European Observatory on Health Systems and Policies


Health Systems in Transition (HiT) profile of Croatia

3.4 Out of pocket payments

OOP payments account for the majority of all private health expenditure in Croatia (Table3.1). They include payments for health care services provided by private providers (not contracted by the CHIF) and payments from patients who do not have complementary VHI cover for services that are not fully covered or not covered at all by compulsory health insurance (provided by providers contracted by the CHIF).

3.4.1 Cost-sharing (user charges)

User charges have explicit objectives to raise revenues for the CHIF. Decisions on cost-sharing are taken by the CHIF (Department of Health Care Contracting and Department of Finance and Accounting). Direct methods of cost-sharing include co-insurance and co-payments (for primary care services and prescriptions) (see Section 3.3.1). Indirect methods of cost-sharing include reference pricing for pharmaceuticals (see Section 2.8.4).

3.4.2 Direct payments

No data are available on the extent of direct payments for goods and services that are not covered by the MHI scheme or by the supplemental insurance scheme of the CHIF.

3.4.3 Informal payments

Although informal payments are illegal and thus not shown in THE data, there is some evidence of their existence in Croatia (Mastilica and Božikov, 1999), as in some other countries in central and eastern Europe (Lewis, 2010). According to a recent EBRD study (EBRD, 2011), although perceived necessity for unofficial payments or gifts for public services is relatively low in Croatia compared to other transition countries, corruption in health care remains relatively high: 15% of the respondents reported having to make irregular payments to get a necessary service. According to a United Nations Office on Drugs and Crime (UNODC) study (UNODC, 2011), the highest percentage of bribe-payers gave bribes to doctors (56%) and nurses (36%). The main reasons for getting involved in bribery are to receive better treatment and/or speed up procedures or avoid long waiting times (UNODC, 2011; Bodiroga-Vukobrat, 2012).