January the 18th, 2022 - Following the release of the official results of last year's Croatian census, which revealed not only another worrying drop in numbers in terms of the population but other uncomfortable facts such as the sheer amount of those remaining people who drawing their pensions, it has turned out that there are very many ''phantom'' Croatian Health Insurance policy holders, too.

The hunt is now on to find 209,000 Croatian Health Insurance policy holders who aren't even registered as living in the country at all. HZZO (Croatian Health Insurance Fund) has its work cut out when it comes to cancelling the policies of all those who are still likely coming home for treatment but live elsewhere.

As Poslovni Dnevnik writes, despite the fact that the 2021 census has revealed that all of the country's counties as well as the City of Zagreb have fewer inhabitants than they had 10 years ago, Croatia still has 209,000 more Croatian Health Insurance policy holders than registered residents and more voters than adult citizens, writes Vecernji list.

According to the first results of last year's census, the Republic of Croatia has a maximum of 3,888,529 inhabitants, while on January the 3rd, 2022, it somehow had as many as 4,097,903 Croatian Health Insurance policy holders.

After the census, the voter register, which includes 3,690,623 adult citizens, will have to be "cleaned up".

Demographers have previously warned about issues caused by fictitious or ''phantom'' Croatian Health Insurance policy holders, explaining that they are most likely Croatian citizens or residents, Serbs who have left Croatia, Croats from neighbouring Bosnia and Herzegovina and Croatian citizens who emigrated but didn't ''check out'' of the system, and foreigners who own real estate in the country but don't live here.

It isn't possible to estimate just how many of these insured persons who aren't residents of Croatia use the so-called "free" healthcare, and how many are no longer here, don't use the system, and are only formally still registered with HZZO.

For more, check out our dedicated lifestyle section.

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

December the 30th, 2021 - The Croatian public health system is faced with a lot of criticism, much of it is unfounded, here's my story.

Last spring was promising me yet another wonderful, very long, carefree and rejuvenating time down by the sea. Retirement is a blessing. It offers freedom of movement (plus freedom of speech if you enjoy it properly) and, especially, total command over one’s time. That's the bright side of it.

Time is man’s only true possession - everything else is precarious, ephemeral, temporary or illusional, much like our own bodies and physical states, for example. They're precarious, ephemeral, temporary, limited, and certainly not a supporting companion to our soul. I think that babies start crying seconds after their birth not because they are terrified by the new environment, but because they experience physical pain. Pain is man’s first experience of the world. Our body is not our friend, and it is less and less so as time goes by.

Health of course is tied to what one does on a daily basis to try to preserve it. Some attempts are futile, most aren't. Some people understand that early on, most don't.

I'm proud to say that my life allowed me to sin for a major part. A lot. Heaps more than most people I guess. I have seen more dawns than twilights, so to speak. Because life in general was generous to me (well, even during the war it was rewarding in many ways when I think of it), serenity prevailed by far over all of my days. When you're young, you are supposed to be all kinds of things when you grow up and you can of course do anything, including becoming an ''adult'' while still underage, because you need to keep up with the boys from your quarter, all of whom are your seniors by quite some years.

You cannot afford to be called a sissy if you didn't smoke, which you would be. At least back then. So I started smoking when I had barely reached the ''ripe old age'' of 16, when of course I knew everything there was to know about life, as did you, I'm sure. Later on, in the long years of studying and then freelancing around the world, partying and booze came into the picture, too, inevitably. Not that I'd get wasted every night, of course, but, well, there was lots of partying and many dawns, and many an estranged taxi taking me to where my bed was while missing my sunglasses and a bottle of water most desperately.

I remember discovering ''The Memories of Hadrian'' somewhere in my early twenties and re-reading that book several times over. Among quite a few memorable points, despite myself being young and utterly healthy, my mind recorded that moment when Hadrian started to become tired of his body which was becoming a nuisance, a traitor, limiting and disabling him. Almost one half of a century later, Hadrian has come to my mind so many, many a time. What a piece of work is man, Master Shakespeare wondered. Indeed.

When you think how you hated your granny (and your mother, and aunt and practically every adult around) who scorned you for not wearing a sweater, not having your shirt tucked in properly, sitting on cold concrete that would certainly make your kidneys ''go bad'', for going out (on a date possibly) with your hair still wet from the shower as a safe way of getting meningitis and inflamed sinuses, not to talk about lessons on how bad smoking is for you and how alcohol damages your liver… But who would listen? All of those irritating pontifications might have been true, but they had nothing to do with you whatsoever in your mind.

