croatia? Expert Explains

Although annually earning about 3 billion kuna in revenues, with investments in the next year to reach more than half a billion kuna and employing about 8,000 professionals, the private healthcare in Croatia still operates under unequal conditions in relation to the public healthcare system and other entrepreneurs. Namely, in addition to a number of law and regulations that need to be adapted to today's needs of the market and the patients, Croatia should also change its mentality which continues to stigmatize private capital in healthcare services, although in more developed European countries it serves as a powerful leverage for the strengthening of the public solidarity-based healthcare system, reports on November 27, 2018.

The Association of Private Polyclinics, Hospitals, Spas and Health Care Institutions of the Croatian Employers' Association has recently spoken about this issue. Jadranka Primorac, the president of the association and member of the Managing Council of the St. Catherine's Specialty Hospital, explains why patients would benefit from stronger private and public sector co-operation, and what needs to be changed to enhance this co-operation.

What are the laws and regulations that hinder the development of private healthcare in Croatia and better co-operation with the public sector?

To begin with, there are many contradictions between the Institutions Act and the Companies Act. Namely, private health institutions operate as companies, we pay the business tax on profits, but the 1996 Institutions Act prevents us from paying out the profits. It means that, if we generate any profit at the end of the year, we can only reinvest it into existing business, we cannot use it for any other purpose, any other investment, etc. The law was adopted in 1996 when private healthcare institutions did not exist in numbers like they exist now, and has not been changed since.

Why do you think the law has not been changed?

The law belongs to the government’s administration department, but it regulates institutions in many segments, healthcare, culture, education, social care, which concerns a wide range of ministries, and that is probably one of the reasons why this process is not proceeding faster. In April, we met with Administration Minister Lovro Kušević, and he promised us he would work on it, but no changes have been proposed.

What would be specific changes in the law if it were to be adapted to the private sector?

It should make it possible to pay out the profits and that would certainly provide a certain degree of investment momentum in private healthcare. There is a lot of talk about medical tourism and 300 million euro investments, but given this law, I am not sure that is realistic, because everyone who invests their capital expects that at the end they will be able to use the profits as they please since that is the key principle of entrepreneurship.

Private healthcare institutions also do not have the right to apply for EU funds?

Paradoxically, many public hospitals have been equipped in the 2014-2020 programme period with the help of grants from European funds. Each hospital asked for between 20 and 30 million kuna in grants. However, we still have to see if all those who asked for money have met all the necessary parameters for financing projects from EU funds since everything is being measured, so the question is what will eventually be paid to them if these parameters are not met. On the other hand, private healthcare institutions could not apply for these funds, we could not buy new equipment under the same conditions as public institutions, because private healthcare facilities were not put into operational programmes. We were looking for a way to have some funds allocated, but unsuccessfully. It should be said that this government is not responsible for it, but we are asking now to be included in the new 2021-2027 programming period. We have received promises that this will happen, but the question is how these negotiations will proceed, given the poor utilization of funds available to Croatia in this period. According to our information, the utilization is at just 22%, which is absolutely unsatisfactory and certainly not a positive for the future programming period.

The cooperation between private and public system is still very weak. How many services in the private sector are realized through the Croatian Health Insurance Institute (HZZO)?

It is still not a lot. On an annual basis, around 1.8 % of the funds are allocated by the HZZO to the private sector (about 400 million kuna of the 24 billion kuna HZZO budget). At the same time, we have a continuous increase of revenues in private institutions year after year, and this three billion kuna were paid by patients from their own pockets, while most of them simultaneously pay 15 percent of their salaries for the compulsory health insurance. So the patients are paying twice and do not have a lot of choices. It is not important to patients whether they go to a public or private institution if they receive a service that they do not have to pay from their own pockets. A good example is the Netherlands, where all insurance companies are private, and you have public and private hospitals working together. The healthcare in the Netherlands has been the best in Europe for many years. It is based on several principles; everyone has the right to healthcare, there is solidarity through health insurance which is compulsory for everyone and accessible to everyone, and they have good-quality and timely health services. The people in the Netherlands pay around 120 euro a month per person, which is comparable to Croatia, and during the year they pay additional 500 euro for treatments. Competition between providers of health services is promoted, and contracts are awarded to those who are the best and have the best outcomes of treatments, which is being monitored through patient registers. There are no waiting lists there. All this shows that our healthcare is extremely expensive and very ineffective, because the share of health spending which our politicians often speak about has little to do with the cost-effectiveness of the system.

But they allowed private health insurance companies to enter the system, while in Croatia they are still not integrated into the system and have the same status as private healthcare institutions.

The question of ownership is not important at all. There are rules that the state as regulator prescribes and controls with a series of parameters. Monopoly is not good in any business. When you have market competition, the quality is increased, performance and outcomes of treatments are being monitored, and you know who is who. If a hospital has excellent results in a particular department, then insurers, public or private, would negotiate more such procedure at that hospital. Nowadays, everything is measurable. Also, the HZZO needs to be transformed into a proper insurer that will then be subject to all the laws that other insurers are subjected to because the current situation is not fair market competition. That would make the HZZO finally turn towards patients who are financing it through their salary contributions, and not to the Ministry of Health, as is the case now. The primary role of the HZZO, as well as any health insurance, is to use the money it gives to hospitals to provide more “health” for the insured.

Does this mean that, without the private health insurance, private healthcare in Croatia will not further develop?

The healthcare system will not be maintained at this level with state monopoly and state health insurance unless a radical turnaround occurs. And there is no need to discover anything new here. We should just apply good solutions from well-regulated healthcare systems in the EU countries.

