SERBIAN MEDICAL CARE 2013 by CorD Magazine

special edition

Serbian Medical Care 2013

UNIQA insurance

The Formula for Success

MedUNIQA Mobile Center in Novi Sad

NIQA Serbia belongs toa leading insurance group, Austria’s UNIQA Insurance Group, which operates in 20 markets in Central and Eastern Europe and serves 18.7 million clients. During its seven years in Serbia, UNIQA has invested more than €50 million and today the company operates in 25 branches with 775 employees. UNIQA Serbia has become one of five leading companies in the insurance industry. For the sixth year in a row it registered the highest growth among insurance companies in Serbia. These results, first-class quality, commitment to clients and efficient quick-claims payments have resulted in UNIQA being declared Serbia’s best insurance company in 2012 by World Finance magazine, a fact also confirmed by more than 1.2

UNIQA’s seven successful years in Serbia have been marked by innovation, awards, consistent growth and 1.2 million satisfied insurance clients million satisfied clients. The prerequisites of UNIQA’s business operations are to make the wellbeing of clients our top priority, followed by innovative approaches, the introduction of new communication channels, products and services adjusted to clients’needs, accuracy and

For the sixth year in a row UNIQA has registered the highest growth among insurance companies in Serbia and was named the country’s best insurance company in 2012 speed, consulting and partnership. Besides numerous services and solutions that distinguish it from the competition, UNIQA is the only insurance company with a separate department for cooperation with banks. UNIQA is a strong brand recog-

nised as a leader in innovation. Several exclusive services are available only to UNIQA clients: MeteoUNIQA, a free-of-charge severe-weather warning SMS service; UNIQA web; My service centre, where in UNIQA insurance agents carry a mobile office ‘packed’ in a small suitcase, ready to deliver policies to a client’s address for free; Road assistance, which provides assistance to all HULL insurance clients; MedUNIQA; and the UNIQA contact centre, supporting clients 24 hours a day. UNIQA is also socially responsible. In the last five years, UNIQA has supported numerous humanitarian projects, cooperated on UNICEF’s School Without Violence project, assisted health institutions and taken part in other activities aimed at helping local communities. «

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Unregulated state of the private health sector

A Third of Serbians Treated by Private Doctors

Medical professionals tell CorD that because private healthcare is marginalised, Serbia’s healthcare system is one of Europe’s most expensive yet among its most low-quality

CorD interlocutors agree there must be a way for the private sector to become involved as well. And for as long as that does not happen, a huge

Dr. Draško Karađinović: Since 2000, the state has been preventing the integration of private practice into mandatory health insurance and access to the funds of the Republic Health Insurance Fund (RHIF) in every way imaginable

t seems that private surgeries and hospitals are to be kept out of the state medical insurance system for a long time to come. It also seems that nobody is serious about tackling this issue. The main reasons for this, according to officials, are that there isn’t enough money to fund it and the unregulated nature of the private sector poses a big problem. This means that those patients who pay for mandatory health insurance will be forced to go to the state health sector for the foreseeable future, and Serbia will be the only country in the region to keep private medical facilities away from state healthcare and the health insurance system.

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number of patients will continue to see private doctors and pay for treatment

Sketchy statistics about private practice

from their own pockets. The Health Ministry has withdrawn an ordinance stipulating the possibility of a private doctor’s right to hospitalise patients or

send them on sick leave, as well as prescribe the use of medical aids. Because this is not regulated at the moment, pa-

There is no reliable statistical data about private practice. Estimates suggest there are more than 3,000 private practice doctors, close to 4,000 private practice dentists and 1,300 privately owned pharmacies in Serbia. By considering these numbers, it becomes clear that very few people have never used a private practice. There are dozens of hospitals and hundreds of sophisticated diagnostic devices (from ultrasounds and X-rays to scanners and MRI machines) in the private sector. The huge potential of this equipment could cut the state healthcare sector’s long waiting lists down to size.

