This chapter provides an overview of Croatia’s disability and work capacity assessment system. It highlights that despite the system’s critical role in determining access to disability pension, social benefits and professional rehabilitation, assessments remain heavily medically oriented, inferring functioning from health conditions rather than measuring actual performance in daily life in line with current international consensus. The chapter identifies major challenges, including outdated medical criteria, insufficient consideration of mental health, and inconsistent definitions of work capacity across institutions. It concludes that Croatia requires a functioning‑based approach to disability assessment to ensure fairness, reduce administrative burden and better support labour market inclusion for people with disability.
Disability, Work and Inclusion in Croatia
Abstract
In Croatia, disability and work capacity assessments play a central role in determining access to services and financial benefits. Yet the current system is highly fragmented and overly medical. Long waiting times, inconsistent assessment practices, and outdated methodologies hinder timely support and reduce the likelihood that people receive the services needed for labour market inclusion.
The governance of disability and work capacity assessment is fragmented and inefficient. Multiple institutions request separate assessments for different rights, using overlapping forms and divergent definitions. Although the Institute for Disability Assessment, Professional Rehabilitation and Employment of Persons with Disabilities (ZOSI) serves as a single assessment body, stakeholders lack access to each other’s findings, creating duplication and inconsistent outcomes.
Long assessment procedures and rising backlogs delay access to benefits and services. Applications – particularly for social welfare benefits – have surged recently, partly due to policy changes. Despite increased output, ZOSI cannot keep pace with the applications, and waiting times have lengthened across all assessment types. This threatens individuals’ financial stability and undermines opportunities for early intervention and professional rehabilitation.
Staff shortages and frequent reassessments overburden the system. A lack of medical doctors limits ZOSI’s capacity, despite contracting external assessors. The number of cases per assessor has more than doubled over the past decade. High rates of reassessments – required even when conditions are unlikely to change – add unnecessary workload to the already large number of applications.
Assessment methodology relies heavily on an outdated medical model. Assessments are based primarily on medical documentation and percentage‑based impairment lists, which infer functioning from health conditions rather than evaluating an individual’s real‑life abilities, environment, and support needs. This approach is poorly suited to complex or fluctuating conditions and does not reflect the focus of the United Nations’ Convention on the Rights of Persons with Disabilities on functioning, participation and performance.
Mental health conditions are not adequately captured. Mental health is now one of the most common reasons for disability assessments, especially among young people and war veterans. Yet percentage tables underestimate their often very disabling impact, and requirements for permanence and completed treatment exclude many with fluctuating mental health conditions.
Different definitions of work capacity cause inconsistent decisions. The Pension Insurance Institute uses a detailed, permanence‑based definition for pension eligibility, whereas the Institute for Social Work relies on a broad, less precise interpretation – but both are referred to as work capacity assessments. This leads to divergent outcomes for the same person and confusion for applicants.
Disability assessment and work capacity assessment is sometimes used interchangeably in every-day life. However, in reality the two assessments differ in their approach and purpose. For the purpose of this report, it is important to define these two types of assessments and note some key differences.
The purpose of work capacity assessments is to determine an individual’s (remaining) ability to perform work-related tasks to assess whether the individual would be able start or return to work and the reasonable accommodations and professional rehabilitation they may need for this, and the potential right to work-related disability benefits, such a disability pension.
As opposed to this, disability assessments focus on limitations in functioning that an individual may experience in different domains of everyday life, for example in mobility, self-care, or communication. Such assessments are usually used to determine eligibility for different monetary benefits unrelated to a person’s employment status and various types of social and disability services.
In this report, these two terms are used in this meaning. Work capacity assessments are most important for the determination of entitlements to a disability pension, while disability assessments are the dominant eligibility requirement for all other purposes and entitlements.
Adequately assessing a person’s disability and work capacity is an important step towards better labour market integration of people with disability as it determines the eligibility for different services and benefits a person can receive which, in turn, can directly impact the likelihood of (re)entering the labour market. Disability benefits improve social inclusion but can provide incentives or disincentives for people seeking to take up work. Professional rehabilitation services play an important role in reskilling and upskilling and reasonable accommodation of work and workplaces make it possible for people with disability to carry out work they otherwise could not. Therefore, developing a good disability and work capacity assessment methodology and process is crucial for ensuring that everyone receives the necessary support for labour market reintegration in a timely manner. Involving all stakeholders that carry out disability and work capacity assessments or provide any rights to people with disability and ensuring smooth communication between them is crucial in this context. Developing a more harmonised assessment methodology would be key to ensure everyone is assessed in a comparable way and on an equal basis for the different rights available from different public institutions and to create a well-functioning governance system.
