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Croatia

Kardiologija (Croatia)


  • Proportionality information

    1. Have you examined whether the requirements under your national legal system are
    directly or indirectly discriminatory on the basis of nationality or residence?
       Yes, Croatia has examined the requirements under its national legal system and there were found no obstacles to exercising one's right to the profession on the basis of one's nationality or residence. 

    2. Which of the following overriding reasons relating to the general interest justifies the measure(s)?
         
    • Public health

    3. What specific risks or benefits have you identified that your measure(s) is designed to, respectively, minimise or maximise?

       Please try to be specific in describing the nature of the risks/benefits you have identified
       Where you have selected more than one overriding reason relating to the general interest in question 2 please be sure to address each of these in your response. Wherever possible please include evidence.

       The Croatian health care system is organized as a public service that takes care of the health of its population. Public services are provided through the prevention and protection of public health as well as curative health services. The quality of services provided (benefit) is increased by postgraduate education and lifelong education of medical doctors specialists. The most relevant measure prescribed in our legal system for the implementation of health care is qualification. This is a necessary and essential measure that requires the professional education of a doctor of medicine specialist and which should not be practiced under any circumstances by a person who does not have the professional title of doctor of medicine. Every doctor of medicine must be registered as a member of the Croatian Medical Chamber. The Chamber, a regulatory body that represents the rights and interests of health professionals, issues a valid license to perform the activities of a doctor of medicine certain branches of specialty. The license is issued for six years. During this period, each doctor of medicine specialist is obliged to improve his professional skills and collect a certain number of points if he wants to renew his license. When the six-year period expires, their license is automatically renewed if they have earned a certain number of points during that period. If they do not gain a certain number of points within the prescribed period, they must pass the exam prescribed by the Chamber. Risks are minimized by abolishing internships and simplifying administrative procedures for conducting medical practice. These measures have increased the employment of medical doctors specialists in the health system. Activities carried out with the aim of improving the health care of the population are preventive public health activities, which seek to raise awareness of caring for their own health. In addition, the implementation of such measures makes it possible to effectively identify the current public health needs of the population and anticipate future trends. This provides the preconditions for their effective management, with the basic goal of preserving and improving the health of the population.

    4. How specifically do your measures operate to minimise the risk(s) or maximise the benefit(s) identified in question 3?

       When addressing this question please try to explain how the measures prevent the risks or guarantee the benefits.
       Where you have selected more than one overriding reason relating to the general interest in question 2 please be sure to address each of these in your response. Wherever possible please include evidence.

       By setting high standards of medical education and training and ensuring that those standards are met, we ensure that those who qualify as doctors in Croatia are fit to practise the profession. Our registration and licensing requirements ensure that only those who are fit to practise medicine are able to enter the profession. From our national legal system we removed the obstacles in the form of a state exam and language requirements to exercise the profession.Main measures for minimizing the risks of violating measures identified in question 3 are fines and disciplinary procedure.

    5. In so far as you are able, please provide information that you have gathered regarding the concrete effects of the measure(s).

       For example, through impact assessments or information gathered during implementation or review of a measure. Member States who have recently undergone reforms may in particular be able to contribute helpfully to this field. Where you are able to provide cost-benefit analyses this would be particularly valuable.
       Information on whether the measures indeed successfully prevented risks from being realised (e.g. the number of sanctions imposed, a drop in transgressions since the measure was introduced or consequences from previous modifications of the regulation) would equally be helpful.
       Where you have selected more than one overriding reason relating to the general interest in question 2 please be sure to address each of these in your response. You may also wish to include evidence on consumer satisfaction or other measurements of the impact.

        Medicine, as a part of the public health system in Croatia, is an important link in solving public health problems and improving the situation in public health in the Republic of Croatia. The patient health care system in Croatia is good, and is implemented on the principles of comprehensiveness, continuity and accessibility. However, there is also room for improving health care (ensuring better accessibility to the population, renovating medical equipment), with the aim of increasing quality in the provision of health care. We regularly review how we carry out functions, which includes reviewing our standards on a regular basis and regulatory processes.According to EUROSTAT, the number of medical doctors per 100000 inhabitants in Croatia increased from 243 in 2003 to 303 in 2013.  The Ministry of Health issued an increased number of specialty trainings as follows: 270 in 2000, 324 in 2001, 377 in 2002, 545 in 2003, 553 in  2004, 437 in 2005, 466 in 2006, 578 in 2007, 399 in 2008, 268 in 2009, 391 in 2010, 441 in 2011, 479 in 2012, 400 in 2013, 540 in 2014, 611 in 2015.

    6. Is the general interest objective you indicated in question 2 pursued in a consistent and systematic manner?.

       In approaching your response to this question please consider examples where you have addressed similar risks for comparable professions, not necessarily within the same sector. Is the approach you have adopted in this particular profession comparable or distinct from such similar cases and why?

       General interest objective is pursued in a consistent and systematic manner because public health is regulated by law in Croatia specifically with Act of Health care and Act of medical practise. Those are the main acts which are important in regulation of medical profession, especially Act of medical practise in which are described main tasks that could be performed by doctor of medicine. The public health is protected because the health services are provided and conducted by a doctor of medicine specialist who is educated with acquired knowledge, skills and professional attitudes.  Specialty medical programs are competency based. From these reasons stated above, the public health system is protected.

    7. Please explain in how far the degree of complexity or the nature of the activities
    which are reserved justify that these activities can be exclusively performed by professionals possessing a specific professional qualification?

       For example: when the tasks are essentially of a straightforward nature (such as preparing and printing pay slips etc.), or involve essentially the execution of instructions, specific professional aptitudes should not be required.

       Knowledge and skills for such activities were acquired by a specialist doctor who graduated from the Faculty of Medicine and completed specialist training. During their education are a necessity and the same activities must not be performed by non-professionals. In healthcare, competence is essential. Only medical doctors with successfully completed specialist medical program lasting 4-6 years (Cardiology lasts 5 years) are qualified and allowed to provide specialty medical services.

    8. Where you have indicated several measures in place in the screening tab,
    have you reviewed the cumulative effect of all these measures on professional activities?

       If not, why not?
       If yes, please outline for us how you approached assessing this issue as well as the results and conclusions or any learning you drew from this. Where possible please include evidence.

       No, because all those measures have the same goal, which is a quality of medical care and competence of all health professionals.The Croatian healthcare system is a public service that maintains the health of its population. Public health system is oriented towards prevention and promotion of health.  

    9. Have you considered the use of alternative mechanisms to achieve your objective(s)?
         
    • Use of other existing measures/regulations

       Please briefly explain. Where you have selected more than one option, please be sure to address each of these in your response.

       Yes, we are considering using alternative mechanisms as follows: the membership in the professional chamber could be on a voluntary basis to remove parafiscal charges. 

    10. Conclusion

       Following your internal examination of this regulated profession, which of the following have you concluded?

    •    Improve current system (simplify guidance, remove burdensome aspects etc.)

       Explain where relevant:

       We consider improving the current system by removing parafiscal charges. 

    11. Any other comments?
       No comments.
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