May 21, 2022 - The costs of Croatian hospitals have skyrocketed. Bills are up to five times higher than last year, so an additional 3.5 billion kuna provided to the Croatian healthcare system from the recent rebalance of the state budget won't be enough to cover expenses.

Even after the rebalance of the state budget, which will provide the healthcare system with an additional three and a half billion kuna this year, which means that instead of the planned 32 billion it will now have 35 and a half billion kunas, hospital directors still say that this will be a difficult year with much uncertainty due to a lot of unknowns in expenses, reports Index.hr.

Namely, the recent warning of wholesalers that debts for medicines continue to grow despite last year's injection of 6.3 billion from the state budget and that they reached as much as six billion kunas, of which four billion are due, is the reason for this early rebalance. Two billion is intended for Croatian hospitals, and one and a half billion for the Croatian Health Insurance Fund for the settlement of old debts.

Bills are five times higher than last year

For now, it is certain to say that 35.5 billion kunas for this year will not cover all costs, which is confirmed by Croatian hospitals bills from the first four months of 2022. They stand out especially for energy, food, and medicine, which in some cases are five times higher than in the same period last year. Therefore, it is not surprising that the losses of the system on a monthly basis are between 400 and 500 million kunas, which could mean a hole in the health fund of at least five billion kunas by the end of the year.

"Our costs increased in the first four months of this year compared to the same period last year by a total of 5.52 percent. But worrying is the fact that energy costs increased the most, by as much as percent, or from 7.8 to 15 million kunas. The cost of food products grew by 8.4 percent, and compared to 2020 by 40 percent, which is a huge increase'', said Dr. Alen Ruzic, director of KBC Rijeka.

Medicines haven't kept the previous numbers of consumption either, so in the first four months, they were 7.76 percent more expensive than last year, and by almost 20 percent compared to 2020.

In the largest Croatian hospital, KBC Zagreb, costs increased by 6.5 percent or HRK 71 million from January to the end of April compared to the same period last year, as it increased from HRK 1,099 billion to HRK 1,171 billion.

During the pandemic, KB Dubrava was a COVID hospital, so some data from last year jumped out of the usual amounts, such as spending on drugs, which were lower than spending in previous years when the hospital was operating at full capacity for all patients. But it is clear that this hospital pays for the largest energy guild, especially the one for gas.

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ZAGREB, 15 April (2022) - SDP leader Peđa Grbin has criticised Health Minister Vili Beroš for not implementing any real reforms to deal with problems in the health sector, noting that the SDP will present its own reform proposal to prevent one of the worst possible consequences of Beroš's inaction - privatisation of healthcare.

"The possible privatisation of healthcare could lead to polarisation in society, dividing people into those who can afford healthcare and those who can't. The SDP will strongly oppose that with its own health reform proposal," Grbin said.

Since early 2021 billions of kuna have been given to the Health Ministry to settle debts which despite that have continued to grow because the government has not done anything to stop their growth but has reduced healthcare outlays, he said.

The SDP leader warned that the coronavirus pandemic had revealed numerous problems in the health care system, from the large number of people with diseases, including malignancies, to the fact that healthcare is not equally available to everyone.

Now that the coronavirus pandemic is waning, we will realise how much the system is inefficient and healthcare inadequate, he said.

Instead of dealing with how to reform the system, the minister again has to deal with anti-corruption investigators who are "combing his ministry's records on the suspicion that some of the contracts awarded to the Cuspis company were overpaid and on the suspicion of conflict of interest," he said.

USKOK is also investigating the procurement of a radiation apparatus worth HRK 11.2 million, which is also suspected of having been overpaid, Grbin said, calling out PM Andrej Plenković over failure to make the health system functional.

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February 18, 2022 - A recent research seeking to determine the quality of the childbirth experience during the pandemic in several European countries has exposed maternity hospitals in Croatia, and for all the wrong reasons.

The prestigious journal The Lancet Regional Health Europe published this month a scientific paper entitled Quality of health care for mothers and newborns in maternity hospitals during the COVID-19 pandemic: an online survey of mothers' perspectives in 12 WHO countries.

The fact that the research was featured on the cover of this scientific journal speaks of its importance on the experience of health care for pregnant women, mothers, and midwives during the pandemic, as well as the quality of investigation and conclusions.

The study included a total of 21,027 women who gave birth in the first year of the pandemic, from March 1, 2020 to March 15, 2021 in twelve countries of the WHO European Region.

The online questionnaire is based on the WHO Standards for Quality of Maternal and Neonatal Care (QMNC) and is organized in four areas: Care Provision, Care Experience, Availability of Staff and Human Resources, and the Impact of COVID- 19 on the provision of care. Based on the results in each area, an overall ranking of responses for that area (0-100) and an overall score (0-400) was formed.