Currently the governance of disability assessments and associated rights is quite fragmented, with different disability or work capacity assessments being required for different rights provided by different institutions. ZOSI, the single assessment body, plays a key role in this field and in the labour market inclusion of people with disability in general by promoting the employment of people with disability through several activities including co‑operating with and providing incentives to employers, overseeing the employment quota for larger companies, supervising the professional rehabilitation centres and carrying out all the different disability and work capacity assessments currently in place in Croatia.
The different assessments are carried out by authorised experts employed by ZOSI who review medical and other documentation and issue a so-called “finding and opinion” with the results of the assessment. Each case must be reviewed by at least two experts, at least one medical doctor and at least one other specialist who can be a psychologist, a social worker, or an expert in the field of education and rehabilitation including speech therapists, educational rehabilitators, educational experts and social pedagogues. Each finding and opinion issued by ZOSI contains a general part which includes generic information about the applicant and a specific part which varies for each type of assessment and includes information specific to the type of request and the right to be granted.
Disability and work capacity assessments in Croatia have several purposes including determining an individual’s (i) physical, intellectual, sensory and/or mental impairment, (ii) functioning capacity, (iii) level of support required, and (iv) remaining work capacity. Nevertheless, all assessments rely heavily on medical documentation and the subjective opinion of assessors. In most cases the applicants are not assessed directly, and their level of functioning, required support or work capacity is inferred from their health condition and their medical record. For some assessments, the use of one of the following lists is required: 1) LIST I – List of damage to the organism, 2) LIST II – List of types and severity of disabilities – impairment of functioning capabilities, and 3) LIST III – List of the percentage of organism damage. These lists have a strong medical focus. Lists I and III assign percentages of physical impairment based on the health condition, or health conditions if more than one, whereas List II determines the severity of disability based on the level of functioning which is inferred mostly from the health condition.
ZOSI receives requests for disability or work capacity assessments from several stakeholders for the evaluation of different rights. Before the establishment of ZOSI, assessments were carried out by these stakeholders themselves. The main institutions requesting assessments are the following.
The Croatian Pension Insurance Institute [Hrvatski zavod za mirovinsko osiguranje] (HZMO) which is responsible for the implementation of policies in the field of pension insurance (HZMO, n.d.[1]). The HZMO can request the assessment of work capacity from ZOSI for employed people with disability. General Practitioners (GPs) play an important role in this process as they are the ones referring patients to the HZMO if, in the subjective opinion of the GP, the patient’s state of health justifies this or if a patient has been on sick leave for a duration of 12 months. When the patient is referred to the HZMO by a GP, the HZMO requests a work capacity assessment from ZOSI. ZOSI then carries out the work capacity assessment and issues a first instance finding and opinion.
As part of the work capacity assessment, the assessors review medical and other documentation, including a form filled out by the GP describing the applicant’s health condition in detail and a form filled out by the employer describing the worker’s job including their education level, workplace conditions and required physical and sensory abilities for the work. Based on these documents the assessors decide whether there is a permanent change in the person’s work capacity or not, and on the extent of the reduction of work capacity if applicable. In line with the Pension Insurance Act, they can conclude that there is:
1. no reduction of work capacity, if the reduction in work capacity is not permanent, or the person can still perform his or her job despite the damage to the organism, or if the reduction of work capacity is less than 50% compared to others with the same education level,
2. a reduction of work capacity, if there is a permanent reduction of work capacity by more than 50% for a person under the age of 55, but the person can be trained through professional rehabilitation to work in other jobs, for which the assessors provide guidance through indicating medical contraindications,
3. a partial loss of work ability, if there is a permanent reduction of work capacity by more than 50% and the person cannot be trained through professional rehabilitation to work in other jobs but he or she can work at least 70% in adapted jobs for which the assessors provide guidance through indicating medical contraindications,
4. a complete loss of work ability, if there is a permanent reduction of work capacity by more than 50% without remaining work ability.
It is important to note that the work capacity is always assessed in relation to the patient’s current job and education level. In the finding and opinion, assessors must provide information about the type of work that the person is able to perform, if applicable. The assessors do not normally suggest specific jobs the person is able to do, but rather provide general information about the types of jobs the person may or may not be able to do with their remaining work capacity through indicating contraindications based on medical information, for example in the case of hand damage, a person may not be able to work in a job that requires fine finger movement. In addition, assessors identify people who work in jobs with special conditions based on a rulebook which describes jobs with special conditions to suggest suitable jobs.
