February the 21st, 2023 - Many are quick to take a (usually warranted) swipe at the state of the Croatian healthcare system. They'd be right to do so. It is grossly mismanaged and chronically underfunded, with both patients and staff suffering the often severe consequences. Croatian doctors, however, just keep on impressing.

Medical wonders never cease at the Radiochirurgia Special Hospital in Zagreb, as the Croatian doctors there are the only ones in the entire world to perform radiosurgical procedures under general anesthesia, which in just one procedure, destroy cancerous tumors of the lungs, pancreas, and prostate without irradiating the delicate surrounding tissues and organs.

As Poslovni Dnevnik writes, this type of radiosurgery procedure can be performed with a patient referral from HZZO (the Croatian Health Insurance Fund), and the hospital which carries it out cooperates with KB (Clinical Hospital) Merkur and the Faculty of Electrical Engineering and Computing. The results in the fight against cancer are incredible, as reported by HRT.

In one patient, they managed to destroy a form of cancer which causes the deaths of millions each year - an inoperable pancreatic tumor - using radiosurgical ablation.

No blood, no pain, no long recovery

"Over 50 percent of patients live longer than 24 months, and somewhere around 13 percent of them live longer than 4 years. The reactions following the procedure are spectacular. There's no blood, no pain, no long-term recovery, and no postoperative complications. The patient comes, and otherwise it is done in one fraction that lasts for 45 minutes to an hour and a half, depending on the patient, and then the patient goes home. That means that this is actually an outpatient procedure", said hospital director Dragan Schwarz.

During the procedure, the patient must be under general anesthesia so that the radiosurgery procedure can be performed as accurately as possible.

"The problem is that cancerous tumors move within the body, due to breathing, peristalsis and other physiological processes. When under general anesthesia, we achieve a situation in which the patient is completely motionless. The anesthesia stops them breathing and reduces peristalsis. This results in heightened safety of over 90 percent. Even according to our own experience, there's a 98 percent chance that the treated lesion will necrotise and then be destroyed," said Hrvoje Kaucic, head of the radiosurgery and radiotherapy department.

A special role is played by medical physicists who are in charge of ensuring that the linear accelerator accurately and precisely delivers the planned and prescribed dose of radiation.

The pancreas is the biggest challenge of all

Cooperation with colleagues from electrical engineering and computing helps them to be more precise and without the anesthesia. They detect moving organs in order to spare them during the targeted destruction of the tumor. The pancreas, they say, is the biggest challenge within the human body when it comes to this.

"It's a challenge, but we managed through this work to carry out the procedure based on the knowledge of other organs and the mutual relationship between the organs and the pancreas, and we got a fairly precise position of the pancreas. From 80 to 90+ percent of the reliability of the position of an individual organ", said Zdenko Kovacic, head of the Laboratory for Robotics and Intelligent Management Systems.

Experts in radiosurgery together with Croatian doctors from KB Merkur provide patients suffering from the rare cancerous Klackin's tumor a fighting chance for a longer life.

"We've now created a model to start radiation with radiosurgical treatment, where a patient who is a transplant candidate and has a Klackin's tumor receives an ablative dose. After that, we put it on the list and after that we successfully transplant it. Survival is much higher and the odds are much better - oer three years," said Stipislav Jadrijevic, head of the Department of Abdominal Surgery at KB Merkur.

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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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May 14, 2022 - Out of a total of 359 gynecologists in Croatian hospitals, 195 refuse to perform abortions.

Of the 29 public hospitals in Croatia that have a contracted abortion service with the HZZO on request, in six of them, no gynecologist wants to do so because they have a conscience appeal, writes Večernji list. Clinical Hospital Sveti Duh in Zagreb, General County Hospital Vinkovci, OŽB Našice, and OŽB Požega and General Hospitals in Virovitica and Nova Gradiška are institutions whose gynecologists employed there have called to conscience and do not want to perform abortions at the request of women.

In the Požega hospital, along with gynecologists and all five anesthesiologists, they also called for conscience and do not perform abortions. Out of a total of 359 hospital gynecologists in Croatia, 164 gynecologists agree to work in public hospitals at the request of a woman by the legally regulated and legal procedure of abortion, and 195 refuse to do so.