tients who have to go on sick leave or be hospitalised must go to a state-run medical facility for a referral or to have their sick leave approved. All of this is probably handled by doctors the patient has never seen before, despite having been treated by private practice doctors up to that point. Even pregnant women, and there are many of those whose pregnancy is overseen by private practice doctors, have to go to state-run community health centres to get a referral for maternity hospital. Dr. Draško Karadjinović of the Doctors Against Corruption Association says that, since 2000, the state has been preventing the integration of private practice into mandatory health insurance and access to the funds of the Republic Health Insurance Fund (RHIF) in every way imaginable. “Serbia is the only state in Europe where insured workers have to pay 12.3% of their gross salaries towards

Specialized Hospital for Internal Medicine Nova Vita Patrijarha Dimitrija Street No. 36, 11090 Belgrade Tel: +381 (0)11 3564 864 +381 (0)11 3564 863 novavitahospital@gmail.com www.novavita.rs

Advantages of private practice - Availability of services - Efficiency and flexibility (private medical practitioners work in the evenings, after patients’ working hours) - Quality (patients can switch doctors if they are not happy with the service) healthcare contributions, and yet they are not eligible for a refund from the state health insurance if they decide to go to a private practice doctor, dentist or privately owned pharmacy,” says Dr. Karadjinović. “What this basically means is that the patient pays twice for the same service. And let’s not forget that the state healthcare system is monopolistic, that it provides low-quality service, that waiting lists are huge and that corruption is flourishing. On the other hand, paying twice for the same service makes the Serbian healthcare sector one of the most expensive in Europe, with total state-healthcare expenditures taking up to 11% of na-

INTEGRATIVE MEDICINE EXPERTS

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tional GDP – and yet the quality of service it provides is the lowest.” According to Dr. Karadjinović, private practice is excluded from the mandatory health insurance system because this is the only way for the political parties and state bureaucracy, which have been running the healthcare system since 2000, to preserve their monopoly on annual discretionary funds of almost €2.5 billion. This archaic state of affairs is justified by evasive rhetoric about the concern for public health and solidarity. “To illustrate just how bad this is for each individual patient and the overall health of the nation, let me just say that when considering the relevant health indicators – contained within annual evaluations performed for the EU by Swedish analytics group EHCI – Serbia takes last (34th) place in terms of quality of medical services,” he says. The private sector has been developing on its own, without the state’s help and in spite of legal and administrative hurdles, as well as bureaucratic pressures and corruption. The biggest problem preventing the acceleration of development is the legalised conflict of interest that forbids state doctors from working at a private practice. The systemic consequences of this harmful rule are quite obvious: the productivity of state healthcare is declining while waiting lists for check-ups, scans or medical interventions are becoming longer. The longer patients wait during the day to get treatment, the more in-demand private practice is, and people become more inclined to go to ‘evening clinics’ where they pay in cash. In the state health system, the waiting period for cataract surgery is up to two years, and half of cancer patients fail to receive radiotherapy within the optimal time. Dr. Karadjinović says that systemic laws need to be amended before Serbia can have an EU-compliant healthcare system. He also adds:

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Zorica Marković: The right to medical treatment is a basic human right. In Serbia, this right is sometimes appropriated due to it being tied to unemployment and a lack of money

“Only then, realistically speaking, will patients be able to pick and choose doctors and hospitals. Currently they are forced to have treatment at a certain medical facility. They are referred to hospitals they might not have cho-

Private and state practice equal in Europe

sen. To have their sick leave approved, they go to the chosen – imposed – state doctor. They are harassed by bureaucracy, pushed into queues that form in hospital hallways and are treated in a very hasty and superficial way until they accept the business card given to them by a state doctor who works privately too. It has been estimated that between 30% and 40% of all medical services are provided by private practice at the moment, mainly in outpatient facilities.” A step in the right direction, i.e. towards including private practice into mainstream healthcare, would be for additional voluntary health insurance to take off in a proper way. Right now, private insurers are in a submissive position and discriminated against when compared with the RHIF. “Simply put, the RHIF has the right to turn deficit into public debt, while if private insurers are in debt, they are forced to declare insolvency,” Dr. Karadjinović explains. “Of course, private voluntary insurance cannot function if state doctors are allowed to work at a private practice and can arbitrarily choose what constitutes basic and additional services. The political elite needs to agree among themselves that radical change to this huge state-run healthcare system, which employs hundreds of thousands of people, is necessary. This can be done only if the EU exerts pressure because such core changes are detrimental both to personal interests and the interests of the political parties.”

