Vili Beroš, Minister of Health : The health system is there for the patients

A resilient and sustainable health system is also a precondition for sustainable economy.

Healthcare system reform is not an issue that this Government and healthcare administration will use to raise media visibility, but an issue that will improve the healthcare system to the satisfaction of all patients and employees of that system, Minister of Health in the Government of the Republic of Croatia Vili Beroš told Diplomacy&Commerce. This is mostly proven by the amendments to the Law on Health Care and the Law on Mandatory Health Insurance, which are about to have their second reading in the Parliament, the Minister adds.

  1. In December, you presented to the Parliament a package of health laws key to health care reform, amendments to the law on health care and on mandatory health insurance. What are the goals of the reform?

In the past year, there was a lot of work on changes in healthcare related to analyses, making projections and creating legal and by-law bases, which were not “visible from the outside”. Now the results of that work and concrete changes in the system are coming to light.

We must be aware that the health system exists for the sake of patients, who oblige us to be guided by comprehensive and sustainable solutions. That is why the general goal of the reform is a sustainable healthcare system with the patient at the center. A resilient and sustainable healthcare system is also a prerequisite for a sustainable economy. We are also directed towards specific goals of the reform, such as strengthening public health, turning to prevention and early detection of diseases, strengthening primary health care, reorganization of hospital health care, investment in human resources in public health, focus on the quality of the system and health services, measurement and evaluation of treatment outcomes and the financial stability of the system. All of the above points to the determination of the Government and the Ministry of Health in creating and implementing a responsible health policy with an emphasis on strengthening public health and fiscal sustainability in changing and challenging demographic, business and economic circumstances.


  1. What is the deadline for implementation of the reforms and how satisfied are you with what is currently being done?

As we announced, we are implementing the healthcare reform in stages. We are currently in the second phase, which means that after the analysis of the situation, the mapping of health needs and the organization of health capacities in line with them, we are proceeding with the adoption of legislative acts and by-laws and the gradual implementation of changes through the health system.

However, we must also be aware that the current healthcare reform is being carried out in times that have never been more challenging, from the coronavirus pandemic, then earthquakes and reconstruction, to geopolitical realignments, financial market instability, inflationary pressures, which left its mark on the healthcare sector as well. We must recognize and be proud that our healthcare system has successfully responded and responds to the aforementioned challenges, but it is important to be aware of the existing context and manage those changes with quality, which means making gradual and sustainable reform strides. It is with such a responsible policy and in challenging circumstances that credit agencies have preserved their trust in the Croatian economy, and health care is a significant reason for this. The most recent example that shows this is the assessment of the Fitch bank, which raised the credit rating to BBB+ in its report, basing the assessment on our reform strides in healthcare.


  1. A large number of clinics and hospitals in Zagreb, but also in Banija, has been damaged in the earthquake. How is their restoration progressing and what does the speed of works depend on?

The dynamics of construction work in the healthcare system is accelerating. In connection with the Zagreb earthquake, 52 contracts were concluded on the allocation of non-refundable financial resources with a total value of EUR 374.9 million, of which EUR 145.1 million is financed from the European Union (EU) Solidarity Fund, and EUR 229.9 million is financed from the National Recovery and Resilience Plan (NPOO) and other sources. When it comes to the earthquake in Petrinja, 44 contracts with a total value of 204.1 million euros were concluded, of which 103.6 million euros are financed from the EU Solidarity Fund, and 100.5 million euros are financed from the National Economic and Social Development Fund and/or other sources.

We have to be aware that the renewal processes have a special weight in our department. The specificity of the renovation of health institutions, buildings that are often more than 50 years old, correlates with ensuring continuous access to health services during the renovation works. Therefore, evacuating the entire building in one take and immediately starting the work is not an option in the health care system.

The health system requires parallel processes:

  • directors, as the key project managers, are obliged to fulfill significant administrative prerequisites that European funds imply, and ultimately carry out the timely renovation of hospital institutions
  • at the same time, they are also responsible for providing adequate and timely health care to patients, which we witness through the reorganization of hospitals, which is a special challenge in a period of higher incidence of respiratory diseases

Also, the COVID-19 pandemic, the introduction of epidemiological measures and limited access to health institutions at the very beginning posed challenges to the health system during the assessment of damage to health institutions caused by the earthquake. Namely, the recording of the condition after the earthquake could not take place at the usual pace because the persons who were in charge of assessing the damage after the earthquake could not physically enter the health facilities for epidemiological reasons.