Due to his conscientious objection, 38 out of a total of 698 specialists in anesthesiology, resuscitation, and intensive care, as many as work in Croatian hospitals, refuse to perform abortions, according to data from the Digital Atlas of Medicine of the Croatian Medical Chamber. Some nurses and midwives and even pharmacists in pharmacies also called for a conscience appeal, but we did not find out exactly how many.

There is no conscience appeal in some hospitals

The conscientious objection in an individual hospital is regulated by the employee writing a statement invoking the right to conscientious objection and delivering it to the employer, such as the personnel or legal service, the director's office or the hospital board, and in some cases appeals are only recorded at the gynecology department.

There is no uniform practice. There are no or almost no appeals of conscience in hospitals in Rijeka, Karlovac, Ogulin, Sisak, Koprivnica, Pakrac, Knin, Vukovar, Pula and Čakovec.

All hospitals whose doctors invoked conscience for abortion have hired doctors from another institution, to whom they then pay extra or have contracts with the health institution where the procedure is performed. Thus, they have fulfilled the legal obligation that they must ensure legal and accessible abortion, writes the journalist of Večernji list Romana Kovačević Barišić.

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May the 6th, 2022 - Dubrava Hospital doctors have performed a form of surgery that has never been done before in the Republic of Croatia, highlighting (once again) the incredible medics this country can boast of, and just how much they deal with and succeed in even within the constraints of a severely strained and underfunded healthcare system.

As Poslovni Dnevnik writes, for the first time ever in Croatia, an operation was performed by Dubrava Hospital doctors in order to reconstruct both feet. A team from Dubrava Hospital enabled a migrant from Gambia to take a new step (quite literally) in life after his toes were amputated due to suffering from severe frostbite, RTL writes.

After four surgeries and two months spent recovering and being treated in the hospital, Eddie Manga is now recovering exceptionally well. He has also learned a few words of Croatian, and now everyone is waiting for him to take his very first steps.

Manga is a nineteen-year-old Gambian who has has his life torn apart since his foot amputation. He set off for Europe with three Afghans, and together they reached neighbouring Serbia.

"They just left me. I was alone in the "jungle", I kept on walking without any food and water. I have had these frozen feet ever since. I walked and walked and walked. On the way I heard cars, I heard traffic. I was close to the road, but I didn't know where I was,'' said Eddie Manga, the Dubrava Hospital patient who will now be able to get his life well and truly back on track thanks to the team of doctors who gave him their all.

Someone eventually caught sight of the young man, wandering around hungry, thirsty, exhausted and somewhat dazed, called the police and then the ambulance arrived. He ended up in the hospital with severe frostbite, which is now thankfully a period of his life he can put firmly in the past.

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January the 22nd, 2022 - The director of the covid ward of KB Dubrava in Zagreb, Prof Bruno Barsic has stated that with the emergence of the highly infectious but far milder variant of the novel coronavirus, Omicron, only two measures make any sense. The rest are quite pointless.

As Poslovni Dnevnik writes, Prof Bruno Barsic of Dubrava Hospital's covid ward pointed out to Index that because of the Omicron variant, we have a large number of infected people, but the pressure on hospitals isn't what it was. He stressed that Omicron patients aren't putting any pressure on the hospital and hoped that it would remain like that.

From Thursday the 27th of January, wearing masks in the United Kingdom will no longer be mandatory, working from home will no longer be officially recommended, and covid certificates (NHS covid passes) will no longer be required to enter nightclubs and partake in certain larger gatherings, according British Prime Minister Boris Johnson, who was recently busted for having parties during the harsh UK lockdown and is being pressured to step down.

The abolition of covid certificates is also being seriously considered in Israel, where Finance Minister Avigdor Liberman has risen up against their continued use. He said that they have no health purposes and that they contribute to creating even more issues and panic.

Cyrille Cohen, one of the Israeli government's vaccination advisers and head of the immunology department at Bar Ilan University, told UnHerd yesterday that covid certificates had become "irrelevant" now Omicron is dominant, and that he expected them to be abolished soon.