Belgium has one of the best healthcare systems in Europe. Belgian citizens can receive treatment at both state and private medical facilities, and between 50% and 75% of medical costs are refunded. There is mandatory health insurance, but hospitals and surgeries are mostly owned privately. In Germany, patients can receive treatment in a hospital of their choosing and have their medical costs refunded under the health insurance policy. Most Germans pay state health insurance (13% of their salary) and can pick any hospital for treatment. Their medical costs are fully refunded. The French can also pick and choose where they receive treatment due to the country’s mandatory health insurance, which in most cases fully refunds the cost of check-ups and treatment.

Zorica Marković, editor of the Zdravoskop website, adds her thoughts on the exclusion of private practice from the mandatory health insurance system and why it is bad for patients: “The reason is simple: they are protecting the state’s monopoly in healthcare and health insurance, and someone’s private interests are very cleverly concealed under the existing format,” says Marković. “The healthcare sector is the only sector where there is no freedom of choice and no competition. Then there is this unhealthy bond between the state and private practice, and it just so happens that an ultrasound in a state clinic is broken; so you are referred to a private clinic where, lo and behold, the same doctor awaits you, who, for objective reasons, could not perform a check-up on you in a state health facility. These anomalies continue to thrive under the wing of the state monopoly.” Marković points out that the right to medical treatment is a basic human right, adding that in Serbia this right is sometimes appropriated due to it being tied to unemployment and a lack of money. In actuality, it is a form of discrimination and should be dealt with seriously from both an ethical and legal standpoint, not just from a financial and economic one. She also complains about the state health sector doing absolutely nothing to adjust to patients and that it still holds on to the old philosophy of patients (citizens) being treated like subjects who must wait humbly for their turn (if their turn ever comes around). “Instead of sitting for hours in waiting rooms, we could have been doing something useful, earning some money, reading a nice book, spending time with our nearest and dearest – nobody has the right to take that away from us,” she says. “Private practice is miles ahead of state healthcare in this respect. I am using my money to pay for medical treatment in a facility

that I think would give me the proper service. Let the money, which I pay into mandatory state health insurance, work for me. It is really not that complicated, only good will is required. But, for now, there is no good will.” She thinks that everything would

Aleksandra Dimitrijević Salom: Private pharmacies should be included into the state system and they should be allowed to sell prescription drugs that are paid for by the RHIF. But even this hasn’t been executed properly

be better if private health insurance were allowed to take off. Pharmacies are an integral part of Serbia’s private healthcare system. Unfortunately, CorD’s interlocutors agree, the situation is grim here too. According to the Chairwoman of the

Association of Private Pharmacists of Serbia, Aleksandra Dimitrijević Salom, pharmacists are also unhappy with the way private practice is treated in Serbia because “it does not resemble the situation in developed countries around the world”. One of the ways for private and state pharmacies to be treated equally is to include private pharmacies into the state system and for private pharmacies to be allowed to sell prescription drugs that are paid for by the RHIF. But, as Dimitrijević Salom says, even this hasn’t been done properly: “Some privately owned pharmacies that signed agreements with the RHIF have already been penalised because they don’t sell anti-HIV drugs. Even state pharmacies don’t stock them but they are not penalised. State pharmacies have been put in a privileged position from the getgo. This only demonstrates that there is no equality whatsoever and that these two sectors are not going to be commensurate. However, small progress has been made, although it is still insufficient.” Another major problem is how the state allows people to set up pharmacy chains, so a person who doesn’t have to be a pharmacist by vocation can own between 60 and 100 pharmacies. This is not the case in developed countries, Dimitrijević Salom says. For instance, the biggest pharmacy chains in Germany have six pharmacies at most, whereas in France it is only three. “The authorities have failed to realise that this is a very delicate vocation that affects human lives and health,” says Dimitrijević Salom. “The EU is very strict when it comes to allowing pharmacists to work with prescription drugs. In our country, anything goes. I really cannot understand why the state doesn’t want to regulate this sector and make life easier both for pharmacists and patients.” «

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INTERVIEW Professor Dr. Slavica Djukić Dejanović, Serbian Minister of Health

Health Workers Do an Honourable Job

Every breach of the law and form of corruption should be penalised, says Serbia’s Health Minister, who also wants to see good work praised and given due attention

