Author
According to the LITP, asylees and foreigners under subsidiary protection shall exercise the right to health care pursuant to the regulations governing health insurance and health care of foreigners in the Republic of Croatia.[1] The costs of health care shall be paid from the State Budget under the item of the Ministry competent for health care.
The Law on Mandatory Health Insurance and Health Care for Foreigners in the Republic of Croatia prescribes that asylees, foreigners under subsidiary protection, foreigners under temporary protection and their family members they have a right to health care,[2] in the same scope as health insured persons under mandatory health insurance.[3]
Amendments to the Law on Mandatory Health Insurance and Health Care for Foreigners in the Republic of Croatia, which entered into force in February 2018, provide that the right to health care is provided on the basis of a valid document issued by the Ministry of Interior.[4] The competent police administration or police station is obliged to notify the ministry competent for health that the asylum, subsidiary protection or temporary protection was granted to foreigner, at the latest within 8 days from the date when the decision on granted asylum, subsidiary protection or temporary protection became final.[5]
This means that there is a difference between the unemployed and employed beneficiaries of international protection. Unemployed beneficiaries of international protection are not insured within the Croatian Health Insurance Fund, but the costs of their health care are covered from the state budget from the position of the ministry responsible for health. In the case of unemployed beneficiary, health care providers should send invoices, a copy of the residence permit and accompanying medical documentation directly to the Ministry of Health. This category of beneficiaries does not have a health insurance card, but prove their status with a residence permit card. Also, they do not have a personal identification number nor are they in the Central Health Information System of the Republic of Croatia. When a beneficiary of international protection gets a job and starts paying health insurance contributions, s/he becomes an insured person. However, unlike Croatian citizens, their family members cannot acquire the right to compulsory health insurance through the insured beneficiary, but costs continue to be covered by the state budget through the Ministry of Health. If a beneficiary of international protection losses employment, he/she ceases to be insured by Croatian Health Insurance Fund.[6] However in practice, healthcare professionals are not sufficiently familiar with the rights of beneficiaries international protection and the way in which they can exercise their right to health care.
In 2020, the Ministry of Health provided instructions to relevant health care institutions and pharmacies on the way that medicines should be provided to asylees and persons under subsidiary protection.[7] According to these instructions, the pharmacy delivers an invoice addressed to the Ministry of Health to the Croatian Health Insurance Fund. A prescription form and a copy of a document issued by the Ministry of the Interior which shows the status of the foreigner to whom the invoice was issued, should be attached to the invoice. The Croatian Health Insurance Fund subsequently submits an invoice for payment to the Ministry of Health after having reviewed the conformity of the medicines prescribed. If it is a medicine that is on the basic list of medicines of the Croatian Health Insurance Fund, the price of the medicine is borne entirely by the Ministry of Health, while in the case of a medicine from the supplementary list, the price is partly borne by the person and partly by the Ministry of Health. If a person is issued a private prescription, the person bears the full cost of the medicine.
Since July 2021, following the decision of the Government of the Republic of Croatia on ensuring vaccination against COVID-19, vaccination against COVID-19 is also available to persons who are not insured.[8]
Problems in the health system were reported by Are You Syrious, the Croatian Red Cross, the Centre for Peace Studies, the Rehabilitation Centre for Stress and Trauma, and other actors.
In course of 2022, AYS[9] provided information on the scope of right to health care protection to beneficiaries of international protection, but also assisted them with enrolment procedures or when persons undertook medical examinations. AYS highlighted that shortcomings continue to be the non-recognition of the right to health care for beneficiaries of international protection. AYS also reported that the lack of translation during health checks remains unsolved.
The same challenges were reported by the Centre for Peace Studies (CPS). In addition, according to CPS; pharmacies are also not informed about the procedure for dispensing medicines to persons under international protection. Therefore, beneficiaries of international protection’s requests are often rejected. CPS also reported that some beneficiaries were treated discriminatorily by doctors and health workers who did not want to examine and provide treatment to some refugees due to unfounded fear that they would spread Covid-19 or other diseases [10]
The Croatian Red Cross (CRC) also reported problems related to health care and provision of services in healthcare facilities as healthcare professionals are not sufficiently familiar with the rights of persons under international protection and the way in which they can exercise their right to health care. According to CRC, doctors are rejecting beneficiaries arguing that they reached their maximum quota of patients or because they do not have a health card so they referred them to the Croatian Health Insurance Fund. Health professionals are often not sufficiently educated on how to enter their data into the Central Health Information System of the Republic of Croatia (CEZIH). [11]
In 2022, the Rehabilitation Centre for Stress and Trauma reported that there is no system for the prevention of mental health issues in place, nor available psychiatric institutions with interpreters. They also pointed out that a small part of the beneficiaries have serious mental health problems and need psychiatric treatment, which they cannot get within the system due to the language barrier. [12]
Centre for children, youth and family –Modus in the course of 2022 provided psychosocial counselling for beneficiaries of international protection with the assistance of the interpreters.[13]
In 2021, the JRS prepared a report on the mental health of refugees in local communities affected by earthquakes and the pandemic. The aim of the report is to advocate for the improvement of mental health services for refugees going through the integration in Croatia and for provision of adequate professional assistance with the help of interpreters in health facilities in earthquake-affected areas.[14]
[1] Article 69(1)-(2) LITP.
[2] Article 17 Law on Mandatory Health Insurance and Health Care for Foreigners in the Republic of Croatia.
[3] Article 21(1) Law on Mandatory Health Insurance and Health Care for Foreigners in the Republic of Croatia.
[4] Article 21(2) Law on Mandatory Health Insurance and Health Care for Foreigners in the Republic of Croatia.
[5] Article 21(3) Law on Mandatory Health Insurance and Health Care for Foreigners in the Republic of Croatia.
[6] Croatian Association of Social Workers: Handbook- The role of social welfare in the process of integration of persons with international protection, available at: https://bit.ly/3uti9M5.
[7] Letter from the Ministry of Health to Croatian Health Insurance Fund, available at: https://bit.ly/3tD9kh1.
[8] Government of the Republic of Croatia, Decision on ensuring vaccination against COVID-19 disease of citizens to the Republic of Croatia and other persons who do not have the status of insured person in the Republic of Croatia https://bit.ly/370qZrl.
[9] Information provided by Are you Syrious, 7 February 2022.
[10] Information provided by Centre for Peace Studies, 18 January 2023.
[11] Information provided by CRC, 18 January 2023
[12] Information provided by the Rehabilitation Centre for Stress and Trauma, 18 January 2023.
[13] Information provided by the Centre for children, youth and family –Modus, 9 January 2022.
[14] JRS, Overview of the results of the research “Mental health of refugees in local communities affected by earthquakes and pandemic”, available in Croatian at: https://bit.ly/3O4tme0.