More People Use Croatian Health System Than Actually Live in Croatia?

Lauren Simmonds

Updated on:

As Croatia’s increasingly alarming negative demographic trend tightens its grip over the country and its economy, there seems to be more people insured by the Croatian health system (HZZO) than actually live and work here…

As Index/Marko Repecki writes on the 26th of February, 2019, due to the negative demographic trends and a fairly low birth rate, Croatia has now worryingly fallen below four million residents, according to the estimates of demographers, but at the same time, there are miraculously 4,145,169 persons who have Croatian Health Insurance from HZZO.

This means that more people are apparently entitled to Croatian health insurance than are actually really living in Croatia. This phenomenon is not entirely new, because when we look at some of the data for the previous years, it can be seen that there are approximately between 90 and 120 thousand people who seem to be insured with HZZO, therefore using the services of the Croatian health system, than actually live here.

Who exactly are these people who have HZZO health insurance and don’t live in Croatia?

Index readily asked HZZO to explain just how this difference of Croatian health system users came about, and they answered that there are persons who are still considered as insured persons in Croatia, although they don’t actually live here.

“On the 31st of January, 2019. 4,145,169 insured persons were registered in the Croatian Health Insurance Institute (HZZO). Please note that in some cases the person is still considered to be an insured person, even though they don’t live Croatia. As an example, we include: active Croatian insured persons with residence in another EU member state (such as an actively insured Croat who lives in Slovenia), beneficiaries of Croatian pensions who have moved to the territory of another [EU] member state, and our delegates doing temporary work in another member state (a worker whom a Croatian employer sent for temporary employment in, for example, Germany). In all these cases, it regards persons who remain insured persons of HZZO, but they also enjoy the right to health care in the territory of other member states, in accordance with EU regulations on the coordination of the social security system,” HZZO’s statement said.

Index also sought further clarification on who is actually considered an actively insured person, and they got the following answer:

“An active insured is a person who is employed and pays contributions for compulsory health insurance, which are paid by their employer. Such insured persons do not pay health insurance contributions in the country where they live, but their contributions are paid in the country where they work. A person can’t be insured in two EU member states, but is insured in the country in which they work, and in the territory of the other [member] state in which they’re living, they have the right to full healthcare, just like all of the other persons with health insurance in that [member] state, on the basis of having health insurance in their country of work. For example, an actively insured person works in Croatia and lives in Slovenia, he is then entitled to full health care on the territory of Slovenia, at the expense of the Croatian Health Insurance Institute,” HZZO replied.

The head of the Lipa Association (Udruga Lipa): “We pay 23 billion kuna every year for healthcare, and the system is breaking down”

145,000 people seems a huge number if we’re talking about people who live abroad, yet work in Croatia, or are retirees with a Croatian pension yet live in another EU member state. Index asked the Lipa Association for a comment:

”We at the Lipa Association don’t know why HZZO has a higher number of insured persons than the population of Croatia according to DZS and to demographers,” said Lipa’s Zoran Löw, but he referred generally to the catastrophic state of healthcare. Although Croatian workers to pay out a sum of money for access to state healthcare, the Croatian Health Insurance Institute, Croatia’s chief health system funder, spends around 23 billion kuna annually, in five years, that comes to a huge amount of 115 billion kuna. We’re witnessing the complete disintegration of the system where people literally die on roads, and examinations are being waited for for months, and in some cases, for years.

Löw added that they forwarded an open letter to Milan Kujundžić, the Croatian Health Minister back in 2017, warning of the need to include private institutions in the state’s health system.

“In many EU countries, private institutions providing health services are integrated into the system so that they compete equally for jobs funded from the public system. Let’s just list some: the Netherlands, Sweden, Portugal, Germany… And this is not just about simpler institutions such as labs or family medicine, the’re also serious clinics. In this way, it introduces some healthy market competition and the whole system becomes more agile and financially viable. Unfortunately, in Croatia, this approach is viewed as the privatisation of the healthcare system. This government and its health minister obviously don’t have the courage to come out with such an initiative and stand behind it,” they stated from Lipa.

Make sure to stay up to date with news on the Croatian health system and much, much more by following our dedicated lifestyle page.


Click here for the original article by Marko Repecki on


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