“I

f you are asking me what we have done in the past 18 months, I would say a lot,” says Serbian Health Minister Professor Dr. Slavica Djukić-Dejanović at the start of her interview with CorD. “But if you are asking me whether I am satisfied, I have to say I am not. We, as a society, have allowed our healthcare system to crumble and now we are paying the price of our own irresponsibility. Every step forward we make, every step towards something better, is small, almost invisible, but every problem is right there, in your face. We simply have to be patient.” ● You say the steps we have made are small but useful for the system. Could you tell us what steps those are? What improvements have been made? - You know, when I was appointed minister I was taken aback by the fact that none of the 531 drugs needed to treat chronic patients were available for one very prozaic reason – they had no price tag. We’ve dealt with that problem. We have initiated a centralised public procurement system. On the one hand, this system is supposed

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to create a simpler supply process for healthcare facilities, as well as saving them money and combating corruption. We were even publicly commended by the relevant international institutions for it. I have also had to deal with the fact that the remodelling of the four most important healthcare institutions in Serbia – the four clinical centres – has been blocked, although the mon-

We are currently working on changing and amending the Healthcare Law, which will abolish second jobs in healthcare. We think that this decision will lead to lower corruption in the healthcare system ey for it was provided back in 2008. This is also something we have reinitiated. The Niš Clinical Centre is already working. We have introduced new laws – the Law on Patient Rights and the Law on Protection of Patients with Mental Disabilities. ● You talk about rights and obligations at a time when people are discussing the usefulness of a flu vac-

cine. Why are people so opposed to immunisation? - The resistance to immunisation is not only present in our country. Between 3% and 5% of Serbia’s population is immunised against flu, and these are mostly chronic patients. It is very important to mention that immunisation and vaccination for the purpose of disease prevention are the biggest accomplishments in medical history. ● In regards to raising awareness, we must underline the importance of prevention. What are your plans to encourage doctors and citizens to concentrate more on prevention? - We as a state have chosen not to sit and wait for severe diseases to prompt our citizens to seek treatment, but have accepted a pro-active role in raising awareness about preventive check-ups. We have introduced a screening programme for the three most widespread types of cancer. In 2014 we plan to reinstate diabetes clinics. We are currently conducting comprehensive research into the health of our population, which will help us realise the severity of the sit-

uation and generate concrete indicators about the future health of our nation. We need to have exact data that will demonstrate to us what we need to do better, and in which areas we have already achieved results. We have also initiated health classes starting with elementary schools. ● Let’s talk about the situation in healthcare facilities. It is a well-known fact that many of these facilities’ problems have been the result of bad management. When are you going to penalise unscrupulous managers? - The Ministry of Health appoints the directors of healthcare facilities founded by the state, and, by default, bears responsibility for managing them. As a minister, I cannot go by media headlines. I have to see concrete work reports, which are compiled by the inspection that is operating under the ministry I head.

● Do you have a plan to compensate for the lack of anesthesiologists, radiologists and cardiac surgeons? - For the first time ever, the Ministry of Health will be devising a personnel plan for the next year by the end of this one. In order to solve the problem of an insufficient number of specialised doctors, we have decided that graduate medical students don’t have to do a two-year mandatory internship. In the time I’ve been the minister, we have approved nearly 1,700 specialisations. And such a vast number of approved specialisations have been unheard of for a very long time.

● A tough crackdown on corruption in healthcare has been in the pipeline for two decades now. Do you have the concrete plan to combat corruption or are we just going to continue only talking about it? - One of the tools for doing In a situation where only €260 that is abolishing second ● One of the things facing per capita is allocated from our jobs. The other tool is havsevere criticism is medical ing centralised public prostaff taking on second jobs national GDP for healthcare, it curements. This is an antiin hospitals. You have an- is quite a challenge to provide corruption measure which, according to experts, should nounced that this will be more efficient and better reduce costs up to 40%. We abolished... quality healthcare have also stepped up coop- We are currently working on changing and amending the Healthcare eration with NGOs that are engaged in anti-corrupLaw, which will abolish second jobs in healthtion activities. One of these organisations is ‘Serbia on the Move’. We should not allow for the devastacare. We think that this decision will lead to lower corruption in the healthcare system, considering tion of the medical profession to continue by highthat healthcare workers were allowed to take up lighting only individual cases. Every breach of the second jobs in facilities where they had already law and every form of corruption should be pebeen working. This doesn’t automatically imply nalised. I also want to see good and honest work that they misused this opportunity. Most of them praised and drawn attention to. are doing an honourable job. Once this stipulation is abolished, health workers will be able to ● How do you react to the frequent and corrobowork up to one third of their working hours in anrated criticism of the capitation formula in primaother facility in accordance with the Labour Law. ry healthcare? - Capitation exists in every single coun-

Savings thanks to centralised procurement ● You have abolished the use of control stickers on medication boxes.

