May the 26th, 2023 - KBC Zagreb (Rebro hospital) is set to become the centre for the treatment of a rare but very severe heart condition which is caused by the accumulation of transthyretin fibrils in the myocardium - Transthyretin amyloid cardiomyopathy or ATTR-CM.

As Poslovni Dnevnik writes, the Clinic for Diseases of the Heart and Blood Vessels at KBC Zagreb has now become the central place for the treatment of the aforementioned rare heart disease which is a cause of very restrictive cardiomyopathy. It is an unfortunately insufficiently studied disease that is still rarely diagnosed, which is why it is crucial to familiarise the general public, as well as healthcare professionals, with a disease in which late detection is one of the most common causes of very poor outcomes and commonly - death.

"Most people don't even know that they're living with this progressive, life-threatening disease. The average survival rates for untreated, late-detected symptomatic patients is 2.5 to 5 years from the diagnosis of the disease. For this reason, it's extremely important to start on time with appropriate treatment that enables better outcomes for patients. This contributes to the reduction of mortality, stops the progression of the disease, reduces the number of hospitalisations and improves the quality of peoples lives,'' explained Dr. Ivo Planinc, a specialist in cardiology at the Clinic for Diseases of the Heart and Blood Vessels at KBC Zagreb.

Just as the case has been until now, this disease can be diagnosed in all clinical hospital centres in Croatia - in Zagreb, Split, Rijeka and Osijek. It's estimated that more than 100 people in the Republic of Croatia live with this rare heart disease, and those with the hereditary, rarer type of the disease most often come from Imotski and its surroundings, which makes this geographical area endemic for this particular disease of the heart.

ATTR-CM is a progressive disease caused by the misfolding of a protein called transthyretin, which is synthesised in the liver, causing the formation of harmful amyloid fibers. They are then deposited in the heart muscle, leading to damage and eventual heart failure. The misfolded protein can accumulate in the heart in the form of amyloid fibers, which stiffen the heart muscle and ultimately causes the heart to fail. There are two types of disease - hereditary, that is, genetically caused, and non-hereditary, the so-called wild or senile type of the disease.

Hereditary ATTR-CM can occur in a person's 30s or 40s, and the non-hereditary form (wtATTR-CM), which is associated with aging, is much more common and mainly affects men over 60 years of age, and is manifested by symptoms of failure heart and heart rhythm disorders. Even years before the diagnosis of the disease, many sufferers will complain of numbness and weakness in the hands and arms, rapid fatigue, swelling of the legs and lack of air during exertion and lying down. The hereditary form (vATTR-CM) affects both sexes equally and is usually diagnosed when an individual is in their 40s, although symptoms of damage to the heart and nervous system may have begun many decades earlier. Close family members (parents, siblings, and children) of the person diagnosed sadly have a 50 percent chance of having the responsible gene mutation and going on to develop the disease themselves.

Life with this rare, progressive and life-threatening disease is characterised by numerous symptoms that overlap with the symptoms of various other diseases, such as rapid fatigue, an irregular heartbeat, shortness of breath, as well as symptoms of the involvement of numerous other organs and systems in the body, such as numbness of the hands and arms, pain or stiffness in the lower back and legs, gastrointestinal problems, diarrhoea, constipation, nausea, and other symptoms which may seem vague, unrelated or nothing of concern at first. Symptoms such as dizziness or fainting when getting up from a lying or sitting position, the inability to hold urine or the spontaneous rupture of the tendon of the biceps muscle in the arms may also occur. If people aren't treated in a timely manner, these symptoms progress and significantly affect the quality of life, and patient outcomes are very, very poor.

For more, check out our dedicated news section.

February the 28th, 2023 - The Croatian healthcare system saved my life. This isn't an understatement. 

Back in 2006 when I went into anaphylactic shock in Zagreb due to allergies I was unaware I had, hitna pomoć (the emergency services) arriving when they did and not a minute later meant that I could keep breathing and can now sit and write about it. I depend on HZZO (the Croatian Health Insurance Fund) for access to my medication, I’ve had four surgeries, and countless tests and consultations have taken place in between. I joke that having to juggle several chronic conditions has turned me into a professional patient. 

Over the past 18 months, besides my GP and dentist, I needed to see a gynaecologist, a urologist, a gastroenterologist, a pulmonologist, an otorhinolaryngologist, a psychiatrist, a neurologist and an anaesthesiologist.  It was a particularly tough time in which my body decided to just go into self-destruct mode. I got through it, but came out with my eyes more open than ever before having witnessed how devastating relying on a system that is so wrongly neglected can be.