After issuing the finding and opinion, in the case of partial and complete loss of work capacity, ZOSI refers the case, along with all the medical and other documentation, for review to the Audit Commission of the Ministry of Labour, Pension System, Family and Social Policy [Ministarstvo rada, mirovinskoga sustava, obitelji i socijalne politike] (MRMSOSP). The Commission reviews the finding and opinion issued by ZOSI and either confirms it or disagrees with it. In the latter case the Commission provides ZOSI with comments and instructions and ZOSI must change the finding and opinion in line with these instructions. After the finalisation, the finding and opinion is returned to the HZMO to complete the administrative procedure.
A similar procedure is also carried out in the case of Croatian veterans from the Croatian War of Independence. The only difference between the procedures is that for war veterans the case file and the finding and opinion is submitted for review to a special Audit Commission of the Ministry of Croatian Veterans [Ministarstvo hrvatskih branitelja] (MHB) which establishes a percentage of disability at first instance with the cause of illness or injury stemming from participating in the Croatian War.
The Audit Commissions of MRMSOSP and MHB are also responsible for determining the timing of the next reassessment for each case to evaluate whether someone should continue to be eligible for the rights they receive. Reassessments are typically requested to take place between around six months and three years. The procedure for a reassessment is identical to the procedure for an initial assessment.
In addition to a work capacity assessment, the HZMO can also request from ZOSI assessments for the purposes of the determination of the percentage of physical impairment, the determination of length of insurance with an increased length of service and the evaluation of the right to a survivor’s pension. The former is based on List I (List of damage to the organism), except for Croatian war veterans for whom LIST III (List of the percentage of organism damage) is applied.
The Croatian Institute for Social Work [Hrvatski zavod za socijalni rad] (HZSR) can request an assessment from ZOSI to evaluate the rights of individuals for the benefits provided by the Inclusive Supplement Act and the Personal Assistance Act which require an impaired state of health, and the Social Welfare Act which provides a higher benefit if someone has an incapacity to work. As part of the assessment for requests from the HZSR, LIST II (List of severity and types of disability – impairment of functioning abilities) is used to determine the severity of the applicant’s disability and issue a corresponding finding and opinion. The list provides four categories of severity for different types of disabilities based on the impairment to functioning. It is important to note that the functioning impairment is based on the severity of the medical condition, which is determined through a high-level assessment of body functions and body structures based on the available medical documentation without directly examining the person. For each type of condition, the list suggests what kind of medical documentation can be submitted which can include a document assessing the applicant’s functioning, e.g. an assessment based on the Barthel Index1 for physical impairment, a report from an educational rehabilitator with a description of functioning for visual impairment, a report from a speech therapist with a description of the functioning status in communication for hearing impairment, etc. However, submitting such a document is not mandatory and there is no unified method or form used to assess functioning for all conditions. HZSR assessments also mention the work capacity of a person but as opposed to the procedure for the HZMO, in the case of the HZSR a person’s complete and partial loss of work capacity is not defined in detail and the reduction can also only be temporary. Assessments for the HZSR do not require a review and decision by the Audit Commission. Social welfare rights are granted for a predefined period after which beneficiaries must undergo a reassessment with ZOSI to assess whether they remain eligible for the rights granted initially.
The regional self-government units (counties), through their Administrative Departments for Health and Social Welfare, request assessments from ZOSI to assess the right to healthcare for uninsured people who are unable to live independently and cannot exercise this right on another basis. Furthermore, parents can also request through the counties’ Administrative Departments of Education, an assessment for the temporary exemption from enrolment in the first class of primary school for school-age children in case of a severe health condition which prevents the child from enrolling in primary education in a primary school, a health or rehabilitation institution, or at home. The exemption may be granted for a maximum of one year (Government of the Republic of Croatia, n.d.[2]). The assessment is similar to that of the requests from the HZSR, using the same form for the finding and opinion. Assessors use the List of severity and types of disability – impairment of functioning abilities (List II); there is no requirement for an audit process; and rights can be granted even in the case of temporary incapacity. Counties can also request an assessment to evaluate the rights of military and civilian victims of war, individuals who were wounded in the former state of Yugoslavia in the period from 1945 to 1991. For such requests ZOSI can assess the percentage of physical impairment, the degree of need for care and assistance from another person, the degree of orthopaedic allowance, inability to earn a living, and the need for a supplement to assist with home care.
