Towards a Functioning-Based Disability Assessment: Croatia's Path to Fairness and Early Intervention

• Analytics of the disability landscape
• Contrast with current practice across institutions
• Cause and effect of reform pathways
• Expert reconstruction and policy roadmap

Croatia has made notable progress in disability policy over the last decades, expanding financial supports and strengthening institutional foundations for assessment, rehabilitation and employment promotion. Yet people with disability remain among the most disadvantaged groups in Croatian society. Poverty rates are high, employment outcomes are poor, and educational attainment remains low for people with disability. The gaps between disabled and non-disabled populations are large by European standards and have widened in the past decade, signaling deep structural barriers and insufficient early support. The central question is how to translate policy gains into fairer, more effective support that helps people with disabilities participate in work and life on equal terms. A functioning-based disability assessment sits at the heart of this reform, yet it requires careful design and broad system reform to deliver results.

The core bottleneck is not the absence of good intentions but fragmentation. A decade ago Croatia established a single assessment body, the Institute for Disability Assessment, Professional Rehabilitation and Employment of Persons with Disabilities (ZOSI). In practice, however, assessments across the Pension Insurance Institute, the Institute for Social Work, the Health Insurance Institute, and the counties continue to rely on separate processes, different definitions, and overlapping forms. These parallel procedures lean heavily on medical documentation and impairment-based percentage scales rather than on people’s actual level of functioning as experienced in daily life. This misalignment creates delays, inconsistent outcomes, and unfair access to financial support and services. The study of reform options must therefore address both the instrument (the assessment tool) and the system (how assessments feed into benefits and services). A guiding principle is that functioning must be measured directly using validated tools, not inferred from health conditions alone. This aligns with the International Classification of Functioning, Disability and Health (ICF) and with the UN Convention on the Rights of Persons with Disabilities (CRPD) framework that Croatia has already endorsed.

To navigate toward a more functional, fair and efficient system, the article argues for a two-pronged reform: (1) adopt a validated functioning-based instrument that can be used across sectors and strengthen early intervention; (2) reform governance, data architecture and process design so that assessment outcomes translate promptly into meaningful supports. The World Health Organization Disability Assessment Schedule (WHODAS) emerges as a practical candidate because it is internationally validated, covers six life domains, yields a transparent 0–100 metric, and can be integrated with existing medical evidence if desired. A shift to WHODAS would complement work capacity assessment processes that currently rely heavily on medical criteria and discretionary judgments by assessors, while enabling trained non-medical professionals to conduct structured interviews and reduce staff bottlenecks at ZOSI.

Analytics of the disability landscape: why a functioning-based approach matters

The essential analytic claim is simple: measuring what people can do in real life is more predictive of their needs and outcomes than counting impairments alone. The current diagnosis-driven model often misclassifies people’s abilities, leading to misaligned benefits and gaps in service delivery. On paper, the system has matured, but in practice it remains tuned to medical pathology rather than functional competence. This misalignment explains why employment and educational attainment remain stubbornly low among people with disability and why poverty persists as a persistent correlate of disability. The logical pivot is to re-anchor assessments in functioning, not solely in health status, and to connect those assessments to timely, appropriate interventions.

Implementing a functioning-based disability assessment hinges on robust psychometric design, clear links between measured functioning and policy outcomes, and disciplined governance. Without these, new tools risk becoming another layer of paperwork that looks impressive but delivers little practical benefit. The international experience warns that functioning measures must be validated, reliable, and transparent, with defined decision rules that minimize assessor discretion. Croatia can learn from those systems that moved toward functioning-based assessment through long-term reform, careful piloting, and ongoing evaluation. The core advantage is fairness: when functioning is assessed directly, people are less subject to the vagaries of doctors’ judgments or administrative bottlenecks and more likely to receive timely rehabilitation and work support.

In practice, a functioning-based framework should be grounded in the ICF model, which distinguishes activity limitations from participation restrictions and situates disability in real-world contexts. This perspective supports an integrated data architecture that links functioning data with medical evidence, rehabilitation records, and employment outcomes. The result is a more coherent understanding of trajectories—from sickness absence to return to work, to long-term employment stability. The step is not merely technical; it reframes policy goals toward early identification, proactive support, and sustained labour market engagement, particularly for those at risk of long-term detachment.