And then, how many times have you heard that somebody died of ''a sudden heart attack''? Sudden!?  It took almost all my life so far for me to learn that there is no such thing as a sudden heart attack. Such events, rare as they are, are freak ones. Every stroke or heart attack has its silent and deadly history built up in the years, it has its progress and, especially its cause(s) that live with you for a long time before that. You pay no attention, and then you're suddenly being transported to an emergency ward. Genetics play a role of course, but the cause is - you. Or, in my case - me. Also because my granny got on my nerves so much. 

The experience I had was more than terrible, and I want to share some of it.

I was in London some eight years ago when the very first rays of warning shone up inside my brain. One day I was walking from an underground station to the house of my friends where I stayed. It was an everyday routine, nothing special, and quite a short distance too. I might have been less than 100 metres from the house when I felt my right calf suddenly become stiff, further steps were oddly difficult, I started limping and hardly made it to the gate. The remaining several days were highly marked by that. I had pains when walking, I could not walk for long, either. It was sudden. It was frightening. That is when I was reminded of the not-so-good genetics pertaining to arteries in my family. There I was. It has caught up with me despite my lack of attention. I should have listened.

Back in Zagreb I hardly made it upstairs, dragging a suitcase along with me to my apartment at the same time. All alarms then began ringing inside me. This was no pulled muscle, and no self-resolving, passing ailment. One or two calls to my friends sent me to a hospital right away. There was a clog in my artery that had stopped the flow of blood to my leg almost completely and the operation, performed under local anaesthesia, was carried out by a young doctor who I made laugh heartily while he dealt with the clog.

When you must not move an eyelash for almost two hours, it feels much longer than it is.  I was alone in a spacious room, I had a TV, my own internet and actually had a good time within the circumstances, however ''disturbed'' by frequent check-ups and controls by medics. The care was total and complete and made me feel safe and comfortable. It was proof that the Croatian public health system, while underfunded, was beyond excellent.

This happened somewhere exactly around Easter Day and I was glad I could avoid traditional lunches and coloured eggs. That’s for kids, I find. Five days later I was back in the normal world with a clean artery and feeling quite good, quite normal again. I avoided driving and public transportation and walked everywhere I could. That is how you control cardiovascular diseases which only require conservative treatment. I soon forgot about that.

Pain gone and experience fading, I soon regained my old lifestyle. A thousand parties and no work, as Gertrude Stein defined the Thirties in Paris. Well, almost. Freelancing allows for that, as anyone who has dabbled in that knows well.

As a heavily addicted smoker, I wasn't aware of what I was silently but lethally doing to myself. Friends and family would warn and rebuke me, some strongly. I continued believing that the slogans on tobacco packages about death, cancer and other pretty things could not possibly affect me. Larger than life I was. Isn't cognitive dissonance a strange thing?

I could not bring to my awareness that getting out from a warm restaurant into freezing rain just to have a smoke made my granny turn in her grave while my arteries were getting more and more clogged by the day, by every single puff on a cigarette, by every single drag. My life was so good again, so why should I listen?

Some years went by, the uneasy feeling in my legs was growing once again, slowly but constantly, until I reached the stage when I could barely make a distance of 50 metres and was in almost constant discomfort. My calf writhing with each step as my body desperately tried to transport adequate oxygenated blood. In vain.  

It was a wonderful evening with a gang of friends of an international composition, with so much fun, laughter, totally uninhibited by ''Weltschmerz'' and the futility of life. When we had to change the place because of a rapidly approaching closing time, I realised I would hardly make it on foot.  The other place was less than 200 metres away. The final alarm was on. Again.

One call to a doctor friend put me in hospital almost the same day. During the first check-ups it seemed it was to be an easy intervention, then they took some blood, did some tests and found out that my blood sugar was above 20. It was too dangerous to operate. I was diabetic too, apparently. I had no idea what my body was suffering from, how could I have been so detached? How dare I feel surprised by my neglect? It was almost one week before they managed to bring it down to an operable stage.

