Friday, 18 November 2022

Need a Croatian GP But Can't Get Registered? Here's What HZZO Advises

November the 18th, 2022 - If you've ever been in need of a Croatian GP but just not been able to get anyone to get you on their list because they're all full, you likely know how frustrating it is. Especially if you've already got that dreaded ear infection. Here's what HZZO (the Croatian Health Insurance Fund) advises.

As Poslovni Dnevnik writes, if you want to change your general practitioner, you've found the database of general doctors on HZZO's website, but you only get rejections, you might be left scratching your head. As a rule, the choice of Croatian GP is made according to the place of your residence and the nearest healthcare institution, and you have the right to a new doctor one year after your last choice of doctor if you're unsatisfied.

An insured person (by HZZO) can check if a Croatian GP is taking on new patients in several ways. This information can be obtained at your regional HZZO office in person. You can also contact the e-mail address This email address is being protected from spambots. You need JavaScript enabled to view it., the Croatian Institute for Health Insurance (HZZO) tells tportal.hr. People insured by HZZO can also contact the directorate of health centres in a particular area, and it is also possible to check which GPs have places for enrollment on the HZZO website.

According to the current rules, the minimum number of insured persons who can be assigned to a team in general/family medicine is 1,275, the standard number is 1,700, and the maximum is 2,125 insured persons.

A person's chosen doctor can refuse to take on an insured person only if they have a maximum number of insured persons determined by the general act of the HZZO (for pediatrics 1190 insured persons, for dental health care 2375, and for women's healthcare 9000) under their care already, or, if between the chosen doctor and between the insured person(s) in question, there is a disturbance in mutual relations that makes it impossible to carry out medical treatment.

Insured persons who suspect that they have been improperly refused registration by Croatian GPs can also report the situation to HZZO or to the regional office responsible for their place of residence. In cases of unjustified refusal of patient registration, the competent regional office/area service of the HZZO can carry out an inspection based on the petition of the insured person, and in case of irregularities, it is able to impose the measure provided for in the contract.

GPs and doctors of dental medicine can, on the basis of gaining special approval from HZZO, contract the implementation of healthcare for a new member of an individual family whose family members are mostly treated by that healthcare provider, even in the case when the team has the maximum number of insured persons under their care.

An HZZO insured person can make a change/alter their choice of their chosen doctor by filling in the information on the statement that they can pick up in the office of the doctor they have chosen. The chosen doctor then also enters their data on the declaration form and certifies it with the signature and seal of the healthcare institution or practice in question.

For more, make sure to keep up with our news section.

Thursday, 10 November 2022

Americans Investing in Brand New Zabok Medical Centre

November the 10th, 2022 - Americans are investing a huge sum of money in a brand new Zabok medical centre, but just how much of a role with the Croatian Health Insurance Fund (HZZO) play in it all?

As Poslovni Dnevnik/Marija Crnjak writes, although many details about the establishment of the new Zabok medical centre, which will be a centre for the treatment of malignant diseases, have yet to be defined, the University of Pittsburgh Medical Centre's (UPMC) investment of about 15 million euros in Hrvatsko Zagorje is the first investment of this magnitude by foreign investors in Croatian healthcare.

The announcement about the investment that will be realised in cooperation with the General Hospital Zabok and the St. Catherine Special Hospital (Sv. Katarina), owned by Dragan Primorac, comes at a time when the state seems to have decided to strengthen cooperation between public and private healthcare.

This is further evidenced by the public support that the founders of the future Zabok medical centre received when signing the cooperation agreement from the government representatives, and support for such projects will also be given by the new legal regulations that will direct patients to private institutions in the country instead of urging them to seek treatment abroad, regardless of whether they have contracts with HZZO or not.

However, we have yet to see how many services from the new Zabok medical centre will actually be made available to Croatia's residents who are HZZO insured individuals. Namely, as confirmed by them, HZZO wasn't officially contacted regarding the possibility of contracting services with the future Centre for Oncology.

For the American investors, however, this is certainly an investment in health tourism, considering that they will be able to gain the market of Croatia's entire wider region, as well as the whole of Europe. It is also the largest American healthcare institution that employs 92,000 employees and 5,000 doctors, with a massive annual budget of 23 billion dollars.

There are a total of 40 hospitals within the UPMC chain, and in addition to over the USA, they are currently present in Italy, Ireland, China and Kazakhstan. As they claim from St. Catherine, this large investment will provide Croatian patients with diagnostic and therapeutic services completely equivalent to those in the USA, in accordance with the existing prices set by HZZO.

The new Zabok medical centre will be located on the premises of the Zabok General Hospital, which the hospital has been renting out to the St. Catherine Special Hospital since back in 2008. It spans 2,200 square metres. In addition, two linear accelerators will be built for radiation purposes, the location has already been defined, and permits need to be obtained for this. The plan is to complete the brand new medical centre in a period of about one year.

"This is primarily about a huge step forward in the transfer of the latest knowledge and technologies from the USA, the kind of which we can only dream of. When we talk to Croatian oncologists, they believe that in a few years, with the support of UPMC, Croatia could be at the very top of the EU in terms of oncology services," Jadranka Primorac, a member of the administrative council of the St. Catherine Special Hospital stated.

She added that this type of therapy and treatment, as well as state-of-the-art diagnostics in cooperation with UPMC, must be available to every Croatian resident. "It is the beginning and the end of everything. If you look at EC strategies, one of the key steps forward is to make this kind of therapy available to everyone, regardless of their ability to pay. Among other things, this is why we have HZZO,'' she explained.

Zabok is apparently now preparing negotiations with the state insurer, HZZO, which so far has not quite fulfilled all the efforts of private institutions to offer their services to the Institute's policyholders in greater numbers. One of the key obstacles was often the too low price of the services covered by HZZO, and since these are new services that didn't even exist within the Croatian healthcare system, those prices have yet to be established.

Negotiations with HZZO will certainly be one of the most important steps for future partners. Director of the Zabok General Hospital, Tihomir Vancina, pointed out that there are still a number of operational and technical matters to be resolved, from space to personnel engagement.

