Croatia has a universal healthcare system providing a form of mandatory insurance of all people. The population is covered by a basic health insurance plan as required by law and optional insurance administered by the Croatian Health Insurance Fund.
Croatia’s social health insurance system is based on the principles of solidarity and reciprocity, by which citizens are expected to contribute according to their ability to pay and receive basic health care services according to their needs.
Croatian citizens are required to participate in health care expenditures, except for certain groups of insured people such as:
- Children under age of 18
- Children of dependents that are incapable of living and working independently
- People with residency in Croatia that are incapable of independent life
- Family members of dead or missing Croatian armed forces members and disabled members of Croatian armed forces
The cost of some elective health care services such as plastic surgery are not covered by mandatory health insurance.
How the Croatian healthcare system works
Every one must have a general practitioner if they intend to use the state health insurance policy. While it is not required to have a general doctor by law, your general doctor should always be your first stop when seeking treatment. At the initial visit, the general doctor will do an analysis and recommend further treatment, testing, and referrals, as needed.
To gain free access to hospital, diagnostic, and poliklinika services, a referral from a public general practitioner with a contract with HZZO, the national healthcare service, is required. This referral is called an “uputnica”, phonetically pronounced “oo-poot-nit-sa”. An “uputnica” is an order of sorts, used for diagnostics such as blood and urine tests, prescriptions, and procedures.
Uputnicas are critical when using the Croatian healthcare system. They are used at every level of healthcare, from simple blood tests to the anesthesia required for surgery. Croatia is paper-heavy and orders such as these are not transmitted digitally, so do not lose your uputnica!
Once more with feeling…DO NOT LOSE YOUR UPUTNICA!
One more thing about your uputnica. If you do not use it, you are supposed to return it to your doctor that created it so it can be returned to HZZO. The world will not explode if you do not, but I learned about this through a thorough chastising by my doctor.
Health care contributions in Croatia are mandatory for all employed citizens and are paid for by their employers. Dependents of employees obtain their health care coverage through contributions paid for by working members of their families. Self-employed workers in Croatia are also obliged to pay health care contributions.
Croatian citizens who are exempt from paying health care contributions include retired people and people with low income. The low income threshold is calculated based on their total income in the previous calendar year, per family member, which must be no more than 45.59% of the national budget base per month. At the moment, it amounts to 1.516,32 kn.
Croatian citizens have the option to obtain health services with private health care providers which are not HZZO contracted partners, either through direct payment or through supplemental insurance which is covering the payment. All residents of Croatia are required to have insurance through HZZO even if they choose not to use it or if they choose to use private insurance. Health insurance premiums do not vary based on residency status, but may change at the prerogative of HZZO.
Supplementary health insurance (Dopunsko)
In addition to the compulsory health insurance, HZZO also offers supplementary health insurance. It covers all types of additional payments regarding the basic health insurance in all healthcare institutions including, without limitation: primary health care, specialist examinations, diagnostics, laboratory tests, physical therapy, dental medicine services, hospital treatment and getting prescription medication. It essentially serves as a means of payment for the co-payment.
You can sign up for your orange supplementary health insurance card by going to the HZZO offices, or you can do it online. The cost for this supplement is 70 kuna per month unless you are a student, low income person, 100% disabled or a blood donor. Blood donors qualify for free supplementary insurance once they reach the minimum threshold of 25 donations for females or 35 donations for males. Once you have donated the minimum number of times, take your blood donation booklet to the HZZO offices and request your free supplementary health insurance.
The steward of the health system is the Ministry of Health, which is responsible for health policy, planning and evaluation, public health programs, and the regulation of capital investments. The Ministry of Finance also plays a key role and is responsible for the planning and management of the government budget.
There are hundreds of healthcare institutions in Croatia, including 79 hospitals and clinics with 25.285 beds, caring for more than 760.000 patients per year. Ownership of hospitals is shared between the state and the counties of Croatia. There are 5.792 private practice offices, and a total of 46.020 health workers in the country, including 10.363 medical doctors. There are 79 emergency medical service units that performed more than one million interventions in 2012.