ZAGREB, February 27, 2019 - According to the Euro Health Consumer Index (EHCI), which measures the healthcare quality and accessibility, Croatia ranked 24th of 35 European countries in 2018, which is an improvement of two places compared to the 2017 ranking but still leaves Croatia behind Serbia, Slovenia and Montenegro.

The EHCI analyses health systems in 35 countries using 45 indicators related to patients' rights, including the right to information, accessibility of treatment, health care and medicines, and treatment outcomes.

Croatia got 644 of the maximum 1,000 points in 2018, which is 24 points more than in 2017.

Even though Croatia's health system applies very advanced and expensive procedures such as kidney transplantation, there remains the problem of long waiting times for specialist examinations, as well as the problem of accessibility of CT scans and long waiting times for surgery.

Croatia continues to have a high mortality rate related to cancer and cardiovascular diseases and stroke, as well as a high infant mortality rate, and it does not achieve sufficiently good results in the prevention of high blood pressure, smoking and drinking, according to the EHCI.

The best-ranked health systems in Europe are Switzerland (892 points), the Netherlands, Noway and Denmark.

Of Croatia's neighbouring countries, Serbia ranks 18th, Slovenia 21st and Montenegro 23rd. The poorest-ranked are Albania, Romania and Hungary.

Croatia's best result was in 2016, when it ranked 19th in terms of healthcare quality and accessibility.

More health news can be found in the Lifestyle section.

ZAGREB, February 4, 2019 - Fighting cancer is the government's priority this year, which is why the adoption of a national cancer plan was included in the government's reform plan in order to raise public awareness of cancer as a big public health problem and to improve prevention, check-up rates, diagnostics and therapy, Health Minister Milan Kujundžić said on Monday on the occasion of World Cancer Day.

About 23,000 people are diagnosed with and about 11,000 die of cancer in Croatia every year.

"Today is World Cancer Day which the whole world observes and it's also the beginning of Croatian Cancer Week. Unfortunately, it is estimated that the number of cancer deaths in the world will rise from 18 million to 30 million annually over the next 20 years. In Croatia, about 23,000 people are diagnosed with cancer annually and a similar rise as in the world is predicted," Kujundžić told a press conference.

He said Croatia followed world trends in cancer treatment when it comes to new medication and that last year saw a significant rise in the procurement of diagnostic equipment.

In terms of risk factors and awareness, Croatia is ranked among the worst, while in terms of screening, diagnostics and therapy, it is in the top third of developed countries. Everything should be done to make citizens go to preventive check-ups and screenings as early detection and timely diagnosis make the disease curable.

"We are especially poor when it comes to smoking and it's well-known that one in four tumours is linked to smoking", said the minister.

There are three screening programmes in Croatia - for breast, cervical and colon cancer. Kujundžić said an increase in breast cancer screening rates from the current 60 to 80% would save 3,000 lives in Croatia annually.

According to Croatian Institute of Public Health data (HZJZ), a fifth cycle of inviting women aged 50-59 to mammogram check-ups is under way as part of the National Breast Cancer Early Detection Programme. The turnout is 60%.

The turnout to the early detection of colon cancer, to which people aged 50-74 are invited, is only 21%, while a programme for the early detection of cervical cancer is undergoing reorganisation.

Low-dose CT scanning for lung cancer is expected to begin soon, it was announced.

The head of the HZJZ Cancer Registry, Mario Šekorija, said the number of people with malignancies was constantly rising, mostly due to higher life expectancy and the increasingly high number of elderly people.

In Croatia, there are 170,000 people who had cancer at one point in their lives.

More news on the health issues in Croatia can be found in the Lifestyle section.

ZAGREB, January 26, 2019 - The Kolibrići association of parents of children with SMA (spinal muscular atrophy) held yet another protest rally on Saturday, outside the government offices in Zagreb, asking that the Spinraza drug be made available to all SMA sufferers and calling for repealing the Croatian Health Insurance Agency's decision (HZZO) not to make the drug available to patients older than 18 and those on life support.

After the rally, the protesters were received for talks by Prime Minister Andrej Plenković, Health Minister Milan Kujundžić, his assistant Vili Beroš and representatives of two Zagreb hospitals.

The protest organisers said that the European Medicines Agency (EMA) had approved the use of the drug for spinal muscular atrophy without any restriction by all SMA sufferers, while the HZZO had made a discriminatory decision denying the right to the drug to children on a respirator and SMA sufferers above the age of 18.

They called on the health minister, the government and the HZZO to repeal the decision which they consider to be unconstitutional, noting that they would not give up on their struggle.

