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Volunteers have been present in palliative care since its inception. With the development of palliative care systems, their role and position are changing. Given growing long-term care needs and limited resources in health and social care, volunteers are becoming an important resource in meeting these needs. In Croatia, palliative care has been developing as an integrated care model since 2014. To assess the position and the role of volunteers, we analyzed legislative documents from healthcare and social care and conducted a focus group with volunteers in palliative care. We found that volunteers provide support from the social aspect of care, for the patient and the family. The formal palliative care system involves them as partners in the provision of care, even though this cooperation is informal. The main determinants of their activities are an individualized approach, flexibility, a community presence, and project funding. In conclusion, these determinants allow them to react quickly to identified needs, but with them come some uncertainties of their sustainability. Their activities could indicate what needs to be integrated between health and social care and in what areas. Volunteers both fill in gaps in the system and are ahead of the system, and by doing this they develop new processes around identified unmet needs.

This article compares the health system responses to COVID-19 in Bulgaria, Croatia and Romania from February 2020 until the end of 2020. It explores similarities and differences between the three countries, building primarily on the methodology and content compiled in the COVID-19 Health System Response Monitor (HSRM). We find that all three countries entered the COVID-19 crisis with common problems, including workforce shortages and underdeveloped and underutilized preventive and primary care. The countries reacted swiftly to the first wave of the COVID-19 pandemic, declaring a state of emergency in March 2020 and setting up new governance mechanisms. The initial response benefited from a centralized approach and high levels of public trust but proved to be only a short-term solution. Over time, governance became dominated by political and economic considerations, communication to the public became contradictory, and levels of public trust declined dramatically. The three countries created additional bed capacity for the treatment of COVID-19 patients in the first wave, but a greater challenge was to ensure a sufficient supply of qualified health workers. New digital and remote tools for the provision of non-COVID-19 health services were introduced or used more widely, with an increase in telephone or online consultations and a simplification of administrative procedures. However, the provision and uptake of non-COVID-19 health services was still affected negatively by the pandemic. Overall, the COVID-19 pandemic has exposed pre-existing health system and governance challenges in the three countries, leading to a large number of preventable deaths.

In Croatia, palliative care has been developing as an integral part of the health care system since 2014. This development is in line with the integrated care concept emerging in many countries. However, there are a number of implementation problems. The aim of this article was to identify positive and negative determinants for the integration of palliative care in Croatia. We identified policy processes or organizational changes within three key domains: the development of new organizational structures, stakeholders' empowerment, and removing barriers to the provision of integrated palliative care. The progress visible in these domains shows the sustainability of the palliative care model used in Croatia. However, there are also barriers hindering the integration of palliative care. We conclude that patient-centred and process-based change in health care can have a positive effect on the integration of care. Staff education and regulation of business processes are key for the sustainability of reforms. Lastly, it seems easier to achieve the integration of care when it develops as a bottom-up model and reflects the need for new processes, than when it is imposed from above as a single regional or national model.

This paper concerns new forms of collective agency in the area of health care in Croatia from 2015 until 2018. These new forms developed in the midst of the growing privatization and commodification of health care and the simultaneous decrease in the accessibility to health care. Privatization has taken place slowly, but continuously over the last 29 years. The traditional civil society organizations in the field of health care used to be characterized by a narrow set of activities, with vertical structures, and were frequently focused on a single-disease approach and collaboration with the pharmaceutical industry. Such practices produced limited results, hence improved forms of activism emerged. In this research, we illustrate their development using the example of three case studies of collective agency. The first case study is looking at the policy analysis and the activist group started by the Organization for Workers' Initiative and Democratization (OWID) ; the second one focuses on the informal group of medical students called U3 formed at the Andrija Štampar School of Public Health with the aim of developing critical thinking ; and the third case study considers the Karika Association, started as an attempt to rethink health care in the community. The main research methods employed included process tracing analysis and research data comparison aimed at showing the differences between the traditional and the new forms of healthcare activism, in addition to the secondary sources of information such as scientific and professional literature. The results show that the new forms of collective agency in the healthcare area include various groups of citizens not necessarily connected with a specific disease, that they have a horizontal structure and are focused on the healthcare system in general. In conclusion, they represent the beginning of a paradigmatic shift in activism from a single- disease approach towards comprehensive health care that has the potential to deal with the growing issue of commercialization, commodification and inequalities in today's healthcare systems.

