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.

ZAGREB, 12 June 2022 - The number of doctors in primary health care in Croatia will drop by 24% in the next five years, which will make work in the sector impossible, while the number of nurses will drop by an additional 25% due to retirement and lack of new staff, the medical and nursing chambers have said.

On the other hand, projections for the next five years show that the number of hospital doctors will increase by 23% considering data on those who will go into retirement in that period and the number of doctors entering the system.

Number of hospital doctors growing, number of primary health care doctors falling

As in other matters, the profession expects the imminent health system reform, announced by Minister Vili Beroš, to provide solutions.

A total of 15,668 doctors work currently in the public and private health sectors, and their number is 9.1% higher compared to 2017. Their average age is 51, and 63% are women.

Hospitals currently employ 9,170 doctors, their average age being 43. Of them, 995 are above the age of 60 and currently 127 pensioners work part-time in the system.

Among the hospital doctors are 6,276 specialists, whose number has increased by about 300 since 2017. Considering that 2,558 are residents, the Croatian Medical Chamber (HLK) estimates that the number of specialists in hospitals will grow by 23% in the next five years.

The situation is quite different in primary health care, where the number of doctors is expected to fall by 24% in the next five years considering the current number of only 236 residents.

The situation is particularly critical in family medicine, with only 131 doctors being trained for family doctors, including 122 who are already team leaders. The number of doctors in that area of medicine is estimated to fall by 27% in the next five years.

There are currently 2,213 family doctors and there is a shortage of 150 doctors in that branch of medicine; 733 of those 2,213 doctors are above 60 so if something is not done, the situation will be unbearable in five years' time, HLK head Krešimir Luetić said at the MedMed conference in Grožnjan.

One-third of 248 pediatricians, who are already in short supply, will retire in the next five years, and their number will drop by 13% while the number of gynecologists will fall by 10%, it was said.

A total of 1,021 doctors, aged 36 on average, have left Croatia so far even though the numbers have been stagnating in the last two years due to the coronavirus pandemic. Most of those who have left today work in Germany, Great Britain, Switzerland, Sweden, Ireland and Austria. Another 839 doctors have sought documents required for employment abroad.

Croatia lacks a system of human resources management in the health system, Luetić says, noting that the HLK has been demanding for years a collective branch agreement for the profession, a law on wages and comprehensive reorganisation of specialist training. The shortage of physicians is also evidenced by three million hours of overtime work annually, he says.

Nurses in short supply

There is a shortage of more than 4,000 nurses, and in the next five years between 5,500 and 7,000 will meet retirement conditions, according to the Croatian Nursing Council.

A total of 38,500 nurses work currently in the health and social welfare system.

The Council calls for urgently increasing enrolment quotas for nurses by at least 50% and encouraging the employment of carers to help cope with a constant, 25% shortage of nurses, as well as for increasing their wages and securing benefits related to professions in short supply.

"In five years' time the number of nurses will drop by an additional 25%. The interest in the profession is great but enrolment quotas are too small and we have asked the Education Ministry to increase them," Council head Mario Gazdić said.

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

February 11th, 2022 - Primary care providers are not responding lightly to the accusations of being unavailable to their patients. At the same time, they are being reprimanded by the HZZO for the sick leave rate increase, despite it largely being caused by COVID-19

The pandemic has led to a significant increase in the number of workers taking sick leave. More than a million citizens have been infected with the coronavirus in the last two years, and as of yesterday, 21,865 people were in isolation.

Although some of them only have mild symptoms and continue to work from home, a good number of people are forced to take sick leave. However, although it is clear to auditors from the Croatian Health Insurance Fund (HZZO) that taking time off for this reason is justified, GPs are being reprimanded for the amount of sick leave they’ve been approving, reports Vecernji list/Romana Kovačević Barišić.

‘My allowed rate of sick leave is 2.8%, and I had 5.5%. The [HZZO] audit did not find any irregularities, but I received a warning for exceeding the rate nonetheless. I didn’t want to sign it, but I was informed that I was putting my contract in jeopardy. I filed a complaint. It was accepted, but it was also confirmed that my exceeding the sick leave rate was unjustified as I signed a contract with the HZZO stating that I would adhere to the stated rate as a contractual obligation. And the pandemic isn’t mentioned anywhere in the contract’, said Marija Gluhak MD, a family doctor from Međimurje, describing her case from November last year.

In case of repeated warnings, the practitioners are first subject to a fine, followed by a possible termination of their contract with the HZZO.

Dr. Vesna Potočki Rukavina MD has seen her contractual sick leave rate of 2.5% increase to 4.9% in the last two months.

‘Omicron has caused a considerable increase in acute sick leave. It mostly affects the younger part of the workforce and inevitably excludes them from work obligations, and HZZO does not look at the situation in the field objectively, so they reprimanded some of my colleagues’, said Dr. Potočki Rukavina. She hasn’t received a warning despite having exceeded the mentioned contractual rate, which only points to the absurdity of a dry bureaucratic approach which is devoid of logic and uneven across the board.

