Legal Framework for Social
Medicine
Rosanda Mulić
October 2011
rosanda@pfst.hr
What is Social Medicine?
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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?
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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?
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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?
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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
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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
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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
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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
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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.
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Every individual must take care of their own health.
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No one shall endanger the health of others.
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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
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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.
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Compulsory Health Insurance Act
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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)
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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
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1. Right to health care,
2. Right to financial compensation.
Pension Insurance Act
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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
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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)
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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?
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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
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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)
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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.
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Act on the Protection of
Patient Rights
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The availability principle in the
protection of patient rights means equal
rights protection opportunities for all
patients in the Republic of Croatia.
Patient Rights
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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
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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.