Croatia is among the last countries in Europe to develop organized palliative care at the national level. Real changes in this area started after the parliamentary elections in 2011 and culminated in the 2013 adoption of the Strategic Plan for Palliative Care Development 2014–2016. The National Board for Palliative Care (NBPC), appointed by the Ministry of Health, was in charge of creating a scalable palliative care model and national guidelines. The Board drew on experiences from both neighbouring countries with similar societies and/or health care models (Bosnia and Herzegovina, Poland) and an international leader in palliative care (United Kingdom). It recognised that provision of palliative care in Croatia, thus far based on volunteering and isolated enthusiastic activities, needed to be improved through professionalization, regulation, and organized development. A variety of policy measures was used to implement these changes, including the introduction of professional guidelines and new payment models. The development of new palliative care structures and services significantly increased the number of patients who could access palliative care, from around 1–2% of patients needing such care in 2011 to 20–35% in 2014. It also ensured the provision of more appropriate services at each point of the palliative care pathway. The Strategy was extended for the 2017–2020 period.

This paper aims to: (1) provide a brief overview of hospital sector characteristics in 11 Central and Eastern European countries (Bulgaria, Czech Republic, Estonia, Croatia, Latvia, Lithuania, Hungary, Poland, Romania, Slovakia, Slovenia); (2) compare recent (2008 – 2019) hospital reforms in these countries; and (3) identify common trends, success factors and challenges for reforms. Methods applied involved five stages: (1) a theoretical framework of hospital sector reforms was developed; (2) basic quantitative data characterizing hospital sectors were compared; (3) a scoping review was performed to identify an initial list of reforms per country; (4) the list was sent to national researchers who described the top three reforms based on a standardized questionnaire; (5) received questionnaires were analysed and validated with available literature. Results indicate that the scope of conducted reforms is very broad. Yet, reforms related to hospital sector governance and changes in purchasing and payment systems are much more frequent than reforms concerning relations with other providers. Most governance reforms aimed at transforming hospital infrastructure, improving financial management and/or improving quality of care, while purchasing and payment reforms focused on limiting hospital activities and/or on incentivising a shift to ambulatory/day care. Three common challenges included the lack of a comprehensive approach; unclear outcomes; and political influence. Given similar reform areas across countries, there is considerable potential for shared learning.

Background: The connection between socio-economic status and health is documented, yet not fully understood. The goal of this research was to analyze the relationship between socio-economic status, lifestyle and health status, availability of health-care, social capital, and satisfaction with life. Subjects and methods: Subjects were 1117 women aged 25-65 years divided in two groups. Group 1 consisted of women who receive public assistance (N1=591), while Group 2 consisted of women who do not (N2=526). The sample was stratified by random choice into multiple stages based on six regions of Croatia, residential area size, and the age of respondents. Visiting nurses surveyed the deprived population, while in Group 2 self-interviewing was conducted. A questionnaire entitled “Inequalities in health” was used. The respondents participated in this research voluntarily and anonymously. Results: Socially deprived women consume spirits and wine more often (p