"We agreed in principle that we want to build the Zabok medical centre, and now we need to see how to implement it all," stated Vancina, who believes that everything can be done in the space of one year, especially considering that the investment has been under consideration for four years since the UPMC team was in Zabok for the first time. "This will be a huge step in improving the quality of the treatment on offer.

In the Zabok General Hospital, we have departments where our oncology patients can have part of the procedure, but for the rest they have to go to Zagreb, which will not be necessary in the future. The cancer survival rate in the USA is significantly higher than it is here in Croatia, precisely because of the available therapy that we're now bringing to the country. For the state, this is an ideal model, because it doesn't have to invest in space, equipment and personnel, it only has to pay for the services," concluded Vancina.

For more, make sure to keep up with our dedicated news section.

 

Wednesday, 2 November 2022

How to Croatia - Navigating The World of Croatian Health Insurance

November the 2nd, 2022 - For foreigners and even those with Croatian citizenship who are moving here, the stress of navigating the sometimes needlessly complicated world of Croatian health insurance tends to come as a surprise...

Nobody wants to think of themselves becoming unwell, developing a hernia or breaking a bone, but it happens. You might eat one too many oysters and need to be in extremely close proximity to a very well functioning toilet, you could jump off a rugged Adriatic cliff and land in a less than ideal position in the sea below, or you might step on the notorious ‘jež’. The jež, or sea hedgehog, isn’t some sort of mythical Croatian monster from times gone by, it is a mere black sea urchin, there are loads of them and they do nothing but sit around all day, but they don’t half pack a punch (or stab, which is more accurate) if you accidentally step on one. 

Health insurance in Croatia is regulated by HZZO, or in English, the Croatian Health Insurance Fund. Much like the rest of Europe, Croatia has a universal healthcare system with private options available too. This doesn’t mean that healthcare is free in Croatia, it isn’t, we all need to do our bit and pay into it to ensure we can all be cared for should we need to be.

Health insurance in Croatia is compulsory, which means everyone resident on the territory of Croatia should have a regulated compulsory health insurance status. That isn’t saying that we all do, many of us don’t, and much like many other ‘mandatory’ things in Croatia… well… the use of the term is a little skewed. That said, you should have it, if for no other reason than for your own peace of mind. 

So, who technically needs to be insured in Croatia?

Long story short - Everyone. Short story long - There are more complications to this than there needs to be, and there are 59 different categories of insured persons!

Let’s start with the basics. In Croatia, there are three types of healthcare coverage. One is obvezno (mandatory), the others are dodatno and dopunsko, which act as additional coverage on top of your obvezno insurance. Think of it in levels; 1) Obvezno 2) Dopunsko 3) Dodatno.

Universal healthcare coverage is the norm all over Europe, with the British NHS being a not perfect but absolutely enviable tax-based model where nothing is paid at all at the point of use regardless of what needs to be done. Croatia’s socialised health insurance system is similar in the sense that it is based entirely on the principles of solidarity, meaning that all residents of Croatia, be they foreign or Croatian, are expected to contribute to the fund according to their respective abilities to pay for it. Everyone is paying for everyone else, and for the system to exist, and in turn they receive healthcare services according to their needs, from the prescribing of antibiotics for that pesky trachea infection that makes you sound like a chain smoker to open heart surgery that you need because you quite literally are a chain smoker.

You don’t need to pay if you’re under 18 years of age, you’re incapable of living an independent life, if you’re a disabled member of the Croatian Armed Forces, or if you’re the direct family member of a missing or dead member of the Croatian Armed Forces.

There are some other exceptions with more detailed explanations, but assuming you’re a foreign resident, you’re highly unlikely to be any of the above, so I’ll move on and offer a brief look at what the different types of Croatian health insurance mean and include.

Obvezno zdravstveno osiguranje is the most basic of the basic must-haves in Croatia. It’s the one everyone living in Croatia is meant to have from HZZO. You don’t need it if you’re an EEA citizen or permanent EEA resident who is covered by national health insurance in another EEA member state. This goes back to what I mentioned previously about not being allowed to be insured in two EEA member states at the same time.

Dopunsko zdravstveno osiguranje is a bit like a beefed up version of obvezno. It’s supplemental and totally optional, and you can take out a policy either as a public or private health insurance policy. You can get it from either HZZO or even from a bank or independent insurer. It eliminates most copayments for medication prescriptions, visits to the doctor, diagnostic workups, tests, and hospital stays should you need hospitalisation for any reason. If you’re someone who is, for example, diabetic, or suffers from some other sort of chronic condition such as hypertension which needs constant medication and frequent monitoring, this would be a good option. Copayments in Croatia are small, but why pay them if you can avoid it?

Dodatno zdravstveno osiguranje is the top of the range when it comes to Croatian health insurance. It covers absolutely everything and isn’t on offer from HZZO but from independent insurers and banks. This policy covers preventive care, visits (as many as you need) to all kinds of specialists, additional treatments, any laboratory test you can imagine, and extended hospital visits should you (God forbid) need that. You won’t need to pay anything out of pocket whatsoever if this is your policy of choice, and once again, it’s great if you’re someone who does suffer from some sort of chronic ailment that needs medicating and/or a watchful eye kept on it.

Now we’ve covered that, you might be wondering how you enrol into HZZO

First, you need to find the HZZO office for your area of residence, a full list can be obtained by accessing hzzo.hr and selecting ‘English’ in the top right corner. Alternatively, you can ask at MUP during your residence procedure.

Once there, you’ll need to explain that you’re a resident in Croatia and you’d like to enrol for obvezno health insurance.

If you’re a citizen or permanent resident of the EEA and as such you have an EHIC, you technically do not need to enrol in HZZO because you shouldn’t be publicly insured in two EEA member states at the same time. You absolutely can enrol in HZZO should you so wish, but you’ll need to provide proof that you’re no longer insured by the other EEA country in question. This is where things can get tricky.

When Britain was part of the EEA, many, many British residents of Croatia had endless issues trying to enrol into the Croatian healthcare system because the NHS is not health insurance but a right automatically afforded to people born and living in the UK, and because the document HZZO wants (proof of no longer being insured in the UK) seems to be as elusive as the abominable snowman. Many people have never heard of such a document and have absolutely no idea what is being sought. Now the UK is no longer an EEA member state, that awkward problem is hopefully a thing of the past.