I had peripheral arterial disease. An incurable but controllable arterial disease which affects the limbs, mainly the legs. My femoral artery was entirely clogged, and so were some others. Well, there we go. Another operation, a big one this time, with general anaesthetic and consent forms galore. I woke up after some hours, the doctors couldn't believe how brilliant my readings suddenly were, how my body which obviously was in dire need bounced straight back after being given what it needed. Instead of a longer sojourn in intensive care, I was taken quite quickly back to my room to recover. Yet again, more very good care at the hospital, another operation gone well, expertly well. It made me think of all those accolades Croatian medicine has been getting from all over the world. It is very deserved. Take it from me.

A few more years passed by. My left leg still had a few problems, some due to nerve damage following surgery, but it was truly nothing in comparison to how I felt before that last operation. I got used to stopping when I walked, waiting for a minute or two when I experienced claudication, and continuing. Naturally, I didn't feel enthusiastic about walking at all. My legs felt heavy and not willing to be exposed to any strain. Because of the pain it caused, although that pain was actually my saviour which would help to treat my disease, I started avoiding going anywhere on foot.

Unlike that first time, the famous blue Zagreb trams became my favourite way of moving around the city, and driving too. Then, my doctor scolded me, telling me that I must walk, walk and walk some more. By walking and straining the legs, you help your body develop more collateral blood paths, you help your heart, you help your - everything. I did reduce my nicotine intake, with lots of effort and self-control, but I could not abandon it altogether. By the way, for all you dirty smokers out there - I reduced the number of cigarettes by allowing myself to smoke only on the terrace, outside, never  inside the house. It helped. Maybe you could try that, too. It was quite an achievement for me who once smoked 40 per day, but I still couldn't quite kick it to the curb. Idiotic, I know.

My close friend, Lauren, started to force me to walk. We'd take long walks, not just to a cafe. She would get me to do it daily, again and again. I felt better. The splendid Maksimir Park offers infinite combinations and paths to stroll, for as long as you can or want to. I was forced to make at least 6000 - 7000 steps each time. For orientation, I could make some 200 in one go. Imagine the effort! I had to stop many times, but I did it. Never without losing my breath, panting or anything, never feeling that my heart was suffering. But to tell the truth, my physical condition was not exceedingly good. To put it modestly.

Fast-foward to April 2021. The leaves on the trees were turning green, everything was in blossom, Maksimir Park looks truly fabulous at that time of year, permeated with the birds’ twitter and the gentle breeze in the thick tree tops. As nice as all that is, as a Dalmatian from Dubrovnik, I was craving the sea. Addicted to the sea and, especially, to swimming - at least for 6 months a year, usually - I started coining my plan to go to the coast much earlier than usual and to make the ''summer'' a very long one indeed. I decided to have myself checked properly, to be sure I could spend several months in a village, far from my doctor friends in case, God forbid, I needed one. 

I contacted my friend, a renowned vascular surgeon from Zagreb, and asked him if he would be willing to check me up ''properly'', with scans and the works, as I really wanted to know what was going on inside me, especially inside my arteries. At one of those check-ups, I ''demanded'' that he check my heart. Without any apparent sign of anything. I just wanted to be sure. It might have been genetic hint from some of my ancestors from ''up there''. I had no cardiac symptoms that I could discern, it just came out of the blue.

How unfortunately right I was! My blood pressure was through the roof. I was suffering from hypertension which is high blood pressure, a common condition in which the long-term force of the blood against your artery walls is high enough that it may eventually cause heart disease. The ultrasound not only found some other little flaws in my heart, but three main arteries were more or less clogged. I needed a triple coronary bypass in an emergency procedure. I was ordered to stay in the hospital that same moment. In other words, I had to be under permanent custody, linked up to various monitors, as my heart could collapse under the strain at any moment. How and why I had not had a massive heart attack during those thousands of steps in Maksimir Park will remain a secret forever. A miracle, in fact, as told to me by my doctor.

An important reminder: there are very, very few sudden heart attacks. They only hit suddenly, when the silently struggling heart can no longer cope.

I did not have a heart attack, as the intervention occurred just before the inevitable happened, and I did not fear one. I told myself I should have that operation as soon as possible in order to be able to - go to the sea. Baby steps.