The HZZO point out that they have an obligation to monitor and control the Temporary Incapacity for Work (TIW) of the insured to see whether the status is justified, and to do so both on a regular basis and in exceptional circumstances.

‘Temporary incapacity for work caused by isolation and illness related to COVID-19 is determined and managed in accordance with the epidemiological measures and guidelines recommended by the Croatian Institute for Public Health and the Civil Protection Headquarters, and cannot be considerably affected by audit. In January 2022, there were 11,303 recorded new cases of isolation or self-isolation due to COVID-19. We can say with certainty that the number is even higher in reality, but many who are isolating or self-isolating in agreement with their employers avail of the option of working from home, take vacation days or paid leave without exercising the right to request the TIW status, so the HZZO doesn’t have them in their records.

Regular audits of TIW leave are intended to monitor long-term TIWs and those TIWs that are determined to last too long given the medical diagnosis on which they are based’, stated HZZO and also brought up the fact that keeping the sick leave rate within the strategic parametres contributes to the rational spending of limited resources of the health care system.

Health Minister Vili Beroš recently again encouraged patients to report it if they cannot get hold of their GPs. Between November 2020 when the email address This email address is being protected from spambots. You need JavaScript enabled to view it. was introduced and the end of January 2022, HZZO received a total of 2697 emails from the insured, 928 of which were determined to be justified complaints.

In 2021, they received 1682 complaints, and between January 1st 2022 and February 9th 2022 there were 457 complaints.

According to the HZZO, the majority of received complaints focused on inaccessibility of service, namely the inability of patients to establish timely contact with primary health care practitioners.

The way this is handled is the HZZO employees immediately look into the allegations listed in the complaints, get in touch with primary care clinics (by phone or e-mail), inform the doctor who supervises the team about the need for a call back to the insured person in question, and get back to the insured persons to inform them of the outcome, stated the HZZO.

The overworked doctors are not taking these accusations lightly. ‘If all clinics have a problem with inaccessibility, we obviously have a bug in the system’, commented Dr. Ivana Babić MD.

Dr. Potočki Rukavina agrees with her colleague. ‘The situation is absurd. If all 2,200 of us combined received a total of ten million calls and e-mails in the first three quarters of last year, I don't know if this is a question of unavailability as much as it’s a problem of over-availability! Always being available to this extent is a danger to our work. Is it possible to do comprehensive, quality work in the two or three minutes that you have for each patient?! And if you process 150 of them, you’ll most likely be unavailable for the 151st’, said the doctor.

ZAGREB, 28 Nov, 2021 - The head of the Croatian Medical Chamber (HLK) said on Sunday that he was surprised that participants in protests against COVID certificates included doctors, confirming the HLK had launched proceedings against doctors making claims not based on science at those protests, thus misleading the public.

"Certain steps have been taken against six doctors... sanctions range from a warning and a reprimand to the revocation of the licence," Krešimir Luetić said in an interview with the Sunday issue of the Novi List daily.

Asked if such doctors should have their licences revoked, Luetić said the HLK's Ethics Board was an independent body that would make its decision.

Doctors embittered by protests against COVID-19 certificate mandate

Asked about his view of the protests against epidemiological restrictions, vaccination and testing, Luetić said that he shared his fellow doctors' resentment about the protests.

He said that after the protest held in Zagreb last weekend, he was contacted by dozens of colleagues who were embittered as the event was in direct violation of epidemiological restrictions but also because of the messages that could be heard at the rally.

95% of doctors vaccinated

Asked about the fact that among the protesters there were also doctors and that not all protesters were uneducated people, Luetić said that he was shocked by the fact that any intellectual, particularly a doctor, would make comments that were not based on science, medical profession and statistics.

He noted, however, that around 95% of doctors had been vaccinated against coronavirus, thus showing their view of the pandemic and vaccination.

Speaking of vaccination, Luetić recalled that the HLK had already taken the position that vaccination should be mandatory in the health system.

As for the mandatory vaccination of the general population, which Austria has already opted for and some other European countries are considering, Luetić said that it would be a political decision.

"As a doctor and from the point of view of the medical sector, I think such a decision would definitely make the situation in the health system easier, and reduce the number of seriously ill people and fatalities," he said.

If you compare countries like Croatia, Belgium, Austria and the Netherlands, you see that they have roughly the same number of daily infections per million inhabitants, however, compared to Croatia, those three countries have three times fewer hospitalisations and up to five times fewer fatalities, Luetić stressed.

"That is a clear indicator of how important vaccination is, and as to whether our citizens understand that, I think the answer is both yes and no," he said.

For more about Croatia, CLICK HERE.