There are various predictors of citizens’ satisfaction with health care system, but there are two main political factors: patient participation and institutional influence of their representative organizations, and political party affiliations (1-4). Some authors concluded that socio-demographic characteristics were only a minor predictor of satisfaction with health care system, but older age appeared to be one of the most consistent positive determinants of health care satisfaction (5-13). Women were found to be less satisfied with care than men because they were more frequent users of care and had higher expectations (14,15). Studies in post-communist states provide mixed evidence in this regard. In a 1991 cross-country survey study, most of the respondents believed that, while the market system was essential to economic development, policies that promoted social and economic egalitarianism were important (16). They also found that women, those with lower educational level, and those with lower income were more likely to be supportive of socialist principles. On the other hand, a study conducted in 1999 showed a change in value systems, with a majority of respondents from Poland and Hungary not favoring further redistribution of income, even at the expense of welfare (17). Furthermore, there was a positive correlation between education and positive attitude to health care competition. Still, in Hungary the older generations were predominantly against increases in health care competition. Since the early 1990s, the public level of satisfaction with the health care system reforms in Croatia has not matched the apparent success of the reform goals. A 1994 consumer survey found that a vast majority of lower- and middle-income Croats was skeptical of health care reforms (18). They attributed this to the legacy of universal access to health care, the view of health care access as a universal right, negative consequences on the patients, and lack of public understanding of the reforms. The same study (18) found the distribution of out-of-pocket payments and co-payment for health care to represent a regressive burden on those in the lower income group. Patient satisfaction was also low: 44% were dissatisfied with the quality of health facilities and 48% with the equipment (18). Similar face-to-face interviews found that citizens of Croatia did not hold a positive view of the health insurance reform (19). Their primary concern were limitations of their rights and the increase in the financial burden related to medical care. A 2005 survey found that during the presidential election campaign period health care was the second most important issue on the voters’ minds, closely following economy (20). Finally, a national survey on patients’ satisfaction with hospital and primary health care in 2006 showed considerable concerns with relations between patients and medical professionals, hospital accommodation, communication between primary and secondary health care, and corruption (21,22). In this study, we present and compare the results of a series of public opinions surveys conducted between 2005 and 2009. This is the first study that targeted public experiences and voters’ opinion as an evaluation of the health care sector in Croatia.

Objective To determine the progress in the development and implementation of health policies on a county level resulting from the learning-by-doing training provided through the County Public Health Capacity Building Program started in 2001 in Croatia. Methods Modular training using management tools, public health theory and practice, and SMDP's Healthy Plan-it™ tool, followed by the self-evaluation of the progress made by county teams in health needs assessment and health policy development, implementation, and assurance. Fifteen county teams consisting of politicians, executive officers, public health professionals, and community members. Results Twelve of 15 county teams completed the program. The teams made progress in the evaluated areas, although to a different extent, which did not depend on the amount of time they had or the governance experience. The differences in improvement depended on the differences in the strength of political, executive, and professional components of the teams. Teams with a strong political and/or executive component, but weak public health professional and community components made major improvements in policy development and/or assurance function, but performed less well in the health needs assessment and constituency building. The reversed was also true. Conclusion Learning-by-doing training program improved public health practices on a county level in Croatia.

Croatia is a small central European country on the Balkan peninsula, with a population of approximately 4.3 million and a gross domestic product (GDP) of 62% of the European Union (EU) average (expressed in purchasing power parity; PPP) in 2012. On 1 July 2013, Croatia became the 28th Member State of the EU. Life expectancy at birth has been increasing steadily in Croatia (with a small decline in the years following the 1991 to 1995 War of Independence) but is still lower than the EU average. Prevalence of overweight and obesity in the population has increased during recent years and trends in physical inactivity are alarming. The Croatian Health Insurance Fund (CHIF), established in 1993, is the sole insurer in the mandatory health insurance (MHI) system that provides universal health coverage to the whole population. The ownership of secondary health care facilities is distributed between the State and the counties. The financial position of public hospitals is weak and recent reforms were aimed at improving this. The introduction of concessions in 2009 (public private partnerships whereby county governments organize tenders for the provision of specific primary health care services) allowed the counties to play a more active role in the organization, coordination and management of primary health care; most primary care practices have been privatized. The proportion of GDP spent on health by the Croatian government remains relatively low compared to western Europe, as does the per capita health expenditure. Although the share of public expenditure as a proportion of total health expenditure (THE) has been decreasing, at around 82% it is still relatively high, even by European standards. The main source of the CHIFs revenue is compulsory health insurance contributions, accounting for 76% of the total revenues of the CHIF, although only about a third of the population (active workers) is liable to pay full health care contributions. Although the breadth and scope of the MHI scheme are broad, patients must pay towards the costs of many goods and services, and the right to free health care services has been systematically reduced since 2003, although with exemptions for vulnerable population groups. Configuration of capital and human resources in the health care sector could be improved: for example, homes for the elderly and infirm persons operate close to maximum capacity; psychiatric care in the community is not well developed; and there are shortages of certain categories of medical professionals, including geographical imbalances. Little research is available on the policy process of health care reforms in Croatia. However, it seems that reforms often lack strategic foundations and or projections that could be analysed and scrutinized by the public, and evaluation of reform outcomes is lacking. The overall performance of the health care system seems to be good, given the amount of resources available. However, there is a lack of data to assess it properly.