I spent two weeks in an utterly nice, freshly renovated ward, feeling alright under the constant telemetric control. I became used to the idea that I must remember the cables attached to me round the clock. To me, there were no signs or signals that my heart was penting up to provide enough oxygenated blood to the rest of me. Once again, to praise the Croatian public health system, it is so good when there is a bunch of communicative doctors and, especially, nurses with who you can share a laugh or two. 

I loved the sliding doors that saved everybody from being woken up by doors slamming somewhere down the corridor. I ignored the fact that I was confined, in detention, it was for my sake and for my good. I also ignored the fact that the pandemic and the inability to have visitors made this period of isolation more conspicuous, in some cases even very cruel. I had all the care I needed, my doctor friend (from another ward) would visit sometimes bringing with him absolute confidence and peace to my soul.

Tests, scans, readings, as the big day arrived. Taken by an ambulance to the central hospital to be operated on, an efficient nurse accompanied me to my new room and a new roommate, and luckily a very funny one. Sarcasm is one of my favourite assistants. New doctors, kind and caring nurses. Preparations for the operation, some not pleasant at all, but all done with patience and total care. The Croatian public health system succeeded very well in making me feel safe, despite all the huge question marks and worries hovering in the air and above my own head. 

The surgery was done. I woke up feeling that I was tied to a bed in an unknown space. It was so dark, just one lamp offered a slip of light somewhere in the distance, at some corner or something, my anaesthetic-induced blurry vision and confusion limited my understanding of my surroundings. My throat felt as if it had been cleaned out by a bit of aged sandpaper. I needed water. I tried to yell, but I produced no sound. I realised I was still intubated. I was helpless. I needed water. There was an attentive nurse on the sentinel who discerned my growling sounds in the dark. It wasn't just water this time, it was the blessing of all the Gods that ever existed to me at that moment. Sleep. More water. Several rounds, a few tests. After some indefinite time, they rolled me back to my room. 

The time of colliding with reality, with the seriousness of my body, had come to me. Thank you, Hadrian, you were so right and I hope you were not this sick and unable. I felt like a broken piece of old furniture chucked out into the street from the fifth floor. One slightest move of any part of my body hurt like hell. I felt like I couldn't breathe properly. I needed air. I needed water. I could not get up. I was even afraid to move my head on the pillow so as to avoid more possible pain. I was just one huge battlefield of all kinds of pains spiced with a total lack of energy, breathlessness and a most absolute state of helplessness. I had done it. I'd reached the absolute pits of my life, the lowest point, a very, very miserable point at that.

All I wanted and could do was sleep, but the attentive staff would not let me enter into a deep and healing slumber, they were in every hour to check on me properly. The care was total, but also irritating. I should've been grateful, not irritated. Yet I was helplessly irritated and wanted only to be left alone. 

The very next day there was a guy of very athletic physique who had a very deep and commanding voice: ''Get up, we're going for a walk!'' the voice said above me.

''For a what? You must be kidding, I can hardly lie on this bed…''

''You must walk, come on, get up!''

I thought I would die right there and then, and the post-operation ordeal seemed totally pointless. He helped me out of my bed with his strong arms, I let out a shriek as my entire body stiffened into a complete and utter pain. My legs were shaky, insecure, pains probed me at random everywhere. We did two lengths of the corridor. I lay back on the bed, depraved of life, in brief. I felt I'd done a marathon. They kept coming in and checking on me and asking me about this and that, taking my blood pressure, my temperature, giving me some pills, pain relief, food, checking on my wounds, measuring this, that, asking similar questions over and over. Irritating at the time, but what amazing care from the Croatian public health system this was.

My sarcastic roommate was released and it made me very sad back then, how I longed to leave this environment. Then, finally the day came when they told me I was going back to my original room in the hospital I was checked in at first. There I found out - I who have been fit and slim all my life, had lost a massive 8 kg. I dared to look at myself in the mirror and immediately thought I'd qualify as a photo model for a labour camp. Even my eyes had changed, they were sullen, sunken, looking back at me hopelessly from some hollow spaces, somehow from afar. My greying skin seemed to have belonged to someone bigger, my arms were like two pieces of dry smoked meat. It was horrendous.

