EU report flags organisation as Croatia’s health challenge

The news in Croatian

1. izvještaj  (m.)
   pisani ili usmeni tekst u kojem se iznose činjenice i podaci o nekom događaju, stanju ili radu ↩︎
2. organizacija  (f.)
   način na koji je nešto uređeno ili organizirano; ustroj nekog sustava ili rada ↩︎
3. primaran
   koji se odnosi na prvu, osnovnu ili početnu razinu nečega ↩︎
4. upravljanje  (n.)
   vođenje, usmjeravanje i donošenje odluka u nekoj organizaciji ili sustavu ↩︎
5. učinkovit
   koji postiže dobre rezultate uz što manji utrošak vremena, truda ili sredstava ↩︎
6. resurs  (m.)
   sredstvo ili izvor (novac, ljudi, oprema, vrijeme) koji se može iskoristiti za postizanje cilja ↩︎

Translation

Text comprehension

Question 1: According to the report, what is the main problem with Croatia’s health system: the number of doctors and nurses, or the way the system is organised?

Question 2: What are two concrete problems in Croatia’s health care mentioned in the report?

Vocabulary

Croatian	English
izvještaj  (m.)	report
organizacija  (f.)	organisation
primaran	primary
upravljanje  (n.)	management / control
učinkovit	more effective
resurs  (m.)	resource

Read the full story

A new European Commission and OECD report on Croatia’s health system concludes that the country’s main difficulty is not a shortage of doctors and nurses, but the way the system is organised and managed. The findings place Croatia broadly in line with wider European trends, yet highlight specific weaknesses in primary care, regional access and hospital pressures.

According to the latest Health Profile for Croatia, prepared by the European Commission, the Organisation for Economic Co-operation and Development (OECD) and the European Observatory on Health Systems and Policies, the number of health professionals has been rising in recent years. In 2023, Croatia had four doctors per 1,000 inhabitants, just below the EU average of 4.3. The country also counted 7.7 nurses per 1,000 people, compared with an EU average of 8.5.

Experts attribute this gradual growth to measures aimed at retaining medical staff within the national health service, despite concerns about emigration to other EU states. However, the report stresses that numbers alone do not guarantee equal access. There are marked regional imbalances: rural and remote areas continue to experience more pronounced shortages of both doctors and nurses, making it harder for residents outside larger cities to obtain timely care.

A particular area of concern is family medicine, which in many European health systems serves as the first point of contact for patients. In Croatia, the share of general practitioners (GPs) within the total number of doctors has been falling for more than a decade. Their proportion declined from 18.1% in 2010 to 15.6% in 2023, significantly below the average of 19.4% in 24 EU member states covered by the analysis. Although the absolute number of family doctors rose from 2,228 to 2,421 over this period, other medical specialities expanded faster, reducing the relative weight of primary care.

The report warns that this trend could have long-term effects on primary health care. With fewer GPs relative to other doctors, patients may face more difficulties accessing basic services, which can lead to overloaded hospitals and longer waiting times for specialist treatment. Strengthening the role of family doctors is therefore presented as an important task for the Croatian health authorities.

The analysis also looks at health spending. In 2023, Croatia spent around €2,032 per person on health, a level described as clearly below the European Union average of €3,832. Despite this, the structure of financing differs somewhat from many other EU systems. Public expenditure accounts for about 85% of total health spending in Croatia, compared with an EU average of around 80%. This means that a larger share of costs is covered through public sources, primarily the mandatory health insurance scheme, while out-of-pocket payments by patients remain among the lowest in the EU.

As a result, the report notes that overall access to health services is relatively broad when compared with other European countries. However, organisational challenges inside the system limit the practical benefits of this financing model. Inefficiencies in work organisation and patient pathways are associated with long waiting lists for certain procedures and examinations, particularly in hospital care.

Croatia’s health system is additionally strained by a high burden of chronic non-communicable diseases. Conditions such as cardiovascular illnesses and cancers account for more than 64% of deaths in the country, according to the report. These diseases typically require continuous treatment and long-term follow-up, which puts extra pressure on hospitals and outpatient services, especially if preventive care and early detection are not sufficiently developed.

The combination of heavy hospital workloads, regional inequalities between urban and rural areas and ageing, chronically ill populations points, in the authors’ view, to the need for stronger management capacity, digitalisation and modernisation. While Croatia does not significantly deviate from broader EU patterns, the report concludes that its future progress will depend “less on the level of investment” and more on the ability to reorganise the system, use existing resources more efficiently and adapt to changing population needs.

These issues are scheduled for debate at the EU Health Forum taking place on 24 April in Zagreb, described in Croatian media as a major European meeting on health policy. Croatia’s Minister of Health, Irena Hrstić, is expected to open the event. Among the participants is Bernd Rechel, one of the authors of the Health Profile for Croatia, who will present the main conclusions on the state of the national system. Other speakers, including Igor Lerman from IQVIA Adriatic and Peter Lindgren from the Swedish Institute for Health Economics, are due to discuss how monitoring treatment outcomes and measuring the efficiency of care can inform decision-making.

The forum will also host the announcement that the international medical journal The Lancet is establishing a new commission on health system performance. This body aims to reassess what makes a health system “successful”, focusing on the balance between spending, quality of care and health outcomes. The question is becoming more urgent as health services worldwide face ageing populations, rising rates of chronic disease, the effects of climate change and the rapid spread of artificial intelligence technologies.

According to early conclusions mentioned in the Croatian coverage of The Lancet’s analysis, differences in performance between countries often stem from factors directly influenced by public policy, such as the quality of governance, the overall organisation of health systems and the decision-making process. The analysis suggests that many different models of health care can function effectively, but only where there is strong leadership and clear lines of accountability.

In this context, the authors underline the need for more resilient and flexible health systems. As citizens’ expectations rise and medical possibilities expand, there is a risk that the gap between what the system can provide and what people expect will grow, unless countries improve how they govern their health sectors and allocate resources. For Croatia, the European Commission and OECD report indicates that the central question is not simply how much money is spent or how many staff are employed, but how effectively the existing health workforce, infrastructure and funding are organised to serve the population.

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