The Medical Device Market: Croatia

The Republic of Croatia is located in South-eastern Europe and is bordered by Slovenia, Hungary, Serbia, Bosnia-Herzegovina and Montenegro. In 2008, the population stands at an estimated 4.4 million, of whom 17.6% are aged 65 or over. Once a prosperous part of Yugoslavia, Croatia was ravaged by fighting after declaring independence in 1991. The civil war which broke out between the Croats and the Serbian minority, who were later aided by the Serb dominated Yugoslav army, resulted in the country's economy plunging into chaos and the lucrative tourist trade collapsing. It also destroyed much of the infrastructure in the east of the country and created another problem as thousands of refugees massed, where towns and cities were destroyed.

Croatia has been able to resume talks with the EU regarding its accession prospects, following the arrest of the war crimes suspect General Ante Gotovina. It is hoping to become a member state by 2010. The government is aiming to bring the performance of the healthcare system into line with that of other EU member states through the National Health Strategy 2006-2011. Funding for healthcare in Croatia is principally through the compulsory health insurance system. It was introduced in 1993 and is operated by the Croatian Institute for Health Insurance (CIHI). The CIHI collects contributions from the working population and the government makes payments on behalf of those exempt, such as the elderly, the unemployed and dependants. The system has significantly reduced the number of unofficial payments made in the healthcare sector.

Given the lack of domestic production of medical devices in Croatia, the reforms of recent years have been lucrative for overseas suppliers; imports rose strongly after the fighting diminished in 1993, although they have fluctuated since, due to changing requirements under the various development projects the country has undertaken. Around 90% of the medical device market is supplied by imports. Germany, the USA and Italy were the leading suppliers in 2006, accounting for over 50% of imports. The value of imports has increased every year since 2001, which coincides with, but is not wholly attributable to, the expansion of the private sector. The general trend will continue to be upward, however, in this stable and relatively wealthy regional market.

Small purchases of medical equipment and supplies are usually made direct by hospitals and local health authorities. For larger items, a competitive tender is issued by the Institute for Health Insurance, which has an advisory panel to assess the requirements of the hospital sector. The appointment of a local distributor will therefore be essential, to navigate the tendering process and reach end-users throughout the country. A few larger companies, such as Astra or Drger, have established their own local subsidiaries.