Croatia: Employment opportunities for people with chronic diseases

  • Observatory: EurWORK
  • Topic:
  • Labour market policies,
  • Work organisation,
  • Disability and chronic disease,
  • Avalikud teenused,
  • Working conditions,
  • Social policies,
  • Published on: 20 November 2014



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Croatia
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Disclaimer: This information is made available as a service to the public but has not been edited by the European Foundation for the Improvement of Living and Working Conditions. The content is the responsibility of the authors.

In Croatia there is no single definition of persons with a chronic disease. Different systems use different terms, which sometimes results in minor or major practical problems. The Register of Persons with Disabilities is kept in Croatian National Institute of Public Health. Due to the demographic ageing of population (the average age is significantly increasing) the percentage of people with chronic disease has been slightly increasing during the last decade. The main problem of persons with chronic diseases is their lower level of employability that is accompanied by their lower education attainment and their lack of working experience.

Block 1: Concept, definitions, sources of information and methodological issues on chronic diseases and work from the national perspective

1.1. National definition of chronic disease

  • What definitions of “chronic diseases” in an employment context are used in your country?

In Croatia there is no single definition of persons with a chronic disease in an employment context. Different systems use different terms, which sometimes results in minor or major practical problems. Thus, for example, the social welfare system uses the concept of physically or mentally impaired persons; the education system uses the term children and youth with disabilities, while pension insurance system and employment use the term disabled persons.

According to a definition provided by the Law on Vocational Rehabilitation and Employment of Disabled Persons (OG 143/02, 43/05), a person with a disability is any person having a physical, sensory or mental impairment which results in a permanent or at least 12 months reduced ability to satisfy the personal needs of daily life. According to the UN Convention on the Rights of Persons with Disabilities, which Croatia is among the first countries to sign and ratify, disability is an evolving concept and that disability results from the interaction between persons with impairments and attitudinal and environmental barriers that hinders their full and effective participation in society on an equal basis with others. Speaking of people with disabilities is actually talking about people with physical disabilities, with chronic illnesses, with hearing impairments, with visual impairments, with intellectual disabilities and with multiple disabilities.

  • What are the sources of these definitions (legislation, statistical sources, administrative documents, social security/health insurance systems)?

Mentioned legislation on social welfare system, educational system, retirement and employment system. Furthermore, the Retirement Act and the Health Insurance at Work Act state what regulates injury at work in the Republic of Croatia.

  • What concrete chronic diseases are included in these national definitions?

Visual impairments, hearing impairments, impairments of voice communications, damage to the musculoskeletal system, damage to the central nervous system, peripheral nervous system, damage to other organs and organ systems (respiratory, circulatory, digestive, endocrine, skin and subcutaneous tissues and urogenital), mental retardation, autism, mental disorders and multiple impairments.

1.2. Information on national sources of statistical information dealing with the issue of chronic diseases and their relation to employment and working conditions

  • Are there national statistical sources (censuses, administrative registers, ad-hoc surveys on chronic diseases, working conditions surveys, other surveys, etc.) that analyse the issue of chronic diseases and their relation to employment and working condition? If so, identify them and provide information on the following issues (per identified information source if it is the case):

There are administrative registers kept by the Croatian National Institute of Public Health (Hrvatski zavod za javno zdravstvo). There are data only in Croatian on unemployed persons with disabilities (osobe s invaliditetom) that are registered by the Croatian Employment Service and the number of unemployed persons with disabilities that have been employed due to mediation by the Croatian Employment Service. Furthermore, Croatia participated in Labour Force ad-hoc module on “Health problems and employment” conducted in 2011, realised by Eurostat.

  • What is the official name of this statistical source (in national language and translation into English) and its responsible body?

Hrvatski zdravstveno-statistički ljetopis (Croatian Health Service Yearbook), responsible body is the Croatian National Institute of Public Health.

  • What definition of chronic disease is used?

The Act on Croatian Register of Persons with Disabilities (OG 64/01) prescribes the manner of collection, treatment and care confidentiality of the data with disabilities. The Register is kept in Croatian National Institute of Public Health, and began with work in 2002. According to this Act, "Disability is permanent restriction or loss of ability (resulting from an impairment) of some physical or mental activities appropriate to the age of the person and refers to ability to form complex activities and behaviours that are generally accepted as essential elements of everyday life."