WHODAS offers a practical instrument to operationalize this shift. In pilot studies across ten countries, WHODAS has shown to capture disability experiences more accurately than diagnosis alone, is feasible to administer within a short time frame, and contributes to fairer decision making. For Croatia, adopting WHODAS could standardize assessments across sectors, facilitate data sharing, and reduce variability in outcomes arising from differing institutional practices. In addition, WHODAS can be implemented in a modular way, enabling phased rollout and continuous evaluation as part of broader reform. The risk, of course, is choosing or adapting a tool without sufficient psychometric backing, which would undermine trust and undermine the reform’s legitimacy. A rigorous piloting phase with independent evaluation would help mitigate that risk.

Beyond the instrument, the upgrade must address staffing and process design. A functioning-based system would enable trained non-medical professionals to conduct structured interviews, easing ZOSI’s workload and reducing dependence on medical doctors who are in short supply. The capacity implications are meaningful: a more efficient assessment workforce can shorten waiting times, expedite rehabilitation referrals, and improve the speed with which people gain access to financial support and services. In a broader sense, this is not a technical replacement but a reconfiguration of roles where clinical judgment informs, but does not dominate, the determination of need and entitlement.

Contrast with current practice across institutions

The Croatian landscape features multiple institutions still operating with overlapping mandates and divergent assessment criteria. The Pension Insurance Institute, the Institute for Social Work, the Health Insurance Institute, and the counties each maintain separate assessment streams, with inconsistent definitions and fragmented data. This fragmentation creates artificial silos that impede early intervention, complicate eligibility rules, and slow down the return-to-work process. The result is inefficiency, inconsistent outcomes, and greater uncertainty for individuals navigating the system. The contrast with a functioning-based framework is stark: a unified, functioning-centered assessment could harmonize criteria, streamline decisions, and align benefits with actual daily living needs rather than with episodic health conditions.

In line with CRPD and ICF principles, a functioning-based system would emphasize direct measurement of capabilities, supported by validated tools and standardized procedures. This would reduce the discretion currently exercised by individual assessors when they interpret medical information. The risk in Croatia’s current path is the temptation to develop new, nonrobust national tools that appear comprehensive but lack scientific validity, transparency or reliability. International experience shows that success depends on disciplined governance, clear measurement links to outcomes, and evidence-based refinement through pilots and evaluations. Croatia should resist the lure of rapid, superficial reform and instead pursue measured, scientifically grounded changes that can be scaled over time.

Mental health remains a weak point in the current system. Assessment processes for mental health conditions are often less developed than for physical disabilities, leading to inconsistent support and delayed rehabilitation referrals. A functioning-based approach would require mental health functioning to be explicitly incorporated into assessment protocols, with appropriate training for evaluators and integration with psychiatric services, social work, and employment services. This is not a marginal adjustment; it is a redefinition of what counts as need and how resources are allocated to address it fairly and effectively.

Practical reform also hinges on workforce strategy. The Croatian context includes staff shortages, particularly among clinical professionals and rehabilitation specialists. By enabling trained non-medical assessors to conduct structured interviews under a robust, validated framework, the system can maintain quality while expanding reach. This does not eliminate professional expertise but optimizes it by aligning expertise with what is most informative for decision-making—functional capacity in real-world settings—and by reducing avoidable bottlenecks. A functioning-based approach thus serves both fairness and efficiency.

Cause and effect: how reform can reshape trajectories

The causal logic is clear: when sick leave becomes a protracted, unchecked period without structured return-to-work support, labour market detachment increases and chances of long-term dependence on welfare rise. The sickness benefit system in Croatia provides income protection but does not guarantee a guided, timely path back to work or to professional rehabilitation when needed. Without early evaluation (no later than three months) and coordinated action among ZOSI, the Health Insurance Institute, and employers, workers drift toward permanent exit from the labour market. Reforming this process is not merely administrative; it changes incentives for all actors—workers, employers, clinicians, and service providers.

