It has been a year since the Ombudswoman, Tena Šimonović Einwalter, submitted a request to the Constitutional Court for a review of the constitutionality of a provision in the Mandatory Health Insurance Act. The provision in question requires certain citizens to appear in person at the Croatian Health Insurance Fund (HZZO) every three months in order to retain their health insurance coverage.

The Constitutional Court has not yet ruled on the request, and citizens continue to file complaints with the Ombudswoman, expressing feelings of injustice and inequality due to the loss of health insurance in extremely difficult life circumstances. Below are some of the most recent examples:

“Due to illness, I was unable to go to the HZZO and extend my mandatory health insurance. I am 100% disabled and dependent on therapy, and now I can’t obtain life-saving medication. I also can’t attend a mandatory check-up after a transplant next week, which could have serious, life-threatening consequences.”

“I live 25 kilometers from the nearest HZZO office. Buses run rarely, and during school holidays, hardly at all. That’s exactly why I lost my health insurance. I have small children, no one to look after them, and no means of transport. What am I supposed to do now without health coverage, with small children? It’s disgraceful!”

“His medication is essential for survival. He has no income and no valid health insurance card, and now he’s losing the right to a dignified life. Even though he submitted all his medical documentation, HZZO denied him access to basic health insurance because he was one day late in reporting. Isn’t the right to mandatory health insurance guaranteed to every citizen by the Constitution of the Republic of Croatia? Please help resolve his case!”

Complaints are submitted by individuals who are seriously or chronically ill, those with limited mobility or who require assistance to move, people from areas with limited public transportation, and students studying abroad. Mothers on maternity or parental leave have also contacted the Ombudswoman, reporting the loss of health insurance, which in turn led to the suspension of financial support from the maternity and parental benefit system.

A significant number of citizens reported not receiving any notification about this obligation and only discovered they had lost their health insurance by chance—when trying to collect necessary medication, arriving at a hospital for a procedure, or, in the case of mothers, when monthly payments were not received.

To date, there have been more than 120 complaints regarding this obligation, with 30 received this year alone, indicating that the issue persists while awaiting the Constitutional Court’s decision. This represents the largest number of individual complaints submitted to the Ombudswoman stemming from a single legislative amendment. Over the same period, HZZO has received 1,991 grievances for the same reason.

In the request submitted to the Constitutional Court at the end of June 2023, the Ombudswoman emphasized that the obligation violates the constitutional prohibition of discrimination and the Anti-Discrimination Act. Not all individuals are able to physically appear at HZZO offices—whether due to disability, health, or financial reasons, especially those living in remote areas far from the nearest HZZO branch. Their constitutional right to equality before the law is thereby compromised.

The Ombudswoman also stressed that this obligation and the manner in which it was introduced endangers other constitutional rights and guarantees, including the right to appeal, the right to leave the country and travel abroad, special protection for persons with disabilities, the right to health care and protection of youth, and equal access to education. In a supplemental request from September 2023, she additionally cited constitutional protections of motherhood, following numerous complaints from individuals receiving parental support.

It is important to note that the requirement to report in person to HZZO every three months was introduced by amendments to the Mandatory Health Insurance Act, which came into force on April 1, 2023. From the very beginning, even when the amendments were merely proposed in 2022, the Ombudswoman warned that such an obligation would have adverse effects on the most vulnerable citizens—and unfortunately, these concerns have materialized.

After raising potential issues early on—first with the competent ministry, then during public consultations, and later in a parliamentary debate before the relevant committee—the Ombudswoman submitted a request to the Constitutional Court to review the constitutionality of this provision. This was done to protect the rights of all citizens affected by this situation, including both those who filed complaints and those who did not, but are nevertheless suffering the consequences of this legislative change.

  • Key information for citizens who have lost their health insurance can be found
  • Further information about this issue and excerpts from citizen complaints can be found here (Ombudswoman’s 2023 Annual Report, Chapter: Right to Health, Subsection: Health Insurance).
  • The request for constitutional review of the provisions introduced by the amendments to the Mandatory Health Insurance Act, regarding the obligation to appear in person at HZZO, is available here (submitted June 29, 2023, with a supplement submitted September 4, 2023).