  • What are the categories of chronic diseases surveyed/registered?

There are following statistical sources:

A person is asked:

“Do you work or you are unemployed?”

Next question is “What are your impairments?”

  • What is the methodology used to collect the data?

Information on the type of physical and/or mental impairment under this Act is submit to the Registry by primary care physician, specialist in school medicine and physician specialist in health care that has examined and/or treated a person with disabilities, and by relevant government bodies and Croatian Pension Insurance Institute. Data on the type of physical and/or mental impairment under this Act are collected according stipulated methodology for the Register on the legally prescribed forms from the various health organisations according the applicable regulations. Data of all deaths in the Republic of Croatia are collected from the National Bureau of Statistics.

  • What information is provided?

The general part of the Register includes general information on a person: name and surname, gender, social security number, place of birth, residence, place of residence, education, occupation, employment, marital status. A separate part of the Register includes information on the types of physical and mental impairments, including: visual impairment, hearing impairment, damage to speech and voice communications, damage to the musculoskeletal system, damage to the central nervous system, damage to the peripheral nervous system, damage to other organs and organ systems (respiratory, circulatory, digestive, endocrine, skin and subcutaneous tissues and urogenital), data on mental retardation, autism, mental disorders and multiple disabilities.

  • Other info (time frequency, origin of the info, etc.)

The data should be sent electronically or in writing form no later than 30 days after the completion of data processing. It is done constantly.

Block 2: Prevalence, recent evolution and effects of the problem of chronic diseases among workers and companies

2.1. People affected by chronic diseases and employment

According to the Census from 2011 Croatia has 4.3 million inhabitants. According to Benjak (2012) the percentage of people with chronic disease in the total population was 11.9% in 2010 or 512 thousand people. Due to the demographic ageing of population (the average age is significantly increasing) the percentage of people with chronic disease has been slightly increasing during the last decade. Thus, mentioned share increased from 9.7% or 417 thousands in 2001 (DZS, 2002) to 475 thousand in 2007 (Strnad et al, 2008) and 12.1% or 518 thousand people in 2012 (Benjak, 2013). In the Census 2011 there were no questions on chronic diseases.

  • What is the employment situation of people with chronic diseases in your country (% of people in employment/unemployment/inactivity that are affected by chronic diseases)?

Till recently there was no a special register of employed persons with disabilities, but it is estimated that about 40,000 people or 9.3% of persons with disabilities is employed (Hrvatski zavod za zapošljavanje, 2008, 2010). In 2013 special register of employed persons with disabilities has been established (although it does not include all employed persons with disabilities) and it shows that in Croatia there are 16,184 employed persons with disabilities, with the share of 65% males and 35% are women.According to the available data by the Croatian Employment Service (CES) there are around 6,000 registered unemployed persons with disabilities (of 58% are males and 42% are women). Mentioned numbers were 5996 in 2011 and 6212 in 2012. They represent around 2.5% of the total unemployed population.

  • Are certain chronic diseases associated to or more prevalent in certain economic sectors/occupations?

According to the information from the Croatian National Institute of Public Health there are more problems with musculoskeletal problems, invertebral disc disorders and dorsopathies by sales assistant and other persons that constantly stand on their jobs, as well as respiratory problems for persons in construction industry that work in dust conditions and with powder ingredients like cement.  

  • What are the typical employment trajectories of workers affected by chronic diseases? (entry/exit patterns)

For people with chronic diseases it is very hard to find a job, and if they find it is usually on the fixed-term contract., primarily because of their low educational attainment and employability. To increase the employability of people with chronic diseases, programmes of vocational rehabilitation and re-education are implemented through which participants acquire knowledge, expertise and skills in order to be more competitive when looking for a job. Vocational rehabilitation programmes are being implemented in Croatia, but there has been relatively little research on their effects. Bejaković et all (2013) in The Study on cost and benefits of vocational rehabilitation for persons with disabilities in Croatia prepared for the Fund for Vocational Rehabilitation and Employment of Persons with Disabilities calculated typical employment trajectories - cost effectiveness of different options of the professional (working) rehabilitation of people with disabilities and chronic diseases. With achievements of the right to work, persons with chronic diseases benefit in many ways. It gives them the possibility of emancipation by showing and confirming their own working capabilities, it helps them in improving their financial and social status, and finally, their work and activities positively influence on the society. Vocational rehabilitation helps people with disabilities in stable integration into the labour market and income generation. Public investment in vocational rehabilitation can accomplish significant tangible and intangible benefits, where it is crucial that participants have a permanent connection to the labour market.