It’s technically HZZO which needs to seek this document, not you. If they ask you for it, let them know that you're not the one who needs to be chasing it, they are.

If you manage to bypass this requirement, or you’re simply not asked, and you’re an EEA citizen or permanent resident, you can be enrolled into the Croatian health insurance system. Your first step is filling in the form to sign up which will be given to you or be made readily available at the office. 

A back payment, for a year in which you weren’t even in Croatia…

This might sound utterly preposterous, and to many people it does appear quite ridiculous, but there’s logic here, so hear me out. Some people (such as those who aren’t being signed up to HZZO) by their employers, need to pay ‘back pay’ to HZZO for the previous year. So this is 12 months of premiums, all in one go. But I wasn’t even here?! I hear you cry. I know, it seems like a complete con, but the reason behind it is this: what if you turned up, enrolled for free, got hit by a bus on your way home and then needed major surgery? What if you have a chronic health condition you failed to mention and started eating the system out of house and home as it were? Insulin, blood thinners, inhalers, statins, the works! That wouldn’t be fair on the people paying into the system, while you’ve paid nothing and yet you’re reaping the rewards of a socialised medical system.

Of course, one sincerely hopes that they will never be hit by a bus, struck by lightning, attacked by a shark, be knocked unconscious by a falling brick or anything else of the sort, but these are things we unfortunately cannot predict, and nor can HZZO. If you have a chronic health condition which will require the use of the system for prescription medication and therapies, you should also be paying your part into the system in order to be on a level playing field with everyone else paying their contributions.

I truly understand that it might seem like an absolute con and a half to be asked for a document that nobody seems to have ever heard of, such as ‘release from health insurance in another EEA country’, and then once you’ve fought that battle, be asked to pay for the health insurance you would have needed to pay for had you been here over the past 12 months, but you didn’t and couldn’t have, because you were not here… Yeah, I’ll give you that, it seems a bit like someone is taking the Michael, as they say in England, but hopefully the above explanation makes it seem a bit more rational.

I’ve been hired by a Croatian company, do I need to go and enrol at HZZO?

No. Your employer is obliged by law to do this for you using what’s known as a T-2 application form. You don’t have anything to do with this process.

Getting a health insurance card

As soon as you finish enrolling at the HZZO office, or as soon as your employer is finished enrolling you, you’re insured. You’ll be given paper confirmation of that fact by the clerk, and you can use this if you do need medical help as proof of you being insured by HZZO. You will get a proper plastic card attesting to that fact in the mail eventually, this can take weeks to months to arrive, so don’t panic if it doesn’t turn up for a while, you’re insured regardless and it will.

How do I find a GP?

Got a cough that just won’t go? Eaten one too many seafood platters and become best mates with the toilet? Found a weird rash you can’t leave alone? Your GP needs to be your first port of call unless it is an emergency, in which case, well, the emergency room needs to be your first port of call. 

From ear infections to ingrown toenails and everything in between, GPs, or as they’re called in Croatia ‘family doctors’ (doktor opće medicine/obiteljski liječnik) are the ones who will prescribe the antibiotics, sprays, prescription ointments and so on. 

Most people have a GP, a paediatrician for their kids if they have them, a gynaecologist if you’re a woman, and of course, the one who tells you off for eating too many sweets - a dentist. 

Let’s not get ahead of ourselves with all of the different doctors. Here’s how to find and get registered as a new patient with a GP

HZZO’s website (hzzo.hr) has a list of GPs. You’ll need to go through the list of those in your area and call them to ask them if they’re taking on new patients. Alternatively, you can use word of mouth, which is worth its weight in gold in Croatia for just about everything. GPs can’t turn you down if they are taking on patients, which is good news. But be aware, they might not pick up the phone when you call, and the GPs with a great reputation among the local bakas (grandmothers) will likely not be able to take you on.

Once you find a GP and are accepted as a new patient, you’ll fill in a form which you’ll get from the doctor’s office, and then you’ll need to give it to the doctor. They then fill in their part, and send it off to HZZO. That’s it, you’re done.

Your GP will be the one you visit first with your health complaints which aren’t medical emergencies. They are qualified to run certain tests, and also to make a decision as to whether you need to be referred for more tests, scans, and/or to a specialist at a polyclinic or a hospital. If you do need to see a specialist for further diagnostics and tests, you’ll be given what’s called an uputnica (a referral). This used to be a slip of paper and it’s now digital (yes, Croatia is actually catching up, believe it or not), and is called an e-Uputnica.

How do I find an English speaking doctor?

English is very widely spoken in Croatia, and most educated people speak it excellently. Most doctors speak some degree of English, some with complete fluency. In smaller areas, especially down on the coast or in the Dalmatian hinterland, you might come across doctors who speak very little to no English, however. The British Government’s website (GOV.UK) and its Croatia page has a handy tool you can use to find the names of English speaking doctors, as does the US Embassy’s website.

In case of emergency

As stated, if you’re experiencing a medical emergency, go straight to the nearest hospital with your health insurance card or the piece of paper HZZO gave to you after you enrolled, don’t wait on your GP. If you’re a mere tourist with no intention of becoming a resident, take your passport and your EHIC. This is now a GHIC if you’re British.

Things to be aware of

Everyone resident in Croatia is supposed to have a GP. Does everyone have one? No. Can everyone get hold of theirs on the phone or via email if they do? Also no. 

Obvezno (mandatory health insurance) does not cover birth control, cosmetic surgery, abortion, or the expenses of medical treatment sought because of some sort of religious conviction or personal preference that isn’t deemed medically necessary.

Unless you have dodatno health insurance (or dopunsko, in a wide array of cases), you may need to pay a small copayment for certain medications, procedures or hospital stays. This is usually a symbolic sum.

Contraception and abortion in Croatia

Contraceptives

Condoms are available in all kinds of stores, from Lidl to newsagents, and even in Tisak kiosks. There are various brands on offer just like all over the world.

I mentioned above that contraceptives aren’t covered by obvezno health insurance in Croatia. Some brands of contraceptive pills, however, are covered if you have taken out a dopunsko policy, but generally you need to pay out of pocket for them and you’ll also need a gynaecologist to give you the green light (and a prescription) following a pelvic examination and a few general health questions to check all is well. The gynaecologist can be a state healthcare provider or a private one, it doesn’t matter at all.