The Croatian Health Insurance Fund [Hrvatski zavod za zdravstveno osiguranje] (HZZO) submits requests to ZOSI for the assessment of the rights for parents of a child with severe developmental difficulties who cannot independently perform activities appropriate to the child’s age and depends on the help of another person to perform everyday activities. The assessment includes the examination of medical documentation and issuance of a finding and opinion. Based on the results of the finding and opinion, the parent can be granted the right to take care leave and receive a cash benefit after maternity and/or parental leave up until age 8 of the child and the right to work part-time and receive a cash benefit with no age limit for the child (HZZO, n.d.[3]). In addition, the HZZO can also request an assessment for the transfer of rights to the other parent due to the serious illness of one of the parents significantly limiting or preventing the parent for a long time from performing parental care, or for the realisation of the rights of both parents for two or more children with severe developmental difficulties.
For all types of disability and work capacity assessments, individuals who do not agree with their finding and opinion can lodge an administrative appeal which leads to a review of all the medical and other documentation by ZOSI resulting in a second instance decision and a new finding and opinion. After this point a new administrative appeal is no longer possible, but individuals can dispute the decision, leading to a court proceeding which can confirm or reject the results of the assessment procedure.
The Croatian Employment Service [Hrvatski zavod za zapošljavanje] (HZZ) is responsible for the labour market integration of unemployed people including people with health conditions and disability. The HZZ cannot refer individuals for work capacity assessment to ZOSI but can also refer them directly to one of the four Professional Rehabilitation Centres (see more in Chapter 5, Section 5.3). The HZZ also operates the internal Register of unemployed people with disability (Box 2.2).
Croatia holds three different registers for people with disability:
1. The National Register of people with disability is operated by the Croatian Institute of Public Health [Hrvatski zavod za javno zdravstvo] (HZJZ) and includes all people who (i) during the expert examination, has been found to have at least one impairment from the List of Organismal Damages (List I) and at least Level 1 from the List of Severity and Type of Disability – impairment of functional abilities (List II), a child with developmental disabilities who has been diagnosed with a disability according to the regulations governing education and social welfare rights, a person who has acquired the status under the regulations regulating seniority with increased duration, and a person who has been diagnosed with a disability according to the regulations on Croatian veterans from the Croatian War of Independence, regulations on civilian victims of the Croatian War of Independence and regulations on the protection of military and civilian war invalids or (ii) have received a positive outcome after undergoing Service 1.1, a shorter version of the rehabilitation assessment of the level of work capacity (see more in 5.3.1), in one of the four professional rehabilitation centres. People with disability have to be admitted to the National Register to qualify for some professional rehabilitation services and for exercising the right to quota employment (as explained below in Sections 5.2.2 and 5.3.1.
2. The Register of employed people with disability is overseen by the HZMO and includes people from the National Register that are employed as part of the employment quota. It is the employers’ responsibility to add their employees into this register to signal their contribution to the quota. This register is used to monitor compliance with the employment quota and for the statistical monitoring of the employment rate of people with disability.
3. The Register of unemployed people with disability is operated by the HZZ and it is used for statistical monitoring purposes. Contrary to the first two registers, this is an internal HZZ register and not an official register mandated by law.
Source: Based on information provided by Croatian stakeholders.
The large majority of disability assessments conducted by ZOSI is for either the HZSR or the HZMO (Figure 2.1 and Figure 2.2). Other cases, including those for the HZZO and for the counties, make up a much smaller share of all assessments. The number of assessments for HZMO has slightly decreased in recent years, whereas the number of HZSR cases has significantly increased over time and especially in the past two years, explaining the overall increase, and now accounts for almost two‑thirds of all completed assessments.
Number of annual completed assessments by institution, 2019-2024
Note: HZSR: Croatian Institute for Social Work (Hrvatski zavod za socijalni rad); HZMO: Croatian Pension Insurance Institute (Hrvatski zavod za mirovinsko osiguranje), HZZO: Croatian Health Insurance Fund (Hrvatski zavod za zdravstveno osiguranje).
Source: OECD calculations based on data prepared by Ultima Labs.
Share of completed assessments by institution requesting the assessment, 2019 and 2024
Note: HZSR: Croatian Institute for Social Work (Hrvatski zavod za socijalni rad); HZMO: Croatian Pension Insurance Institute (Hrvatski zavod za mirovinsko osiguranje), HZZO: Croatian Health Insurance Fund (Hrvatski zavod za zdravstveno osiguranje).
Source: OECD calculations based on data prepared by Ultima Labs.
Disability and work capacity assessment is an important policy lever to ensure people with long-term health conditions or disabilities can access the right financial support and services, including professional rehabilitation services that facilitate their integration or return to the labour market. However, the current assessment methodology and procedure face several challenges which need to be addressed to improve the labour market inclusion of people with disability. Most of these challenges are shared between the different types of assessments for different institutions, suggesting that addressing them could be a key step towards a more harmonised system and approach.