Dosadašnja istraživanja pokazuju vezu između niskog socioekonomskog statusa (SES) i povećanog pobola i smrtnosti. Iako je socijalna uvjetovanost rizičnih zdravstvenih ponašanja i nepovoljnih zdravstvenih ishoda u hrvatskoj literaturi istraživana, pitanja povezanosti nezdravog načina prehrane, tjelesne inaktivnosti, pušenja i prekomjerne konzumacije alkohola sa socijalnim statusom još uvijek nisu dovoljno istražena. Cilj rada je bio istražiti povezanost SES-a te nezdravog načina prehrane, tjelesne inaktivnosti, pušenja i prekomjerne konzumacije alkohola u hrvatskoj odrasloj populaciji te dolazi li do promjena u zastupljenosti rizičnih zdravstvenih ponašanja u različitim skupinama SES-a u promatranom petogodišnjem razdoblju. Korišteni su podaci dvaju ciklusa Hrvatske zdravstvene ankete (HZA), 2003. i 2008. godine, a u istraživanje je uključeno 1227 ispitanika. Analize su rađene za zdravu populaciju i kronične bolesnike, 2003., u kompletnom uzorku, ali i u zdravoj populaciji odvojeno, socijalni status statistički je značajno bio povezan s nezdravim načinom prehrane (p, Introduction and Aim: Based on the previous research, there is strong association between low socioeconomic status (SES) and high morbidity and mortality rates. Even though association between SES and risky health behaviors as the main factors influencing health has been investigated in Croatian population, some questions are yet to be answered. The aim of this study was to investigate the presence of unhealthy diet, physical inactivity, smoking and excessive drinking in low, middle, and high socioeconomic group of adult Croatian population included in the cohort study on regionalism of cardiovascular health risk behaviors. We also investigated the association between SES measured by income, education and occupation, as well as single SES indicators, and risky health behaviors. Sample and Methods: We analyzed data on 1227 adult men and women (aged 19 and older at baseline) with complete data on health behaviors, SES and chronic diseases at baseline (2003) and 5-year follow up. Respondents were classified as being healthy or chronically ill. SES categories were derived from answers to questions on monthly household income, occupation and education by using two-step cluster analysis algorithm. Results: At baseline, for the whole sample as well as for healthy respondents, SES was statistically significantly associated with unhealthy diet (whole sample/healthy respondents: p=0.001), physical inactivity (whole sample/healthy respondents p=0.44/p=0.007), and smoking (whole sample/healthy respondents p

This study examined individual and combined influence of smoking, physical inactivity, alcohol drinking, and unhealthy diet on total mortality. Relationship between individual and combined poor health behaviours and total mortality were examined using Cox proportional hazards regression. Out of 7490 individuals included in the study, during 5 years follow up 808 died. Adjusted hazard ratios (HRs), and 95% confidence intervals (95% CIs) for men with health behaviour scores 1, 2, 3, and 4 compared with those with score 0 were 1.67 (1.24-2.24), 2.28 (1.64-3.18), 2.24 (1.32-3.84), and 2.86 (0.77-11.70), respectively (p value for trend < 0.001). Adjusted HRs (95% CIs) for women with health behaviour scores 1, 2, and 3 compared with those with score 0 were 1.17 (0.97-1.42), 1.37 (1.02-1.86), and 1.20 (0.37-3.61), respectively (p value for trend = 0.04). A unit of the health behaviour score increased mortality risk equivalent to being 5.9 and 2.9 years older, for man and woman respectively.