When it comes to intrauterine devices (IUD), you also need to pay. You can get certain types at certain pharmacies and gynaecology practices. Following the purchase, a gynaecologist needs to perform the procedure and insert the IUD into your uterus following the ‘green light examination’ I mentioned above. They may want to examine you again and ask some questions before beginning the procedure to double check.

Plan B and C

Levonorgestrel, more commonly referred to as the morning after pill (Plan B) is available to purchase at all pharmacies (a pharmacy is called a ljekarna in Croatian). Health insurance doesn’t come into this. You can just go and purchase it. It prevents pregnancy in an impressive 95% of cases if taken within 24 hours, and you don’t need to speak to a doctor, nor do you need a prescription.

Mifepristone is a drug often used in combination with another drug called misoprostol to induce a medical abortion and manage early miscarriage. This is known as Plan C, you need a prescription and it can be used until the 10th week of pregnancy in Croatia. Once the prescription is taken to a pharmacy, they aim to have it within one to two days, after which you must take it for a period of four days. After that, you’ll need to go back to the gynaecologist who will perform another pelvic examination to make sure the termination is complete.

Abortion

This is still a touchy subject in Croatia, but abortion is legal and has been for a very long time. If you’re determined to have an abortion and you’ve passed the 10 weeks of pregnancy mark, you need to be absolutely certain of your decision, and while you don’t need any counselling like you do in certain other countries, even the more liberal ones, you do need to convince your doctor you’re 100% sure, as well. 

Once you’ve made your intentions clear, you’ll be spoken to about something called the Commission of First Instance, consisting of a gynaecologist, another doctor, and a social worker or registered nurse. The commission then either chooses to approve the abortion if it is medically necessary to save the woman's life or preserve her state of health, whether that threat to her health is present during the pregnancy, or during the delivery itself.

What does that mean?

An abortion after 10 weeks will likely be approved if what will become a baby is likely to, or will definitely be born with a congenital defect or if the unwanted pregnancy is the result of a crime such as incest or rape. The Commission's decision may be appealed to a Commission of Second Instance, whose decision is final. This sounds daunting, but it doesn’t even come into it in situations where the woman's life or health is in immediate danger or the abortion procedure has already begun. 

Once you’ve been given the green light, you’ll be referred for the procedure, which typically lasts around 40 minutes as long as there are no complications or bumps in the road, and is typically carried out at a hospital. The facility set to carry out the abortion must have a obstetrics and gynaecology department.

Abortions aren’t free, and they are typically not covered by HZZO. You’ll need to fork out a few thousand kuna for the gynaecological exam, blood tests, and the procedure itself.

Things to note

Certain types of IUD are free of charge and covered by HZZO entirely if the woman in question suffers from anaemia as a result of blood loss during abnormally heavy periods.

There are numerous types of contraceptive pills available in Croatia, ask the gynaecologist which one is right for you based on your own medical history, possible medical issues, and potential hormonal issues. If you have had issues with a particular brand in the past, make sure to mention it.

Some pharmacies can refuse to sell Plan B (the morning after pill) on religious grounds. It sounds absolutely beyond comprehension, but it can and does unfortunately happen. If this happens to you, go to another pharmacy.

There is something called ‘conscientious objection’ in Croatia, and much like the above case with Plan B and some pharmacists, some doctors use it to refuse to agree to refer a patient for an abortion, or to carry out the procedure. If this does happen to you, don’t waste your time pleading your case, save yourself the energy and seek out another doctor.

The tide appears to be turning when it comes to the issue of abortion in Croatia. Back in the pandemic-dominated year of 2020, the Ipsos Puls agency conducted a poll in which 81% of respondents agreed with the statement that a woman should have a right to choose regarding pregnancies, giving birth or abortions, of which 68% completely agreed and 13% mostly agreed.

On a much lighter note, you can get free tests for sexually transmitted infections (STIs) through HZZO.

If you’re prescribed some medication, you’ll pay a very small copayment when picking it up from the pharmacy. The amount is symbolic.

Additional information in more specific cases, such as cross-border healthcare, can be accessed by visiting HZZO’s National Contact Point page, or emailing them at [email protected]

Alright, I’ve found a doctor, how do I go about finding a dentist?

Dentists are those kinds of people you just don’t even think about until you can’t stop thinking about them, either because your tooth has suspiciously just started hurting or because you’ve parted with your hard earned cash, all for a tiny filling you won’t even be able to see and what feels like a smack in the face.

They don’t evoke pleasant thoughts, nor do their whirring tools, but they’re very necessary. 

If you’re a tourist in Croatia, you just quite literally need to find one, see if they have an appointment free for you, pay out of pocket for what you need to be done and then be on your merry way, hopefully never to return again. In all honesty, the same can be done as a resident who has Croatian health insurance. If you’re willing to pay out of pocket, you can’t be bothered to go flicking through the dentists which have contracts with HZZO and you need help right now, you’re free to do as you like and go to whoever will treat you. 

Dental care in Croatia is typically of a very high standard, and the prices are very favourable compared to what many people are used to paying elsewhere. This has become such a trend that Croatian dental (and health in general) tourism has been blossoming, with some polyclinics having earned stellar reputations among locals and foreigners alike, be they coming for necessary work or cosmetic procedures.

Finding a dentist who has a contract with HZZO

If you want to find a dentist who has a contract with HZZO and it isn’t cosmetic work you’re after, you’ll be able to be treated for free, although you might need to pay a very small contribution in participation costs.

Cosmetic dentistry

Croatia is making quite the name for itself in this regard, and there are, as I mentioned a little while ago, numerous polyclinics springing up offering excellent services for very favourable prices. Dentists in Croatia study at the School of Dental Medicine in Croatia, which is the only one of its kind in the country, and the care they provide is of high quality. Foreigners from all over the world come to Croatia to get their dental work done, enjoying stays in hotels, sightseeing and the gastronomic scene (as long as they can eat, of course!) all while completing their treatments. 

Croatian dentistry has an absolutely brilliant reputation internationally, and with very good reason.