2.2.1. The assessment procedure is too long threatening the return to the labour market
Recent legislative changes on the eligibility for certain benefits and the increase in the monetary amount of some benefits from the HZSR has caused a large increase in the number of applications for assessment received by ZOSI. The large increase is partially driven by a large number of veterans of the Croatian War of Independence, about 40 000 by early 2025, who have given up their veteran status and the related benefits to be able to claim HZSR benefits as these are more generous than some of the benefits the veterans were able to receive under their special system. Although the overall number of completed cases has also increased in recent years, this increase has not been enough to cover the continuous increase in applications over the past few years leading to a large and continuously increasing backlog of cases, as shown in Figure 2.3. The large and increasing backlog has also led to an increase for most people in the length of the period until a finding and opinion is issued (Figure 2.4). Although the backlog is driven by an increase in applications for HZSR benefits, waiting times have risen for assessments in other fields as well, even slightly more for HZMO cases than for HZSR cases (Figure 2.5). The current lengthy assessment procedure is problematic as it presents applicants with increasingly long waiting times for the required services and financial support threatening their livelihoods and reducing the likelihood for professional rehabilitation and a successful return to the labour market.
Unresolved cases and cumulative backlog of cases, disability and work capacity assessments, 2015-2024
Note: The number of unresolved cases is calculated as the number of received cases minus the number of completed cases in a given year. The number is negative in some years as in those years more cases were completed than received which means that the backlog has decreased for the next year.
Source: OECD calculations based on data from the Institute for Disability Assessment, Professional Rehabilitation and Employment of Persons with Disabilities.
Competed disability and work capacity assessments by duration, 2019-2024
Source: OECD calculations based on data prepared by Ultima Labs.
Assessments by duration and institution requesting the assessment, 2019 and 2024
Note: HZSR: Croatian Institute for Social Work (Hrvatski zavod za socijalni rad); HZMO: Croatian Pension Insurance Institute (Hrvatski zavod za mirovinsko osiguranje).
Source: OECD calculations based on data prepared by Ultima Labs.
A main reason behind the length of the disability assessment procedure is the fragmented governance of the entire system. ZOSI is responsible for the finding and opinion for many different institutions, as described above, however, the different assessment forms used in the process have many overlapping sections adding an unnecessary administrative burden for ZOSI and its assessors and lengthening the procedure and waiting time for applicants. In addition, the involvement of various stakeholders and the use of these different findings and opinions lead to communication difficulties. For example, each stakeholder receives the results of the finding and opinion for their own institution only, without necessarily having access to the results of the finding and opinion for other institutions for the same person, even if that information could be valuable for a full overview of the applicant’s situation, their conditions and abilities, and their needs for potential services.
ZOSI is currently aiming to resolve some of these issues by proposing the introduction of a “single finding and opinion” for all stakeholders, with all information about the assessment of certain rights being stored in one casefile. The information would be shared between the different institutions ensuring that access to information and communication between stakeholders is smoother, thereby reducing some of the administrative duplications. However, the wider impact on the average duration for ZOSI’s decision and on ZOSI’s assessment resources and capacity would remain to be seen.
The proposed new approach would require that, at the first application for any of the available benefits, an applicant would have to undergo all the assessments included in the single finding and opinion even if they only applied for one of the rights or benefits. Undergoing all assessments would not automatically mean applicants are granted all rights they would be eligible for based on the assessment as for each right applicants must meet other criteria as well (e.g. for a disability pension, the period of insurance years is also considered). Accordingly, the applicants would still need to apply separately for each right to the responsible bodies. If applicants apply for a different right at a later date, providing new medical information, they would need to undergo all assessments again.
The introduction of a single finding and opinion could be an important step towards improving and accelerating the communication between stakeholders, but it could add to ZOSI’s already considerable workload and further lengthen the assessment process and the waiting times. This makes a more harmonised approach and reducing the fragmentation of the assessment process even more urgent. Irrespective of the introduction of a single finding and opinion, there are other barriers in Croatia to harmonising different assessments, as described below, and additional reasons for the long assessment process, including the scarcity of assessing doctors and an unusually large number of reassessments.