Today's protest was the sixth rally held over the past year by parents whose children suffer from SMA and the second one to be held in the capital.

The head of the Kolibrići association, Ana Alapić, said that there are twelve children who suffer from SMA and are on a respirator. There are around 19 adult SMA sufferers, she said, adding that the association did not know their exact number as over the past year and a half that protests had been organised, nobody cared enough to compile a nation-wide register of SMA sufferers. "This makes it clear that there is no awareness that this problem needs a comprehensive and long-term solution," Alapić said.

The protesting parents all said that they would not give up their fight and that the decision not to approve the use of Spinraza by SMA patients above 18 and children on a respirator meant the death sentence for them.

They also called on Minister Kujundžić to provide evidence for his assertion that the drug was ineffective in patients above 18.

Health Minister Kujundžić said that the relevant commission of the Croatian Health Insurance Agency (HZZO) would issue a new opinion on the Spinraza drug in 15 days. "Money was not an issue in the case of 30 other patients and it won't be an issue in the case of these 12 patients, however, the drug cannot be registered by bypassing professional rules," said Kujundžić after the meeting.

"The HZZO Medicines Commission will issue a new opinion in 15 days on what it has found in studies," the minister said, adding that the decision would be made by medical professionals who deal exclusively with spinal muscular atrophy in children and adults. The minister would not speculate as to what the commission would decide.

Alapić said after the talks that she was partially satisfied with the meeting with government officials. "I am partially satisfied but I am aware that we have to wait for the opinion of medical professionals. I believe the opinion will be in our favour," she said.

More news on the medical issues in Croatia can be found in the Lifestyle section.

Although the health authorities have announced it, the helicopter emergency medical service cannot be introduced this year because the helicopter acquisition takes at least a year, which is the usual delivery deadline for new helicopters. The state plans to buy new emergency helicopters, which is clear from the amount of 34.6 million euro, which includes an investment in the purchase of four helicopters and the training of teams which would use them. The price of a single helicopter is about eight million euros, reports Večernji List on January 2, 2019.

The state plans to buy the helicopters, but the service will be managed by a private company, with three permanent and three seasonal bases. How will this public-private cooperation work and when will Croatia really get a helicopter emergency medical service, these are questions the answers to which should be given by a feasibility study which the Ministry of Health has declared to be a non-public document. It is not known who declared this document to be a secret, but it is understood that the study has been drafted by two consulting companies which received 157,900 kuna from the budget.

What the "secret study" suggests is not known even to the HELP association (Helicopters Assist Physicians), whose president Mladen Tureček believes that the helicopter emergency service in Croatia should work according to the tried and tested model of Germany and Austria.

“It should be a civil service which is not paid from the state budget but is covered from various sources (beneficiaries), including by grants. Such a model does not allow the excessive number of employees. The proposed concept with three permanent and three seasonal bases does not meet the needs of Croatia. The proposed model does not cover enough population nor does it meet the ‘golden hour’ criterion for everyone. Four helicopters are not enough to cover their six-base model or our five-to-eight base proposal,” said Tureček, adding that, if new helicopters are to be acquired, it is impossible to establish the service this year.

The government plans to establish three permanent bases: Zagreb, Krk and Split. However, as Tureček explains, if such a plan is adopted, there will be significant parts of Croatia which will remain out of reach of the helicopter emergency medical service during the so-called golden hour.

“Golden hour" is a one-hour period after the call about an incident has been received. Patients should be transported to a health institution before the hour is over. With the three permanent bases, areas such as Zadar, Gospić, Slavonia and the far south of the country would be left without the service. If the plan is to solve this problem with seasonal bases in Dubrovnik, Slavonski Brod and Karlovac, the question is – what will happen during the period of the year when the seasonal bases are closed?

Translated from Večernji List (reported by Ivana Rimac Lesički).

More news on Croatia’s healthcare system can be found in our Lifestyle section.

ZAGREB, January 2, 2019 - The enactment of the law lowering the standard Value Added rate of 25% to 5% on non-prescription medicines will pave the way for the reduction of retail prices of OTC medicines by 18-19 percent as of the start of 2019, the Croatian Chamber of Pharmacists (HLJK) has stated.

The Croatian government has recently proposed that all medicines, including prescription and non-prescription drugs, should be taxed by a 5% rate as of 1 January 2019.

This would lead to a marked lowering of prices of non-prescription medicines as of the new year, which means that medicines for influenza and cold, nose drops, painkillers and about 500 kinds of other OTC drugs will be 18% cheaper, HLJK chairwoman Ana Soldo has said.