“When it comes to the Omicron variant, we don’t see virtually any difference between the vaccinated and unvaccinated, and both can become infected by it more or less equally,” he said.

"That's logical. It's going in that direction. If you have 50 percent of those tested returning a positive result, then what's the use of testing? It seems logical to me that we are going in that direction in this country as well,'' said Prof Bruno Barsic.

He also commented on other epidemiological measures that are in force in this country and pointed out which ones he would drop if he was in charge. "Of all the measures, I would keep those that limit mass gatherings and wearing masks. So far, masks are very important because we can see how rapidly and easily Omicron spreads and infects people,'' he said.

Prof Bruno Barsic also stated that the elderly population still needs to be vaccinated.

"And that's it. It seems to me that the need for less measures is slowly emerging. But I'm not an expert in epidemiology, so I'd leave it to those who are to make those decisions,'' concluded Prof Bruno Barsic.

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January the 20th, 2022 - The emergence of the far more infectious but apparently far more mild strain of the novel coronavirus, Omicron, has altered the course of the pandemic for many countries who are now opting for much different measures which resemble the ''old normal''. Prof Ivica Luksic of KB Dubrava has also noted that this variant is changing things.

As Poslovni Dnevnik writes, the wave of the epidemic caused by the Omicron variant is still resulting in a large number of new infections, but there are indications that something is changing in the course of the epidemic.

"Over more recent days, we've had a continuous number of patients. We aren't experiencing significant growth, but we don't have a continuation of decline either. At KB Dubrava, we have about 70-80 coronavirus patients and about 20 of them are in the intensive care unit,'' said Prof Ivica Luksic, the director of the Dubrava Clinical Hospital, for Dnevnik.

He pointed out that apparently something in the course of the coronavirus pandemic is indeed changing.

"We have an enormous increase in new infections, but fortunately it is not accompanied by an increase in patients. Obviously, Omicron has changed the course of the pandemic, and we're adapting to these new circumstances within the hospital system," he said.

Regarding the age structure of patients requiring hospital treatment for their more severe clinical pictures, Prof Ivica Luksic said that the patients who are hospitalised are mostly older people and those who are unvaccinated.

"In the fourth wave of the pandemic, there was an increase in younger patients, those who were unvaccinated, and now we're returning to the situation in which we mainly have older people needing treatment," Prof Ivica Luksic said.

Asked if he could confirm that Omicron is mostly retained in the upper respiratory tract and doesn't descend further down into the lungs, Prof Ivica Luksic said it was too early for more serious conclusions to be firmly made, but that according to the clinical pictures of some of the first hospitalised Omicron patients, it does appear milder than it was before.

“You could say it’s going in the direction that the upper respiratory system is affected more often,” he said.

Asked if Omicron was the beginning of the end, Luksic said that its emergence has accelerated some things in any case.

"It's to be hoped that Omicron may have accelerated the end or indeed be end of the pandemic and the transition to the endemic phase of the disease," responded Luksic, emphasising the continued importance of vaccination.

"There are currently no patients who have received two doses of the vaccine or received a booster among those admitted to hospital," he told HRT.

For all you need to know about coronavirus specific to Croatia, make sure to bookmark our dedicated section and select your preferred language if it isn't English.

ZAGREB, 13 Jan 2022 - In the past seven days, there have been over 48,600 new cases of infection with coronavirus in Croatia, which is the highest weekly caseload since the outbreak of the pandemic, Prime Minister Andrej Plenković told his cabinet on Thursday.

This is twice as high as two weeks ago, he added.

The COVID-related death toll exceeds 13,000.

"This fact is important to highlight against the backdrop of the slowing daily rate of inoculation. From early March to the end of May 2021, 1.14 million persons were given a shot. Since then, less than a million have been given the first dose," the premier said.

Commenting on vaccine hesitancy, Plenković said that it was detrimental to unvaccinated people, particularly those who had caught the virus and died of the infection.

Better protection against the virus can be ensured provided there is a combination of higher vaccination rates, booster doses, and compliance with COVID protocols, he said, adding that the government had made sure that there were enough amounts of vaccines for all.

He reiterated the importance of immunization in light of the fast spread of the highly contagious Omicron variant of coronavirus.