The current regulation on the assessment procedure (Government of the Republic of Croatia, 2023[4]) determines that the council of experts carrying out the different assessments should consist of at least two people, at least one of them a medical doctor and at least one of them a social worker, a psychologist, or another professional. The lack of medical doctors in Croatia makes it difficult to find people for the council of experts to carry out disability and work capacity assessments. While the number of experts employed by ZOSI has remained relatively stable over the past decade, it is not enough to cover all applications. To respond to the fast-rising backlog, ZOSI has contracted additional external experts, with their number varying from year to year (Figure 2.6). Even with employed and externally contracted experts combined, however, ZOSI struggles to complete all applications, despite the workload of assessors having more than doubled in a decade (Figure 2.7). In addition, the population of medical doctors is ageing, suggesting this will become an even larger problem in the future, accelerating the lack of staff and therefore further increasing an already considerable backlog. A potential solution to this challenge could be introducing a disability assessment which does not always require the involvement of medical doctors.
Number of assessors employed and contracted by ZOSI, 2015-2024
Note: ZOSI: Institute for Disability Assessment, Professional Rehabilitation and Employment of Persons with Disabilities (Zavod za vještačenje, profesionalnu rehabilitaciju i zapošljavanje osoba s invaliditetom).
Source: OECD calculations based on data from the Institute for Disability Assessment, Professional Rehabilitation and Employment of Persons with Disabilities.
Annual number of cases of disability or work capacity assessments per assessor, 2015-2024
Source: OECD calculations based on data from the Institute for Disability Assessment, Professional Rehabilitation and Employment of Persons with Disabilities.
A large number of reassessments, unusually large in international comparison, also adds to the large backlog of cases and the large and increasing workload of ZOSI. The number of reassessments as a share of first-instance assessments is high across all institutions, and especially high in the field of social welfare (Figure 2.8). The reason behind the large number of reassessments lies in the regulation according to which every case must be reassessed in regular intervals, as determined by the Audit Committee for HZMO work capacity assessments or at the end of the originally granted period for HZSR benefits. Whilst this can be beneficial to ensure everyone still has the right to the service or the benefit they receive, it may be unnecessary in many cases as some disabilities and disadvantages will likely not change over time. Better targeting of regular reassessments on conditions with a high likelihood of improvement could reduce the number of reassessments to be conducted by ZOSI, without major implications otherwise, especially where a permanent incapacity has been established already in a previous assessment. This could ease the workload of ZOSI as well as reduce the burden on people with disability who must go through often unnecessary reassessments repeatedly. Interestingly, the number of reassessments was reduced slightly in 2023 and very sharply in 2024, without any change in the legal regulations. Most likely this reflects ZOSI’s capacity constraints, with first-instance cases taking priority due to the increasingly large backlog (Figure 2.8). It is unclear though whether this is due to postponing reassessments or conducting fewer reassessments altogether. In addition, the latest instructions from the MROSP to ZOSI in 2026 are that control assessments are not required for work capacity assessments.
Share of reassessments in first instance assessments by institution, 2019-2024
Note: HZSR: Croatian Institute for Social Work (Hrvatski zavod za socijalni rad); HZMO: Croatian Pension Insurance Institute (Hrvatski zavod za mirovinsko osiguranje).
Source: OECD calculations based on data prepared by Ultima Labs.
2.2.2. The assessments have an outdated medical approach
Although Croatia ratified the CRPD which promotes a functioning approach to disability assessment almost 20 years ago, disability and work capacity assessments used in Croatia today still have an overly medical focus. While most stakeholders have made a mental switch towards a stronger focus on participation and performance, the two main characteristics of functioning, this switch is not reflected enough in the way in which disability is being assessed. Using a medical approach is not only outdated but fails to account for individual differences overlooking what a person is able to do in their daily life. It is also not a way to measure the person’s true level of disability level and experience, which is mostly inferred from the health condition without sufficient attention to the person’s actual situation, and thus not a good measure of a person’s actual needs.
Current disability and work capacity assessment in Croatia puts a strong emphasis on reviewing medical documentation as well as using tables assigning percentages of disability to a health condition and determining or rather inferring the severity of disability and the level of functioning based on that medical condition. There are several disadvantages to this approach. First, a medical approach assigns a fixed severity and percentage of disability based on a health condition, with no attention to the actual disability experience of individuals with the same health condition, e.g. due to social and environmental factors such as age, support that is available to them and personal adaptation. Second, a medical approach fails to consider functioning impacts and, therefore, may underestimate or overestimate the resulting capacity to work, social participation and ability to perform daily activities. Third, a medical approach also tends to be rather inflexible and not adapted to complex or comorbid conditions and fluctuating illnesses. Finally, an assessment with a medical focus alone may not take medical advancements sufficiently into account and disregard that some health conditions which may have been severely disabling in the past may not be any longer, due to better medical treatment and rehabilitation.