The results indicate huge differences in the quality of care for women and newborns. Unfortunately, Croatia is in the penultimate place on the list of 12 countries. At the top of the scale are Luxembourg (355), Spain (345) and Germany (335) and at the bottom are Romania (275), Croatia (270) and Serbia (205).

Maternity hospitals in Croatia were rated best in the areas of care (80 out of a possible 100) and in the assessment of changes related to COVID (70 out of a possible 100), while the experience in care (65 out of a possible 100) and the availability of staff and human resources were rated worse (55 out of 100), reports Novi list.

In collaboration with the leaders of the scientific project Imagine EURO, Trieste Burlo Garofolo Institute, the project was worked on in Croatia by the head of the Reproductive Rights Program at the Roda Association, Daniela Drandić, M.Sc.

"This research once again pointed out all the problems in health care for pregnant women, mothers, and midwives, which Roda has been warning the competent institutions and the public about since the beginning of the pandemic. The only question is whether the competent institutions will direct their efforts towards solving these problems", warned the Roda Association.

"Once again, we have seen that, despite the constant talk about demography, when it comes to changes in the health care system, women and children are simply not a priority.", they added.

Several more scientific studies will be published as part of this research project, including work measuring the experiences of health professionals in the pandemic. "Over 3,000 health professionals from Europe have already participated in the research on the experiences of health professionals in maternity hospitals during the pandemic, and we call on those from maternity hospitals in Croatia to do the same; the survey questionnaire is open to all health professionals working in maternity hospitals.

In addition, we continue to invite women who gave birth in the hospital during the pandemic to participate in the research that is still ongoing; namely, we want to investigate the experiences of women throughout the pandemic''.

Source: Slobodna Dalmacija

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ZAGREB, 7 Nov 2021 - Croatia has a shortage of 207 family doctors and 104 gynecologists, the Croatian Chamber of Physicians (HLK) said earlier this week, adding that it is necessary to advertise residencies to increase the number of doctors in primary healthcare.

Amendments to the Healthcare Act should ensure better working conditions in primary healthcare as they are the main reason why young doctors are leaving Croatia, the HLK said after a meeting with representatives of the Health Ministry and the Croatian Health Insurance Fund (HZZO), which focused on the situation and future solutions in family medicine and gynecology.

Primary healthcare spends only a small portion of the HZZO budget and even a minor additional investment in this area of healthcare would greatly benefit both citizens and the health system, they said.

Besides the shortage, it is worrying that family doctors are 52 years old on average and 33% are over 60, including 184 over 65 who are eligible for retirement, the HLK said.

The situation is equally bad with primary healthcare gynecologists as there is a shortage of 31% or 104 doctors. One gynecologist has 5,500 patients on average, which means that at least 250,000 women don't have one in primary healthcare, and these doctors are 54 years old on average, the HLK said, adding that the situation is worst in Brod-Posavina, Bjelovar-Bilogora, and Lika-Senj counties.

Increasing the number of doctors would reduce the average number of patients per doctor and it is also necessary to relieve teams of administrative duties in order to improve quality and efficiency, HLK representatives said at the meeting.

Lack of investment in primary healthcare, which is expected to provide for 80% of citizens' health needs so as to relieve the more expensive hospital system, has resulted in less available health services and poorer treatment outcomes. However, family and general medicine doctors had more contact with patients during the pandemic, according to the HZZO's 2020 report.

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ZAGREB, 4 Nov 2021 - Health Minister Vili Beroš said on Thursday that statements by individuals about the deterioration of the health system were not true and that all COVID and non-COVID patients were being taken care of without delay.

"I wish to appeal to the media that statements by individuals about the deterioration of the health system are simply not true. Indeed, large resources are being redirected towards the treatment of COVID patients, which could have been avoided by timely vaccination. However, all COVID and non-COVID patients are being taken care of without delay," Beroš told a cabinet meeting.

National COVID-19 response team considering a possible new set of measures

The head of the national COVID-19 response team, Interior Minister Davor Božinović, said that they were considering a possible new set of measures to contain the spread of the virus. He said that interdepartmental talks were ongoing and that the public would be informed of any new measures in due course.

Beroš said that today's number of 6,310 new cases in Croatia was by far the largest daily number recorded to date.

"The causes of this surge lie in ourselves alone, in our refusal to comply with the basic epidemiological measures, and in our insufficient awareness of the benefits of vaccination," Beroš said.

7 in 10 new cases and 8 in 10 patients on ventilators unvaccinated

He said that the test positivity rate was 43.90 percent, and 233 infected people had been hospitalized in the 24 hours alone. In the past week, of the total number of new cases, 72.8 percent were not vaccinated, and 77.2 percent of the patients on ventilators were not vaccinated, he warned.