Would the strengthening of the role of private healthcare accelerate the reform of the public health system?

Yes, I believe that the public healthcare system cannot be reformed and I do not believe that it is possible to have full impact on cost-effectiveness as long as the state is the main and sole provider of both the insurance and the treatments.

Maybe the change is not in someone's interest?

The system as it has been set up is unsustainable. When we sum up everything, we have paid almost 30 billion kuna to cover the debts of the public healthcare system in the last 27 years. That is with no interest charged, which in the end makes this amount even larger. Thus, the way in which the Croatian health system is currently functioning is a "bottomless pit," and quality healthcare cannot survive in the long run unless processes and funds are managed rationally and unless there is competition, quality control and cost efficiency control, together with the accountability and professionalism in management.

If these legal changes were to be made and were to encourage foreign investment in healthcare, would anyone have an interest in buying a Croatian hospital that is currently operating with a loss?

No one will buy a public hospital, there is no fear, since that is not realistic, primarily because these are institutions that need large investments in facilities and equipment.

Despite these obstacles, what are the business results of the private healthcare in Croatia? It seems like you are doing pretty well.

The private healthcare in Croatia has an annual income growth of about ten percent; foreigners are coming, health tourism is getting stronger. However, in private healthcare institutions in Croatia, the profit is not as high as in some other sectors, since the price of services in Croatia is low compared to the Western countries and the cost of labour is high. So the return of investment is slow, but if the EU funds were to be opened, if we could acquire equipment through the funds, or if we could use the Investment Incentive Act, the return of investment would be much simpler and easier.

For more on the Croatian healthcare sector, click here.

Translated from (reported by Marija Crnjak).

Sunday, 25 November 2018

Public Health Institute Warns of Smoking and Drinking Among Youngsters

ZAGREB, November 25, 2018 - A third of Croatian school-age children are smokers, and Croatia ranks third in Europe according to the prevalence of this problem in society, said participants in a roundtable discussion organised by the Croatian Institute of Public Health (HZJZ) on smoking and drinking among youngsters.

During the discussion held in Zagreb, doctors supported the planned rise in excise taxes on alcoholic beverages and cigarettes, as they believe that higher prices will make those products less available to pupils.

On the other hand, the Croatian Employers' Association (HUP) insists that the higher prices of alcohol and cigarettes, the more prevalent illegal sale of such products.

Ivana Pavić Šimetin of the HZJZ presented some of the alarming statistics such as the fact that 4% of boys and 1% of girls have got drunk at least twice so far in their life. Pavić Šimetin spoke about the importance of making cigarettes and alcoholic drinks less available to underage buyers. "The HZJZ is not focused on a rise in income but on safeguarding public health against smoking and alcohol, having in mind the fact that the availability of alcohol and cigarettes to young people is 10% higher in Croatia than in other EU member-states," she said.

The ESPAD European survey on smoking and alcohol and drugs consumption among the youth in 2015 shows that every one in three Croatians below the age of 16 is a smoker, and 54.7% of those in this age cohort drank alcohol in the previous 30 days.

Danijela Štimac of the HZJZ warned that in Croatian cafes a shot of brandy costs 6 kuna and a glass of freshly squeezed juice 25 kuna.

Of all EU member-states, Croatia has the second lowest tobacco prices after Bulgaria, HZJZ director-general Krunoslav Capak noted.

Furthermore, in Croatia 25% of the population smokes on a daily basis, twice as much as in Finland, for instance, said Ivana Brkić Biloš of the HZJZ department for epidemiology and prevention of non-communicable chronic diseases.

"Alcohol as a risk factor has been identified in more than 200 different diseases, and in the world 3.3. million of deaths are believed to be linked to alcohol consumption, and in Croatia 3,000 deaths annually. Smoking is believed to be the cause of seven million deaths in the world annually, and in Croatia every fifth death is linked to smoking," she said.

HUP officials said that in principle they are opposed to increasing prices of such products as they usually lead to the creation of the grey market.

For more on health in Croatia, click here.

Saturday, 17 November 2018

No Conscientious Objection in Pharmacies, says Health Minister

ZAGREB, November 17, 2018 - After a pharmacist in Zagreb refused to issue contraceptive pills to a patient, citing conscientious objection, Health Minister Milan Kujundžić said on Friday that the pharmacist's behaviour was impermissible, while the Social Democratic Party (SDP) called for urgent regulations regarding conscientious objection so as to prevent recurrence of similar cases of denying someone medication or health protection.

There is nothing that a pharmacist has the right to deny a patient based on conscious objection, Kujundžić said after a government meeting when asked about the incident. "Every patient has the right to be issued with a prescribed medication in any pharmacy. The pharmacist has the right to freedom of conscience but not in the workplace, in the pharmacy," the minister explained.

In response to the incident the opposition SDP called on the Croatian Medical Chamber to finally present its official stance on the issue of the conscientious objection and said that that it expected the Health Ministry and Minister Kujundžić to regulate acts when conscientious objection can be cited.

SDP expects the authorities to draw up registers of pharmacists, physicians and other health personnel citing conscientious objection because citizens have the right to that information.

"We don't have to point out that actually (non)regulation of conscientious objection is usually at the expense of women in exercising their right to terminate pregnancy," SDP said in a press release.

In light of the fact that a month ago a very large number of women decided to break their silence and talk about violations of their rights regarding reproductive health, and also about the treatment in hospitals with gynaecological wards, we consider this to be yet another attack on women's rights in Croatia, SDP said.

For more on the position of women in Croatia and attempts to deny them their rights, click here.

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