Croatia: health system review

The Health Systems in Transition (HiT) country profiles provide an analytical description of each health system and of reform initiatives in progress or under development. They aim to provide relevant comparative information to support policy-makers and analysts in the development of health systems and reforms in the countries of the WHO European Region and beyond. The HiT profiles are building blocks that can be used: to learn in detail about different approaches to the financing, organization and delivery of health services; to describe accurately the process, content and implementation of health reform programmes; to highlight common challenges and areas that require more in-depth analysis; and to provide a tool for the dissemination of information on health systems and the exchange of experiences of reform strategies between policy-makers and analysts in countries of the WHO European Region. This series is an ongoing initiative and material is updated at regular intervals.

Croatia: Health system review

This analysis of the Croatian health system reviews developments in its organization and governance, financing, provision of services, health reforms and health system performance. Croatia has a mandatory social health insurance system with nearly universal population coverage and a generous benefits package. Although per capita spending is low when compared to other EU countries, the share of public spending as a proportion of current health expenditure is high and out-of-pocket payments are low. There are sufficient physical and human resources overall, but some more remote areas, such as the islands off the Adriatic coast and rural areas in central and eastern Croatia, face shortages. While the Croatian health system provides a high degree of financial protection, more can be achieved in terms of improving health outcomes. Several mortality rates are among the highest in the EU, including mortality from cancer, preventable causes (including lung cancer, alcohol-related causes and road traffic deaths) and air pollution. Quality monitoring systems are underdeveloped, but available indicators on quality of care suggest much scope for improvement. Another challenge is waiting times, which were already long in the years before 2020 and are bound to have increased as a result of the COVID-19 pandemic.

Croatia: health system review

The Health Systems in Transition (HiT) profiles are country-based reports that provide a detailed description of a health system and of policyinitiatives in progress or under development. HiTs examine different approaches to the organization, financing and delivery of health services and therole of the main actors in health systems; describe the institutional framework, process, content and implementation of health and health care policies; and highlight challenges and areas that require more in-depth analysis. Croatia is a European country in transition with a population of 4.4million. The population generally enjoys good health and an increasing life expectancy of less than three years below the European Union (EU) average. Croatia’s health system is based on the principles of inclusivity, continuity and accessibility. Croatia spends a relatively high share of its gross domestic product (GDP) on health. Public funds for health care originate from two main sources: contributions for mandatory health insurance (predominantly) and funds collected by general taxation. The network of health care providers is organized in a way that makes it accessible to all citizens. The Croatian health system has good health outcomes in relation to countries at comparable income levels. Provision and funding of services are largely public, although private providers and insurers also increasingly operate in the market. Since 1991, the Croatian health system has been subject to a range of organizational reforms.These have mostly relied on decreasing public and increasing private expenditure in the system. While reforms have, up to a point, managed to decrease public spending on health care, they have failed to adequately address issues such asgrowing arrears and productivity. Important actions involving strengthening policy, monitoring, regulation and more advanced supply-side-oriented tools remain to be prioritized and implemented.