 

For more on navigating the practicalities of life in Croatia, make sure to keep up with our How to Croatia articles each week by following our lifestyle section.

Friday, 28 October 2022

A Week in Croatian Politics - Schengen, Slovenia, Ukraine and Nancy Pelosi

October the 28th, 2022 - This week in Croatian politics, we've had everything from insults, Slovenia's opinions on Croatian Schengen entry and wage increase proposals to healthcare reforms, Milanovic's latest actions, and Nancy Pelosi.

The Croatian Health Insurance Fund's HDZ boss referred to Croats as arrogant in his speech about healthcare not being free

The director of the HZZO, HDZ member Lucian Vukelic has referred to Croats as arrogant because "they think healthcare is free". The HDZ member at HZZO's helm also made sure to refer to himself as somewhat arrogant, too, just for good measure.

"We have a lot of relatives in America, as soon as you see them, they say: 'Thank God I'm healthy'. They say that because healthcare costs serious money in America. In America, you pay for your healthcare out of your own pocket. Our people here are arrogant, and I must say that even I was arrogant, people in Croatia say 'it's free'. It's not free. Healthcare in Croatia isn't free, healthcare in Croatia also costs money," he said.

Vukelic failed to really explain what the point of saying any of that actually was, but he seemed to imply that there is a widespread opinion across Croatia that healthcare somehow doesn't cost money. Moreover, Vukelic himself said that a third of Croats who work annually pay 26 billion kuna from their wages for basic health insurance, so they certainly know that healthcare isn't free.

Of course, there's also the question of what we actually get out of this healthcare we're paying for, which HDZ member Vukelic claims is expensive. It would perhaps be okay if, given that Vukelic is already more than happy to admit that we all pay dearly for our healthcare, he explained why every now and then people are forced to collect money for their treatment, why pregnant women sometimes have to take their own toilet paper to maternity hospitals with them, why the waiting times for often basic examinations are so long and why medical staff are leaving Croatia.

Only later, when asked by a journalist about his statement, did the HDZ member try to justify himself by calling himself arrogant as well, which is absolutely true, but it is also true that he called other people arrogant with the thesis that "our people say that healthcare is free", which honestly, they don't. When they see how much of their wage is shaved off for it each month, they definitely do not.

A man who takes home a monthly salary of over 18,000 kuna, who drives a 300,000 kuna Mercedes, who has an official car, who owned a 150,000 kuna 2001 Harley Davidson until 2019 and who claims his ''communication skills are excellent'' but makes sexist remarks on a TV show (Otvoreno) about women talking a lot should perhaps quiet down before calling others arrogant.

On the topic of healthcare, Health Minister Vili Beros has announced reforms to the system

Beros has presented his healthcare reform package, and it's extensive. Preventative examinations will be introduced, with pilot projects beginning next year in two Croatian counties, the number of specialisations in primary healthcare will be widened, there will be revisions for national preventative programmes for malignant diseases, a focus will be placed on melanoma, hospital system changes are set to come in, and there will be an emergency helicopter service fully established and up and running (or flying) by 2024.

This is just a little bit of what was presented and discussed. You can read more details in this article.

Are Croatia and Slovenia set to start falling out over Schengen entry?

The topic of Croatian Schengen entry is hotting up as the country's Eurozone accession rapidly approaches, but is neighbouring Slovenia ready to throw yet another spanner in the works? 

An expert in European Union law from the Faculty of Law in Maribor, Janja Hojnik, was a recent guest of Novi Dan on N1 where Croatia's entry into Schengen, among other things, was discussed. Hojnik noted that, as far as it seems, the Slovenian Government has not decided to block Croatia's entry into Schengen in any way.

"It has been determined that it is a mutual benefit for Croatia to enter the Schengen zone. The plan is for Slovenia to also ratify the agreement on Croatia's entry into Schengen," she said. She also commented on the announcement, which was published yesterday in the Ljubljana-based newspaper Delo, that Slovenia will issue a unilateral note stating that Croatia, by entering the Schengen area, accepts the arbitration ruling which was reached in the past regarding a territorial dispute.

"Recently, I was on Slovenian television and they asked two ministers for their comments on those statements and one minister said that it was all misinformation, and the Minister of Justice said that the Government hadn't even commented on it and that she knew nothing about it, that this statement should be confirmed in parliament, and there is no information from the Foreign Policy Committee about it. We can only speculate whether it will be brought to the Slovenian Government itself or to parliament. I think it would be a little unusual if it were inserted into the Act on Ratification. This is not the norm and the European Commission would probably ask Slovenia what it all means. I don't think that ratification with this condition is possible. I don't see any legal consequences to this. Such a statement can't be part of European Union law, and it doesn't have any legal consequences even in international law,'' explained Hojnik.

When speaking about the arbitration agreement between Slovenia and Croatia, she said that the task of politics is to resolve relations between neighbours, not to deepen them.

"I'd like Slovenia and Croatia to solve this problem themselves, without any external factors getting involved. Schengen is probably the last thing where Slovenia could have a veto. It is in Slovenia's interest that they aren't on an external border. I see it as the responsibility of politics to find an agreement,'' she said.

Plenkovic says he's going to regulate work on Sundays and raise the minimum wage. Again.

PM Andrej Plenkovic recently discussed the state of the economy, ongoing inflation, the consequences of the global coronavirus pandemic and of course, Russian aggression against Ukraine. Digitalisation and the green transition, two topics that keep coming up, were also touched on. Perhaps what attracted the most attention of all, however, were the discussions on banning (or should I say regulating) work on Sundays (remember that?) and of course, talk of raising the minumum wage. If you've spent any time following the domestic political scene, neither of the aforementioned and farily worn out topics will come as a surprise to you.

"We're going to regulate work on Sundays and the minimum wage will go up,'' says Plenkovic, who announced that his government would make several steps forward in both this and in other regards in the coming weeks. "We'll regulate work on Sundays and we've come up with a rational, well-balanced proposal," Plenkovic assured, adding that the minimum wage will also increase from next year to 4,220 kuna net, and a proposal for an additional tax on extra profits is being prepared in order to more fairly share the burden of the ongoing crisis. He also announced the continuation of the social dialogue with the trade unions, with whom intense conversations have been happening of late.

