Croatia


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Patient Access to Physiotherapy or Physical Therapy Services / Entry Point

Physiotherapy services in the Croatia are determined by the profession. The physiotherapist has clinical autonomy. 
The Croatia offers both public and private physiotherapy services. [1]

A physiotherapist shall take a patient into a physiotherapy treatment according to indication for physiotherapy by a doctor and prepare a plan and programme of physiotherapy in
accordance with the referred doctor's diagnosis.

Private practice may be pursued only by a physiotherapist with completed physiotherapy study having a licence issued by the Croatian Council of Physiotherapists.[2]

Therapist Preparation

      Degree/Credentialing

University study includes three levels: undergraduate, graduate and doctoral degrees.

Undergraduate university study program lasts for three to four years and upon its completion students earn 180 and 240 credits. Completion gains university degree of Bachelor / Bachelor of a specific profession. Graduate study lasts for one to two years and upon completion students earn 60 to 120 credits. Upon completion of undergraduate and graduate study whose completion students earn at least 300 credits, student receives the academic title of Master / Master 's Degree. Postgraduate study normally lasts for three years and upon its completion students earn of a rule 180 credits and the degree Doctor / Doctor of Science.[3]

There are 4 physiotherapy schools in the country with about 220 students per year and the number is rising. Studies take 3 years (min. 2.700 hrs) Studies result in an academic degree. and allow for postgraduate courses. Physiotherapists are involved in both teaching and research.[1]


University of Applied Health Studies

Medicine faculty of Rijeka

Polytechnic Lavoslav Ruzicka in Vukovar

University of Split


 Entry level physical therapy education programmes


      Specialization
  • Do clinicians specialise in certain areas of care and if so how?

Professional Associations


The Croatian Council of Physiotherapists

The Croatian Council of Physiotherapists is is both a professional body and regulatory body and has its own headquarter and has four staff employers and managing director. The organisation holds regular Executive Committeee meetings (one per month) and furthers liasions with other health care professions and authorities.

The rules of professional conduct (code of ethics) are determined directly by Croatian Council for Physiotherapists. Croatia requires a registration to practice by the Croatian Council for Physiotherapists.
The physiotherapist must be registered with the Croatian Council of Physiotherapists and obtain a licence to practice. The national authority responsible for the physiotherapy profession in Croatia is the Croatian Council for Physiotherapists.

Council has the following transactions with public authorities:

  • Keep a register of its members,
  • Issue, renew and revoke authorization to work independently,
  • Perform supervision over the work of its members.

The Croatian Council of Physiotherapists was established on 28 January 2009 by the Ministry of Health and Social Welfare, the Croatian Association of Physiotherapists and the Croatian Society of Physiotherapists. [4][1]


Croatian Society of Physiotherapists (CSPT)

Croatian Society of Physiotherapists (CSPT) was founded at March 10th 2000 as a second national organization of PT’s. 

Objectives of CSPT are:

  • achieve the highest standards of excellence in physiotherapy and training of physiotherapists
  • forming a common position to be transferred to the public
  • promotion of publishing CSPT members papers, books and the other scientific activities
  • continuous improvement of physiotherapy (physical therapy) resources through the education of CSPT members
  • promote the fundamental values ​​of physiotherapy directed to man as a complete being.

CSPT works through following professional societies:

  • Croatian society of sport physiotherapy
  • Croatian society of manual physiotherapy
  • Croatian society of physiotherapy students
  • Croatian society of management in physiotherapy
  • Croatian society of neurophysiotherapy
  • Croatian society of respiratory physiotherapy and noninvasive ventilation
  • Croatian society of neonatologic, perinatologic and gynocologic physiotherapy
  • Croatian society of scientific study in physiotherapy
  • Croatian society of physiotherapists in rheumatology
  • Croatian society of physiotherapy publication editors
  • Croatian society of physiotherapists in orthopedics and traumatology

CSPT cooperates with Croatian Council of Physiotherapists and other national association – Croatian Association of Physiotherapists[5]

Information about the Patient Community

Croatias total population is aproximately 4307000. Life expectancy for males is 74 years, for females is 80 years.[6]