Considering the above, renovations in the health sector are very complex and extensive. Bringing historic buildings to a higher level of seismic resistance while simultaneously providing health care is truly a great challenge for our system in the process of restoration, and directors of the institutions are successfully coping with this. I would especially like to thank the health care institutions that have shown significant progress in the reconstruction so far and have shown that it can be done, and I would emphasize that it must be done! At the same time, with this example, we once again demonstrate the strength, flexibility and resilience of the health system in demanding situations, which we also demonstrated during the acute phases of the COVID-19 epidemic.

  1. Croatia is getting closer to realization of the strategic project of Helicopter Emergency Medical Service. When do you expect that project to come to life and how far has it come in its realization?

We have achieved important prerequisites for announcement of the public procurement procedure and the realization of full operation of the Helicopter Emergency Medical Service (HEMS), a strategic goal of the Government of the Republic of Croatia, by the beginning of 2024. Thanks to the contracted technical assistance of the European Commission (EC), with intensive cooperation of the Ministry of Health and consultants, considerable progress was made in the process of preparing the public procurement procedure. For the project with a total estimated value of 63 million euros, a market analysis, examples of good practices of other EU member states with recent experience in procuring HEMS services from civil operators, and a preliminary consultation procedure with interested economic entities have been carried out. In accordance with good European practice and public procurement procedure, before the call which is planned for the end of February 2023, an additional round of preliminary consultation with interested economic entities was announced in order to present to all market participants the minor changes and adjustments to the documentation resulting from previously collected comments from stakeholders who participated in the previous consultation. During the preparation of procurement documentation, special attention was paid to the need to establish HEMS in the shortest possible time, to adopting good practices from other EU member states, to the aspect of security and quality of service, as well as to geographical coverage of the entire territory of the Republic of Croatia within the framework of the golden hour standard for all patients. In parallel with the mentioned activities, intensive work is being done on securing and preparing the necessary infrastructure, personnel and medical equipment. In the context of the existing global challenges, the mentioned steps speak enough about the determination of this Government and the health administration as well as the EC in the implementation of this project.


  1. As the minister who was at the head of a key ministry during the COVID-19 pandemic, do you think now that everything that was done on this occasion was a good job, or would you change something?

Today, it seems that COVID-19 is something that is very close to us, but three years ago we were just getting to know this virus and the disease. Then, at the very beginning of the epidemic, we involved the entire profession, created a quick response to the first appearance of COVID-19 in Croatia, but we also looked towards the future. Proof of this is the formation of the Commission for post-COVID in the first 6 months of the epidemic, as well as the provision of a free vaccine against COVID-19 through the EC. There are many challenges behind us that we have overcome, but they also reminded us of the importance of respecting the profession and implementing prevention, which was founded by Dr Andrija Štampar, promoting health literacy and prevention not only in Croatia but throughout the world. Health literacy, prevention, an active role of each individual in the health system and public institutions in the function of health are precisely the focus of our reform measures. That all this is easy to achieve and do overnight – it is not. We need to be ready for gradual and long-term changes, which is what this Government and the health administration are aiming for. It is the only way to empower citizens to make good decisions in preserving their health and the health of their loved ones.

  1. What do you think is the biggest problem of Croatian healthcare, and what would you single out as something you are most proud of in a positive sense?

The COVID-19 epidemic was a challenge for us all, but also an opportunity for us to show our advantages which are often overlooked or taken for granted. It is precisely our health system that showed strength, flexibility and resistance of the health system during the epidemic and it continues to do so during the current reconstruction of health institutions for earthquake victims.  Our resilience in crisis situations has been recognized beyond the borders of Croatia, which we should be proud of, and not downplay it. Perhaps it is also a matter of our mentality, which at first does not recognize our achievements until they are recognized outside the borders of Croatia. And we truly do have them, from the excellence of our doctors, medical achievements, a more recent one is the National Program for Early Detection of Lung Cancer to the management of crisis situations and raising the credit rating on the basis of reform strides in healthcare. Of course, there is room for improvement, which I mentioned in my first address to the Parliament and which I am still doing today together with the Government and the health administration. We all agree that we need to improve the healthcare system, implement the necessary reform measures, but if we only criticize and find counter-arguments that something cannot be done, we will not get far. We can and must find solutions and answers to the many open questions of our healthcare together, in harmony with wishes, expectations, needs and possibilities. I believe that we are on the right track and that all stakeholders in the healthcare system will see that with further reform steps, we can achieve positive developments, both for the patients and for healthcare workers. I have no illusions that it is easy to achieve, but I have faith that the contribution of each of us in their workplace can make a shift for the better.