He noted that in just two months, the Republuc of Croatia will be among the fifteen countries in the world that are in NATO, the European Union, Schengen and the Eurozone, and that negotiations with the Organisation for Economic Cooperation and Development (OECD) have been launched.

Plenkovic uses yet another opportunity to troll President Zoran Milanovic (SDP)

If you've spent any time in the City of Zagreb over the last few days, you'll have noticed that getting anywhere by road proved impossible for about 48 hours. The Crimea Platform Summit was being held right here in the Croatian capital, and for road users, the problems were very much in evidence. Plenkovic recently discussed how this extremely significant summit went, making no effort to hide his satisfaction with how it unfolded, and once again offering words of support to Ukraine.

It didn't stop there. If you follow Croatian politics, you'll know that Andrej Plenkovic (HDZ) and Zoran Milanovic (SDP), the Prime Minister and the President of Croatia, make sure to miss no chance to insult or troll each other, and this was no exception. Plenkovic made sure to make his feelings clear on Milanovic's earlier comments about Nancy Pelosi and the aforementioned summit.

"I think you're more than aware of just how important, useful and excellent an event like this that we organised actually is for the courageous, correct and moral foreign policy of the Croatian Government. This topic of whether or not someone went to Makarska just isn't the subject of my interest. He can explain that one himself,'' Plenkovic said, referencing Milanovic having gone to the aforementioned part of Central Dalmatia.

''I guess you can see who has been saying what over the past few years. I don't know what sort of rally he'll decide to go to, maybe he'll go to one Russia organises. Mrs. Pelosi didn't waste her time on irrelevant things, and neither did we," Prime Minister Plenkovic concluded, having made a very clear jab at Milanovic with the Russia comment. Gordan Grlic Radman, the Minister of Foreign Affairs, also touched on the topic of Milanovic, claiming that ''people are calling and asking what Croatia's position actually is'' in regard to the Russia-Ukraine war.

Nancy Pelosi praises Croatia for its humanity towards Ukraine and refers to the country as a leader in the diversification of energy sources

Nany Pelosi said that Croatia could offer Ukraine a lot owing to its relatively recent experience of war, and she also said that this country is a leader in the diversification of energy sources. Pelosi issued a warning that energy has become a means of blackmail in Russia's horrendous aggression against Ukraine, before thanking Croatia and Plenkovic for their leadership in the field of energy.

"Croatia is a small enough country to be resilient, but big enough to be significant in terms of security, democracy, peace and values," Pelosi believes, adding that the diversification of energy sources is helping to save planet Earth. Plenkovic said that with the construction of the LNG terminal on Krk, Croatia has now ''finally resolved" a four-decade-long debate in energy circles and that by deciding to increase its capacity, the government has "enabled Croatia to become an energy hub'' for natural gas.

Pelosi also said that the Croatian capital is the "perfect" place for the summit to be held, emphasising the very strong Croatian-Ukrainian friendship and the help that Zagreb continually provides to Kyiv as it goes through such terrible times.

For more on Croatian politics, make sure to keep up with our dedicated section, and keep an eye out for our A Week in Croatian Politics articles which are published each Friday.

Tuesday, 16 August 2022

Savings Could be Made With More Generic Drugs on Croatian Market

August the 16th, 2022 - Replacements of certain medicines are set to arrive on the Croatian market as making savings becomes extremely necessary in the enfeebled Croatian healthcare system.

As Poslovni Dnevnik/Josipa Ban writes, counting the pennies within the wider Croatian healthcare system, especially in the consumption of medicines, is now more needed than ever. We've been witnessing accumulated debts for medicines for decades now, which, after numerous rehabilitation attempts by the Ministry of Finance, are still far from reduced. In fact, they only grew enough to reach slightly more than six billion kuna at the end of April this year.

HUP - the Association of Pharmaceutical Manufacturers have been warning about some of these debts for some time, noting that they definitely can be reduced. The Croatian healthcare system's annual savings could rise from the current 300 million to as much as one billion kuna if consumption were to increase and the procedure for including generic drugs on HZZO's list of drugs for the Croatian market was finally accelerated.

There are some substitute drugs that come to the Croatian market when the patent rights to the original drug eventually expire. As their placing on the Croatian market means more competition, the price of the medicine also drops at the same time. The situation here, at least according to data from back in 2019, is that 61 percent of the volume in the consumption of prescription drugs across the Republic of Croatia is made up of generic drugs, and they only account for 5% of the total healthcare sector's budget.

"Although this percentage has been increasing over the years, it's still somewhat lower than the EU average, which stands at 67 percent. This shows us that there is still a great potential for the use of generic drugs in this country,'' they emphasised from HUP- the Association of Medicines Manufacturers, whose members, in the period from 2010 to 2020, invested a total of 5.4 billion kuna. As far as biosimilar medicines are concerned, the situation is much worse, and back in 2019 they occupied a modest 13 percent of the Croatian market.

A complicated procedure...

One of the reasons for the lower consumption of generic and biosimilar drugs, which causes higher expenditures for such medicines, is the procedure that manufacturers must go through in order to get on HZZO's drugs list.

Jerko Jaksic, president of the PharmaS Management Board and president of the HUP Association of Drug Manufacturers, explained that the process of placing a generic drug on the Croatian market takes approximately one to two years.

"The first stage is the registration of the drug with HALMED or, for biosimilar drugs, with the European Medicines Agency (EMA). After approval from HALMED or EMA, it takes up to six months for the HZZO to place the drugs on their list. Although the situation is somewhat better than it was around ten years ago, that part of HZZO could and should be accelerated. What I mean by that is that following HALMED and EMA approval, these medicines should automatically be included in the lists of medicines, without any additional administrative steps because there's no need for them. Unfortunately, here too we have an example of resistance to changes and adaptation of the system, as well as the classic slowness of the administration,'' pointed out Jaksic, adding that automatic inclusion would speed up processes and the arrival of medicines on the Croatian market, as would cheaper drug therapies for patients in three to six months.

"It would also bring savings of several tens of millions of kuna on an annual level for the entire Croatian market," said the president of the PharmaS Management Board. HUP noted that the role of generic and biosimilar drugs is extremely important for both the healthcare system and the patients themselves.