After some days, some more blood tests, some more tests, some more questions, I was tested for covid and then released home. It was the very end of June. The temperature outside was around 30º C. I could make it to the kitchen owing to the help of my hands and door frames only, from one to another, aiming with concentration and focus. I had family there to help me and they couldn't do enough for me, which was a God send. My doctor friend came to check on me, to remove my stitches, to check my wounds. I began to walk, each day a little longer, I began to take my body as seriously as it had so nearly taken me for my negligence.

As I'm writing this six months later, I've put the weight I lost back on and I feel I belong to another, far more normal world with that wonderful sensation when you bend to pick something up and nothing hurts. I have taken up exercise regularly, even physiotherapy (another utterly professional service in the very heart of Zagreb), I try to walk as often as I can, to use my Orbitrek and, well, to be happy, meeting with friends for coffees and lunches with all serenity and joy, remembering well what Hadrian had eerily warned me of such long time ago.

Albeit at times when, indeed, there were also my grandparents and parents and aunts and uncles that I would not listen to regardless of their gender, age or advice. I was young enough to know everything, wasn’t I? Weren't we all?

Do not wait to be hit all of a sudden, don't harm your heart until it says no more, check your health thoroughly and profoundly, give up smoking (I know, it's preposterous coming from a filthy ex chain smoker of like 40 cigarettes a day), but if I can stop totally, you can too. Have a drink and be happy for as long as it lasts, because there is an expiry date and more often than not, it comes silently. 

Say what you want about Croatian corruption, politics, the lack of funding, the lack of... well, a lot. But Croatian public health stepped up and saved my life at the very last minute. There are a great many truly extraordinary doctors and other medical personnel in this country. Just in case you read this article with a cigarette in hand not having moved around for a few days... just sayin’. But why should you listen to me after all I have gone through? I'm not your mother, for God’s sake, so let me just wish you a Happy New Year - from my heart!

If you would like further reading material and/or if you're trying to stop smoking, it's worth noting that cardiovascular disease kill more people in Croatia than anything else. That's right, even the dreaded cancer comes second to the silent killer. Did you know there is an artery called the widow maker? There's a reason. Cardiovascular disease is the leading cause of death and accounts for more than half the overall mortality in this country. Furthermore, cardiovascular mortality has been constantly rising since the 1970s due to our dire habits.

Despite Croatia's observance of World no Tobacco Day, smoking is still killing many here, and it is continuing to cripple the Croatian public health system. Hrvatski dan nepusenja (The Croatian day of non-smoking) is also prominent. Can we reverse the trend? Be a part of it before it's too late.

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

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

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

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

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

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

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

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

October the 23rd, 2021 - As many as 120,000 Croatian residents are set to get free supplementary health insurance (dopunsko) provided to them by the state. These individuals are overwhelmingly pensioners.

As Poslovni Dnevnik writes, as of December the 1st, 2021, as many as 120,000 Croatian residents, primarily pensioners, will receive a supplementary health insurance policy from HZZO at the expense of the state.

At yesterday's session, the Croatian Government accepted Silvano Hrelja's proposal to amend the Law on Voluntary Health Insurance, which raises the income threshold on the basis of which Croatian residents are entitled to the state to pay for their supplementary health insurance, so, in the future, the threshold per household member will be two thousand kuna, and for a single person it will rise to two and a half thousand kuna.

This represents an increase in both categories by more than 400 kuna, or 25 percent compared to the current census, and Croatian Health Minister Vili Beros explained that in the future, an additional 120,000 Croatian residents will, as stated, receive a supplementary HZZO health insurance policy at the expense of the state. The state budget will have around one hundred million kuna per year taken out of it as a result.

The fact that the Croatian Government is ready and willing to accept Silvano Hrelja's proposal could be inferred from the fact that among the MPs who signed the support for sending legal changes to the parliamentary procedure were numerous HDZ members, and Minister Beros himself said that this sets a more appropriate threshold for the most socially sensitive in our society.

Hrelja's support from the Croatian Government has already resulted in the previously announced intervention in the area of ​​family pensions, which the Government has included in the national recovery and resilience plan, taking place two years earlier than originally envisaged, which should bring a 10 percent increase to pensions for more than 200,000 retirees as of the year 2023, Novi list writes.

For more, make sure to check out our lifestyle and politics sections.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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ZAGREB, September 3, 2020 - The coronavirus epidemic, which has lasted in Croatia for slightly over six months, has cost the Croatian Health Insurance Institute (HZZO) HRK 258,200,823, the Jutarnji List daily reported on Thursday.

