Serbian
MEDICAL CARE S P E C I A L
E D I T I O N
2015
FOREWORD
PRIVATE MEDICAL PRACTICE ON THE RISE
Greater Comfort,
FASTER DIAGNOSIS Private medical practice in Serbia has been in existence for over 20 years and during this period many privately-run medical facilities and private surgeries have found their rightful place in society, earning great reputations and winning the trust of patients
A
n issue that has been troubling private medical professionals and patients for years is why Serbia’s private healthcare sector has been marginalised and why its inclusion in the state healthcare system has been so slow. The very few previous experiences of integrating private healthcare into the Serbian state sector have shown good results. Ten years ago the state health sector signed a contract with privately-run dialysis centres. By so doing, the state no longer had to secure additional investments in building and equipping the dialysis facilities crucial for the well-being of kidney patients who, at the same time, are now able to receive the latest health services, which cost the same as they would if provided by the state health sector. A similar arrangement was also concluded with a privately-run hyperbaric chamber. All of this has led us to believe that the relevant state authorities should take previous experiences into consideration. What are the advantages of private
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healthcare? First and foremost, doctors who are more focused on patients’ health issues and where diagnosis takes much less time. Many private healthcare facilities have prearranged programmes that immediately recognise patients’ needs, like executive check-ups or health centres specialising in the treatment of specific diseases, where an entire team of medical professionals can
Doctors in the private health sector are more focused on patients’ health issues and diagnosis takes much less time conduct all of the required check-ups in just a day. This is impossible in Serbia’s existing state-run healthcare system. Professor Rajko Hrvačević, MD, who is also the director of the Fresenius Medical Care Company, believes changes are possible and necessary. He says that the society's transition into capitalism inevitably implies equal treatment of the public and private healthcare systems.
“This kind of integration is necessary for at least two reasons. Firstly, patients need to have improved access to health services, i.e. waiting lists need to be shorter. Secondly, patients have to be able to choose health facilities and doctors for themselves, which entails applying the kind of competition principles that always result in improved quality of health services. Of course, all of the aforementioned is a process that requires time, and it is up to us to decide how long this process will last,” says Professor Hrvačević. He also mentions the limited financial resources available to the National Health Insurance Fund, adding that the amount of money allocated to healthcare in Serbia is significantly smaller than in other countries, including neighbouring states. With this in mind, he proposes the compiling of a list of the most urgent health services, including those rendered by private medical facilities, in accordance with current waiting lists. “First and foremost, this list should include health services which, if post-
poned, could lead to a negative outcome for the patient. These services should be treated as a priority. The goal is to use all available resources, whether state or private, to provide our citizens with timely, high quality health services. In order to reach this goal, we have to rely on the experiences of other countries that have already been through the transition process. Private-public partnership could certainly become one of the modalities for applicable to certain segments of healthcare,” suggests Professor Hrvačević. His opinion is shared by Dr Jasmina
tor as an aid or partner to the state sector. For instance, state hospitals with long waiting lists could sign contracts with private medical facilities possessing both the capacity and the staff to treat patients currently on these waiting lists. Moreover, if the state has no
Patients need to have improved access to health services and to be able to choose health facilities and doctors for themselves. Waiting lists need to be shorter
sector. Quoting the Association’s mission, Dr Predrag Stojičić says that the private health sector should have its ID, i.e. a detailed description of all private medical facilities in the country, the number of services they provide and the number of patients they treat. He adds that this would provide a precise overview of the private healthcare sector in Serbia and its potential. “Also, the existing regulation should be improved, as it is not conducive with private medical facilities. The Association also plans to set up a network that will list the segments in which
FIGURES - There are close to 1,500 private healthcare facilities in Serbia. - These facilities have 3,732 doctors. - If we include nurses in this number, estimates suggest that the Serbian private healthcare sector employs over 10,000 health workers. - Data compiled by the World Health Organisation shows that 38% of all the money spent on health services in Serbia goes to the private sector. - Of a total of 45 MRI scanners in Serbia, 23 are located in private medical facilities. - It has been estimated that 25% of all medical scanners in the country are located in private medical facilities. Knežević from the Bel Medic General Hospital. She says that the money from the state healthcare budget should work for the patient, regardless of where they receive their treatment – be that a private or state health facility. She also suggests a compromise solution whereby the National Health Insurance Fund would pay private facilities the same money as it would pay state facilities for the services rendered, while the patient can cover the price difference or take out a private medical insurance policy. “There are many segments in which we can engage the private health sec-
intention of investing in or developing certain healthcare segments in the foreseeable future, this opportunity should be offered to the private sector, which could be interested in taking it on and finding an appropriate solution. There are many opportunities for cooperation and complementing each other, especially in areas like medical treatments for the elderly or cataract surgery,” adds Dr Knežević. The establishment of the Association of Serbian Private Healthcare Providers in September was an important step towards improving the private healthcare
the private sector could help the state, while providing the best possible health services to the people of Serbia. Our long-term goal is to integrate private medical facilities and private practices into the Serbian healthcare system,” notes Dr Stojičić. The Association of Serbian Private Healthcare Providers was established in September 2014 with the goal of regulating the private healthcare sector, reviewing the sector’s capacity and investigating the possibilities of integrating the private healthcare sector into the Serbian healthcare system. •
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MILENA GAJOVIĆ SHRESTHA
INTERVIEW
CEO of MediGroup
The Private Medical Institution that Handles
THE MOST PATIENTS - We expect concrete steps. For example, that a patient has his chosen doctor in a private health centre and that those employed with doctors in private health centres having state sick leave cover.