"In fact, these drugs make many key therapies available to more patients, and for the same or at a lower cost than before their introduction. For example, two to three boxes of prescription drugs issued in Croatia come from the generic industry, and the share of generic drugs in the cost of all drugs is only 27 percent. If we look at the pharmacy system, the share of generic drugs is 65 percent, and this accounts for less than 40% of the drugs budget," they explained.

Great potential

In addition to all of the aforementioned, there is no fear for the patient because prescription drugs and generic drugs are the most organised part of the healthcare system. Jerko Jaksic noted that their importance has long been recognised by GPs. However, hospital doctors are not yet following suit.

"Hospital doctors have a lower level of knowledge of generic and especially biosimilar therapies, they also lack a developed awareness of the financial savings they can enable. There's a great untapped potential there, above all in the sense of using cheaper generic and biosimilar therapies in order to reduce costs for hospitals,'' said Jaksic.

There are, therefore, several mechanisms that we must change in order to accelerate the introduction of generic and biosimilar drugs on the Croatian market, and thereby contribute to significant savings.

"It's necessary to systematically implement the existing regulations for the determination of the price of drugs, to include generic drugs on HZZO's drugs list faster, and to enable the faster penetration of generic and biosimilar drugs into the wider hospital system,'' the HUP Association of Drug Manufacturers believes.

With these measures, along with measurements of treatment outcomes, they say, savings in the healthcare system can reach up to 1 billion kuna per year. So, the ruling party has a solution. But is the will there?

For more, make sure to check out our dedicated lifestyle section.

Saturday, 13 August 2022

Important Scan Can Now be Done Privately with HZZO Footing the Bill

August the 13th, 2022 - There have been some absolutely horrific stories about the state of the Croatian healthcare system of late, and so it might seem as if nothing within the four walls of a hospital can be trusted. While that is absolutely not true at all, it is more than understandable that people fear potential illness. Some good news is that HZZO will now foot the bill for a test that can be done in a private facility, without all of the long waiting times typically associated with busy, overworked state hospitals and other healthcare facilities.

Magnetic resonance imaging, commonly known as MRI, can reveal an extremely wide array of issues going on within the human body in a remarkably clear way. This type of scan is used for all sorts of health issues, and the waiting times associated with them are sometimes bafflingly long. A new plan for which HZZO (Croatian Health Insurance Fund) will gladly foot the bill may relieve some of that pressing problem, which is an issue for both hospitals and of course for the patients.

As Poslovni Dnevnik writes, in order to reduce the usually extremely long national waiting list for magnetic resonance imaging (MRI), HZZO came to what will be to most a very welcome decision on entering into a contract with Medikol Polyclinic.

As reported by the aforementioned polyclinic, according to that decision, HZZO will provide the Medikol Polyclinic with a list of patients who are on the waiting list for MRI scans in hospitals for a variety of different reasons, and the Medikol Polyclinic will provide them with magnetic resonance imaging through a referral by December the 31st, 2022. MRI scans carried out via this new agreement with HZZO will be available in Zagreb, Cakovec, Split and Osijek.

''We will be able to accept referals only from those patients who are already on waiting lists for MRI scans in hospitals and are on the list provided by HZZO,'' they wrote from Medikol when it announced the new plan on its Facebook page.

For more on healthcare in Croatia, make sure to check out our dedicated lifestyle section.

Monday, 27 June 2022

A Short Guide to Croatian Public Services and Institutions

June 27, 2022 - You see them on the street, you see them on your bills, and you hear them on the phone. Who is who among the Croatian public services and institutions? We'll tell you more in this short guide.

If moving to Croatia is one of your short-term projects, or even if you're already in the process of adaptation, you may have heard of or been in contact with one of these institutions. These Croatian public services and institutions will be part of your daily life here, and it is true that sometimes it can be a bit confusing trying to distinguish them from each other.

In this short guide, we've listed some of the Croatian public services and institutions that you will be in contact with most often, and we hope that this will help you when you don't know where to go for a certain task, or when it's time to do your accounts at home.

MUP

If you're working on getting your residency or citizenship in Croatia, you have most likely gone to a local MUP office. It's also likely that they've called you on the phone or have written you an email or two. MUP is the Ministry of the Interior, and it provides services to both locals and foreigners alike. At MUP, you will also carry out procedures to obtain your passport, your driver's license, your Croatian identification card, and more.

HZZO 

HZZO is the Croatian Health Insurance Fund, it's part of the Ministry of the Health and it includes everything that is related to public health insurance services in the country. As you well know, public health insurance is mandatory if you reside in Croatia. If you wish to enroll in the Croatian public health system, you must go to the HZZO offices in your city of residence. There you can also find out everything related to your health coverage, sign up with a family doctor, and more.

HZZ

HZZ is the Croatian Employment Office, and it serves to report your current employment status, whether you've found a job or if you don't currently have one. At the Employment Office, you can also find job openings that match your skills. 

HZMO

The Croatian Pension Insurance Institute (HZMO) is a public institution that is dedicated to the implementation of mandatory pension insurance based on generational solidarity (1st pillar of the pension insurance) and the child benefit entitlement procedure.

Porezna uprava

Porezna uprava is the Croatian Tax Administration, and it's a unique and independent administrative organisation within the Finance Ministry whose basic task is the application and supervision of tax regulations and laws on the collection of contributions. Most of your bills will be issued by Porezna uprava. They'll also issue you with tax rebates.

FINA

FINA, the Financial Agency, is a leading Croatian company in the field of financial and electronic service provision. Although state-owned, Fina operates exclusively on a market basis and cooperates with banks, the Croatian National Bank, numerous business systems, and other similar entities. A multitude of payments can be paid at their offices.

Hrvatska Pošta

Hrvatska Pošta is the Croatian Post Office, and it has locations in every city and town across the country. In addition to being the place where you can send letters and packages throughout the country and even abroad, it's also the place where you can pay for your phone, electricity, water, health insurance, and more.

HEP

A state-owned company, HEP is the Croatian Electricity Company and it is the only energy entity authorised to provide a public electricity supply in the Republic of Croatia. It also performs the activities of electricity production and heat production for central heating systems, in addition to the management, maintenance, construction, and development of the electricity distribution network.