"However, the newly-awakened interest among citizens in getting vaccinated is encouraging. As many as 14,379 persons were vaccinated yesterday, the largest number in a single day to date," the health minister said.

Beroš said that 29,627 people had so far received a booster shot against COVID-19, adding that three percent of children aged 12-14 and 18.6 percent of young people aged 15-19 had been vaccinated to date.

"Insufficient compliance with the epidemiological measures and refusal to get vaccinated are the main causes of the rapid spread of the virus. We are seeing consequences at all levels of the health system," Beroš warned and once again appealed to citizens to get vaccinated.

He said that the ministry had instructed local coronavirus response teams to ensure additional capacities for medical treatment in their counties.

Božinović said that 11,578 inspections had been carried out in the past week to check compliance with the epidemiological measures. He said that the irregularities mostly concerned the provision of catering services after midnight and failure to wear face masks and maintain a physical distance in enclosed spaces. He said that 27 infringement notices, 176 written warnings, 14 oral warnings, and 17 fines had been issued in that regard.

For all you need to know about coronavirus specific to Croatia, make sure to bookmark our dedicated COVID-19 section and select your preferred language.

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ZAGREB, Dec 21, 2020 - Health Minister Vili Beros said on Monday that the COVID crisis had so far cost the health system HRK 927.4 million.

Data show that by December 18, HRK 574.4 million was spent on testing, HRK 268.9 million on treatment and more than HRK 83 million on sick leaves, Beros said at the national COVID-19 crisis management team's press conference.

He also said that a meeting was being held at the Health Ministry with drug wholesalers regarding the health system's debt to them.

Beros said that the number of new COVID-19 infections had started dropping.

The average number of services provided in all health institutions in Croatia is at 67.21% compared to the second week of December 2019.

"These are encouraging data as they show that despite the burden of COVID-19 positive patients we are finding ways, strength and opportunities to respond to other needs, especially in oncology," Beros said.

Despite the fact that the health system has completely adapted to COVID patients, the number of services provided in Zagreb's hospitals is at 74% compared to the second week of December last  year, and only the KB Dubrava hospital, which is completely focused on treating coronavirus patients, has provided 11% of other services.

Other patients using KB Dubrava's services, 3,993 of them, have been sent to other health institutions via the call centre, Beros said.

He added that there were also institutions like the Magdalena Clinic which is at 119% of provided services due to taking over some of KB Dubrava's cardiac surgery patients.

Beros said there would be no changes regarding the realisation of the right of health workers to a full salary after getting infected with COVID.

He said that all those who had got infected at work would receive 100% of their salary, but they have to ask their employer for confirmation.

(€1= HRK 7.5)

December the 19th, 2020 - I think just about everyone has an HZZO story, and not a positive one. I myself have quite a few of them in which they sought documents that quite literally do not even exist before they'd agree to give me access to what my employer pays every single month and what I have a fundamental right to - basic healthcare. I know I'm far from the only one, and this article is, as such, unlikely to surprise anyone.

As Poslovni Dnevnik/Marija Crnjak writes, due to the influx of patients who couldn't go to hospitals to have various tests done because of the ongoing pandemic, private polyclinics asked the Croatian Health Insurance Institute (HZZO) to contract a larger number of procedures for referrals multiple times throughout the year. HZZO said no.

HZZO refused them to perform this act of decency every single time, explaining that the request was unjustified precisely because the contracted capacities of public hospitals apparently remained unused, ie vacant. This primarily regards magnetic resonance imaging (MRI) and PET CT scans, the sort of examinations that are most often needed by cancer patients, and many of them cannot be delayed due to the nature of that disease.

Private institutions that provide some of the services at the expense of HZZO, such as the Medikol polyclinic and the Sveta Katarina Special Hospital, warned that the state hasn't used the services of private health institutions in other segments during the pandemic, even though they've been offering such services readily since back in spring.

HZZO figures confirm that the pandemic has slowed down important diagnostics, but also that public hospitals, even without the presence of the novel coronavirus, have a generally weaker execution of contracted procedures than private ones do. Last year, hospitals performed 95 percent of their planned MRI procedures, and this year only 80 percent were performed, ie 110.3 thousand procedures instead of the contracted 136.5 thousand of them.

About a hundred fewer patients are being treated in hospitals per month than they were in the previous months, and almost 5,000 fewer bedridden patients were treated than last year, equal to about 12 percent less on a monthly basis. In the case of PET CT this year, the number of examinations at the University Hospital Centre Zagreb is similar to last year (3174), but last year and this year, about a third fewer procedures were performed than agreed.

In 2020, 4620 procedures were contracted at Rebro, and 3174 of them were performed. Back in pre-pandemic 2019, 29,516 magnetic resonance procedures were contracted in private polyclinics, and 25 percent more were performed.