  • What are the main difficulties/problems for people with chronic diseases to access or stay in the labour market?

According to Paun Jarallah (2008) the main problem of persons with chronic diseases is their lower level of employability that is accompanied by their lower education attainment and their lack of working experience. Around one-fifth of people with disabilities is without or has completed only primary school, nearly two-thirds had completed secondary school in duration of three years, one eighth finished high school education in duration of four-years, while only about 2% of persons with disabilities has attained tertiary education. Furthermore, many of them finished educational programmes for obsolete occupations, for instance in the field of textile and graphic art and/or have other occupations that are less in demand on the labour market. Finally, more than two-fifths are without work experience and are long-term unemployed.

  • What are the main difficulties/problems for enterprises with workers affected by chronic diseases? What solutions do enterprises adopt to deal with these workers affected by chronic diseases?

In Croatia the employment of persons with chronic diseases is regulated by the Vocational Rehabilitation and Employment of Disabled Persons (OG 143/02, 33/05). There are distinguished terms and conditions of employment under general regulations in the area of labour and employment and a special employment in a sheltered workshop or self-employment of people with disabilities which is focused on employment of persons with chronic diseases who are not employable under the general conditions. These provisions are vague and do not provide a precise definition of employment under the general or special conditions and their mutual relations. It is not clear what the special conditions are for people with disabilities in sheltered workshops. These definitions introduced considerable confusion. In that way sheltered workshops found themselves in an unfavourable position, because they de facto work on the open labour market and are in the same position with all other employers. In the process of implementation is a new quota system

  • Are there differences in the previously mentioned patterns by types of chronic diseases or groups of pathologies? are there differences according to age or gender.

Due to the economic crisis it looks like that male economic sectors (particularly building industry) suffered more than female sectors. Thus, the share of males in registered unemployment increased and also increased the share of males in all registered unemployment people with disabilities and/or chronic diseases. According to the age and gender, older persons and female workers are more cautious and respect the rules of safety at work (Ivic, see rererence in the further text). .

  • Is it possible to identify some changes in the previously mentioned patterns in recent years?, reasons for this and possible specific effects of the economic crisis

Mostly no, but there was significant decrease in the number of employees in the building industry that seriously suffered due to the economic crisis. .

2.2. Working conditions of employed people affected by chronic diseases

Exposure to risks and hazards is particularly present in the building sector, although situation in the last few years improved regarding H&S measures implemented at workplace level to avoid and palliate injuries. In the whole economy number of work injuries per year have been constantly around 16,000 injuries, 12,000 on the working place and 4,000 on the transport to and from the job.  According to the latest data by the Croatian Institute for Health Insurance in the publication Analiza_ozljeda_na_radu_2013 (The analysis of occupational injuries in 2013), in Croatia in 2013 there were 13,796 occupational injuries. The number of injuries was twice more often by male than by female. 18.5% of injuries happened on the way or return to the place of work. Of the 11,252 injuries that occurred at the workplace, 8197 or 72.85 % happened in the six economic sectors, namely: C - Manufacturing, G - Wholesale and retail trade; repair of motor vehicles and motorcycles , H - Transportation and storage , Q - Human health and social work activities, F - Construction and O - Public administration and defence; compulsory social insurance.

The mentioned reduction in 2013 could be attributed to additional incentives for occupational safety and better respect for the related laws (Vojak et all, 2013). The most common injuries that occurred in the workplace are dislocations, sprains and strains. Ptičar (2014) underlines that exposure to risks and hazards is more prevalent by shift work and particularly night work because the extreme fatigue and reduced functional abilities cause various damages of the cardiovascular, endocrine, gastroenterology and immune system as well as by functions of the central nervous system with negative effect on the function of sleep and wakefulness. Zavalić study from 2013 demonstrated that workers doing overtime experience stress more frequently than workers of the same age and sex not required to do overtime hours. Stress generated by overtime frequently causes insomnia; workers are more likely to experience heart infarction or stroke; workers suffer more often from higher blood pressure and diabetes type II, and are overweight or even obese. Also, they have higher levels of cholesterol and lipids in the blood. These workers experience, earlier than others, damage to the locomotor system, in particular to the cervical and/or lumbar regions of the spine. In addition, workers required to do overtime have unhealthy eating habits, and many smoke and consume alcohol. More frequently than other workers, they come to work even when suffering from health problems (presentism). All these factors contribute to earlier retirement which affects the quality of their lives and puts a financial strain on the state budget. The problem requires extra efforts on the part of the team responsible for health and safety at work. The author concludes that the workers should be educated on the harmful effects of overtime and should work together with the employer on the prevention of occupational diseases.