What other cutbacks have you planned? - The Ministry of Health has sent a letter to the Medicine and Medical Devices Agency of Serbia, the Institute for Manufacturing Banknotes and Coins and the Ministry of Health with the aim of assessing the feasibility of further labelling for control stamps. The most significant savings will be achieved though the centralised supply.

Where science meets art

Centar za dentalnu estetiku i implantologiju

Dr Igor R. Ristić Eurpean Society of Cosmetic Dentistry Board Member International Academy of Dental-Facial Aesthetics American Academy of Cosmetic Dentistry International Team of Implantology

Cvijićeva 38,11000 Beograd, Srbija +381 (0)60DENTIST www.drristic.com Serbian Centar.za.Dentalnu.Estetiku medical care 9

try. Its goal is to provide the best service possible to patients and to have medical workers actually doing their work during working hours. In the beginning we based the capitation formula on the average work performance in healthcare facilities. Medical workers who do have average work performance will receive 100% of their salaries; those whose work is above average will receive higher salaries. The reward system should be different for people working in secondary and tertiary healthcare because we are not all the same and our attitude to work is not the same. That’s why we should differentiate. The percentage of the variable sector is much higher in Montenegro and Slovenia. ● People don’t have full and clear information about organ transplantation. They should be told why, for instance, only livers are taken from a dead patient and not the kidneys too, as this creates grounds for speculation about organ trading. How will you tackle this problem? - We need to increase the number of donors and that could be done by eliminating prejudice. In order for people to have more information on the matter, we need to have a constant and continuous campaign and the media reporting about organ transplants. We are hugely grateful to the families who, at very delicate moments of saying goodbye to their loved ones, have given their consent for organ donation in order to save somebody else’s life. In order to carry out transplantation after a patient has been brain dead, the family of the deceased patient needs to give their consent. A highly specialised team at the transplantation centre, consisting of doctors of various specialties, carries out an assessment of the donor’s organs. Up to 30 people can participate in the transplantation process and this is done only in large clinics. Only the patients who are on the organ transplant lists are operated on for organ donation.

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● When are heart and liver transplants going to take off and when is Serbia going to become a member of Eurotransplant? - In order for Serbia to become a Eurotransplant member, we need to have 10 donors per million inhabitants. In the case of Serbia, that means that we should have at least 70 do-

In the time I’ve been the minister, we have approved nearly 1,700 specialisations. And such a vast number of approved specialisations have been unheard of for a very long time. We have also decided that graduate medical students don’t have to do a two-year mandatory internship nors annually. In the last few years this number was four per million inhabitants, i.e. between 26 and 28 donors annually. Close to 750 patients are waiting for a new kidney and 70 patients for a new liver. We are currently compiling a heart transplant list.

● When is the Ministry finally going to tackle the private practice issue and when can we expect private medical practice to be included in the mainstream healthcare system? - This will happen gradually. We have started with pharmacies first. I think that first we need to include those private medical practitioners who are performing procedures that state-run medical facilities cannot, due to insufficient capacity. I am referring to diagnostic procedures for which there is a waiting list or that can be done in outpatient facilities. ● What kind of effect did the decision about private pharmacies issuing prescription medicine have? - Allowing private pharmacies to issue prescription medication is a validation that we have made a step in the right direction, leading to the equation of private with state-funded medical practice. We have made medicine more accessible for our patients and they can now pick up medication from pharmacies that are the closest and most convenient for them. ● When are the patients going to receive better treatment, and are you optimistic about the future of Serbia’s healthcare system? - To be Health Minister means to be responsible for the health of almost 8 million people living in our country. This is by no means easy. In a situation where only €260 per capita is allocated from our national GDP for healthcare, it is quite a challenge to provide more efficient and better quality healthcare. That’s why it is so important for employers to pay their healthcare contributions regularly. «

