Ombudswoman Requests Constitutional Review of the Mandatory Health Insurance Act Amendments
As previously announced, Ombudswoman Tena Šimonović Einwalter submitted a request for a constitutional review of certain provisions of the amendments to the Mandatory Health Insurance Act to the Constitutional Court last week. According to these provisions, some citizens are required to personally visit the Croatian Institute for Health Insurance every three months to maintain their health insurance coverage.
If one is to assume that these amendments were intended to determine the number of insured persons and prevent abuse, this could have been achieved in a different way. Personal visits every few months should not be the only means of verifying the citizens’ life circumstances in the 21st century. Moreover, no exceptions have been specified in the law, for example for the persons with mobility issues, and the law does not require the Croatian Institute for Health Insurance to issue decisions in cases in which the citizens health insurance is terminated due to failure to personally visit its offices on a quarterly basis, which is a precondition for the filing of an appeal.
The Ombudswoman emphasizes that all legislative solutions, in line with the principles of legal certainty and the rule of law, should be thoroughly planned out, clearly defined, and justified in advance, and the failure to take these steps cannot be compensated by subsequently allowing individual exceptions. When designing new legislative solutions, it is always necessary to consider the effects on different groups of citizens, not forgetting the most vulnerable.
Instead of the periodic personal visits, the Ministry of Health could have utilized data exchange between various public bodies and facilitated their stronger cooperation. For example, it would have been possible to enhance the cooperation between the Croatian Institute for Health Insurance and inspections and to use the records of the Ministry of Finance – Tax Administration (regarding tax residency) and the Ministry of the Interior (to control the status of Croatian citizens residing and working abroad without registering a change or cancellation of residence in Croatia).
This solution is problematic when it comes to individuals with mobility issues or those undergoing treatment in healthcare facilities, who therefore cannot appear at the Institute’s offices in person. An additional problem arises if they live in areas with no public transportation or with poorly organized transportation to the nearest Croatian Institute for Health Insurance office. Citizens in these situations will be at risk of being discriminated against based on disability, health condition, and financial status, and put in an unequal position before the law.
The issue of mandatory health insurance when it comes to students studying outside of Croatia and the European Union is currently unclear, even though the Republic of Croatia has a constitutional obligation to protect the youth, and it would thus make sense for the government to support young people pursuing education, to maintain a connection with them during their studies, and to then encourage their return to Croatia after completing their studies.
A particular problem lies in the fact that the Croatian Institute for Health Insurance currently does not have the obligation to issue decisions to citizens confirming their cancellation of health insurance unless they specifically request it. However, it is questionable how many of them will be aware of this possibility, and since it is not possible to file an appeal without a decision, they will, consequently, not be able to do so.
In her request for constitutional review the Ombudswoman proposed that the Constitutional Court issue a temporary suspension of the implementation of these provisions until a final decision is reached. Furthermore, given the various types of information available in the public domain regarding this topic, she proposed that the Constitutional Court decide on the matter based on a public debate in which representatives of the Ministry of Health, as the expert body responsible for the amendments to the Mandatory Health Insurance Act and of the Croatian Institute for Health Insurance, as the implementing body, would be invited to participate. This is particularly important taking into account the fact that the amendments to this piece of legislation failed to clearly define the intended objective and to specify whether less burdensome measures, such as data exchange between public bodies, were considered and, if so, why they were not chosen.
It should be noted that the Ombudswoman has been raising these issues even before the aforementioned law was sent to the parliamentary procedure.
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