  • Reconciliation of working and non-working life: are people with chronic diseases allowed special conditions in terms of work-life balance, flexibility at work to cope with the diseases/attend treatment, ability to set their own working time arrangements, etc.?

With the aim to improve the process of employment of persons with chronic diseases, the Law on Social Welfare (OG 33/12) prescribes the service of professional support in carrying out work and employment, and professional support in the inclusion in the work process as a mean for improve and maintain work-life balance. Barišin et all (2011) results show that unemployed women with disabilities had a lower mean score on all health-related quality of life domains: psychological health, social relationships, environment, as well as on a separate item of self-assessed health than their employed counterparts. This disparity was not found only in the domain of physical health. The largest positive impact on life satisfaction in both groups was family. Thus, it can be concluded that disabled women are a particularly vulnerable population group, stressing the importance of employment and family as factors affecting their quality of life may help equalizing opportunities and upgrading the quality of their life.

  • Career and employment security: to which extent and how is the employment status of people with chronic diseases affected by their health situation?; is there an impact in their remuneration levels/conditions?; in what measure is there a repercussion on their employment security and working career?; are they allowed/forced to changes in their jobs?

Carrying out work under the Law on Social Welfare includes types of work that enable persons to retain already acquired knowledge and develops new capabilities, including satisfying work needs of beneficiaries. The services are provided by professionals from social welfare homes, religious communities, associations or other legal persons registered for social welfare activities in line with the Law, and the right to receive services is confirmed by the competent social welfare centre on the basis of a preliminary opinion of the service provider. In line with the measures and activities of the National Strategy for Equal Opportunities for Persons with Disabilities 2007-2015, the services of professional guidance are continually provided to persons with disabilities, regardless of their age, education level, and work status. Regarding the security on the job, according to the Labour Act, article 150, person with chronic diseases cannot be fired without the consent of Worker’s council. It is stipulated that an employer may take decisions only with the prior consent of the Worker’s council for dismissing a worker with an occupational disability, or the worker who is in immediate danger of disability and terminate the labour relation with disabled employee. Furthermore, according to the Labour Act, the Article 79 Dismissal in case of occupational inability to work or immediate danger of disability, the employer may dismiss a worker who has an occupational inability to work or who is in immediate danger of disability only with prior consent of the workers' council. The workers' council shall give consent to the employer to cancel a labour contract if the employer proves that he or she has done his or her very best to provide appropriate job to the worker referred to in paragraph 1 of this Article or if the employer proves that the worker has refused an offer to conclude a labour contract for the performance of job suited to his or her abilities in accordance with the expert opinion of the authorised person or body.

  • Skills development: in what measure have chronic diseases an impact in the access of workers to training activities promoted by the employer? Has the training anything to do with the disease situation?

During the years 2011-2013 in average 1800 persons with disabilities were included in the services of professional guidance. The Croatian Employment Service also includes, within the sphere of its regular activities, services of “early intervention” which aims to prevent early abandonment of the education system and consequently, social exclusion. The key characteristic of the Croatian model of professional guidance is the approach aimed at needs and possibilities of the beneficiaries with a goal of providing services to pupils with certain risk factors (pupils with health and learning difficulties, behavioural problems, etc.). Educational, psychological, medical and social aspects of target groups which have the greatest need for comprehensive services of professional guidance are assessed.

  • Are there any significant differences in these working conditions according to different groups of affected workers (type of disease, gender, age, sector, etc.)?

No, but it looks like that older workers are more careful and suffer less from the injuries at work. Thus, the number of injuries on the working place declines with the increase of workers age (Ivic, 2011).