The aims of this paper are to investigate the change in prevalence of psychological distress (PD), to investigate the cumulative incidence of the psychological distress and to indicate are there any differences between genders and various age groups in Croatian adult population. Psychological distress status was measured by the five-item Mental Health Scale (MHI-5) of the Short Form questionnaire (SF-36).Psychological distress was present in 28.5% (95% CI 25.7%-31.2%) of men and 32.1% (95% CI 30.1%-34.0%) of women in 2003. In 2008 PD was present in 33.0% (95% CI 30.1%- 35.9%) of men and 34.1% (95% CI 32.1% - 36.0%) of women. The highest incidence of PD, both for men and women, was in the oldest age group (>65 years). Results of this study demonstrating the fact that every third adult men and woman in Croatia are in psychological distress, the fact that there is an increase in PD prevalence for men and women should be taken into account in the future mental health policy planning.

Croatia has a long tradition of non-communicable disease prevention, but also obstacles to the implementation of preventive programs related to the general attenuation of public health and primary health care sector. The aim of this study was to determine trends in behavioral and biomedical risk factors and evaluate primary non-communicable disease and cardiovascular prevention. Physical inactivity was a leading risk factor with increasing trend and prevalence of 33.9% and 38.9% in men and women in 2008. In 2008, obesity was present in 26.1% and 34.1%, and hypertension in 65.8% and 59.7% of men and women. During the follow-up only smoking and alcohol consumption in men decreased significantly, while alcohol consumption and obesity in women, and hypertension in both sexes significantly increased. In the present situation, with the existing trends and environment it will not be possible to stop negative trends. Revitalization of public health activities and primary health care is essential.

Over the past decade, public opinion surveys have shown that Croats are deeply dissatisfied with their health care system and asses it to be one of the most important issues. However, health care hardly makes it into any political discourse in Croatia. This study analyzes the results of a public opinion survey conducted before the 2007 parliamentary elections to find out what the public sentiment on health care performance in Croatia is and to analyze the reasons why health care is not addressed by political actors. Evidence suggests that while health care is the most salient issue today, the public often understands it poorly. Thus, in a political environment of competing issues, and given the complexity of tacking health care in the policy arena, politicians strategically avoid discussing the issue.

The aim of this article was to identify parameters that determinate PCS and MCS values, and analyze 5-year changes in those values according to the age, sex and geographic region. Cohort of 3229 participants was obtained from the CAHS 2003-2008. Results revealed no statistically significant differences between same age group, sex, and different region regarding PCS and MCS. When chronic conditions were in the model difference was present, PCS being more influenced by all conditions but bronchial asthma. The strongest influence comes from musculoskeletal conditions; followed by weak heart. Values for PSC and MSC decreased in 2008 compared with 2003, but only in few cases decrease was statistically significant. Values of PCS and MCS are higher in men in all regions, but they show higher variability than woman. Our results support the findings that data obtained through SF-36 could be the useful for public health interventions regarding chronic diseases.

Nutritional habits between urban and rural population differ as much as life style and socioeconomic standards of these populations. In Croatia, rural populations are mostly live stock producers. Their nutrition frequently depends on their own production, which includes high quantity of cured meat products, eggs and dairy products. Data were obtained from longitudinal the Croatian Adult health Survey and pilot cross-sectional survey in three villages in Sisa~ko-moslava~ka county. Our findings show that there is no great difference between urban and rural population regarding salt intake. The difference is in the type of food and food preparation, as well as life style. We propose combination of more culturally and socially sensitive questionnaires along with analytical methods that include biological matrix, such as 24-hour urine collection.

Cardiovascular diseases are the leading cause of death in Croatia, with significant regional differences. Despite high mortality rates, high prevalence of various cardiovascular risk factors and well organized public health network, comprehensive system for cardiovascular disease monitoring and interventions does not exist. In this study we analyzed legislation framework and responsibilities of stakeholders relevant for cardiovascular disease surveillance and prevention. According to the international experiences we analyzed characteristics of cardiovascular disease prevention in Croatia and causes of the problems appeared in the preventive programs in Croatia. Analysis showed that primary problem is not inefficiency, but the existence of barriers in preventive activities definition, responsibilities distribution and task implementation. Main cause for such situation is incompatibility of the existing practices in clinical medicine and public health with recommendations from other countries. For the successful prevention of cardiovascular disease in Croatia at least three changes need to be made – define new terms and contents of prevention, define new responsibilities distribution and provide equity in health as basic criterion for successful preventive programs.