In total population, the leading causes of death in 2008 were circulatory diseases (591.2/100,000), followed by neoplasm, responsible (299.3/100,000). These two disease groups accounted for three quarters of overall causes of mortality. On the scale of ten leading individual causes of death in 2008 in Croatia, five belong to the cardiovascular group of diseases. The three leading diagnoses are ischemic heart disease, followed by the cerebrovascular diseases and heart failure while the ninth and tenth are atherosclerosis and hypertension. The remaining deaths were caused by injuries and poisonings (68.4/100,000), diseases of the digestive system (54.8/100,000), diseases of the respiratory system (50.7/100,000) and other less common causes. In 2008, Croatia recorded 3,034 violent deaths. Among accidents with a rate of 48.4/100,000, the leading were deaths due to falls with a rate of 19/100,000. Suicides had a rate of 17.9/100,000.


In Croatia there is a higher percentage of smoking males than females, and a greater percentage of overweight /obese males. It also shows more males engaging in sport, but a higher percentage of active working females doing lighter work, with only a small percentage of them doing markedly heavy work. Data on dietary habits indicate lower consumption of fruits and vegetables among men in comparison to women, while fat, salt, meat and alcohol consumption are on the overall greater in male population. Thus, the cardiovascular disease group imposed itself as a health system priority. Cardiovascular diseases are also the leading cause of hospital treatment of Croatia’s inhabitants, and in the second place of diagnoses registered in primary health care. Mental disorders as a group are among the leading causes of hospitalization in 2008, with two thirds of all such cases involving alcoholism, schizophrenia, depressive disorders and reactions to severe stress, including Post-traumatic Stress Disorder (PTSD). [7]


Social/Cultural Influences

Health Beliefs and Practices

• Patients are encouraged to communicate about their illness, so that relatives can give moral and physical support.
• Patients will likely want detailed explanations of tests and procedures.
• Treatment is often not considered complete without medication. Awareness of health issues may be high, but often not mplemented in lifestyle.
• Exercise is uncommon.
• Traditional healing with teas, herbs, grasses and ointments is often practiced.

Family Planning

• Sex education and family planning issues are not discussed because these topics are considered highly taboo.
• Abortion is considered a basic form of birth control.
• Younger generations tend to have a more contemporary view on sexuality.

Food practices/Diet

• Food is highly important and a good appetite is considered healthy.
• Bread is a dietary staple.
• Relatives may bring food from home to supplement hospital food.

Family Structure

• Honor is very important.
• Children are not pampered.
• Sons are given preference over daughters.[8]

Division of Labor by Gender.

Traditionally, a loose division of labor allocates housework and child care to women and outside work to men. But women have long been part of the labor force. Before socialism, rural women worked alongside men in fields and on the farm. They also prepared meals and processed food for storage, kept the house, did laundry, and minded the children. Under socialism, women were encouraged to join the workforce. Today, most women expect to have a job or career.

When women work for wages, men share some of the duties at home. Grandfathers traditionally spend time with grandchildren, and fathers take a fairly active role in raising children. Men are less likely to clean, do laundry, cook, and to think of domestic work or child care as their responsibility.

The Relative Status of Women and Men.

Croatia is portrayed as a patriarchal society, but women have fairly equal status with men. Men enjoy more privileges and have a higher status and many families prefer sons to daughters. Women are represented in most professions, politics, and the arts and are not likely to take a secondary role in public life. Women are as likely as men to pursue higher education. Status differences are as marked between older and younger people, and between professional or working-class individuals, as they are between the genders. Gender differences are more pronounced among farmers and the working classes than among professionals.

Kin Groups.

