At 7.4% of GDP, current health expenditure is much lower than the EU average of 9.9%, and this translates to EUR 1,241 per capita in 2015, the fourth lowest in the European Union. Out-of-pocket expenditure amounts to 15%, equal to the EU average.
The country has undertaken a number of important health reforms in recent years to improve health system performance, but the reforms have not been systematic and some have been abandoned, so the Commission is concerned that the fiscal sustainability of the health system appears to be at high risk in the medium term.
The Commission says Croatia has abandoned plans to increase the basic insurance payment to the Croatian Health Insurance Fund and the cap on patients’ copayments as well as plans to reform the ‘additional insurance’ scheme. The long-awaited reorganisation of the hospital system is stalling and developing the stewardship function of the Health Ministry will be crucial for safeguarding achievements so far and addressing the remaining challenges in health care delivery and public health.
The Commission warns about the shortage of physicians and nurses, notably in rural areas and on the islands, following Croatia's entry into the EU in 2013, and says low salaries are additional challenges to the affordability of health care for certain population groups. The numbers of physicians and particularly nurses are low compared to the EU average, making the strategic planning of human resources for health a further challenge.
Life expectancy at birth in Croatia has increased overall by almost three years since 2000, rising from 74.6 to 77.5 years in 2015, but it remains more than three years below the EU average of 80.6. There is a large gender gap, with women living about 81 years and men about 75.
Cardiovascular diseases and cancer are the two main causes of death, accounting for a total of 76% of all deaths among women and 72% among men, almost double the EU average, and mortality rates from lung, breast and colorectal cancer are among the highest in the EU.
Infant mortality, at 4.6 per 1,000 live births in 2015, was among the highest rates in the EU, where the average is 3.6.
The absolute numbers of chronic lower respiratory diseases and diabetes recorded substantial increases over the last 14 years.
More than one third (36%) of the overall burden of disease in Croatia in 2015 can be attributed to behavioural risk factors, notably smoking, alcohol use, dietary risks and physical inactivity.
Smoking and obesity rates are higher than in many other EU member states.
One quarter of Croatian adults reported being daily smokers in 2014, and regular smoking among 15-year-olds, at 23% in 2013–14, was the second highest rate among EU countries and nearly 1.5 times greater than the EU average.
Alcohol consumption among adults was the fourth highest in the EU in 2014, at more than 12 litres per adult (compared with 10 litres for the EU average). Obesity rates are rising, particularly among children, where the rate has grown by 50% since 2001.