General practitioners - a journey that began 19 years ago

I took my first GP for granted. I remember how my allergies were the first thing listed on my “karton” (medical file) in capital letters and highlighted so that nobody could get it wrong. She was considerate and noticed symptoms I didn’t even complain about. I was safe with her. Later she retired and I moved away from Zagreb.

My second GP was a different story. She’d prescribe me medication during consultations and then pause to ask me, “What are you allergic to again?” This made me worry enough to check the ingredients on all prescribed medication before taking anything. Once she prescribed a pill which those suffering from asthma were (strongly) advised not to take. The second time she gave me a tablet which she reassured me didn't contain any ingredients I was allergic to. I went home, I took it, then minutes later my eyes started burning and my airways tightened up. It wasn't bad enough to go to make me go to the emergency room, but I did make a firm decision to change my GP after that. My criterion wasn’t to find a doctor who cares, only one who wouldn't accidentally kill me.

Good GPs are hard to come by. If you're lucky enough to land one, you should expect that you'll end up needing to wait a while for consultations and they will be hard to get a hold of via phone. If you have time, it’s okay. Otherwise, people save themselves the frustration by opting for ''okay enough'' doctors or simply paying out of pocket.

The deeper you dive, the murkier the water gets...

It may all look great if you’re generally healthy and only need a doctor for the occasional infection or unfortunate accident. I’ve read accounts from foreigners needing to go to the emergency services at the hospital and coming out praising the treatment they receive. Yeah, but… Go there three or four times, hand the technicians at the porta a local name, then sit and wait, and boy will you wait.

I once sat at the ER for hours whilst an older woman kept screaming in complete anguish on the other side of the door. “Ajmeeeee! Ajmeeee! Ajmeee!” (“Ajme!” means “Oh my!”) I couldn’t see her nor in any way know what the problem was, but her pain reverberated through all of us sitting there in the waiting room. We could hear and occasionally see medical personal shuffling around her but clearly nobody was offering this woman comfort. Instead, business went on as usual. After a day spent at the hospital, doing a run around and some tests, I got up and left before I saw a doctor. The psychological strain of hearing that poor woman scream for hours on end was more painful than the physical pain and distress I was feeling. “I’d rather die at home than be here,” I thought. 

I’ve had a dental technician dig in my mouth without gloves for an x-ray. A filling gone wrong resulted in the loss of a tooth...

Last year I went to see a specialist, the head of his department. I entered while he was on his mobile phone in a private conversation. I sat in front of him for fifteen minutes, without him even acknowledging my presence with so much as a gesture for me to wait, before he decided to start the consultation.

A routine gynaecological exam

Gynaecological exams are uncomfortable at best. You just want it over with. I once arrived for an appointment to find that my regular doctor wasn't there and the nurse proceeded to tell me that she was not returning. There was a substitute doctor in her place (most of my unexpected bad visits happened with subs I didn’t plan to see).

I went into my usual routine of undressing, getting into position, closing my eyes and waiting for it to be over. I noticed that it was strangely painful for a routine check-up (the most painful thus far) so I looked down. I was horrified that this man was “down there” and not wearing a mask. This was in the middle of the pandemic when we were still wearing masks everywhere and not just at the clinic. He didn’t give me any feedback so I waited and then asked him if everything was okay. Affirmative. We spoke about medications and I explained my allergies to him. This part was the cherry on top: He prescribed a medication with an ingredient I am allergic to.

I hear more and more women say they go to private gynaecologists following bad experiences in the system.

The coronavirus crisis

Both my husband and I are asthmatic. When asthmatics were included on the government list of high risk patients to be among the first to receive COVID-19 vaccines, I called to place us on the list.

“Where do you live?” The operator asked.

“Janjina.”

“Okay. We’ll notify you when the vaccine becomes available to you.”

Weeks passed and I heard about other chronically unwell patients already receiving their booster shots in other parts of the country. Could it be where we live?

As it turned out, yes. We were listed in the system as residents of our village and would therefore be notified when the vaccines would become available here. Before that happened we contracted COVID-19 and developed a more severe clinical picture which almost landed me in the hospital and took months for both of us to recover from. Had somebody told me to ask to be listed under ''Dubrovnik'' and we would have made it onto the list and simply taken a 1.5 hour drive for our vaccines. I don’t blame the operator. I blame an ineffective system.

Finding a good doctor

Najdoktor.com features doctors with ratings and reviews by patients. It has become my first step in finding new doctors. I won’t accept a rating of less than four stars, and only due to waiting times and personnel, otherwise I want five stars. Anything below that and you’re taking a risk. Unfortunately not all doctors are listed, especially those in rural areas and smaller towns and cities.

