Croatia

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Patient Access to Physiotherapy or Physical Therapy Services / Entry Point

• How do members of this country access Physical Therapy services?

• What is the entry point or typical path the patient must follow in order to receive services?

• Do PT's have direct access or are they part of a primary care team?

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

(http://www.physio-europe.org/index.php?action=15&subaction=details&member=20)

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.

(http://www.mvep.hr/zakoni/pdf/847.pdf)

Therapist Preparation

      Degree/Credentialing

• What is the education process to become a Physiotherapist or Physical Therapist in this country?

Professional Title/ Qualification: Bachelor Physioterapists(Baccalureus Fizioterapeut).

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.
Schools training goes on for 3 years

(http://www.physio-europe.org/index.php?action=15&subaction=details&member=20)

      Specialization

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

Professional Associations

• What are the professional associations associated with Physiotherapy or Physial Therapy in this country?

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.

(http://www.physio-europe.org/index.php?action=15&subaction=details&member=20)

Information about the Patient Community

• What is the population these PT’s serve?

• What are the major causes of morbidity and mortality in the population served?

Croatias total population is aproximately 4307000. Life expectancy for males is 74 years, for females is 80 years. (http://www.who.int/nmh/countries/hrv_en.pdf) 

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). 

(http://www.who.int/countryfocus/cooperation_strategy/ccsbrief_hrv_en.pdf)

Social/Cultural Influences

• What is the influence of the family on a patient's health status?
• What are the typical patient's living conditions, family dynamics, and cultural back ground?

Delivery of Care

• Is delivery of care provided in a timely manner?
• Special methods? Home health etc
  

Type of Health System

• Is it a national health system with universal access?
  

C
roatia’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 �99�, 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 �99�, Croatia has also witnessed a rapid growth of private secondary health care facilities: mostly special hospitals and polyclinics (outpatient facilities).

(http://www.euro.who.int/__data/assets/pdf_file/0010/96445/E90328.pdf)

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.

(http://www.hzzo-net.hr/english_01_03.php)

Payment System

• What methods to patient use to pay for service? (Insurance, bartering etc.)

The insurance cover for physiotherapy is paid both through the national health care system and privately the patient.
(http://www.physio-europe.org/index.php?action=15&subaction=details&member=20)

Resources

WCPT Country Profile for Croatia

Croatian Association of Physiotherapists