Legal Framework for Social Medicine Rosanda Mulić October 2011

What is Social Medicine? Social medicine looks at these interactions in a systematic way and seeks to understand how health, disease and social conditions are interrelated. This type of study began in earnest in the early 1800′s. It was the time of the Industrial Revolution and it was impossible to ignore the extent to which the factory system impoverished the workers, thus creating poverty and disease.

What is Social Medicine? The most famous representative of early social medicine is Rudolf Virchow, the distinguished German pathologist who developed the theory of cellular pathology. Virchow was also a social reformer who remarked that “politics is nothing more than medicine on a grand scale.” In the 20th century George Rosen would distill the Virchow’s principles into the following: Social and economic conditions profoundly impact health, disease and the practice of medicine. The health of the population is a matter of social concern. Society should promote health through both individual and social means.

What is Social Medicine? It is possible to argue that all medicine by its very nature is social. The way we define diseases and health, the methods we use for diagnosis and treatment, how we finance health care, all these cannot help but reflect the social environment in which medicine operates.

Why Legal Framework for Social Medicine in Medical School? all aspects of the practice of medicine, and healthcare more broadly, are affected by the law important for physicians to have an awareness of how the law affects them and their patients

Legal Framework in Croatia Health Care Act (NN150/2008) Compulsory Health Insurance Act (NN150/2008) Compulsory Pension Insurance Act (NN121/2010) Social Welfare Act (NN57/2011) Act on the Protection of Patient Rights (NN169/2004)

Health Care Act This Act regulates the measures and principles of healthcare, the rights and obligations of individuals when using healthcare, owners/institutions in charge of health in the society, the content and organizational forms of health care, and supervision over health care as a profession.

Health Care Health care within the meaning of this Act is a system of social, group and individual measures, services and activities aimed at preserving and improving health, disease prevention, early detection of illnesses, timely treatment, and care and rehabilitation.

Health Care Act Every person has the right to health care and the right to achieve the best possible health condition, in accordance with the provisions of this Act and the Act on Compulsory Health Insurance. Every individual must take care of their own health. No one shall endanger the health of others. In a case of emergency, every individual must provide first aid to the injured or ill person and access to emergency medical services (EMS).

Health Care Act The Republic of Croatia fulfils its rights, obligations, tasks and objectives in the field of health care by: – planning health care services and establishing a strategy of health care development – providing the legal basis necessary to meet health care objectives – encouraging healthy living habits with tax and economic policy measures – providing conditions for health awareness-raising in the population – ensuring the development of a health IT system in the Republic of Croatia, –

Health Care Act The Republic of Croatia fulfils its rights, obligations, tasks and objectives in the field of health care by: - facilitating the development of a telemedicine system in the Republic of Croatia – ensuring the development of scientific activities in the field of health care – providing conditions for the training and education of health care staff.

Compulsory Health Insurance Act This Act regulates compulsory health insurance in the Republic of Croatia, the scope of health care rights and other rights and obligations of persons with compulsory insurance according to the Act, the conditions and ways of claiming and financing such rights, as well as the rights and obligations of compulsory health insurance owner (institution), including the rights &obligations of contractual parties in charge of providing compulsory health care services.

Compulsory Health Insurance Act (NN /2008) The Croatian Institute for Health Insurance is in charge of providing compulsory health insurance. The rights under the compulsory health insurance are granted to all insured persons under equal conditions. Everyone who has a permanent address in the Republic of Croatia, and all foreign nationals with permanent stay permits in the Republic of Croatia must have compulsory health insurance according to one of the insurance bases prescribed by this Act, unless otherwise defined in an international treaty on social insurance.

COMPULSORY HEALTH INSURANCE – RIGHTS 1. Right to health care, 2. Right to financial compensation.

Pension Insurance Act The system of pension insurance in Croatia is made up of: 1) compulsory pension insurance based on generation solidarity 2) compulsory pension insurance based on individual capitalized savings 3) voluntary pension insurance based on individual capitalized savings.

Pension Insurance Act The following rights are mandatorily granted: 1) right to old age pension 2) early old age pension 3) disability pension 4) family pension 5) the lowest pension 6) basic pension 7) professional rehabilitation 8) compensation for bodily harm/injury 9) compensation of travel expenses related to the granting of insured rights.

Social Welfare Act (NN 57/2011) This Act regulates: - Social welfare activities - Social welfare planning and financing - Rights in the social welfare system and procedures for claiming such rights - Beneficiaries - Content and organizational forms of social welfare activities - Professional staff in social welfare - Role of professional chambers, databases and oversight - Other issues of importance for social welfare activities.

What is Social Welfare? Social welfare is: - An activity in the interest of the Republic of Croatia - Performed as a public service which ensures and implements measures and programmes aimed at socially disadvantaged persons and persons with an unfavourable personal or family condition - These programmes include assistance in meeting basic living needs and support to the individual, family and groups, in order to improve life quality and empower beneficiaries to independently sastify their basic needs and to actively participate and get involved in the society.

Act on the Protection of Patient Rights This Act prescribes the rights of patients when using health care and the ways of protecting and promoting patient rights The patient, within the meaning of this Act, is any person, ill or healthy, who demands or is provided with a measure or service aimed at preserving and improving their health, preventing illnesses, providing treatment or care and rehabilitation.

Act on the Protection of Patient Rights (NN 169/2004) In Croatia, patient rights protection is granted based on the principles of humaneness and availability.

Act on the Protection of Patient Rights The humaneness principle in patient rights protection is achieved by: – ensuring that all patients are respected as human behings, – ensuring rights to the physical and mental integrity of patients – protecting the patient’s personality, which includes respect for their privacy, points of view, and moral and religious beliefs.

Act on the Protection of Patient Rights The availability principle in the protection of patient rights means equal rights protection opportunities for all patients in the Republic of Croatia.

Patient Rights Patient right to co-decide includes the right to be informed and the right to accept or decline a diagnostic or therapeutic procedure.

Patient Rights Protecting patients involved in scientific research: - The explicit consent of an informed patient is required if a patient is to be studied or reasearched for scientific purposes and included in medical lessons.