The current situation is an unfortunate side effect of Croatia’s brain drain. When I'm lucky enough to get to a very good doctor and they’re still young, panic sets in as I wonder if they’ll decide to go work abroad at some point. If they’re reaching retirement age I panic because I know how difficult they'll be to replace. Our choice, especially in rural areas, is not between good, okay and bad doctors; it is sometimes only between bad doctors who will mostly make okay decisions and no doctor at all. The reality is that okay decisions still save lives (let’s not talk about the bad ones).

Money keeps you alive and where you live matters

I used to be able to depend on the Croatian healthcare system for all my healthcare needs. This has become impossible, so now I’ve switched to a system of prioritising. If it’s high on the priority list, I'll pay. If it’s not so urgent then I'll wait my turn in the system. It’s a juggle in which every element is crucial because I couldn’t possibly pay for everything out of pocket.

I was extremely reluctant to start paying for anything because I was unwilling to let go of the ideal that healthcare is a human right afforded to all citizens. For years I believed that ideal to be a reality in Croatia because I lived it. In most cases I’m paying for speed and not better care. Many of the doctors who work privately come from the public sector so you won’t be seeing a better doctor; just you’ll get to see them sooner.

Your options if you require a brain MRI, for example, are to either wait ten months (or four months if your doctor says it’s urgent) or get it done the next day if you’re willing to pay 240 euros privately. It could be devastating if you don’t have the months or the euros at hand.

I also find that people are making more and more trips to Zagreb. There is a bigger pool of doctors and hospitals, making it much easier to get what you need. The other thing that helps, as with all things in this place, is “veze”, otherwise known as connections. If you know the right person you can get to what you need sooner without paying.

In an ideal world

I’d like doctors to look me in the eyes when they meet and examine me, not stare straight at the screen and start typing as I speak. I’d like more authentic listening and practical solutions and fewer prescriptions. I’d like to leave the hospital feeling like a recognised human being and not one of thousands that nobody noticed. Unrealistic? I don’t think so. But it may be a thing of the past.

I get that doctors have to switch off to stay sane. If they were to invest emotions into every patient they wouldn’t make it or be able to work. It makes sense. However, I feel that a system that is increasingly forcing people to switch off is a clear sign that it is broken for them too.

Where are we headed?

The Croatian healthcare system as it is creates an unhealthy environment for patients, doctors and all personnel.  Healthcare workers are primarily accountable to the system that employs them, leaving us all to have to navigate through its obscure web to get anything done. We need healthcare practitioners to be accountable to us first, the patients whose wellbeing is in their hands.

The problem has been present in the media for years. I’ve been following it in the Dubrovnik region in particular. I always find it funny that reporters mostly interview senior citizens when they pose questions to the public about healthcare. Baka or djed (grandmother or grandfather) will tell you that doctors are not as good today as they used to be and we have a big problem. We nod our heads and perhaps even roll our eyes because they say that about everything. For as long as you're healthy, this is probably a normal reaction. As a “young” person struggling through this system I want to point out that they are not exaggerating and the stories I hear from other chronically ill patients confirm my worries.

I don’t know if it’s going to get better. The way I see it is that if you want the equivalent quality of care compared to what you could get in this country ten to fifteen years ago through state-funded health insurance, then you'll have to pay for it today. Medical tourism will likely fuel this as more foreigners will be willing to pay what for them is a low rate and good doctors will be incentivised to leave the public sector.

Nevertheless, having the good doctors remain in Croatia although in the private sector is better than losing them altogether to emigration. I hope we can save this system and fix the cracks; otherwise Croatia will increasingly become a place where a person’s paycheque dictates their access to healthcare.

For more, check out our lifestyle section.

February 8, 2023 - Inspection by the Croatian Ministry of Health in some public and private institutions in Zagreb and Split revealed that some Croatian doctors who worked in hospitals were caught outside their workplace and that they were working in private institutions even though they did not have a permit for this from the director of the hospital where they were employed.

Večernji List / Index report. "Doctors who were found to be performing health care activities in institutions other than their primary employer institutions, without the approval of the director, were reported to the competent misdemeanor courts. The directors were also informed about those events in order to take measures in accordance with the Labour Act. In connection with the issue mentioned above, the Ministry of Health will continue to conduct inspections and transparently inform all stakeholders about what has been established," Minister Vili Beroš said.

Some Croatian doctors worked in private practices after they would finish their duties at their primary hospitals or on their days off. The problem lies in the fact that they did not have a permit for that. The valid Ordinance on the additional work of doctors stipulates that doctors who properly fulfill their obligations from the employment relationship and have permission for additional work can conduct such additional work, while working on the side without a permit is considered a violation of the obligations from the employment relationship. When such a violation occurs, the doctor in question will not be allowed to work two jobs for two years.