Croats practice bilateral kinship. In principle they favor the father's side of the family. Couples traditionally resided with the husband's parents after marriage, and were expected to have more to do with the husband and father's relatives. Traditional kinship terms reflect this, with different terms for the husband's parents and the wife's parents, and for the two mothers-in-law. In practice, however, many families have resided with or near the wife's parents. Whether a couple live with or are closer to one set of parents or another depends to some extent on personal preference, and also on economic matters (who has room in their house for the couple, who is likely to leave a house or apartment to the couple).[9]


Delivery of Care

The Ministry of Health and the HZJZ are responsible for determining the national strategy for public health, setting national annual targets, measuring and monitoring performance against set targets and, together with the county public health institutes, organizing and delivering preventive and health promotion services.
Public health services are organized through a Network of Public Health Institutes: one state institute (HZJZ) and 21 county institutes. Their internal organization comprises the following departments: epidemiology, social medicine, environmental health, microbiology and school health. Each department is responsible for implementing programmes in its area of work and overseeing the work of relevant services at county level. The Network of Public Health Institutes provides the following services: epidemiology of quarantine and other communicable diseases, epidemiology of noncommunicable diseases,
water, food and air safety, immunizations, sanitation, health statistics and health promotion. Additionally, the system monitors the work of health care providers in terms of the number of services provided, distribution of personnel, etc.
Public health institutes are also responsible for overseeing compulsory immunization programmes. These programmes are carried out by primary health care doctors (family doctors and primary health care paediatricians) and school doctors for children of school age. Non-compulsory vaccination programmes are delivered through family medicine doctors or county public health institutes.

Primary health care

According to the Croatian Health Care Law, the two main roles to be fulfilled by primary health care are: being the foundation of the health care system, and gatekeeping. Primary health care is organized as a network of first-contact doctors. Each insured citizen is required to sign up with a specific GP.
Primary health care is delivered through a network of individual offices, larger units comprising several offices (some including small laboratories), and health centres that provide general medical consultations, primary care gynaecology services, care for pre-school children, school medicine, occupational health services and dental care.

Secondary and tertiary outpatient health care

Secondary and tertiary outpatient health care in Croatia represents outpatient specialist care. It is provided through consultations for primary health care physicians, specific diagnostic treatments or curative medical treatments (diagnostic procedures, treatment and rehabilitation).
Services may either be provided privately or publicly, in which case providers have to enter into contracts with the HZZO and the uptake of patients is based on referrals from physicians practising in primary health care. Secondary outpatient health care services are mostly delivered through hospitals. Some units are located in polyclinics or single practices.[10]

Type of Health System

Croatia’s health care system is based on the principles of social health insurance. Provision and funding of services are largely public, although private providers and insurers also operate in the market. The health care system is dominated by a single public health insurance fund: the Croatian Institute for Health Insurance, the HZZO. Since 1991, the health care system has been subject to a range of organizational reforms. Ownership of secondary and tertiary health care facilities (buildings) was distributed among the State, counties and cities. Tertiary health care facilities remained state-owned, comprising clinical hospitals, clinical hospital centres and national institutes of health. Secondary health care facilities (general and special hospitals) and county institutes of public health became county-owned. The majority of primary health care general practitioner (GP) offices located in health centres were privatized, and the remaining ones were left under county ownership. Since 1991, Croatia has also witnessed a rapid growth of private secondary health care facilities: mostly special hospitals and polyclinics (outpatient facilities).[10]

Health care standard in Croatia is mainly satisfactory, with better accessibility to health care facilities in major cities. Range of health services rendered in remote areas and islands is less, but still within acceptable.

Health care contributions in Croatia are mandatory for all employed citizens, i.e. their employers. The dependents obtain their health care coverage through contributions paid by working members of their families. Self-employed workers in Croatia are also obliged to pay health care contributions. Croatian citizens who belong to a particularly vulnerable category are exempt from paying health care contributions; retired people and persons with low income are insured and have access to health care facilities - contractual partners -of the Croatian Health Insurance Fund (CHIF).

Croatian citizens have the option to obtain health services within private health care providers which are not CHIF contracted partners, either through direct payment or through supplemental insurance which is covering the payment.

Croatian citizens are required to participate in health care expenditures, except for certain categories of insured persons (e.g. children under age of 18) or insured persons suffering from certain diseases, when health care services are being rendered due to complications caused by those diseases (e.g. malignant diseases or chronic mental illnesses). Some health care services, such as plastic surgery, insured persons are obliged to pay on their own, i.e. the cost is not being covered by mandatory health insurance. Family doctor (GP) suggests patient's further treatment in secondary or tertiary health care service if needed, which enables the patient free access to hospital and polyclinics which have signed contracts for rendering health care services from mandatory health insurance (contractual partners).