Croatia has logged 9,157 new COVID cases and 23 related deaths in the past 24 hours, with the latest infections putting the number of active cases at 55,500, the national COVID-19 response team said earlier today.

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ZAGREB, 13 Jan 2022 - The rate at which the Omicron coronavirus variant is spreading is alarming and it has started to cause serious problems in the health system due to a growing number of doctors and other medical staff who cannot go to work due to infection or compulsory self-isolation.

According to data from the Croatian Public Health Institute (HZJZ), 800 nurses and 353 doctors who work in medical institutions are positive or in self-isolation, reports Jutarnji List.

The KBC Split hospital operates without 36 of its doctors and as many as 82 nurses, the KBC Zagreb hospital has 29 doctors and 68 nurses who are either positive or in self-isolation, while the KBC Rijeka hospital operates without 17 of its doctors and 37 nurses.

In the KBC Zagreb hospital, 186 workers did not show up for work on Tuesday while on Wednesday 244 did not show up. In the city's KB Dubrava hospital, 65 medical staff were in isolation and self-isolation on Tuesday.

"We are still not in trouble, but if the number of employees who are in isolation and self-isolation continues to grow, that could become a problem. We are concerned. Most of our positive employees are vaccinated so they have very mild or no symptoms but regardless of that, they cannot show up at work," said KB Dubrava director Ivica Lukšić.

The head of Zagreb's Sisters of Charity Hospital, Davor Vagić, is of the same view, and notes that the number of employees who cannot come to work because of infection or self-isolation keeps growing, which, at some point, could become a problem.

KBC Zagreb hospital assistant director Milivoj Novak says the situation is still not alarming but an increase of as much as 76% in the number of positive employees in a single day does not look good.

For all you need to know about coronavirus specific to Croatia, make sure to bookmark our dedicated section and select your preferred language if it isn't English.

November the 29th, 2021 - The largest private Croatian hospital is set to be constructed in the City of Zagreb. What Zagreb and the Croatian state failed to do itself will now be made private.

As Poslovni Dnevnik/Marija Crnjak writes, Poslovni Dnevnik has found out that in 2023, a new Special Hospital for Orthopedics and Traumatology, Akromion, will spring up in the Dugave settlement in Novi Zagreb near the exit towards Velika Gorica. It will be the largest private Croatian hospital, larger than most public hospitals, and Osteon gradnja plans to invest 160m kuna in this massive project.

Orthopedist Nikola Cicak, the director of Osteon and one of the founders of the Akromion Hospital in Krapinske Toplice, explains why Akromion is moving to Zagreb.

"Akromion has become a respectable orthopedic hospital in this part of Europe since its founding, we've found ourselves in a situation where we have simply outgrown the space we use in Krapinske Toplice. It became cramped for us, we lacked space in the wards, to the extent that we had to postpone some procedures because we had nowhere to place the patients after they had their operations. We have nowhere to expand in that location, and we decided to build a hospital that would suit our needs better.

The second reason lies in the location itself, Zagreb is more accessible to our patients who come from all over Croatia, but also from other countries, Slovenia, Serbia, Bosnia and Herzegovina, we also have Croats living abroad and foreigners living in Croatia who need such services. Zagreb will be a better address for our further expansion of business,'' explained Nikola Cicak, who founded Akromion with his fellow doctors back in 2008 in a facility that they rented from the Special Hospital for Medical Rehabilitation in Krapinske Toplice.

In terms of revenue and number of employees, Akromion is the largest private orthopedic hospital in the entire country, and in 2019 it generated 40.5 million kuna in revenue.

It is an institution that specialises in the treatment of injuries and diseases of the locomotor system, with a wide range of surgical procedures on offer, from arthroscopy to the installation of artificial joints and reconstruction, and in addition they are engaged in scientific work and education. Apart from Krapinske Toplice and Zagreb, they also provide services in locations in Dalmatia, more precisely in Split and Zadar.

They have a total of 70 full-time employees, and since its establishment until today, 15,248 operations, ie 249,111 medical services, have been performed in Akromion, and more than 30,000 services are performed on an annual basis, including approximately 1,300 operations.