Even a doctor who works with a permit can end up having it taken away if they do not regularly fulfill their obligations at their primary hospital. Some hospital directors have already acted according to the findings of the inspection and handed warnings to doctors.

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

February 6, 2023 - Croatian healthcare has reached an alarming state. The country currently lacks up to 230 family doctors and around 170 primary pediatricians, gynecologists and speech therapists, Social Democrat member of parliament Romana Nikolić estimated on Monday. Over 180 doctors are over 65 years old and work only out of pure enthusiasm because they have no one to leave their patients to, 750 doctors are over 60 years old, and currently only 150 of them are in specialization, Nikolić warned at the press conference.

As Poslovni writes, if al the older doctors were to retire at this moment, around 300 thousand citizens would be left without their chosen family medicine doctor. Nikolić noted that Croatia is threatened with the collapse of the entire healthcare system.

She believes that young doctors stay away from family medicine because they have the lowest salaries and benefits in the system.

This can best be seen in the example of Đakovo. The Trnava Municipality, which consists of six villages, according to the last population census has about 1,300 inhabitants, and has not had a family doctor for a year, says Nikolić.

She also stated that every doctor needs to be given the opportunity to choose whether they want to work in a health center or in a private practice, but to still be contractually bound by the HZZO, with clearly set rules and without administrative obstacles.

She finds it necessary to promote family medicine during studies, and the local self-government should, she says, find ways to stimulate young people to come and work with them through scholarships and housing subsidies.

Hajduković: Mobile clinics and pharmacies would help older citizens

"Pediatricians are retiring, and they don't have adequate replacements. The entire region of Miholjac depends on one pediatrician who works part-time while in retirement, reminds parliament member and party vice-president Domagoj Hajduković.

He also notes that there is a big problem with internships that must be completed in order to get a work license and so that doctors can enter the labour market.

The state does not provide it to the required extent, it takes a few years and then many decide to leave Croatia, Hajduković points out. He adds that there are currently around 3,000 people waiting for an internship, and that the minister has announced that only 1,500 places will be secured in 2023. He sees the basic problem in the fact that the state did not provide enough money so that everyone could complete the internship within a reasonable time.

Hajduković also states that access to health care for many elderly citizens is limited and that this problem could be partially solved by establishing mobile clinics, palliative clinics and mobile pharmacies that would be part of the Health Centers of local and regional self-government units.

These are projects that literally mean life for the rural area, and such problems should have been solved by the so-called project Slavonia and European money, Hajduković concluded.

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

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 ncp-croatia@hzzo.

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.

November the 5th, 2021 - Croatian hospitals are once again busy preparing for the worst as the coronavirus infection rate climbs across the country and threats of a similar situation to what we experienced this time last year looms. With nowhere near enough of the population vaccinated, worries for the healthcare system reign strong.

As Poslovni Dnevnik writes, it was recently reported that just 31 percent of the population in Split-Dalmatia County have been vaccinated with two doses of the vaccine against COVID-19, making it the worst county in all of Croatia. This means that out of about 450 thousand inhabitants of this county, only about 150 thousand of them have been vaccinated, while 300 thousand of them, for whatever reason, haven't.

''It's a real shame and those are extremely poor numbers. I have nothing more to say, I've been "blunt" for more than a year now when saying that people should and must be vaccinated, but people obviously don't have enough understanding of that appeal. Whatever people say and no matter how much they convince people that they have to be vaccinated, they constantly think someone is trying to lie to them or do harm to them. And, believe me, I personally know quite a few of them who are now in Croatian hospitals, in a serious condition and now they strongly regret that they didn't get vaccinated. But when a man ends up in the hospital, then it's too late for him, by that point, he's got nothing to do but try to think about how he can remain alive,'' stated prof. dr. sc. Zlatko Trobonjaca, an immunologist from the University of Rijeka.

The newer Delta strain of the novel coronavirus spreads much more efficiently and quickly, it is much more contagious than previous variants.

''That's why I expect that in fifteen to twenty days there will be chaos going on in Croatian hospitals. If we know that hospitals are ''behind'' with those hospitalised with COVID-19, as those infected and needing urgent care usually arrive two to three weeks after having been initially infected, it should be very clear to you what awaits us soon.

Currently, those in Croatian hospitals with COVID-19 arrived when the number of total infected in Croatia was much lower than these numbers have been over more recent days. Recently, we've had more than four thousand people infected a day, and the more infected there are, the more hospitalised people there will be. The National Civil Protection Directorate knows that in two to three weeks, there's going to be a huge blow to Croatian hospitals,'' warned Trobonjaca.

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.