Ivic, Lj. (2011) Ozljede na radu u Republici Hrvatskoj (Work Injuries in the Republic of Croatia – Safety Indicators), Sigurnost 53 (3) 261 – 269.

  • Are there any significant changes in recent years? Possible effects of the economic crisis on these situations, if any.

Despite the economic crisis and due to the better organisation and co-operation of all stakeholders, the number of employed persons with chronic diseases has increased from 954 in 2003 to 1465 in 2011 and 1278 in 2012 what is mostly caused by improved preparation of these persons for the labour market and employment (Croatian Employment Service, 2013, particularly pages 31-32) and realised public campaign. According to the PROGRESS project „Equality on the Croatian Labour Market“ finished in 2010 by the Croatian Employment Service and partner organisation, persons with disabilities and chronic diseases have been very often exposed to discrimination in employment. Employers often stated that they were not sufficiently and/or fully informed about the discrimination, and thus generally were not aware of errors that they have been doing in the selection process of potential candidates for employment. Due to public awareness campaign and activities of The Fund for Vocational Rehabilitation and Employment of Persons with Disabilities (FPREPD) in the society has been accepted that employees with disabilities but with some employability can be very productive when they are employed. There are also substantial social benefits mostly in the form of reductions in expenditures for various rights in the employment policy and social welfare, while employed persons with disabilities pay social security contributions and income tax. Even when these persons are employed co-financing payment is used for covering a certain part of their salary as well as for reducing the contribution from salary. The activities of FPREPD are continuously promoted, what results in significant increase of employers using incentives and thus the increased number of employed disabled persons. With a view to improving recognition of the status and enhancing of the public awareness on employment of persons with disabilities, the CES has recognizing the importance of education and exchange of experience of relevant stakeholders in the field of education, professional rehabilitation, employment and assistance to disabled persons, organized in 2008 the international symposium “Education and Employment of Disabled Persons: Experiences, New Trends”. The Symposium was aimed at acquiring comprehensive insight in the current status and conditions of disabled persons in the labour market, as well as exchange of experience of the leading national and foreign experts in this area.

Block 3: Policies and measures adopted by public and private agents to favour the employment situation and working conditions of people with chronic diseases

3.1. Description of main policy measures/initiatives developed by public authorities or social partners

With the aim to improve and further strengthen the protection of rights of persons with disabilities and children with developmental difficulties, the Croatian Government in 2006 has adopted the National Strategy for Equal Opportunities for Persons with Disabilities 2007-2015 (NSEOPD).

  • Objectives pursued (staying-in-work/return-to-work), support offered, activities carried out.

In the NSEOPD the approach to persons with chronic disease and disabilities is focused to active approach which implies commitment to enable, whenever possible and in the scope in which it is possible, persons with disabilities to control the conditions of their lives for themselves, also implying actions relating to their rehabilitation and employment. Also, the NSEOPD additionally defines other goals: to conduct indiscriminate policy in the area of work place and social  integration of persons with disabilities, that is, to promote their active participation in the area of professional rehabilitation, employment and work; to promote acquirement of knowledge, skills and habits necessary for the employment and staying employed; to promote employment of persons with disabilities on the open labour market by using measures of positive discrimination, to implement employment in protected environment, to conduct employment with support, to encourage alternative models of work, and to encourage employment in work centres (for persons who are not able to find work in the open market). Different implement measures of employment of disabled persons were realized through various types of self-employment; by carrying out particular crafts of service activities (promote the development of entrepreneurship of vulnerable groups). Promotion of integration and combating discrimination against persons being in unfavourable position in the labour market, measures for unemployed and employed disabled persons are carried out through five groups of activities: 1. Co-financing of the costs for adjustment of the working place and working conditions; 2. Co-financing of interest for special purpose loans for purchasing of machines, equipment, tools and appliances; 3. Compensation of the percentage of the wage due to the reduced performance of disabled person; 4. Co-financing of a portion of costs for personal assistant or occupational therapist for disabled person; 5. Three-months return of contributions calculated and paid for wages of employed disabled persons. In 2008 the incentives were used by 310 employers for 1,924 employed disabled persons. For comparison, in 2007 the incentives were disbursed to 114 employers for 862 employed disabled persons. The number of employed disabled persons for whose employment the employers are entitled to incentives amounted to 1,924 on December 31, 2008 (in 2007 the overall number of 862 disabled persons). The number of business entities entitled to FPREPD incentives to 310 (in 2007 the overall number of 114 business entities) at the end of 2008. The number of newly employed disabled persons for whom the employers used the incentives in 2008 amounted to 120; however the FPREPD disposes of no data on employment of disabled persons in cases when the employers have not used the FPREPD incentives. In 2010, 1 471 disabled persons participated in professional counselling activities carried out by the Croatian Employment Service (CES), of whom 458 persons received counselling through workshops. A total of 48 workshops adjusted to the needs of the disabled were held. Workshops on active job search for the unemployed with hearing impairment, organised by CES. Part of the active policy measures for co-financing employment implemented by the CES refers to encouraging the integration of persons in unfavourable position, such as the disabled, into the labour market. In addition to measures for co-financing employment, the CES encourages employment through measures for co-financing and financing education, as well as measures for inclusion into public works. In 2010, active employment policy measures implemented by the CES included 349 disabled persons, significantly more than in 2009, when only 146 disabled persons were included (Ministry of Social Policy and Youth, 2012, 2013). 