Cardiovascular diseases are the leading causes of death in Croatia, and significant differences in cardiovascular risks between regions in Croatia are found. Despite high mortality rates, high cardiovascular risks and organized public health network, comprehensive system for cardiovascular disease monitoring and preventive intervention does not exist. In this research we analyzed legislation framework and responsibilities of stakeholders relevant for prevention. According to international experiences we analyzed specificity of prevention in Croatia and root causes of the problems appeared in the preventive programs in Croatia. Analysis showed that primary problem is not inefficiency, but there are limits in preventive activities definition, responsibilities distribution and task implementation. Main cause for such situation is incompatibility with current trends in medicine and public health in the world. For the successful prevention of cardiovascular disease in Croatia it is necessary to: define new terms and contents of prevention ; new responsibilities distribution ; equity in health as basic criteria for successful preventive programs.

The introduction of DRGs in Croatia

Aim: To investigate the importance of issues related to health care provision in the 2005 Presidential elections in Croatia. Methods: A computer randomized, two-stage stratified telephone survey of a 1000 respondents sample of the Croatian voting population was surveyed in December 2004, 5 days prior to Presidential elections. Respondents were asked to rank priority areas in politics and specific priority areas in health care. Only responses from those voters who identified the two most likely candidates were used in analysis: candidates Stipe Mesić and Jadranka Kosor (center left and center right political options). Results were analyzed with chi-square test and binary logistic regression. Results: Citizens ranked health care issues as their second most important priority in politics, preceded only by economic issues. Top three priority areas recognized in health care were organization (24.7%), financing (23.2%) and corruption (24.3%). Ranking of priority areas in health care varied insignificantly between left and right wing candidate voters. However, right wing oriented voters were more likely to identify lack of finances as the top health priority in the multivariable model (Odds ratios 2.21, 95% CI 1.25 - 3.89). There were no other differences between the two candidate groups. Conclusion: Health and health care ranked as the second most important issue in the list of general priorities in Croatia. The study recorded a strikingly high level of homogeneity between specific health care priority areas in the two groups of voters. The phenomenon might be attributed to the magnitude and importance of issues that burden the basic functioning of the health care system: poor organization, inadequate financing and corruption. Public opinion on health care priorities might be a useful tool in determining priorities for policymaking, especially in transitional health care systems undergoing reforms.

Cases of American liver fluke (Fascioloides magna) were detected in Croatia for the first time in January 2000. Initial suspicions with regard to the presence of Fascioloides magna in the red deer (Cervus elaphus L.) population were raised in Baranja, eastern Croatia, during the winter of 1999. Red deer liver samples from that area were examined and 22 adult parasites were recovered. The parasites, as well as mature eggs, were determined to be Fascioloides magna. The parasite was probably introduced into the Baranja region by natural deer migration from neighbouring Hungary., Tijekom siječnja 2000. godine po prvi puta je ustanovljena prisutnost velikog američkog metilja (Fascioloides magna) u Hrvatskoj. Sumnja na njegovu prisutnost u populaciji jelena običnog (Cervus elaphus L.) postavljena je tijekom zime 1999. godine u istočnom dijelu Hrvatske, odnosno Baranje. Dostavljeni i pregledani uzorak jetre jelena običnog s tog područja sadržavao je 22 odrasla parazita. Paraziti i zrela jajašca determinirani su kao Fascioloides magna. Paraziti su vjerojatno uneseni na područje Baranje prirodnom migracijom jelena iz susjedne Mađarske.

Based on repeated measurement of health behaviors the CroHort Study showed that health behavior explains a great deal more of class inequalities in mortality than observed in previous studies. These include decreasing prevalence of smoking and increase in obesity, hypertension and diabetes mellitus. The lowest prevalence of health risks was recorded among children and adolescents, followed by general adult population from the CroHort Study. Hospitalized coronary heart disease patients had higher risks prevalence than general population, while the highest prevalence of risks was recorded among patients in cardiac rehabilitation program. The higher levels of stress were associated to lower financial conditions, poorer social functioning and poorer mental health for both men and women. Higher levels of stress were also associated with heart problems, higher alcohol consumption in men while in women stress was associated to poorer general health, higher age and lower levels of education.