Reform requires expanding the responsibilities of key stakeholders. ZOSI and the Health Insurance Institute should share responsibility for timely assessment and appropriate rehabilitation referrals. Employers must participate through workplace adjustments, flexible return-to-work arrangements, and structured coordination with employees and health professionals. The Croatian Employment Service (CES) already plays a pivotal role in identifying unemployed people with health conditions and directing them to rehabilitation when appropriate; expanding its capacity and aligning its referral rules with early intervention can dramatically shorten detachment periods. This shift is actionable only if the data architecture supports integrated monitoring and evaluation.

Unemployed individuals with health barriers are particularly at risk of late identification. Early referral to professional rehabilitation, broader training opportunities, and more flexible eligibility rules can dramatically increase outreach and impact. The current system’s data dispersion across institutions makes it difficult to trace trajectories or assess reform effectiveness. A robust, integrated disability data system would connect ZOSI, pension, health insurance, welfare, and employment services, enabling accurate tracking of pathways from sick leave to rehabilitation to labor market return. Without such data fusion, policy evaluation remains speculative and reforms risk losing momentum.

Evaluation must be built into reform design from the outset. Transparent dissemination of results, independent audits, and iterative refinement are necessary to establish trust and ensure that reforms produce the intended outcomes. The central policy question is whether the new functioning-based framework, supplemented by WHODAS and a stronger early intervention system, translates into measurable improvements in labour market outcomes, educational attainment, and poverty reduction for people with disability. The evidence from international experience underscores the importance of long-term commitment, pilot testing, and rigorous measurement to avoid early overclaims and to build a credible reform trajectory.

Expert reconstruction: a policy roadmap to implement functioning-based disability assessment

The recommended roadmap rests on four pillars: a unified assessment body, validated functioning-based measurement, strengthened early intervention, and a robust data architecture. Each pillar reinforces the others and should be implemented in a staged, evidence-driven sequence.

• Unified assessment framework: Consolidate assessment criteria across ZOSI, the Pension Insurance Institute, the Institute for Social Work, and the Health Insurance Institute into a single functioning-based standard anchored in the ICF. Harmonize definitions of capacity, activity, and participation to remove cross-institution conflicts and ensure consistent outcomes for benefits and services.
• Adopt WHODAS as the core instrument: Use WHODAS as the primary tool for measuring functioning, complemented by medical information when necessary. Ensure psychometric robustness, standardised administration, and clear decision rules that minimize assessor discretion while preserving clinical nuance where needed.
• Strengthen early intervention and rehabilitation: Pair assessment reform with rapid referral pathways to professional rehabilitation and to CES pathways that support return-to-work planning. Expand eligibility and service capacity, enable flexible pathways, and integrate gradual return-to-work arrangements with workplace accommodations.
• Build an integrated disability data system: Create a centralized data architecture that links ZOSI, pension, health insurance, social welfare, and employment services. Use this system to monitor trajectories, evaluate policy changes, and publish transparent outcomes to inform continual improvement.

Implementation should proceed with careful piloting, ongoing evaluation, and transparent learning. The risks of moving too quickly with untested tools or with a fragmented rollout are real: they can generate false confidence, erode trust, and undermine the reform’s legitimacy. Croatia’s advantages—strong professional rehabilitation networks, commitment to CRPD principles, and existing data streams—provide a solid base for a cautious, evidence-driven reform that emphasizes functioning as the core metric of need and entitlement.

To ensure momentum and legitimacy, the reform process should emphasize stakeholder engagement, including disabled people’s organizations, employers, unions, clinicians, and service providers. Communication should focus on the practical benefits: faster access to rehabilitation, clearer return-to-work pathways, and more predictable outcomes. The result would be a system where disability does not equate to exclusion from work but rather to timely, adequate support that enables sustained participation in the economy and society.

Ultimately, Croatia has an opportunity to modernize its disability system by combining a functioning-based assessment with strong rehabilitation and a robust data backbone. The path forward involves disciplined reform, careful measurement, and steady investment in capacity. If implemented with rigor, the country can reduce fragmentation, strengthen early intervention, and move toward a more inclusive future where disability does not determine life chances but rather is addressed through effective supports and opportunities.

In sum, the shift to a functioning-based disability assessment anchored in WHODAS, complemented by integrated data and a reinforced early intervention framework, offers a credible path to greater equity and economic participation for people with disabilities in Croatia. The building blocks exist; the decisive step is to translate them into a coherent, measurable reform that persists beyond political cycles and delivers tangible outcomes for those who need it most.

