For the next couple of weeks, I’m traveling in Europe with my family. Since I’m unwilling to keep up with AZ & US public health policy stuff, I thought I’d share some insights from the public health and health care systems in the countries I’m visiting. First up: Croatia.
Croatia’s Universal Health Care System
Croatia provides universal health care coverage via the Croatian Health Insurance Fund. The system is primarily funded through payroll contributions. Patients choose a primary care doctor who acts as a gatekeeper for specialty care.
Hospitals are public and private, but reimbursement comes mainly through the Croatian Health Insurance Fund. Many Croatians buy supplemental insurance to cover co-pays or get faster access to certain services, but no one is uninsured.
A Hybrid National – Regional Approach
The Croatia Ministry of Health sets the country’s public health policy. The Croatian Institute of Public Health runs national-level programs like vaccination, disease surveillance, and chronic disease monitoring. Each county also has its own public health institute, which oversees day-to-day work like restaurant inspections, environmental health, and school health.
Infectious disease outbreaks are tracked nationally by the national Institute of Public Health, which works with county institutes to implement testing, tracing, and vaccination campaigns.
Hospitals, Nursing Homes, & Child Care
Hospitals are licensed and regulated nationally through the Ministry of Health. Inspectors check for compliance with staffing requirements, infection control, and patient safety standards.
Nursing homes are regulated jointly by health and social welfare authorities, blending medical oversight with social service support. Childcare centers must meet standards set by the Ministries of Health and Education, with public health inspectors ensuring safe sanitation, food, and building conditions.
Food Safety and Restaurant Inspections
Croatia’s counties do restaurant inspections under national rules that are in sync with EU food safety standards (Croatia is in the EU). This includes monitoring kitchens, storage, and preparation areas. Restaurants must also follow the EU’s “farm to fork” policy, which requires traceability of ingredients from producers to plates.
Compared with the U.S., there’s less variation between regions since EU rules apply equally across member states.
Emergency Medical Services
Emergency medical services are run by counties but coordinated nationally. Ambulance networks extend to rural and island areas, which is important in a country with a long coastline.
EMS centers in Zagreb, Rijeka, Split, Osijek provide 24 h service as does more decentralized service at their 54 county health districts – with at least one to two EMS teams. In areas with 30,000 inhabitants, ambulance services are staffed by “on call” or “on duty” family physicians.
Physical Activity & Urban Planning
One striking difference between Croatia and the U.S. is the role of daily physical activity built into life. Croatian cities are far more walkable, with compact town centers, car-free pedestrian zones, and extensive bike paths.
Public policies at both the national and city level support walkability and cycling, from investing in sidewalks to expanding protected bike lanes. In smaller towns, the layout still reflects centuries-old planning—markets and schools are often within walking distance.
This urban design naturally builds in more purposeful physical activity. Where in the US driving is the default, in Croatia walking or biking is often the easiest way to get around. That has a measurable effect on obesity rates, which are much lower than in the U.S. Of course, the better food standards in the EU when compared to the US also plays a role.
Mental Health & Substance Use
Care for serious mental illness and behavioral health is integrated into the health system, though resources are more limited than in much of the EU.
Specialized psychiatric hospitals exist, and outpatient mental health services are covered. Substance use treatment, including programs for alcohol and opioids, is available through both hospitals and community clinics, with public health institutes playing a role in prevention.
Still, stigma is still a big barrier I’m told. Croatia is investing in community-based mental health care to reduce reliance on institutional treatment, following EU recommendations.
Alcohol consumption in Croatia is higher than in the U.S. Wine and beer are part of daily culture, and per capita alcohol intake is above the EU average. Public health campaigns have targeted youth drinking and binge drinking, but alcohol is still a significant health challenge.
Firearm Violence
When it comes to firearm violence, the gap between Croatia and the United States is striking. In the U.S., gun deaths remain a leading cause of premature mortality, with firearm homicide rates hovering around 5 to 6 per 100,000 people in recent years. Croatia, by contrast, reports only about 0.1 to 0.3 firearm homicides per 100,000 — an order of magnitude lower.
The reasons are fairly straightforward: America has far more guns (roughly one per person) while Croatia has far fewer (around 14 per 100 people). Add in tighter licensing and storage rules across the EU & you have a recipe for far fewer violent incidents involving firearms. In Croatia, homicides and suicides are far less likely to involve a gun at all, while in the U.S. firearms are central to both.
Incarceration Rates
The same kind of disparity shows up in incarceration. The US imprisons 541 people per 100,000 residents (one of the highest rates in the world) while Croatia incarcerates around 115 per 100,000.
The US locks up about five times as many people per capita as Croatia does. These differences reflect not just policy choices around criminal justice but also the underlying social drivers of violence. Inequality, community disinvestment, and easy access to firearms amplify violent crime in the U.S.
Health Outcomes Compared to the U.S.
- Obesity: About 25% of adults, compared to more than 40% in the U.S.
- Smoking: Around 25% of adults, much higher than in the U.S.
- Alcohol: Higher per capita intake than both France and the U.S.
- Life Expectancy: About 78 years, lower than Western Europe and slightly below the U.S.
The Role of the European Union
EU membership has had a good influence on Croatia’s public health. Food safety, chemical safety, and consumer protections are governed by EU-wide rules.
Additives and preservatives that are common in the U.S. are banned or restricted. The EU also sets reporting standards for infectious disease, requiring Croatia to share surveillance data with European networks.
Next week I’ll cover France’s health care and public health environment.
