Health care for beneficiaries

Croatia

Country Report: Health care for beneficiaries Last updated: 22/04/22

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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 and foreigners under subsidiary protection are not health insured persons, but 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 stay was granted to foreigner, at the latest within 8 days from the date when the decision on granted asylum, subsidiary protection or temporary residence 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 can not 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 Ombudsperson, Are You Syrious, Centar for Cultural Dialogue, Croatian Red Cross, Rehabilitation Centre for Stress and Trauma, JRS and other actors.

In course of 2021, 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 also informed health institutions about the rights of persons under the international protection and the necessary procedure for patient enrolment. AYS highlighted that shortcomings continue to be the non-recognition of the right to health care for beneficiaries of international protection AYS reported that the lack of translation during health checks remains unsolved. In addition, pharmacies are also not informed about the procedure for dispensing medicines to persons under international protection according to AYS. Therefore, beneficiaries of international protection are often rejected.

Are You Syrious? in cooperation with the organisation BRID published the publication “Administrative advices in practice for the treatment of patients who were granted international protection.”[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]

Similar issues were reported by the Centre for Peace Studies (CPS).[12]  In 2021, the Rehabilitation Centre for Stress and Trauma provided psychosocial counseling for beneficieries with chronic or acute mental health problems due to traumatic experiences. [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]  The publication available in Croatian at: https://bit.ly/3vjXgke.

[11]   Information provided by CRC, 4 January 2022

[12] Information provided by Centre for Peace Studies, 10 January 2022.

[13]  Information provided by the Rehabilitation Centre for Stress and Trauma, 14 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.

Table of contents

  • Statistics
  • Overview of the legal framework
  • Overview of the of the main changes since the previous report update
  • Asylum Procedure
  • Reception Conditions
  • Detention of Asylum Seekers
  • Content of International Protection
  • ANNEX I – Transposition of the CEAS in national legislation