The nominee for the new Health Minister, Irena Hrstic has in the meantime announced changes and new criteria for the dual practice of physicians.

Hrstic stated that she would introduce new, clear rules for supplementary work by doctors, requiring them to fulfill all obligations at their public healthcare institution before being allowed to work privately. The draft with new rules is expected to be in public consultation soon.

The inspection conducted 42 checks on private practices last year and found that a number of doctors at the Zagreb and Split clinical hospital centres were absent from their regular work duties during working hours or were working privately without permission.

For all those cases, misdemeanour proceedings have been initiated against doctors with the relevant courts, and the Health Care Act stipulates a fine of 1,320 to 6,630 euros for working in a private institution without approval.

Hina has sent inquiries to several hospitals about the number of doctors with permits, waiting lists for orthopedic procedures, and potential abuses of dual employment. In all the responses received, it is emphasized that no irregularities were observed.

According to the responses from the hospital administrations, around one-fifth of doctors in large healthcare institutions have permission from the hospital director for extra-contractual work in private clinics.

One of the reasons for dual employment can be financial benefits.

Wages in public healthcare increase by up to 36%

Considering that this year salaries in public healthcare have increased by 6 to 35.8%, the director of the Gospic hospital, Sandra Cubelic, says that the average salary for a 50-year-old specialist with 8-9 on-call shifts per month now amounts to around 5,000 euros. In exceptional cases, it can reach as high as €9,000.

Department heads have lower coefficients than specialist advisors and often choose more favourable conditions for themselves by opting out of the department head coefficient. In the Gospic hospital, only one doctor works for a private practice, according to Cubelic.

Data from Fina shows that the private healthcare sector is growing year by year. In 2022, there were 1,706 businesses in healthcare with 10,691 employees, and by last year, that number had risen to 1,776 entrepreneurs and 11,315 employees.

Annual reports on their operations show that the total revenue of entrepreneurs in private healthcare in 2023 amounted to €649.6 million, compared to €764.6 million in 2022.

In 2022, the leading institution was the Special Hospital Radiochirurgia Zagreb (HRK 160.7 million in total revenue and HRK 52.4 million in profit), followed by the Clinic for Cardiovascular Diseases Magdalena and the Medikol Polyclinic.

HZZO: €90m paid to private providers in 2023

The Croatian Health Insurance Fund (HZZO) has 317 contracts with private healthcare institutions. These include 84 polyclinics, five special hospitals, 128 private practices and laboratories, 75 home physical therapy institutions, and 25 private home physical therapy practices.

In 2023, the cost for private institutions and hospitals in private ownership amounted to €90 million, according to the Fund.

The financial plan of the Croatian Health Insurance Fund (HZZO) for that year amounted to €5.1 billion, with the share of private providers in the financial allocation accounting for 1.76%.

The HZZO emphasizes that referrals are equally valid for both public and private institutions that have a contract with HZZO, which pays for the services provided at the same price to all.