The up and coming largest Croatian private hospital is being built over 8.5 thousand square metres of land, which Osteon bought from private owners for a total of 12.5 million kuna. The hospital itself will cover about 10 thousand square metres, it will have five floors including a garage, and the total value of the investment is 160 million kuna. Cicak explained how the project was put together after around a dozen previously planned versions, because it was done in such a way that the hospital staff gave instructions to the architects.

"We gave them instructions on what we need, so that they could build a hospital according to our needs, and not to adapt the hospital to the facility, as was the case, for example, during the adaptation of the Akromion facility in Krapinske Toplice. When the pandemic first struck we were sort of in a dilemma as to how to proceed, they asked me if we were still going to go for it, so I said yes, let’s go, now is the right time. We worked on the main project for a year and a half, and that was finished this summer,'' revealed Cicak.

This spring, the company Osteon gradnja was first established, which will be in charge of the project, and the financial side of the construction will be settled with the help of a bank loan that has yet to be selected. There are four banks in the ''game'' - Zagrebacka banka (Zaba), PBZ, Erste and HBOR, all of which offer excellent loan conditions.

Back at the beginning of October, an application for a building permit was submitted, and a contractor was selected, and the Akromion Hospital will be built by the company Kamgrad. The plan is for the facility to open its doors in 2023.

Instead of the current three operating rooms, which is the situation at Akromion in Krapinske Toplice, there will be four rooms in the largest private Croatian hospital in Dugave. Another magnetic resonance imaging device is also being made available, as well as CT scanners which they currently don't have. The hospital, which will extend through one entire department, is also being expanded.

"It will be like patients who go to spas to recover after their operations, which is convenient especially after some procedures such as the installation of a new hip or knee prosthesis. With such procedures, it takes time for the patient to return to a normal life, and whoever wants to return home "healthy" can stay in our hospital in order to do just that,'' Cicak stated.

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November the 16th, 2021 - A brand new Zagreb Infectious Disease Clinic is set to be constructed. On top of that, the full renovation of part of the existing hospital will also be carried out next year.

As Poslovni Dnevnik writes, the renovation of part of the current Zagreb Infectious Disease Clinic will begin at some point in 2022, and the construction of a new, modular building with additional insulation units is also planned. The new Zagreb Infectious Disease Clinic complex will cover 15,000 square metres and will be completed within a four to five year period, Vecernji list reported recently.

Every cloud has a silver lining and every evil brings with it, in some sense, some good. On those tracks, the ongoing coronavirus pandemic has helped very much to raise people's general awareness of the importance of the Zagreb Infectious Disease Clinic (Dr. Fran Mihaljevic), a pavilion-type institution founded way back in 1893, which today is the central institution in the fight against the novel coronavirus. On the hill on the corner of Mirogojska and Rockefellerova in Zagreb, the construction of a modern clinic for patients infected with the most severe infections is planned.

"There are big plans for the construction of a new, modern hospital, the realisation of which, according to the programme study, will take about four to five years. It should have up to 15 thousand square metres of surface, and a significant increase in the capacity of the clinic itself is planned. Through the National Reconstruction and Development Fund and partly through the World Bank, we've secured the funds to build a modern new Zagreb Infectious Disease Clinic for both adults and children in the central part of the clinic. The value of this stands at about 350 million kuna for the central building, which would consist entirely of insulation units and would contain the largest part of the clinic for both adults and children, an intensive care unit, and a radiology department,'' explained prof. Alemka Markotic, the director of this well known Zagreb clinic.

Some old existing buildings will have to undergo major renovations and the project will go slower also because two major earthquakes which struck Central Croatia and Zagreb back in 2020 have occupied all capacities in the construction profession.

While all of the preparatory works are being carried out for the new Zagreb Infectious Disease Clinic, the project involving renovations is already underway and one complete building is being renovated, also with funds from European Union (EU) funds. The value is 50 million kuna.

"The project documentation is in the final phase and the renovation of the building will begin at the end of next spring," announced prof. Markotic. As part of the project, the clinic will carry out the reconstruction and equipping of Pavilion II, within the hospital complex, for the needs of a day hospital, and thus contribute to improving the availability and effectiveness of treatment.

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