Key takeaways for policymakers and practitioners include the following:

• The need to replace fragmented, diagnostic-centric assessments with a unified, functioning-based framework anchored in ICF and CRPD principles.
• Adoption of WHODAS as the central measuring tool to ensure comparability, fairness, and reliability across institutions.
• Strengthening early intervention and professional rehabilitation to shorten sick leave durations and prevent long-term detachment from the labor market.
• Building a linked data infrastructure to monitor trajectories, evaluate reforms, and inform ongoing improvements.
• Ensuring transparent evaluation and inclusive stakeholder engagement to sustain reform and build public trust.

With these elements in place, Croatia could move to a disability system that is less about categorizing limitations and more about enabling functioning, participation, and meaningful work for all citizens.

What is a functioning-based disability assessment and why does it matter?

In plain terms, a functioning-based assessment looks at what a person can actually do in daily life, across activities and participation in work and social life, rather than focusing only on a diagnosis or impairment count. This matters because it improves fairness, speeds up access to rehabilitation, and aligns supports with real needs, which helps people return to work sooner and remain engaged in society. It also creates a common standard across institutions, reducing inconsistent decisions that arise from medical-focused criteria. Overall, it supports better outcomes and clearer accountability for service providers.

Analytically, this approach is linked to outcomes data, such as return-to-work rates and educational attainment, and it supports a more integrated disability system by reducing variability in entitlement decisions.

How would WHODAS be used in Croatia’s reform?

The plan is to adopt WHODAS 2.0 as the central instrument for measuring functioning, complemented by medical evidence when needed. Trained assessors—potentially non-medical staff—would conduct structured interviews across six life domains, producing a 0–100 score that anchors eligibility and supports. The first sentence of the direct impact is that WHODAS helps standardize assessments across institutions, leading to faster referrals to rehabilitation, more consistent benefit decisions, and improved data comparability for policy evaluation. The broader analysis shows that standardized tools reduce discretionary bias and improve the linkage between assessment results and concrete supports, such as workplace accommodations and training opportunities.

In practice, phased pilots, independent evaluations, and clear decision rules will be essential to maintain trust and ensure validity across sectors.

What role does data integration play in reform success?

Integrated data systems connect ZOSI, pension, health insurance, welfare, and employment services to track trajectories from sickness absence to rehabilitation to work outcomes. The direct benefit is transparent monitoring of reform impact; the analytical upside is the ability to identify bottlenecks, test policy adjustments, and publish credible results. A robust data backbone supports timely decisions, reduces duplication of work, and makes it easier to demonstrate progress to citizens and funders. It also underpins future enhancements, such as real-time dashboards for stakeholders.

From a strategy view, data governance, privacy protections, and interoperability standards are as important as the tools themselves.

How does mental health integration influence early intervention?

Integrating mental health functioning expands the scope of early intervention by ensuring that people with anxiety, depression, or cognitive challenges receive timely rehabilitation and workplace accommodations. The first effect is a shorter sickness absence horizon, followed by structured return-to-work plans, vocational training, and supported employment arrangements. The secondary benefit is a more inclusive labor market where mental health needs are recognized and addressed promptly, reducing long-term detachment and poverty risk associated with disability. Analytically, early action improves long-run employment stability and educational outcomes for a broad cohort.

What is the expected impact on equality and access to services?

The reform aims to standardize access rules so that people with similar functioning profiles receive similar supports, regardless of the institution that administers benefits. This improves equity, reduces regional disparities, and strengthens the social contract with disabled citizens. In practice, the expected outcomes include faster rehabilitation referrals, clearer eligibility pathways, and more predictable support timing, which collectively raise overall participation in the economy and community life.

What are the risks and how can they be mitigated?

Key risks include implementing an instrument without robust psychometric validation, and rolling out across agencies without aligned governance. Mitigation involves rigorous piloting, independent evaluation, transparent reporting, and stakeholder engagement, including disabled people’s organizations, employers, and clinicians. The result is a disciplined, evidence-based reform that builds confidence and sustains momentum beyond political cycles.