Rural areas, where 47.6% of the Croatian population lives are not generally the focus of research; yet there are challenges which affect the rural population that often go unreported. These communities often exhibit disadvantages in many areas of health. The aim of this study is to examine the specific health needs and related determinants of rural populations influenced by transition that were affected by the consequences of war. The focus of the research is rural lifestyle, behaviour and cardiovascular risk factors in three villages of Sisa~ko-moslava~ka County. Results show that participants generally understand that their own lifestyles influence their health, but they often neglect to change their behaviour to improve their health. This can be explained through complex socio-economic conditions and traditional values of their heritage. These results suggest a need for further research on health status, attitude, and behaviour of Croatia’s rural population. Specific public health intervention and services for rural populations must be promoted.

The objective of this study was to investigate regional gradient of a synthetic cardiovascular burden (CVRB) in Croatia. Analysis was based on a multistage stratified sample representative of general adult population in six regions of Croatia (Croatian Adult Health Survey). Synthetic CVRB was defined by incidents (heart attack, stroke), blood pressure, overweight/obesity (BMI, waist circumference), and risky behaviours (smoking, physical inactivity, high alcohol consumption, inadequate nutrition). Total CVRB in Croatia was 44.7% for men and 50.3% for women. Combining both high and moderate CVRB, men were found to be under more risk than women (72.8% vs. 61.7%, respectively). The result showed an east-north-west gradient in continental Croatia, with high CVRB in Eastern (40.2%) and Central region (44.3%), City of Zagreb (45.7%) and Northern region (53.1%). Mountainous region had the lowest prevalence of respondents with high CVRB (39.2%). Coastal region with the prevalence of 46.3% of high CVRB was nearly the same as the City of Zagreb. The results suggest the presence of substantial regional differences in the cardiovascular risk burden.

This analysis of the Croatian health system reviews developments in its organization and governance, financing, provision of services, health reforms and health system performance. Croatia has a mandatory social health insurance system with nearly universal population coverage and a generous benefits package. Although per capita spending is low when compared to other EU countries, the share of public spending as a proportion of current health expenditure is high and out-of-pocket payments are low. There are sufficient physical and human resources overall, but some more remote areas, such as the islands off the Adriatic coast and rural areas in central and eastern Croatia, face shortages. While the Croatian health system provides a high degree of financial protection, more can be achieved in terms of improving health outcomes. Several mortality rates are among the highest in the EU, including mortality from cancer, preventable causes (including lung cancer, alcohol-related causes and road traffic deaths) and air pollution. Quality monitoring systems are underdeveloped, but available indicators on quality of care suggest much scope for improvement. Another challenge is waiting times, which were already long in the years before 2020 and are bound to have increased as a result of the COVID-19 pandemic.