  • Specific target groups

All people with confirmed chronic disease and lower employability, like blind, deaf people and those with hard of hearing. Furthermore, according to Unemployed women with disabilities had a lower mean score on all health-related quality of life domains: psychological health, social relationships, environment, as well as on a separate item of self-assessed health than their employed counterparts. This disparity was not found only in the domain of physical health. The largest positive impact on life satisfaction in both groups was family. Thus, it can be concluded that disabled women are a particularly vulnerable population group, stressing the importance of employment and family as factors affecting their quality of life may help equalizing opportunities and upgrading the quality of their life

  • Financing of the measures

Through state budget and allocated outlays for employment.

  • Outcomes: major results/consequences of the measure on the improvement of working conditions of people with chronic diseases.

As mentioned, as a consequence of said measures and improved co-ordination between various stakeholders, the number of employed persons with chronic disease has increased.

  • Assessment (lessons learnt, future prospects)

Due to better organisation and co-ordination of various stakeholders positive effects of the increased employment of the people with chronic diseases are: facilitating realisation of daily activities and easier social inclusion, easing and improving family relationships, expanding the social network, positive effect on the mood, physical appearance and fitness, and personal understanding of own disease or disability and changing social perception and attitudes toward persons with disability.

  • Link to the identified measure/initiative

http://www.fond.hr

3.2. Examples of enterprises and/or collective agreements implementing initiatives or establishing clauses to support people with chronic diseases

The Croatian Employment Service (public) in cooperation with the URIHO (Institution for rehabilitation of disabled persons by professional rehabilitation and employment, 240 employees, public and private), City of Zagreb and Fund for Vocational Rehabilitation and Employment of Persons with Disabilities (public).

New models of professional rehabilitation – “Work centres” and “Virtual workshop”. This initiative was started in 2009 and is still ongoing. The initiative was designed in line with the measures and activities of the National Strategy for Equal Opportunities for Persons with Disabilities 2007-2015.  

The purpose was to develop new models for the employment of persons with disabilities as well as to create conditions for establishing 23 the regional centre for professional rehabilitation with the goal to enhance employment on the open labour market.

One quite positive and praiseworthy activity is the award "Key Difference": The award relates to the encouragement of gender equality, age equality, equality of people with disabilities and the equality of national minorities. The evaluation committee consists of representative of various bodies including Ombudsman for People with Disabilities, the Croatian Association of Employers, the Centre for Education, Counselling and Research - CESI, the Centre for Peace Studies, the Croatian Youth Network, the Association "Inkluzija" and other. The aim of the award was to recognise, promote and reward employers with positive practices in the inclusion of diversity in human resources, particularly people with chronic disease in the labour market.

There has been continued growth since 2007 of newly employed persons with disabilities from the CES unemployed persons records.

http://www.hzz.hr/default.aspx?id=11700

Commentary

Having in mind the inevitable ageing of the labour force, a trend in obesity, lack of (or at least insufficient) exercise and physical activity and overall fitness in the general population, it is likely that the presence and effects of chronic disease probably will intensify and worsen rather than improve in the medium-to long term period. One should be concerned that this will have adverse impact on the quality of working life of many Croatian workers, and that will cause the lowering productive capacity of the Croatian workforce.

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