Health care services on secondary and tertiary level in major cities are mainly rendered in hospitals. Hospitals can be classified as clinical, general and special hospitals. General hospitals have organized activities that include OBGYN, internal medicine, surgery and pediatrics. 

Although in the middle of the reform, the Croatian health care system is rendering health care services in accordance with European standards. Access to health care outside major cities is fairly reduced, but this mainly concerns outpatient-conciliar health care, while primary health care and emergency medicine are available in all parts of the state.[1]

Payment System

Health care in Croatia has a mixed system of financing. The Croatian public health care system is financed by funds from social health insurance contributions, co-payments, voluntary complementary health insurance, privately provided supplementary health insurance, the state budget and local self-administration county units’ budgets. In terms of medical services provided, the majority of the Croatian health system is financed according to the social health insurance model with one insurance institution or sickness fund, the HZZO. 
Funds for social health insurance are collected mainly from payroll taxes paid by employees, the self-employed and farmers’ contributions. Social health insurance for certain vulnerable categories of the population is partly crosssubsidized from payroll contributions and additionally funded by transfers from the central government budget and from county budgets. These categories include the unemployed, disabled, elderly, people under 18, students, war veterans and the military.
Patients are required to pay for access to certain publicly provided health services through co-payments or to buy complementary health insurance. Certain groups are exempt from paying co-payments. These include the unemployed, disabled, people under 18, students, the military, war invalids, and multiple voluntary blood donors.

Supplementary insurance is optional. It is provided by private insurers and covers the costs of hotel amenities or a higher standard of care in public hospitals (e.g. choice of doctor, single rooms with television, air conditioning, etc.). It can also be used for preventive check-ups and treatment in privately owned practices contracted by the respective insurance company. Additionally, since 2004 it can be used to cover co-payments charged by public providers.

Privately owned facilities can enter into contracts with the HZZO and become a part of the publicly funded system. Alternatively, they can choose to operate on their own and charge private fees or enter into contracts with private insurers and charge for services provided under supplementary insurance. Since 2002, the Croatian system does not allow for opting out of social health insurance.
Social health insurance contributions are collected through the Government and accumulated in the State Treasury. Budgetary funds for social health insurance are determined annually and allocated to the HZZO. The HZZO collects premiums for complementary insurance on its own.
The State also funds extra services such as antenatal and maternity care, school health services and care for the elderly and subsidizes costs of health care in remote regions. The State pays for public health and environmental protection, and health education, and provides income substitution during maternity leave. Capital investments are also funded from the state budget. On an annual basis, each county receives “decentralized funds” from the state Government, which are to be used (after approval by the Ministry of Health) for investments in buildings, technical equipment, etc. County budgetary contributions also fund some public health and environmental protection activities and can additionally be used for further capital investments in county-owned hospitals. The HZZO, aside from paying for medical services, also participates (to a small extent) in funding procurement of medical equipment for publicly owned providers.[10]

The insurance cover for physiotherapy is paid both through the national health care system and privately the patient.[1]


Resources

WCPT Country Profile for Croatia

References

  1. 1.0 1.1 1.2 1.3 1.4 http://www.physio-europe.org/index.php?action=15&subaction=details&member=20
  2. http://www.mvep.hr/zakoni/pdf/847.pdf
  3. http://www.azvo.hr/index.php/hr/visoko-obrazovanje/vrste-studija-u-republici-hrvatskoj
  4. http://www.hkf.hr/Default.aspx
  5. http://www.hzf.hr/hzf.html
  6. http://www.who.int/nmh/countries/hrv_en.pdf
  7. (http://www.who.int/countryfocus/cooperation_strategy/ccsbrief_hrv_en.pdf)
  8. http://www.fhp.org/fhpdocs/CrossCulturalResourceGuide.pdf
  9. http://www.everyculture.com/Cr-Ga/Croatia.html
  10. 10.0 10.1 10.2 http://www.euro.who.int/__data/assets/pdf_file/0010/96445/E90328.pdf