U radu su uvodno uspoređeni opći sociološki i ekonomski parametri dviju država, a nakon toga bitni zdravstveni pokazatelji. Dio njih pokriva zdravlje žena i djece, a dio se odnosi na opću populaciju. Odabrani su parametri koji se ili bitno razlikuju u Hrvatskoj i Norveškoj ili koji pokazuju dinamiku u svojim trendovima. Pokazalo se da, iako su dvije države u ekonomskom razvoju smislu drugačije, u mnogim zdravstvenim pokazateljima su usporedive i općenito gledajući imaju zdrava društva. Hrvatska nešto zaostaje u područjima u kojima bi preventivne aktivnosti dugoročno mogle pokazati pozitivne trendove, poput navika pušenja, kulture vožnje, a nažalost i smrtnosti od tumora dojki, prostate i dišnog sustava. No Hrvatska ima općenito nižu incidenciju pojave tumora, a i nižu stopu elektivnih abortusa i kongenitalnih malformacija. Što se organizacije zdravstvenih sustava tiče, obje države imaju općenito decentralizirani pristup organizaciji, no dok je Norveška općenito podijeljena u 4 regije, Hrvatska svoju decentralizaciju usklađuje s 20 županijskih organizacija i Gradom Zagrebom. Obje su države socijalne države i građani imaju univerzalan pristup zdravstvenom sustavu, iako je to u Hrvatskoj donekle ograničeno regresivnim financiranjem zdravstva te općenitom ekonomskom nestabilnošću i nižim socioekonomskim standardom većeg broja stanovnika., The paper starts with a comparison of general social and economic parameters of the two countries and afterwards important health indicators are compared. Some indicators cover health of woman and children and a part covers the health of the general population. The chosen parameters either differ considerably between Croatia and Norway or show a dynamic in their trends. It is shown that although the two countries are different in the sense of economic prosperity, they are comparable in many health indicators and generally speaking have healthy societies. Croatia lags in areas in which preventive measures could show positive results on the long run, such as smoking habits, culture of driving, and unfortunately breast, prostate and respiratory system cancers as well. However, Croatia generally has a lower incidence of tumors, as well as a lower rate of elective abortions and congenital malformations. As far as the organization of healthcare systems is concerned, both countries use a generally decentralized approach, however while Norway is divided into 4 regions, Croatia aligns its decentralization with 20 county organizations and the City of Zagreb. Both are welfare states and their citizens have universal healthcare access, although this is somewhat restricted in Croatia due to regressive healthcare financing as well as general economic instability and a lower socioeconomic standard of a significant part of the population.

Korištenje komplementarne i alternativne medicine rašireno je diljem svijeta. Proizvode komplementarne i alternativne medicine upotrebljavaju kako zdrave, tako i bolesne osobe. Međutim, svrha tih proizvoda je različita. Cilj ovog istraživanja bio je dobiti podatke o upotrebi komplementarne i alternativne medicine kod pacijenata oboljelih od onkoloških bolesti koji se liječe u Kliničkom bolničkom centru Zagreb, Klinici za onkologiju. Podijeljena su 144 upitnika, a odaziv je bio 92 %. Najveći broj ispitanika boluje od zloćudnih bolesti probavnog trakta (47,7 %) i zloćudnih bolesti urogenitalnih organa (19 %). 75,4 % ispitanika liječi se intravenskom kemoterapijom. Ukupno 45 ispitanika (35 %) koristi metode komplementarne i alternativne medicine u svom liječenju. Najzastupljenija metoda liječenja je liječenje lijekovitim biljem. Kao razlog korištenja komplementarne i alternativne medicine ispitanici najčešće navode da vjeruju da će im pomoći. Više od polovice ispitanika (57,8%) obavijestilo je svog liječnika onkologa da koriste metode komplementarne i alternativne medicine. I razlozi obavještavanja i razlozi neobaviještavanja liječnika onkologa o korištenju metoda komplementarne i alternativne medicine međusobno su slični, iz čega proizlazi potreba za cjelokupnom edukacijom zdravstvenih radnika, kao i osoba oboljelih od onkoloških bolesti, o dobrim i lošim učincima komplementarne i alternativne medicine., The use of complementary and alternative medicine is spread wide over the world. The products of complementary and alternative medicine are used by healthy and sick persons. However, the purpuose of those products are different. The aim of this research was to get informations about the use of complementary and alternative medicine by the patients with an oncology disease who are treated in the Clinical hospital center Zagreb, Clinic of oncology. Hundred forty-four questionnaires was shared, and the response was 92 %. The bigest number of the respondents is suffering from malignant diseases of the digestive tract (47,7 %), and the malignant diseases of the urogenital system (19 %). Even 75,4 % of the respondents is treated with intravenous chemotherapy. A total of 45 respondents (35 %) is using methods of complementary and alternative medicine in his treatment. The most common method of treating is treating with medicinally herbs. As a reason why they use complementary and alternative medicine, the responders mostly believe that it will help them. More then a half of the responders (57,8%) informed they oncologist about the use of complementary and alternative medicine treatments. The reason of informing and not informing they oncologist about the use of complementary and alternative methods of treatment are similar to each other, which implies the need for overall education of the medical staff, as well as the oncology patients, about the good and bad effects of complementary and alternative medicine.