Health Coverage

To help you better understand the health care system in Croatia, here is some information on their public health insurance plan. Thanks to Mr. Josip Paunovic for the info during our lecture at the Makarska City Hall.

Health insurance in Croatia is provided through the government, with about 80% of the funding from taxes and 20% from the federal budget. This health plan covers 97% of the population (the other 3% is not covered due to reasons like working or living outside of Croatia). Private providers and insurance options are also available, but the system is mostly public. In the U.S., there is currently no national health insurance program to cover all citizens. The only public programs in the U.S. are Medicaid, Medicare, and the Children’s Health Insurance Program. (The pictures are from the Public Health Insurance Buildings in Osijek).

According to the Croatian Ministry of Health, in 2003 total spending on health was estimated at 8.9% of GDP, in 2004 at 9.7% of GDP and in 2005 at 8.7% of GDP. In the U.S. in 2005, national health expenditures totaled 16$ of GDP, with this number increasing every year.

There are three types of care: primary, through small clinics; secondary, through hospitals; and tertiary, through institutional hospitals, typically more advanced procedures. This plan covers dental, hospitalizations, vision, and care at primary and secondary health centers. Pharmaceuticals are also included, and those that are covered are listed in a national database. One half the cost of tertiary services are covered under this plan. Cosmetic surgeries are not covered.

Patients are required to pay for certain publicly provided health services through co-payments or to buy supplemental health insurance. Certain groups are exempt from paying co-pays, including: the unemployed, disabled, people under 18, students, the military, war veterans with disabilities, and people that voluntarily donate blood more than once.

The Croatian health insurance program also includes services such as prenatal and maternity care, school health services, and care for the elderly and subsidizes costs of health care in remote regions. The government pays for public health, environmental protection, and health education, and provides paid maternity leave. The Public Health students were surprised to learn about this during our presentation at the Psychodermatology clinic in Zagreb. The psychologist giving the presentation came in during her maternity leave and told us a little about maternity leave in Croatia. Every woman has a child in Croatia has the choice of maternity leave up to one year from the child’s birth, with an additional 45 days of leave. After the first three month’s of the mother’s leave, the father can opt to take paternity leave if the mother chooses to go back to work. In the U.S., women do not have the right to maternity leave, and maternity leave policies differ from company to company.

During our time in Croatia, we discovered many things we liked about the country’s policies, like paid maternity leave, free education through college, and free health insurance for those under 18.

Also, we would like to say thank you to our wonderful professors, all of our guest speakers, program planners, tour guides, and to Mr. and Mrs. Phillips for allowing so many students the opportunity to visit and learn about such a wonderful country!

- Elizabeth

Brac

We visited the island of Brac for one night and I think it is safe to say we all wish we had more time at this particular hotel (The BlueSun)!! May 31st marked our last hike of the trip. We hiked to a Monastery in what seemed like the middle of nowhere. No, scratch that- it was in the dead center of nowhere. The only way to get to the Monastery is by foot- up, down, and around a canyon surrounding the Monastery. We learned that the the villages were built deep into canyons because pirates would come and plunder the villages if they were close to the sea. The "church" was built in 1757 and was considered to be the cultural, spiritual, and educational center of the island.

The school portion was designated for four basic grades of education for children. After this level of schooling, kids of the area went to other villages on the island for more education. The school in the Monastery was operative until 1962, with a class size of 15 students. Everyday the students would bring a log for the fire, that was used for heat and cooking.

While touring the Monastery, we saw various sizes of original weights in the hall that were used by the monks.

We also saw the original kitchen of the Monastery, which is over 400 years old. The kitchen was a central place of the monk's lives.

The monks utilized the land to their benefit by producing goods for bartering. There was never any money exchanged for goods, just a barter system of different goods from foods to wool to furniture. Wheat and corn were ground to produce flour; if a person ground all day, they could produce 10 kilos of flour. There were 3000 olive trees available to the Monastery and this would produce 60,000 gallons of olive oil per year. We also saw a schematic of a beehive layout of the island. Three tons of honey were produced each year from the 237 beehives.

Outside in the courtyard of the Monastery, we learned of the bathroom mechanisms and burial methods for the Monastery. The bathroom was a pretty ingenious idea: there was what was like an outhouse to the side of the courtyard that utilized gravity for flushing. There are no pipes and no running water and the waste is naturally pulled down and away from the "bathroom".

The ancient burial processes for this island are much different from what we think of as burial processes. The dead were buried in a vertical position to make room for others in such a small and confined place. The bodies were wrapped in sheets, then placed in the ground. Once the bodies deteriorated, the bones would fall together in a pile and allow for more room in the burial pit. We learned that where we were standing former priests and residents were buried, totaling about 70 people buried in the courtyard.

Water is a major issue on an island. We learned that the monks would use cisterns to collect rain water and store it in jugs and pots for later use. The island of Brac is used to having many, many sunny days in the year, so rain was very precious. The water to the Monastery and the rest of the island now comes from pipes from the mainland.

There are five things to consider about water: quality (free of sediments, algae, parasites, and clean); cost (has to be affordable); proximity (must be within 1km of person); quantity (minimum amount needed for hygiene and cooking/drinking; 5L/person/day); and reliability (water must be available and there when one needs it). Water should be considered a basic human right, because an individual can only live without water for about a week. Water that is contaminated must be boiled to kill anything harmful (this is one of the reasons the students had to bring logs to school, to ensure a way to boil the water to clean it for drinking and cooking). Storage of the water is a part of proximity and reliability. The mechanisms used to store the water must not contain any cracks and must be easily transported. Storage of the water must also be close enough for the people to access if they are going to cook or clean. We learned that people who have reliable water sources have improved health.

We were also informed about trash being an important issue to consider on an island. There is already limited space on the island, so the trash produced by humans must either be incinerated or transported to a landfill, as to not waste space of the island. We learned that trash from Brac was picked up by barges on a regular basis and transported to a landfill on the mainland.

Mental health is the last issue we learned about that is important to island life. Recent data shows that Croats living on the islands scored higher in better physical conditions compared to those not living on an island. These people did score as having feelings of isolation, but it should be noted that they want an isolated life. This is the reason why they moved away to the island. They feel more vital and not restrained as they do on the mainland. Generally those who are sick or have underlying health problems do not stay on the island because of the limited access to health care. Island people are more likely to endure pain than their non island counterparts. There was also a significant decrease in gastric/pancreatic cancers of the Croatian island people compared to non-islanders.

This last hike was by far one of the hardest, but really interesting to participate in.
-Rachel

Last night in Croatia

We have come to the conclusion of an amazing three weeks in the country of Croatia. Our time here has been filled with academics, culture, explorations, and new friendships. The blog will be complete on Sunday, so please check back then to read our last posts and see some other pictures. We have thoroughly enjoyed our time studying abroad and hope our blog has given you some insight in international health.
- Thanks for following our trip
- Ben, Elizabeth, and Rachel