New health insurance cards in three to four years

● How accurate was the story about new health insurance cards and

what will happen with this idea eventually? - Thanks to the amendments and changes to the Law on Health Insurance, the deadline for substituting paper health insurance cards with electronic ones has been moved to 2016 or 2017. The laws need to be adhered to, but sometimes life produces circumstances that are more realistic. We are legally bound to introducing new health insurance cards and that is a given. We should not take a step back and say now that we don’t need a new national health insurance document, but we need to have a timeline for its introduction.

Strong and Successful Team Medical professionals tell CorD that because private healthcare is marginalised, Serbia’s healthcare system is one of Europe’s most expensive yet among its most low-quality speedy recovery of post-op patients. The vast experience, the latest equipment and utilisation of the best ophthalmological brands in the world are a guarantee of our success in treating all kinds of ophthalmological problems. Here is some useful advice from Stankov Ophthalmology experts:

he specialised ophthalmological hospital Stankov Ophthalmology was founded in 2000 as a specialised ophthalmological surgery with four employees. Professor Dr. Branko Stankov has been at the helm of this institution since the very beginning. At first the surgery was focused on ophthalmological problems in children. But with patients becoming more interested in general ophthalmological services and additional specialist services, the number of staff grew and new business systems were introduced. Today, Stankov Ophthalmology has a 25-member-strong team who successfully deal with ophthalmological problems such as contactology, strabology, cataract problems, retinal detachment, vitrectomy and many other ophthalmological conditions. The outpatient section of Stankov Ophthalmology is located on Terazije, Belgrade and is a place where children and adult patients can have all kinds of ophthalmological examinations, including examinations of the anterior and posterior of the eye. The stationary part has a modern surgical block and a ward equipped to aid the

FOR PARENTS How to choose first glasses? - They have to be of adequate size, done by an experienced optician who made them exactly according to the ophthalmologist’s prescription. - A good optometrist will adjust the glasses so they comfortably rest on the nose and don’t slide down, while making the glasses cosy enough for little ones to wear.

Stankov Ophthalmology has a 25-member team who successfully deal with ophthalmological problems such as contactology, strabology, cataract problems, retinal detachment, vitrectomy and other conditions FOR EVERYBODY How to spot a problem? - If a child tilts their head frequently. The reason for this could be strabism, as children with strabism move their heads from one side to another in order to avoid double vision. - On field trips or walks, a child cannot recognise the things you are point out to him or bumps into things

frequently. Or while drawing, the child almost touches the paper with his nose. The cause of this problem is probably short-sightedness. - When you approach a child from the side; they can only see you if you approach from the right-hand side and they do not notice when you come from the left-hand side or vice versa. - If a child often complains about headaches, especially after playing with small objects, doing puzzles or looking at fairytale books. The cause of this problem is probably far-sightedness. FOR ADULTS Cataracts - A cataract is an innate or acquired clouding of the lens inside the eye regardless of how it affects your vision. The main symptom of this condition is a gradual loss of sight in the affected eye. According to the latest reports from the World Health Organization (WHO), 48% instances of blindness are due to cataracts, which translates into 18 million people. -A cataract can be easily and accurately diagnosed by a slit lamp. The clouded lens is removed surgically in two ways – the so-called classical method (ECCE) or the ultrasound method (PHACO). - The PHACO method is shorter, as is the healing time, while the likelihood of post-operative astigmatism and postoperative complications is reduced. «

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INTERVIEW Professor Dr. Višeslav Hadži-Tanović, Cardiologist

Private Practice Makes Perfect The pioneering cardiologist is advocating for an expansion of rights and access for private medicine. According to a survey, over 80% of Serbian citizens would use private healthcare services if state-funded health insurance were to cover it. So should medicine and healthcare in Serbia seek a second opinion?

