January 12th, 2022 - Those who have left Croatia but keep using Croatian public healthcare at the expense of the state will soon be removed from the HZZO database

As many as 300.000 Croatians could soon have their public health insurance policies cancelled by the Croatian Health Insurance Fund (HZZO), reports Novi list. Namely, Health Minister Vili Beroš has announced that the HZZO would be cancelling the policies of those insured whose residency or employment status does not grant them the right to free health coverage anymore.

Most of that list consists of citizens who emigrated in the last decade and now work and reside abroad, but retain their Croatian public health insurance at the expense of the state on the basis of being unemployed in Croatia.

A large number of such policyholders prefer to use the services of GPs or dentists when they visit Croatia, as they find it much more affordable than the equivalent service in the country they currently reside in. It’s estimated that two thirds of Croatian emigrants avail of their health insurance benefits in such a manner.

The HZZO states that a considerably large number of people benefit from the rights guaranteed by their public health insurance despite not paying the compulsory insurance contributions. The exact number could become known in a month’s time, once HZZO and the Croatian Employment Service (HZZ) have merged their databases.

All citizens who are not on file with the HZZ, but avail of the free compulsory health insurance on the basis of their unemployment status, will have their health insurance policies cancelled, as well as their dependents.

According to the director of the HZZO Lucian Vukelić, those citizens who are not registered with the HZZ as unemployed persons could lose their free health insurance policies as early as in February 2022, once the two institutions have signed the data exchange agreement.

In recent years, many Croatian citizens have left their homeland in search of work; while the number of HZZ applicants dropped significantly as a result, they mostly remained on file with the HZZO and held onto their free health insurance.

A number of Croatian emigrants were removed from the HZZO database in the summer of 2021, after a data exchange with the Ministry of the Interior showed which citizens had cancelled their residency in Croatia.

According to the HZZO, at present it’s nearly impossible to find out which Croatian citizens work in other countries where they also pay their health insurance contributions and where they should thus avail of public healthcare as well. Even though it’s illegal to have public health insurance in two countries simultaneously, there still doesn’t exist a unified EU database that would reflect where citizens have contributory health insurance and use public health services.

‘Considering that there’s a bunch of different insurance providers in most countries, it’s impossible to obtain the data. You would have to search all over Europe for each policyholder individually to find out if they’re insured in a certain country. It so happens that no one in Croatia ever cancels their health insurance; [employers in] most EU countries are obligated to insure their workers upon employment, and so we end up with an enormous number of people who work abroad and are insured in Germany, Austria or Norway, whereas in Croatia their public health insurance remains covered by the national budget’, said Vukelić.

The HZZO does not have the exact figures regarding potential savings for the national budget if Croatians who are not factually unemployed were removed from the HZZO’s list of unemployed policyholders.

However, if we were to consider the 300.000 people in question, based on the health contribution rate of 16.5% of a monthly gross salary of e.g. HRK 5,000, the state is HRK 2,7 billion out of pocket each year. This does not even take into account the annual costs of health services in Croatia that such policyholders avail of.

The HZZO will also look to cancel the policies of Croatian citizens who have not left the country, but use the benefits provided by their health coverage even though they are not paying the contributions.

An example of this are undeclared workers who neither pay for the coverage nor are they on file with the HZZ, but retain their free health insurance. Such persons will need to register with the HZZ and find legal work, i.e. pay the relevant taxes and contributions.

https://www.novilist.hr/novosti/hrvatska/hzzo-cisti-evidenciju-besplatno-osiguranje-moglo-bi-izgubiti-300-000-ljudi-radi-se-mahom-o-iseljenicima/
Ljerka Bratonja Martinović

ZAGREB, 11 June 2021 - The number of insured persons registered with the Croatian Pension Insurance Institute (HZMO) increased to 1,573 949 in May 2021, or 3.3% more than in May 2020, thus rising for four months in a row, the HZMO reported on Friday.

Broken down by business activity, the highest number, 245,053, are in the processing industry, and 239,352 in the wholesale and retail trade sector.

In comparison to May 2020, the highest increase of 8,200 more insured persons was registered in the construction industry, and 7,730 more in the hospitality and catering industry.

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Since as far back as 1998, when a person is left without work, their health insurance and the right to receive health care has been made possible by going and registering with the Croatian Health Insurance Fund (HZZO).

As Poslovni Dnevnik writes on the 19th of March, 2019, although thousands upon thousands of people have left Croatia in recent years, many of them are still being treated medically in their homeland, primarily because it pays off more than doing so elsewhere. This trend was warned about by the Croatian Association of Contracting Ordinations. They estimate that as many as 330,000 people who don't actually live in Croatia are still exercising the right to the country's health insurance benefits through HZZO.

As mentioned, since back in 1998, when a person becomes left without work, their right to health insurance is realised rather simply via registration with HZZO. At the same time, this person does not actually have to be regisered as unemployed officially, as was explained by HZZ. This leads to a large number of people working and paying their taxes over in Germany, and coming and getting their teeth fixed while on holiday in summer in Croatia.

This is apparently also an issue in the mind of the Croatian health minister, both financially and morally. "It's not fair to those who live here and who pay for health insurance, therefore HZZO will undertake and is already taking out certain measures [to attempt to deal with this issue]," said Minister Milan Kujundzic. Such measures will also soon be taken up by the European Union itself. Electronic data exchanges between member states is being introduced, which will help control those who are HZZO insured.