State‑of-the‑art models of disability assessment based on the International Classification of Functioning, Disability and Health (ICF) promote a functioning approach considering physical, psychological and social factors but also the person’s social and physical environment and associated necessary adjustments as well as their condition’s impact on daily activities and tasks. Importantly, an ICF-based approach is already in place for an assessment for professional rehabilitation in Croatia (see section 5.3.1.), however, no such approach is currently used for ZOSI’s disability and work capacity assessments. Although the assessment for HZSR does consider functioning aspects, these are still strongly inferred from health conditions, or from body functions and body structures, and it is not even mandatory to submit any functioning information. Moving from a medical to a functioning approach would be crucial to align Croatia’s approach with the intention of the CRPD and ensure that people with disability receive the services and benefits that they really need.
Turning towards a state‑of-the‑art approach to disability assessment would require the abolishment of the use of Lists I, II and III as they embody all the disadvantages that a medical approach entails. Several OECD countries, such as Denmark or the Netherlands, have turned away from assigning percentages of disability based on health conditions and many others, such as Latvia and Italy, are moving in this direction. If the abolishment of these lists does not seem feasible now, lists I and III could at least be merged, as both assign percentages of disability based on health conditions; there is no reason why these percentages should be different between war veterans and the general population.
In addition, moving towards a functioning approach could reduce the involvement of medical doctors in the assessment process by giving a larger role in the process to social workers who are well placed to assess people’s life situation and disability experience and administer a questionnaire examining the functioning capacities of people with disability across all life domains.
2.2.3. Current assessments do not seem to take mental health sufficiently into account
Mental health conditions are often very prevalent although still highly stigmatised across OECD countries. In Croatia, mental health conditions are one of the most common conditions amongst disability benefit applicants with available data, accounting for a higher share of observations than other traditionally common diseases amongst disability claimants, such as diseases of the nervous and circulatory systems, and musculoskeletal diseases (Figure 2.9). It would be crucial that disability assessment is well-suited for mental health conditions, however, that is not currently the case in Croatia.
Applying a predominantly medical approach to disability and work capacity assessment and the use of percentage tables to determine the degree of disability underestimates the impact of mental health conditions which are increasingly important for disability determination today. For example, the tables currently in use as part of List I and List III that are used to determine the damage to the organism, grant around 20‑40% of disability to mental health conditions such as post-traumatic stress disorder (PTSD) or anxiety, even though these conditions can be very disabling. This is also crucially important for the special system for war veterans as 80% of veterans undergoing work capacity assessment now do so for mental health conditions many of which may arise only now, several decades after the War of Independence, but may still to a significant degree be a long-term consequence of the war.
Share of assessment cases by ICD10 code, 2024
Note: ICD10: International Classification of Diseases, Tenth Revision. Observations with ICD 10 code S and T (Injury, poisoning and certain other consequences of external causes) are not included in the calculation of the shares.
Source: OECD calculations based on data prepared by Ultima Labs.
In addition, as part of the current work capacity assessment for HZMO, a partially or fully reduced work capacity and eligibility to professional rehabilitation is only granted if the reduction in work capacity can be considered permanent. Yet again, this is particularly problematic in the case of many mental health conditions which are often temporary but recurring to a varying degree. ZOSI grants permanent status to certain mental health conditions if it can be proven that they are severe and have required hospitalisation multiple times in the past. However, people not meeting these criteria may still experience a very disabling mental health condition which can lead to an unstable job history and eventual exit from the labour market. For example, PTSD, which is often but not only experienced by veterans, may not disable individuals constantly but can temporarily incapacitate them very much under certain conditions. Finally, the condition of completed medical treatment, necessary to undergo a work capacity assessment, is difficult to establish in the case of many mental health conditions.
The requirements for condition permanence and treatment completion for the HZMO work capacity assessment and the medical approach used in all assessments make the system too rigid to capture the fluctuations in mental health conditions and consequently in the individual’s degree of disability. Introducing an assessment that looks at the true disability experience in a person’s life would be crucial for mental health conditions and could benefit certain groups especially, such as young people and war veterans who tend to have higher levels of certain mental health conditions than the rest of the population.