Prices of painkillers and anti-inflammatory drugs are currently between 25 and 40 kuna and will further drop to between 20-30 kuna. Drugs for cold symptoms and nose drops will be 10 kuna cheaper.

The most frequently sold OTC drugs in Croatia are painkillers and anti-inflammatory drugs as well as drugs for cold symptoms.

Spending on OTC drugs in Croatia is currently twice as high as it was five years ago. However, Soldo has warned that some of the drug companies have in the meantime already risen prices of their products that the lower VAT would only offset that increase, which means that the prices of such products would not be changed as of the new year.

In this context, the HLJK chamber points out the German Berlin-Chemie as the only one that has increased the prices of its products to such extent that buyers cannot see the effect of the lower VAT on its products in 2019.

Soldo hopes that other producers will not follow the example of that company. She criticises Berlin-Chemie for its ill-considered decision that will neutralise the good effects of the lower VAT rate on OTC drugs.

The Croatian Health Insurance Fund (HZZO) has recently stated that it expects an additional 1.3 billion kuna in revenues in 2019 after the increase of the standard health insurance contribution rate from 15% to 16.5%.

All that should facilitate efforts to reduce the overall debt of kuna 8.2 billion in the public healthcare system.

More news on the healthcare in Croatia can be found in our Lifestyle section.

ZAGREB, December 30, 2018 - Health Minister Milan Kujundžić said on Saturday that all medicines, including Spinraza, were put on the essential medicines list by the Croatian Health Insurance Agency (HZZO) Medicines Commission, stressing that patients aged over 18 and those on a respirator would be given the drug if its efficacy in such cases was proven.

"The main criterion (for putting a drug on the essential medicines list) are indications cited by the company making the drug. As soon as the relevant company reports that the drug should also be given to patients on a respirator and if there is evidence that it is a useful method, the Commission will decide that Spinraza should be given to those patients as well," Kujundžić told the RTL commercial broadcaster when asked when spinal muscular atrophy patients older than 18 or on a respirator would be able to use Spinraza.

More news on the healthcare in Croatia can be found in our Lifestyle section.

ZAGREB, December 3, 2018 - Health Minister Milan Kujundžić confirmed on Monday that he would ask for an extension of the constitutional deadline for the adoption of a new abortion law because it would not be possible to adopt it by 21 February 2019, which is the current deadline.

The Constitutional Court on 21 February 2017 gave the parliament two years to adopt a new law on pregnancy termination, setting 21 February 2019 as the deadline.

"The issue is too sensitive and the deadline is not likely to be met," Kujundžić said at a conference held on the occasion of the International Day of Disabled Persons, confirming that an extension of the deadline would be sought.

"A task force is analysing the experience and practice of European and other countries and will define what is best for Croatia in line with its findings. There is no solution on this matter that can satisfy everyone," said Kujundžić.

Commenting on the case of a bribe-seeking surgeon from Split, which prompted the Health Ministry to send an inspection to the hospital where he works, Kujundžić said that he could not say anything before the inspection presented its findings.

"If what is being said is true, then it's horrible and must be condemned, and the inspection will see if aside from bribery there was also malpractice," Kujundžić said, adding that the inspection's findings would be known by the end of the week.

Commenting on media reports that the Croatian Health Insurance Agency (HZZO) had proposed that as of next year patients pay a part of the price of almost all types of insulin, Kujundžić said that there had been no discussion on such a proposal at the level of the Health Ministry.

He also commented on a two kuna increase in the price of tobacco, saying that it was due to alignment with a European directive and not his demand for a significant increase in tobacco prices. "I advocate protection of life and health, and it has been proven that a significant increase in tobacco prices results in 50-80% fewer children starting to smoke," said the minister.

For more on the abortion issue in Croatia, click here.

ZAGREB, December 2, 2018 - The Croatian Health Insurance Fund (HZZO) reported recently that it was continuing to achieve good financial results this year and that in the first nine months of the year, it had generated a positive financial result of more than 668 million kuna.

These results are due to positive macroeconomic trends, and in particular due to the 5.4% increase in the average gross wage, HZZO stated.

The Croatian Health Insurance Fund's Jan - Sept revenue was 5.81% higher year-on-year and amounted to 18.5 billion kuna.

The higher contribution rate of 4.08% was conducive to this, as did a 20% increase in revenue from the budget which led to an additional 500 million kuna in contributions increasing from 2.5 kuna billion to 3 billion kuna.

