Croatian ER

How would you like to go to the emergency room for treatment and never have to pay for it? That is how the system works in Croatia. Everything is free- even the medicines. The “emergency rooms” here are more like our Urgent Care centers in the United States, but with more on-going services. The ER does not deal with major trauma issues, births, or major surgeries. These types of services are done at the hospital.

May 21st the Public Health Students visited a Croatian Emergency Care Center in Labin. We were given a tour by the Director of the Emergency Care Center, who is a medical doctor for 8 hours of the day and the manager of the center for 4 hours. We toured many of the different areas of the clinic, from the Emergency Receiving to other specialized areas of the clinic. The ER was built in the 1970s, and was once a full hospital. It is now basic emergency care and other services. Our guide noted that one entire building is empty and there is too much room now, and they have to pay a lot of money to pay for the unused building. There are about 25,000 people in the area and the center sees about 40 patients on a normal day, and up to hundreds on the weekends. The majority of the patient load in the summer comes from tourists. It should be noted however, that the free services are only free for the citizens, not tourists. Tourists have to pay for treatment and medicines.

The ER provides Basic Life Support, Emergency Life Support, x-rays, basic surgery (2 rooms), EKGs, and general care for everyday occurrences (sore throats, headaches, etc.). Other services offered by this Croatian ER were dialysis, hospice, a dental clinic and dental moldings, school health, immunizations, laboratory for blood work, pharmacy, rooms for Hepatitis A and B, and radiology and diagnostics. Dialysis patients come 3 times a week and there are about 22 patients who come. We visited the Dialysis room and saw about 6 patients receiving treatment. The hospice in Croatia differs from the U.S. that when elderly people have been in the hospital and need to monitored in a clinical setting and there is no room for them to be kept in the actual hospital, are moved to the ER center.

There is an on-site dentist and dental lab where false teeth are made due to the aging population near the ER. We also were allowed to go in this room and saw all kinds of teeth impressions, dentures, and workers molding the fittings with flames and paste.

We also visited the school health areas. Children come to this area for immunizations and education. Croatia also takes the vaccines to the children at school. The schools are visited almost everyday. The student’s health records are also kept at the ER center, not just at the school. The guide noted that sex education is presented in regards to STIs and safe sex, but she noted that they do not give out condoms because of the large Catholic influence in the area. Students can come to the clinic and have more sexual health education if they want it. The clinic does offer the Gardasil (quadrivalent-HPV vaccine) shot to females for $1027 kuna, which is roughly $192 per shot.

The ER gets lab work the same day, sometimes in 30 minutes depending on the type of labs requested. The patient’s general doctors will receive the results the next day. Wait times for being seen depend on how many other people are waiting for treatment, and if the doctor is out on an ambulance call. Sometimes the wait time is 30 minutes, and others it is 2-3 hours. There is no triage system, so it just depends on what kinds of symptoms a person is experiencing to determine the order in which they will be seen. Chest pain or asthma attacks will be seen immediately, and those patients who are there for mild illnesses and discomforts will have to wait to be seen a little longer.

The Director noted that the doctors are paid based on how many patients they see and the doctors depend on large amounts of patients, because this is how they pay for other employees such as the Speech Therapist, Psychologist, Accountants, Administrative Assistants, and Cleaning services. This kind of works in their favor since many people come into the clinic for mild illnesses and complaints, but also if the patients General Practitioner is working, the patient is sent there and the ER will not treat them.

We saw inside of the ambulances that are used for bringing people to the clinic and they are very different from ambulances in the United States. The vans are not fully stocked at all times, because it costs too much money to keep them fully stocked. When there is an emergency call, the EMTs pick up a case filled with medical supplies and put it on the van. When we first entered the ER, we got to see some of the EMTs bringing in someone from heat exhaustion.

Other services our guide mentioned were that the Red Cross offered CPR training and diabetes education. Doctors from the hospital were sometimes asked to do presentations at alcoholics meetings. There are other education efforts in the works, but for now will have to wait because of money concerns.

Our time at the ER was very informative. We learned a lot about Croatian medical care and saw a different side of Public Health than we have seen on the other parts of the trip. - Rachel