''According to the data we have, as of the 31st of December 2018, compared to 2017, we've got 40,850 less insured persons -  that's about 0,96 percent. Our records include some 60,000 workers who work for our _Crpatian+ companies in the EU,'' said the HZZO's director, Lucijan Vukelić. He emphasised the fact that HZZO has been caught up with the various problems of expatriates from Croatia who pay their taxes abroad and are still in HZZO's register, and are therefore treated for whatever ailments may bother them here in Croatia.

Vukelić also noted that HZZO should enter into a joint data exchange with the EU on the 1st of July this year. This data also includes non-EU countries, but involves them as they are economically linked to the EU. It is a bi task and a fairly painstaking process because there are many countries involved, both EU and non EU across the European continent.

There are numerous confusing laws that many misinterpret when it comes to health insurance in Croatia which came into force when Croatia joined the EU back in 2013.

EU countries with a public health system such as Poland and the UK made it so that, for example, British nationals who are resident in Croatia could use their EU health card to access healthcare in Croatia, effectively trading one public insurance policy for another. Such laws appear to have created more confusion than sense, and whether or not HZZO will manage to get to the bottom of the situation with its own nationals with MUP's help is yet to be seen.

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As Croatia's increasingly alarming negative demographic trend tightens its grip over the country and its economy, there seems to be more people insured by the Croatian health system (HZZO) than actually live and work here...

As Index/Marko Repecki writes on the 26th of February, 2019, due to the negative demographic trends and a fairly low birth rate, Croatia has now worryingly fallen below four million residents, according to the estimates of demographers, but at the same time, there are miraculously 4,145,169 persons who have Croatian Health Insurance from HZZO.

This means that more people are apparently entitled to Croatian health insurance than are actually really living in Croatia. This phenomenon is not entirely new, because when we look at some of the data for the previous years, it can be seen that there are approximately between 90 and 120 thousand people who seem to be insured with HZZO, therefore using the services of the Croatian health system, than actually live here.

Who exactly are these people who have HZZO health insurance and don't live in Croatia?

Index readily asked HZZO to explain just how this difference of Croatian health system users came about, and they answered that there are persons who are still considered as insured persons in Croatia, although they don't actually live here.

"On the 31st of January, 2019. 4,145,169 insured persons were registered in the Croatian Health Insurance Institute (HZZO). Please note that in some cases the person is still considered to be an insured person, even though they don't live Croatia. As an example, we include: active Croatian insured persons with residence in another EU member state (such as an actively insured Croat who lives in Slovenia), beneficiaries of Croatian pensions who have moved to the territory of another [EU] member state, and our delegates doing temporary work in another member state (a worker whom a Croatian employer sent for temporary employment in, for example, Germany). In all these cases, it regards persons who remain insured persons of HZZO, but they also enjoy the right to health care in the territory of other member states, in accordance with EU regulations on the coordination of the social security system,'' HZZO's statement said.

Index also sought further clarification on who is actually considered an actively insured person, and they got the following answer:

"An active insured is a person who is employed and pays contributions for compulsory health insurance, which are paid by their employer. Such insured persons do not pay health insurance contributions in the country where they live, but their contributions are paid in the country where they work. A person can't be insured in two EU member states, but is insured in the country in which they work, and in the territory of the other [member] state in which they're living, they have the right to full healthcare, just like all of the other persons with health insurance in that [member] state, on the basis of having health insurance in their country of work. For example, an actively insured person works in Croatia and lives in Slovenia, he is then entitled to full health care on the territory of Slovenia, at the expense of the Croatian Health Insurance Institute,'' HZZO replied.

The head of the Lipa Association (Udruga Lipa): "We pay 23 billion kuna every year for healthcare, and the system is breaking down"

145,000 people seems a huge number if we're talking about people who live abroad, yet work in Croatia, or are retirees with a Croatian pension yet live in another EU member state. Index asked the Lipa Association for a comment:

''We at the Lipa Association don't know why HZZO has a higher number of insured persons than the population of Croatia according to DZS and to demographers,'' said Lipa's Zoran Löw, but he referred generally to the catastrophic state of healthcare. Although Croatian workers to pay out a sum of money for access to state healthcare, the Croatian Health Insurance Institute, Croatia's chief health system funder, spends around 23 billion kuna annually, in five years, that comes to a huge amount of 115 billion kuna. We're witnessing the complete disintegration of the system where people literally die on roads, and examinations are being waited for for months, and in some cases, for years.

Löw added that they forwarded an open letter to Milan Kujundžić, the Croatian Health Minister back in 2017, warning of the need to include private institutions in the state's health system.

"In many EU countries, private institutions providing health services are integrated into the system so that they compete equally for jobs funded from the public system. Let's just list some: the Netherlands, Sweden, Portugal, Germany... And this is not just about simpler institutions such as labs or family medicine, the're also serious clinics. In this way, it introduces some healthy market competition and the whole system becomes more agile and financially viable. Unfortunately, in Croatia, this approach is viewed as the privatisation of the healthcare system. This government and its health minister obviously don't have the courage to come out with such an initiative and stand behind it,'' they stated from Lipa.

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Click here for the original article by Marko Repecki on Index.hr

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