This has resulted in a positive financial result in that period of about 668 million kuna, HZZO said.

The report further added that the average number of total insurees is decreasing, however, the number of active insurees is growing and as of 30 September there was an average of 1,563,452 registered employees, which is an nominal increase of 42,191 employees or 2.77% compared to the same period last year.

The rate of people on sick leave in the period from January to September increased slights and amounted to 3.41% y-on-y (3.22% in 2017) but has fallen compared to the first six months of this year when it amounted to 3.53%.

For more on Croatia’s health system, click here.

ZAGREB, November 26, 2018 - The new abortion law is expected to be finalised by February next year, and since this is a very sensitive matter, the recently established commission will first analyse the existing legislation in European Union countries, both those in which abortion is banned and those in which it is fully liberalised, Health Minister Milan Kujundžić told Hina on Monday.

The bill drafting commission has about ten members, including representatives of the medical profession, bioethicists and jurists, who will primarily focus on the results of legislation in the EU rather than on worldview issues, the minister said. He would not reveal the names of the commission members or of the institutions they come from, citing the sensitivity of the matter.

The abortion law currently in force in Croatia was adopted in 1979. "Governments have changed without touching it. I think that the Constitutional Court ruling is right and that the law should be brought up to date. This government will take that responsibility," Kujundžić said.

The Constitutional Court delivered a ruling on 2 March 2017 obliging the Croatian Parliament to pass a new abortion bill within two years, noting that it was not possible to ban pregnancy termination.

"The legislative arrangement under which termination is allowed up to ten weeks of pregnancy is not unconstitutional. If the Parliament decided to the contrary, it would be against the Constitutional Court ruling," Constitutional Court president Miroslav Šeparović said then. He added: "I don't think that there is a constitutional right to abortion as a human right but only women's right to privacy, which includes the right to freedom of choice."

The Constitutional Court passed the ruling after throwing out a motion filed by a civil society organisation 26 years ago to declare the 1979 Abortion Act unconstitutional.

Gender Equality Ombudsman Višnja Ljubičić said that so far she had not been invited to participate in drafting the new bill, but that she expected the new law not to be restrictive on women's rights. "I expect it to retain the existing rights and possibly to be more modern in certain areas," she said, adding that the names of the members of the bill drafting commission should not be kept secret.

"Anything concerning the preparation of national legislation should be transparent. A vow of secrecy is not good in any respect and does not give a sense of security to citizens," Ljubičić said. She announced that she would ask for her office to get involved in drafting the bill by submitting its proposals and remarks.

"We don't want to act post festum, through amendments. We want to take part in policy making because we work on specific cases of human rights violations and because we receive complaints from citizens and can help improve any legal framework," Ljubičić said.

Iva Davorija of the Platform for Reproductive Rights, which brings together non-governmental organisations, said they considered it a problem that the new bill would be finalised within the next three months without the public knowing who was working on it and who was deciding on women's rights. She said that it was not clear whether the Catholic Church would be involved in drafting the bill.

For more on the abortion issue in Croatia, click here.

ZAGREB, November 17, 2018 - After a pharmacist in Zagreb refused to issue contraceptive pills to a patient, citing conscientious objection, Health Minister Milan Kujundžić said on Friday that the pharmacist's behaviour was impermissible, while the Social Democratic Party (SDP) called for urgent regulations regarding conscientious objection so as to prevent recurrence of similar cases of denying someone medication or health protection.

There is nothing that a pharmacist has the right to deny a patient based on conscious objection, Kujundžić said after a government meeting when asked about the incident. "Every patient has the right to be issued with a prescribed medication in any pharmacy. The pharmacist has the right to freedom of conscience but not in the workplace, in the pharmacy," the minister explained.

In response to the incident the opposition SDP called on the Croatian Medical Chamber to finally present its official stance on the issue of the conscientious objection and said that that it expected the Health Ministry and Minister Kujundžić to regulate acts when conscientious objection can be cited.

SDP expects the authorities to draw up registers of pharmacists, physicians and other health personnel citing conscientious objection because citizens have the right to that information.

"We don't have to point out that actually (non)regulation of conscientious objection is usually at the expense of women in exercising their right to terminate pregnancy," SDP said in a press release.

In light of the fact that a month ago a very large number of women decided to break their silence and talk about violations of their rights regarding reproductive health, and also about the treatment in hospitals with gynaecological wards, we consider this to be yet another attack on women's rights in Croatia, SDP said.

For more on the position of women in Croatia and attempts to deny them their rights, click here.