1. Health Insurance for the Unemployed: The Croatian Experience
Sanja Crnković-Pozaić

2. Status prior to change of legal framework
Each student upon graduation or a person who lost their job registered within 30 days of the change in status at the Croatian Employment service (CES)
One of the main motives was to gain health insurance – no one missed it regardless of the motivation to seek and find employment
It as simply assumed that persons who are not working are unemployed
The result: it was impossible to differentiate between the unemployed and the inactive
The CES did not undertake any measures to identify the inactive registered unemployed since this would endanger the individuals’ constitutional right to have health insurance
In order to cater only for the unemployed or job-seekers it was necessary to decouple unemployment status from health insurance

3. How was this done and what were the immediate consequences?
The change of law in 2002 stated that claim of health insurance was contingent on registration with the Health insurance institute within a given period
This meant more administrative work for all individuals who changed status – they had to register with two government institutions and not one as before BUT they could choose not to register with CES
This was contrary to the efforts of government to establish one-stop-shop principles as well as creating a much heavier workload for the administration in the Croatian Health Institute
It took many years for this change to become accepted and still many individuals have not changed their behaviour and will not risk not registering at the CES even though they are not looking for work, e.g. young women who are starting families or laid off workers who are continuing to work on their family farms

4. Impact of the change
Extremely difficult to quantify for the following reasons:
Unemployment status guaranteed many other benefits other than health insurance, for example, free travel on local transport, subsidized legal advice, financial support for unemployed single mothers, (36 such small benefits in the City of Zagreb)
At a certain point the CES started providing the possibility for the unemployed to register with the Health insurance institute through them in – so it was an easier option for the beneficiaries
Some anecdotal evidence is surmised in the following view of one newly registered person: “I know that I will have health insurance anyway but you never know which additional benefits will accrue to me through the unemployment status, so I will just be on the safe side”. Later he used soft loans for self-employment and was proved right.

5. Impact continued….
The biggest effect of the change was not on the numbers of unemployed as such but on the ability of the CES to implement activation measures WITHOUT LOSS OF HEALTH INSURANCE for the registered individuals
This enabled the CES to introduce processes which assessed the actual status of the registered unemployed by checking for active job search, inactivity, work or self- employment, etc.
Over the years, this affected the behaviour of the unemployed in the direction of more active job search, taking more responsibility for labour market outcomes.

6. A possible new approach to health insurance
As a Constitutional right it should have treatment which is independent of economic activity status of individuals or the change therein
How can a right guaranteed to every citizen be treated as insurance against a certain contingency which is paid only by the employed?
In transition countries such a narrow fiscal base which is finally used by all is not sustainable in view of the rising costs of heath provision while making the cost of labour prohibitively high
Due to the high incidence of informal work – too many free lunches are being handed out
A new system of financing health provision which has the widest possible tax base on all economic transactions should be considered – and not only in the transition countries