ical practice in Serbia, and its present capacity? - In the period between 1990 and 2013, a total of 4,500 private medical facilities were opened in Serbia. They are registered as independent business entities with the Business

fter being banned by the Communist regime for almost 40 years, private medical practice was reinstated in Serbia in 1989, with the first privately owned clinic being the Dr Hadži-Tanović International Heart Clinic in Belgrade. This is just one of the reasons CorD has decided to interview its founder, renowned cardiologist Professor Dr. Višeslav HadžiTanović, who is also the Chairman of the Association of Private Medical Practitioners of Serbia and has been advocating for private medical practices to be given the same treatment as state-run ones, giving private practice its rightful place in Serbia. ● Could you tell us about the development milestones of private med-

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tion type, these are surgeries, polyclinics, private health centres, clinics, hospitals, diagnostics and clinical centres. Private medical practice in Serbia has the latest diagnostic equipment, namely more than 3,000 ultrasounds, and over 100 scanners and MRI machines.

A large number of private treatments are gynaecological ones. Terminations of pregnancy (curettage) are the most frequent treatments performed, while the number of patients undergoing IVF at private clinics is also on the up Register Agency. Close to 10,000 doctors work temporarily or permanently in these facilities. In terms of organisa-

German healthcare as a role model

There are over 100 private hospitals in Serbia that can take up to 1,000 patients and which perform all kinds of surgeries apart from brain surgery.

We should emulate European healthcare systems such as, for instance, the German one. In Germany there are over 250 health insurance companies, so each German citizen and employer can choose the best insurance policy for themselves. This facilitates the freedom of choice, i.e. German citizens can choose whether to be treated in a private or staterun medical facility. The issue of private practice’s equality is not controversial in the EU since this is engrained in their democratic system. Patients have the right to choose private doctors because they are paying for their medical insurance every month. In order for this happen, all it would take is for the State Healthcare Fund to conclude a contract with the private healthcare sector.

● How much do people in Serbia seek private treatment? - Serbian citizens have recognised the advantages of going to private medical practitioners. Currently, over 40% of patients use private health services, more than 60% of them use diagnostic and specialist services, 65% go to private gynaecologists and 80% use the services of private labs and dentists. In a survey conducted by Radio Television of Serbia, over 80% of surveyed Serbian citizens would use private healthcare services if state-funded health insurance covered it. All sections of society, including pensioners, go to private doctors. ● What are the reasons for deciding to use private health services? - Patients are respected and their rights are upheld, unlike in the statefunded health sector. Patients are also free to choose their own doctors and appointment time. In private healthcare there are no waiting lists and you can be examined immediately. Health services are of high quality and performed at a very professional level. That’s why patients choose to go to private doctors. ● What is so specific about private medical practice in Serbia? - It is specific because it is not performed by family doctors, who unfortunately are not recognised in

Private practice works parallel to state healthcare, and since the authorities are quite discriminatory towards the private sector, it’s not covered by state medical insurance and operates on the free market

Serbia, but by various medical specialists, which provide over 90% of health services in private medical practices. Most of the private medical facilities are gynaecology and internal medicine/cardiology surgeries, followed by eye specialists, psychiatrists and dermatology/venereal disease specialists. In terms of private hospitals, most of them are plastic surgery and ophthalmology hospitals, as well as general surgery and gynaecological hospitals. And the number of ophthalmological surgeries is growing, especially for treatments like the insertion of intraocular lenses and the correction of congenital eyesight anomalies. ● Who should be credited for the rapid development of private healthcare? - The Association of Private Medical Practitioners of Serbia, formerly the Private Medical Chamber of Serbia, should take most of the credit for such a fast development of private medical practice in Serbia. For the past 23 years, the Association has been helping, providing logistics and encouraging doctors to open private medical practices. Since knowledge, expertise and implementation of the latest medical achievements are the main prerequisites for the successful treatment of patients, the Association has been very keen on educating its members, and it holds

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the International Private Medical Practice in Serbia conference every year. The most renowned foreign doctors are usually conference speakers, while conference participants are presented with the latest developments in diagnostics, therapy and pharmacology. ● Do you overlap with the state healthcare system? - Private medical practice works parallel to the state healthcare system. Since the state authorities are quite discriminatory towards the private sector, this sector is not covered by the state medical insurance and it basically operates on a free market. In Serbia there is only one type of medical insurance – the monopolistic state health insurance, which hasn’t changed since its establishment. It has been tweaked on a few occasions but it is still not able to carry out all of its duties. This is in direct violation of the patient’s right to choose medical insurance freely. The money from the State Health Insurance Fund is usually spent imprudently, so patients are not able to enjoy comprehensive, high-quality healthcare. There have been attempts to establish private health insurance but the current legislation hampers this, thus fuelling the monopoly of state health insurance in Serbia. Presently, there are several types of supple-

mentary private health insurance, which have not been able to fulfil their potential due to discriminatory legislation. ● What action should be taken? - We need to reform medical insurance in order to have several kinds