HAC 

Hrvatske autoceste or Croatian Motorways Ltd is a Croatian state-owned limited liability company tasked with the management, construction, and maintenance of motorways in Croatia.

HRT

Croatian Radio and Television (HRT) performs the activity of providing public broadcasting services. On their radio and television channels, they dedicate themselves to the dissemination of news, information, culture and other related content. Even if you don't watch their channels or listen to their radio stations, a bill of 80 kuna from HRT will always arrive at your home.

For more, check out our lifestyle section.

Saturday, 4 June 2022

Croatian Company Atos to Work on eHZZO Project for 19 Months

June the 4th, 2022 - The Croatian company Atos has been chosen as the more favourable bidder for a new Croatian Health Insurance Institute (HZZO) project worth a lot of money. The company will spend nineteen months on the project.

As Poslovni Dnevnik/Marija Crnjak writes, the Croatian Health Insurance Institute (HZZO) has announced the start of the brand new eHZZO project, worth almost 115 million kuna, which aims to establish more efficient management and supervision within the healthcare system.

The construction of this brand new new system is being co-financed by the European Union (EU), and will enable easier communication with external users, as well as the high availability of data necessary for business process management and different forms of reporting.

"The Croatian Health Insurance Institute has one of the most important information systems in operation within the Republic of Croatia, so the eHZZO project will benefit all insurance policyholders through the better organisation and availability of the healthcare system," said Deputy Director of the Croatian Health Insurance Institute, Veronika Lausin.

The entire eHZZO project is worth a total of 114.7 million kuna, of which 85 percent is being financed with European Union money. The project will be worked on for the aforementioned period of nineteen months, and the strategic partner of the project, the Croatian company Atos, was selected as the most favourable bidder in the 2021 tender.

Three bidders, two consortia and one independent bidder appeared in the tender. The Croatian company Atos applied for the tender within a group consisting of a Czech company of the same name and a Macedonian enterprise called Nextsense, and their offer was the cheapest of all.

Ericsson Nikola Tesla and IN2 also competed together with CUSPIS. The third bidder was King ICT.

For more on Croatian companies, entrepreneurs and innovation, make sure to check out our dedicated business section.

Wednesday, 18 May 2022

HZZO to Cover Cost of Pregnancy Termination in Slovenia for Mirela Čavajda

ZAGREB, 18 May 2022 - The Croatian Health Insurance Agency (HZZO) will cover the cost of pregnancy termination for Mirela Čavajda in a hospital in Ljubljana.

The HZZO said this in a statement issued after earlier in the day the Jutarnji List daily reported that Čavajda would most probably not have the cost of her pregnancy termination abroad covered by the HZZO.

Čavajda is a woman six months into her pregnancy who who could not have her pregnancy terminated in Croatia despite the fetus's serious malformations.

Jutarnji List says is has learned from unofficial sources that Croatian doctors, even though they refuse to perform the procedure guaranteed by law, are also unwilling to put their refusal down in writing, and that hospitals have sent the HZZO notifications saying that Čavajda has been offered the necessary medical procedure - induced labour.

"Since she does not want that procedure but insists on pregnancy termination, the HZZO considers this to be a refusal of the medical service offered in Croatia, which makes it questionable if there are legal grounds for the HZZO to cover the cost of the medical service she will seek in Slovenia", the daily says.

For more, make sure to check out our dedicated lifestyle section.

Sunday, 17 April 2022

Faster HZZO Medicine Listing Would Save Another Billion for Healthcare System

April the 17th, 2022 - The much more rapid and efficient listing of HZZO medicine could end up saving the already enfeebled Croatian healthcare system another billion kuna.

As Poslovni Dnevnik/Marija Crnjak writes, the Croatian healthcare system could save an additional one billion kuna per year if the policy of putting generic and biologically similar drugs on the lists of the Croatian Health Insurance Institute (HZZO) was improved and accelerated, according to Croatian pharmaceutical generic companies within the Croatian Employers' Association (HUP).

Currently, the system saves about 300 million kuna a year with the use of this HZZO medicine, but the potential is significantly higher, said Jerko Jaksic, president of the Association of Drug Manufacturers at HUP, at a briefing for journalists which took place on Thursday.

According to data from back in 2019, 61 percent of the volume of prescription drugs in the Republic of Croatia is made up of generic drugs, which is slightly lower than the EU average of 67 percent. The situation with biosimilars is much worse, they accounted for a modest 13 percent of the market in total consumption of biological drugs.

Although further growth is expected in the coming years, in addition to education, it's necessary to accelerate their application when they are registered with the European Medicines Agency and the Croatian Medicines Agency.

As the manufacturers have explained, the HZZO procedure for listing a drug, which is purely administration and paperwork, takes an average of four to six months, during which time money is directly lost that could be saved by using generic instead of innovative therapy.

“So-called drug penetration into the system should be significantly quicker, which is even more significant when it comes to biological drugs, as biological drugs are very expensive. We have announcements from the Croatian Health Insurance Fund that this process could be accelerated, and we're very happy about that. There's no reason why a drug shouldn't automatically be on the list immediately after its registration, and it would be very good if the new procedure comes to life by the middle of this year because patents for some drugs expire soon,'' Jaksic said.

In particular, these are diabetes related drugs, and the potential for savings is 30 percent for the healthcare system, with the release of patient participation. With proper application, in 2023, 15 percent more patients could be treated for the same cost in this segment alone, HUP pointed out. The data also shows that biosimilars have increased the availability of biologic therapy.

For example, in the immunology segment, 67 percent more patients were treated for only 19 percent more. Back in 2021, 2.5 times more patients were treated with the chemotherapy mitigation drug than in 2019 for approximately the same total cost. In 2020 alone, biosimilars provided savings of 200 million kuna. However, the biggest shortcoming in the drug policy in Croatia is still poor cost control, due to insufficient therapeutic guidelines and measuring the effectiveness of therapies, they added from HUP.

Patient registries exist only for a small number of diagnoses and a large role in this is played by patient associations, which are as such fighting for the better availability of some drugs, but for most patients and diagnoses, not all treatment parameters are systematically monitored.

For more, check out our lifestyle section.

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