Most of the money spent was spent on testing, with as many as 175,346 tests having been peformed, which so far has cost HRK 200,154,907.

Medical treatment of COVID-19 patients has cost HRK 33.614 million, while the disease itself and isolation have cost HRK 24.431 million.

HZZO director Lucian Vukelic would not comment on how much more money Croatia could spend on the fight against the disease and he sees a widely applied vaccine as the only solution.

"The HZZO budget amounts to HRK 27.5 billion so the HRK 258 million spent on the coronavirus is not a big amount... but it has to be clear that COVID-19 and this epidemic is not something we had counted on, so every amount spent is important," he said.

The entire system and the economy are at risk and every drop in GDP is very problematic, he said.

"If people lose jobs, no contributions will be paid into the budget... the budget is not being filled, and money is being spent," Vukelic was quoted by the daily as saying.

(€1 = HRK 7.522517)

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ZAGREB, Aug 2 (Hina) - Spending on drugs totalled HRK 7.6 billion in 2019, according to unofficial information, while Croatian Health Insurance Fund (HZZO) outlays for drugs, according to an annual report, amounted to HRK 5.6 billion, the Institute of Public Finance says in a study on drug spending.

HZZO outlays for drugs rose from 19% of its total expenditures in 2014 to 24% in 2019 and a big increase in outlays was recorded for highly expensive drugs. In 2018, spending on drugs totalled HRK 6.6 billion, while in 2017 it amounted to HRK 6.1 billion.

"The increase in spending on drugs isn't the problem. The demand for drugs is growing because of increasingly widespread chronic diseases, population ageing and new treatment possibilities. However, it's important to examine how to optimally use money for drugs, i.e. check a drug's efficacy in relation to its price, and that is the goal of pharmacoeconomics, which isn't sufficiently developed in Croatia," says Marijana Badjun, author of the study.

Hospital debts mounting, wholesale drug suppliers waiting, state intervening

Badjun underlines the need for detailed and transparent statistical data on expenditures in Croatia's health system, notably for hospital healthcare. She says it is also necessary to analyse the market of highly expensive drugs and look for ways to control the constant increase of public outlays for drugs without undermining the quality of healthcare.

Badjun recalls that the government and wholesale drug suppliers agreed recently that the HZZO should pay HRK 500 million from the state treasury to hospitals for the settlement of part of their debt to the suppliers, which exceeds HRK 4.2 billion.

Excluding hospitals, Croatia second to last in EU in per capita spending

Badjun says it is useful to look at drug consumption in Croatia in the international context.

Organisation for Economic Co-operation and Development data on drug spending do not include hospitals. If they did, the status of Croatia and other countries would be different.

Excluding that, Croatia is second to last in the EU with US$ 388 per capita according to purchasing power parity. Only Denmark spends less ($399), while Germany tops the rankings with $844 per capita.

(€1 = HRK 7.5)

As Vedran Marjanovic/Novac writes on the 15th of July, 2020, in the midst of the preparations for the recently held parliamentary elections, the Government expanded the circle of Croatian citizens who have the ability to exercise the right to have their additional health insurance paid out from the state budget, of which there have been about 670,000 so far.

These are, among others, 378 thousand family members and single people who have a lower income, about 150 thousand students and about 29 thousand insured persons with 100% disability.

It is estimated that under the new Law on Voluntary Health Insurance, the right for the state to pay for their additional health insurance will be exercised by another 200 thousand Croatian citizens this year alone, with a belief that in 2021, the state budget, due to the effects of cononavirus on the economy, will be obliged to pay for the additional health insurance for close to one million citizens.

''Detailed analyses of the number of insured persons who are entitled to a supplementary health insurance policy on the basis of the income census at the expense of the state budget of the Republic of Croatia are still being prepared, and we'll be able to provide accurate information later on. Last year, 520 million kuna was allocated from the state budget for supplementary health insurance policies at the expense of the Croatian state budget, ie around 779.87 kuna per policy or per insured person,'' the Croatian Health Insurance Institute (HZZO) answered in response to the question of just how many Croatian citizens will have their additional health insurance politices paid for from the state budget, and in what amount(s).