For the same money, 30,208 procedures were contracted during the first 11 months of this year, and 15 percent more were performed. Polyclinic Medikol, the only private institution that performs PET CT, performed 99 percent of its contracted examinations last year, as was the case during the first 11 months of this year.

The Medikol Polyclinic has an agreed number of services with HZZO, which mostly involve radiological and nuclear diagnostics, at the level of 40 percent of the capacity utilisation that the polyclinic actually has at its disposal. During 2020, Medikol has repeatedly asked HZZO to increase its services at the expense of the Institute, and as stated, HZZO said no, despite the dire situation we're all in.

''Unfortunately, HZZO keeps on giving us negative answers to all of our inquiries about the possibility of increasing this contractual limit, with the explanation that we're not the only contracted health institution,'' stated a rightfully annoyed Trstenjak Rajkovic of Medikol.

This year, the number of patients who paid for services themselves because they couldn't have them performed normally in public health institutions increased, and due to the limited contracted number, they couldn't provide the service based on a referral.

At the same time, due to the ongoing crisis, they had a large number of appointments. When it comes to PET/CT, they have a fixed contractual number of tests for a total of 7380 procedures per year, which is why a good part of oncology patients were literally forced to pay for this test out of their own pockets, and it costs about 10 thousand kuna. When it comes to MRI devices, about 10 thousand procedures are contracted per year.

As has since been found out, HZZO does indeed plan to extend the contract period, and after a comprehensive analysis of how things were executed this year, and in accordance with available funds, it will plan as well as possible. Medikol expects that the number of procedures will increase in 2021, because the pandemic hasn't simply annulled the existence all other, often very serious diseases.

At Medikol, they believe that the low level of cooperation between public and private healthcare in Croatia is still a question of stigmatisation of the private sector. The director of the aforementioned polyclinic pointed out that in a situation where the public health system is overloaded, enviable human and material resources boasted private healthcare facilities remain unused.

HZZO confirmed that during the contracted period there were no changes in the contracts they hold with private facilities, meaning there were no changes in the scope of work despite the need for that obviously being stronger than ever before.

Jadranka Primorac, a member of the Management Board of the St. Catherine's Special Hospital, pointed out that HZZO's cooperation with private institutions could only represent savings for the state, and not an extra cost.

"By contracting with private institutions, the state pays only for the service, and we bear the costs of everything else, from the purchase and maintenance of equipment to staffing costs and all other costs. It's clear to us that the pandemic, along with the reduction of economic activities and the consequent situation with the state budget, caused a loss of revenue and additional costs for public health, but additional contracting in the last quarter of 2020 wouldn't be a major financial expense for HZZO and would significantly contribute to reducing waiting lists. Through the Croatian Employers' Association, we offered cooperation to the Ministry of Health way back in March to help during the pandemic,'' revealed Jadranka Primorac.

St. Catherine's Hospital has contracted very little further capacity for radiological examinations with HZZO, which will only further increase the burden on the public healthcare system, especially in the future when even greater pressure is expected from patients who couldn't get things done because of the virus.

"Our goal isn't for HZZO to cover all services, but there's room for expansion and I hope that it will be considered,'' concluded Primorac.

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October the 2nd, 2020 - If you've been in Croatia long enough, you'll have heard of an uputnica. This little piece of paper is your key to a 'pregled' or check up by a specialist, a scan, surgery and more. In true Croatian fashion, they're not digital and you needed to hold on to this slip of paper like gold - until now. Say hello to e-referrals.

As Poslovni Dnevnik writes on the 1st of October, 2020, paper uputnice/referrals are coming out of use and e-referrals should finally be the new normal. Such instructions were given to doctors and they are ready to refer all of their patients electronically from the 2nd of this month, Vecernji list has learned.

However, neither the Ministry of Health nor the Croatian Health Insurance Fund have officially confirmed this piece of news, despite the fact that the competent minister sent instructions attesting to it to all relevant primary care doctors on the 18th of September. Hesitation with the announcement of such excellent news points to the fact that they know that in practice it will not go smoothly, and that computerisation is still a sore point in Croatia, even though it has been being announced for ten years now.

The problem is that not all hospitals in Croatia are networked within CEZIH, the central health information system of Croatia. "On October the 1st, 2020, the printing of a referral on a paper form for newly issued referrals will be abolished and we'll start working with e-referrals," reads the letter received by family doctors on September the 18th, 2020 from Health Minister Vili Beros.

The minister's letter regarding the changes to the Croatian Health System goes on to say that "by abolishing paper referrals, selected doctors will have to make either a direct e-referral or request the target institution to appoint their patients" and that requests for appointments for patients who have been issued an e-referral by sent by e-mail. However, family doctors say they don't agree with this. Seeking appointments for patients from hospitals is considered an administrative task that disrupts public health and imposes additional administrative obligations on selected physicians, to the detriment of direct contact with the patient.

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