As shown in Figure 2.10, young people who undergo disability assessments at ZOSI more often tend to have mental health conditions than older people. Compared to other countries, the shares shown in this figure are relatively low, however, suggesting that this data is likely to significantly underestimate the real numbers of people applying with mental health conditions as such conditions are strongly stigmatised in Croatia. In several OECD countries, the number of disability benefit applications due to mental health conditions has increased very fast over recent years as these conditions became less stigmatised, and, especially among older applicants, have often replaced traditionally prevalent musculoskeletal diseases. Among younger applicants, the share of mental health conditions is typically around 50‑80% and among older applicants around and above one‑third. This is not yet the case in Croatia, but likely to happen in the future further highlighting the importance of using an assessment approach that is well-suited for mental health conditions to be well-prepared for the coming shift.
Share of observations with mental, behavioural and neurodevelopmental disorders (ICD10 code F) by age, 2024
Note: ICD10: International Classification of Diseases, 10th Revision.
Source: OECD calculations based on data prepared by Ultima Labs.
2.2.4. Use of different definitions of work capacity across institutions
In the current system, work capacity is assessed for the evaluation of rights from the HZMO and from the HZSR. However, what work capacity entails differs markedly for the two systems.
The requirements to receive a disability pension from the HZMO are set out in the Pension Insurance Act of 2023 which requires work capacity to be reduced by more than half compared to a healthy person with the same or similar education level which is permanent and irreversible by medical treatment (Government of the Republic of Croatia, 2023[5]). The ability to work is assessed against jobs that are mentally and physically appropriate for the person and that are similar to their previous job. For an employed person, the assessment is based on their current job, whereas for unemployed individuals it is based on their occupation or education. This assessment of work capacity relies somewhat on the assessors’ subjective interpretation but less than that of the HZSR, as the definition for work capacity is more comprehensive and takes into account various aspects such as the applicant’s current job and education level as well as the permanence and irreversibility of the incapacity.
The meaning and assessment of work capacity by the HZSR is very different. Rights from the HZSR are granted based on the Social Welfare Act of 2024, which does not provide a detailed definition of a partial or complete loss of work capacity and instead defines a person with partial work capacity as a person who received such an assessment during the expert assessment procedure (Government of the Republic of Croatia, 2024[6]). The loss of work capacity can be permanent or temporary as per the Act. This suggests that what is considered to be reduced work capacity for rights from the HZSR relies heavily on ZOSI’s assessors’ subjective opinion and experience.
Using two different definitions for reduced work capacity means that the same person may end up having different degrees of work capacity from the two systems which is confusing for the person and complicates the situation for assessors. The large difference in definitions is also reflected in the difference in the share of positive findings and opinions issued for the two work capacity assessments. HZSR work capacity assessments almost always result in a positive decision, whilst only about one in two cases receive a positive finding and opinion for HZMO, (Figure 2.11). Harmonising the definition and identification of work capacity seems indicated. However, as the two assessments do not have the same purpose, Croatia may want to consider reviewing how each assessment fits its purpose and adapt it accordingly. The aim of the assessment for HZMO is to determine a person’s eligibility for a disability pension and professional rehabilitation; this requires a well-defined and comprehensive work capacity assessment. The assessment for HZSR has its emphasis on a person’s ability to function in life; therefore, an assessment that measures the level of functioning, including at work, may be the most appropriate.
Share of first instance assessments with a positive outcome, 2019-2024
Note: HZSR: Croatian Institute for Social Work (Hrvatski zavod za socijalni rad); HZMO: Croatian Pension Insurance Institute (Hrvatski zavod za mirovinsko osiguranje).
Source: OECD calculations based on data prepared by Ultima Labs.
References
[6] Government of the Republic of Croatia (2024), Social Welfare Act, https://www.zakon.hr/z/222/Zakon-o-socijalnoj-skrbi (accessed on 21 March 2025).
[5] Government of the Republic of Croatia (2023), Pension Insurance Act, https://www.zakon.hr/z/91/Zakon-o-mirovinskom-osiguranju (accessed on 21 March 2025).
[4] Government of the Republic of Croatia (2023), “Regulation on expertise methodologies”, National newspapers [Narodne Novine] 96, pp. 1-58.
[2] Government of the Republic of Croatia (n.d.), Enrolment in the first grade, https://gov.hr/en/enrolment-in-the-first-grade/1006 (accessed on 21 March 2025).
[1] HZMO (n.d.), Activities and Organisation, https://www.mirovinsko.hr/en/activities-and-organisation/36 (accessed on 21 March 2025).
[3] HZZO (n.d.), Rodiljne i roditeljske potpore, https://hzzo.hr/rodiljne-i-roditeljske-potpore (accessed on 21 March 2025).
← 1. The Barthel Index is a tool used to measure functioning through ten activities of daily living. The tool was developed in 1965 for rehabilitation patients with stroke and other neuromuscular or musculoskeletal disorders.