In any case, back in May this year, the Government decided to change the formula according to which the right to additional health insurance is determined at the expense of the state for Croatian citizens of a lower financial status. According to the old regulation, the basis for exercising the right was the amount of income of 1,516 kuna for a family member, or 1939 kuna for a single person. Anyone below that amount was able to receive supplementary health insurance payments from the state budget.

The problem, however, for many families and single people who have exercised the right to have their additional health insurance paid by the state arose when, due to some increase in their pension or salaries, they transferred the aforementioned amounts back to them and as such, they were left without this assistance from the state. If we take the average annual expenditure of almost 780 kuna, it is certainly not small for families and single people of a lower financial status. In addition, the cost of living is constantly increasing, which increases in pensions or salaries can barely keep up with.

''About 260,000 low-income Croatian citizens remained without their additional health insurance payments being made directly from the state budget from 2012 to 2020 due to a typically very minimal increase in their income,'' claimed MP and President of the Croatian Pensioners' Party, Silvano Hrelja, who sent a proposal to Parliament last year with the aim of changing the formula for calculating the ''threshold'' for the exercising of the right to have this paid from the budget.

Hrelja stateed that the goal of his bill was to increase the threshold for family members of a lower financial status by 313 kuna, and for single people by around 400 kuna.

''The Government rejected my bill on the grounds that it was financially unacceptable for the budget, although I calculated that the implementation of the law as proposed by the budget would cost an additional fifty million kuna in 2019 and 100 million kuna this year. Then, the Government passed a regulation according to which the income census increased by 47 kuna for family members and by 61 kuna for single people of a lower financial status,'' Hrelja explained.

Under the new Voluntary Health Insurance Act, the threshold for exercising the right to have additional health insurance payments paid for by the state is aligned with the growth of the cost of living and the rate of change of the average gross salary in the country. According to the remarks of the Government submitted to the Parliament with the proposal of the aforementioned law, the threshold for the realisation of the payment of additional health insurance payments from the state budget will increase this year to 1563 kuna and 25 lipa for family members, or by 2000 kuna for singles, and thus the coverage of Croatian citizens who are free to exercise that right will be greater.

While HZZO stated that the amount of additional health insurance policies that could be paid for by the state, the Government stated that the expected number of newly insured persons who could meet the conditions for the payment of this type of insurance from the budget is around 200 thousand, with the corresponding annual additional budget expenditure standing at 160 million kuna.

''At this time, we're not able to increase the funds from the state budget to cover additional health insurance policies, given the fact that this depends on the indexation or harmonisation of the income threshold with changes in the average consumer price index, as well as changes in the average gross wage at the end of the year, this also regards the available funds in the state budget,'' they stated from HZZO.

The aforementioned political party claimed that the new coverage of the right to have additional health insurance payments paid out from the state budget will cover a maximum of 13 thousand newly insured persons, ie, that the Government actually released completely incorrect estimates in their notes to the proposal of the Law on Voluntary Health Insurance.

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Isn't it funny how all of a sudden, owing to the ongoing coronavirus crisis, everything can can be done over the phone or digitally in Croatia? It's ironic that now we can't take entire days off work to stand around taking numbers and lining up with hands full of (usually pointless) documents, the internet and a few new phone lines are here to save us.

The dream of a Digital Croatia appears to have been somewhat sped up by the appearance of coronavirus, and even the Croatian Health Insurance Fund (HZZO) has set up an information phone line for insured people to contact should they need to.

As Poslovni Dnevnik writes on the 7th of April, 2020, residents with health insurance provided by HZZO can call this new temporary number every working day from 08:00 to 16:00 and ask questions regarding their entitlement to compulsory or supplementary health insurance, and the right to maternity and parental benefits.

Amid the coronavirus pandemic, HZZO has introduced a temporary information telephone to enable its policyholders to be provided with prompt, simple and high-quality information in these exceptional circumstances. Which does beg the question of why it wasn't just done before, given the fact that we are in the 21st century.

Cricitism aside, the temporary telephone line is: 033 62 88 88 and costs the normal price of a local call, HZZO claims.

In addition to the various e-mail addresses that can be found on HZZO's official website, this number is now available to residents so that they can get information as soon as possible without having to go to HZZO's offices in person, as was otherwise the norm.

In this way, HZZO is properly adhering to the guidelines and is protecting both its employees and users from the possibility of contracting coronavirus.

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