We need to reform medical insurance in order to have several kinds of mandatory health insurance that would allow people in Serbia to pick and choose a set of services that best suit their needs of mandatory health insurance that would allow people in Serbia to pick and choose a set of services that best suit their needs. Passing laws that would stimulate the creation of more

State healthcare is corrupt while private healthcare thrives According to the EU Health Commission, Serbian healthcare is at the very bottom in Europe, while, in terms of corruption, it is at the very top. We are talking about state healthcare. In the last 10 years more than €10 billion ended up in Serbian healthcare. We don’t know how this money was spent but we do know that during this period the Serbian health system has been on a downward spiral and is much worse now than it was 30 years ago. In the same period, private healthcare, which is practically a parallel system to the state one, has been thriving despite operating under the rules of the free market and not being covered by state medical insurance. The private healthcare system in Serbia is the healthiest system in the country, economics-wise. In terms of expertise and the quality of management, our private healthcare is already in the EU.

Serbian

medical care

private medical insurances would facilitate faster and better development of not only the private medical sector, but the state one too. Because of the present health insurance system and the huge corruption in state healthcare, Serbian citizens and patients are both at a loss. If you choose private

medical services, you have to pay in cash, which actually means that you pay for the same service twice. The state health insurance does not recognise or refund the costs of private medical services the patient had already paid for once before. ● What about patient rights? - Patient rights are severely violated in Serbia since patients are not able to receive medical treatment wherever they want, despite having paid their medical insurance in advance. They are also not able to choose their doctors freely, namely to have private medical treatment covered by state health insurance. For instance, a patient from Niš cannot receive treatment in Belgrade if they want to and a patient from Belgrade cannot be treated in Novi Sad. Recently, a pregnant woman from Pančevo, which is only 12km

because of corruption, bad management, and the lack of quality staff, equipment and medication.

from Belgrade, was returned from a Belgrade maternity hospital and sent to Novi Sad, which is 75 km from Belgrade, because Novi Sad is in the province in Vojvodina, just like Pančevo. Also, excluding private healthcare from the state healthcare system is prejudiced and constitutes a severe breach of Serbian citizens’ human rights to choose their own doctor and hospital because they have paid medical insurance. ● When can we expect reforms? - The Association of Private Medical Practitioners in Serbia has been urging the Serbian government to conduct healthcare reform with a focus on medical insurance reform, which would serve as the basis for a comprehensive reform of the entire healthcare system in Serbia. Considering the basic principles of democracy and respecting human rights in terms of everyone having the right to choose freely for their money, we have suggested that instead of having the monopolistic health insurance, the authorities should allow for the creation of at least three supplementary private health insurances. Unfortunately, over the past 23 years the government did not demonstrate the political will or the knowledge to do that, so the situation hasn’t changed at all. The state healthcare system has been in constant decline

The state healthcare system has been in constant decline because of corruption, bad management, and the lack of quality staff, equipment and medication

● What would happen if private healthcare was covered by state medical insurance? - If private healthcare were covered by state medical insurance, and if the private healthcare system had the same treatment as the state’s, we would have had a competitive market that would contribute to the better and faster development of both systems. This would benefit the patients who, in that case, would have been able to enjoy better healthcare. Only 30% of certain private medical capacities, such as surgeries and diagnostic methods (scanners, MRIs, ultrasounds), are actually utilised. On the other hand, you have these long waiting lists in state healthcare, where some patients have been known to wait for 10 years to be operated on or six months to have a scan or ultrasound examination. The state has been spending taxpayers’ money on purchasing new equipment while the equipment in private healthcare is underused. That’s why it makes perfect economic sense to have private medical treatments covered by the mandatory state health insurance, with the aim of cutting back costs and reducing, or even totally eliminating, waiting lists in this time of economic crisis. «

Serbian

medical care