MediGroup offers the widest range of medical services at primary and secondary levels of healthcare
M
ediGroup is the first and only private healthcare platform in Serbia, with a total of six private health institutions: the MediGroup General Hospital, the Jevremova Specialist Gynaecological Hospital and Maternity Clinic, the Miloš Clinic and Special Hospital for Ophthalmology and three health centres: DZ Jedro and two Dr Ristić clinics, in New Belgrade and on Banovo Brdo.
• How does MediGroup stand at the end of 2014 compared to other private health institutions? - Overall in the private health sector, MediGroup offers the widest range of medical services at primary and secondary levels of healthcare, has the largest number of patients per year and carries out the largest number of medical procedures.
• What do you expect from the health minister’s announcement on the introduction of the private system to state health, specifically in primary healthcare?
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• Do you introduce new services and procedures? - MediGroup hospital has a modern, fully equipped diagnostic centre that offers comprehensive and precise radiological diagnoses: magnetic resonance imaging power of 1.5 T, 64-slice CT-scanner – a device that also performs virtual colonoscopy and bronchoscopy procedures. ULTIMAX RTG is one of the most advanced X-ray machines in the world, while there is also the latest generation mammography unit, in which the level of radiation is reduced to a minimum. Besides a complete polyclinic department with more than 20 specialisations, 24/7 patients can access the hospital, internal medicine department, general surgery, gynaecology and obstetrics. For surgery there is an operating block with three very modern operating rooms, intensive and semi-intensive care and suites with more than 20 beds. Operating rooms are equipped with
Although the provision of healthcare is generally considered the responsibility of the state in any country, private capital and expertise are increasingly considered welcome as sources of assistance that serve to introduce efficiency and innovation highly sophisticated equipment for the implementation of classic and laparoscopy surgical interventions of all kinds. In addition to developed abdominal and thoracic surgery, we place a special emphasis on the Centre for Obesity and Bariatric Surgery, as well as the Oncology Centre. In the field of ortho-
paedics, we conduct endoprosthesis operations of the hip, knees, shoulders, ankle surgery, arthroscopic joint surgery and spinal deformity surgery. We handle many urological operations, including the non-invasive modern ESWL method of breaking up kidney stones without X-ray radiation, then ENT surgery for children and adults. In the field of IVF, as of late the Jevremova MediGroup member introduced new embryo transfer methods, which lead to an increase in the success of the method. Last year the success rate of clinical pregnancies via embryo transfer reached around 48%. Programme THS – Total Health Screening is a unique programme that includes a full health check and diagnostic procedures in one day, in just six hours, enabling the patient to take detailed control over their overall health. In order to meet the needs of our patients, we offered the “9 on 9” programme, which enables the complete management of the pregnancy, prenatal preparation, complete delivery with post-natal nursing for mothers and babies, with the option of paying in several instalments.
• What part of MediGroup functions the best? Has the maternity department fulfilled expectations when it comes to the number of deliveries? - We are proud of the MediGroup maternity clinic, where more than 240 deliveries were carried out during 2014. The Maternity Ward of the MediGroup General Hospital is equipped with modern birthing rooms, an operating room to perform Caesarean sections, as well as an intensive care unit and a neonatology unit that are ready for any situation.
• What are MediGroup’s future plans? - Further development plans are focused on the creation of new health facilities in the primary healthcare segment. •
INTERVIEW
Professor BERISLAV VEKIĆ
MD, Serbian State Secretary for Health
Serbian Healthcare on the
RIGHT TRACK
Very soon there will be no obstacles to patients with national health insurance receiving treatment at private medical facilities
R
eforming the healthcare system and engaging private healthcare in the state system are the most urgent tasks to be handled by the Ministry of Health next year. We are busy modifying the Law on Healthcare and Health Insurance, and we are executing various changes and amendments. We are also awaiting an ordinance to be finished so that we can set clear and precise conditions to be fulfilled by private medical facilities in order for them to be engaged in the healthcare system – says Professor Berislav Vekić, MD, Serbian State Secretary for Health at the Ministry of Health, speaking to CorD. According to Dr Vekić, the health ministry will consult all relevant as-
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sociations of private medical facilities on these matters. These facilities will have to comply with certain standards relating to venues and staff. If these standards are met and agreement is reached on prices of medical services that are going to be the same as at state facilities, then there will be no obstacles to patients with national health insurance receiving treatment at private medical facilities.
- Soon after that, patients will be able to use diagnostic capacities of private medical facilities, like MRI and scanners. In this way, we are raising the quality of service, boosting fair competition and eliminating or shortening waiting lists which are one of the main corruption sources. Waiting lists are deemed tools of corruption, because certain patients are paying to gain an advantage over others.
• Do you expect problems regarding prices of medical services? - I expect private medical facilities to accept the prices that are applicable to the state healthcare sector, as that would bring them more patients and continuity in their work. These plans will begin
• Which waiting lists are currently the longest? - Appointment lists in Serbia are just as long as in any other country. In regards to certain medical sectors, like orthopaedics, ophthalmology, diagnostic procedures (scanner and MRI), interventional cardiology, cardiac surgery and radiotherapy, our plan is to review the situation in each of them by the end of 2014 and hopefully conclude that we have shortened waiting lists by 10%. The activities pertaining to cutting waiting lists are being handled by our most renowned professors and academics. There are several factors that resulted in over 70,000 people in Serbia being on waiting lists today. These include lack of appropriate equipment, delaying public acquisitions and insufficient medical accommodation.
Appointment lists in Serbia are just as long as they are in any other country. Our plan is to review the situation in each of them to be realised in 2015. That's one of our priorities. We are also embarking on reform of primary healthcare, i.e. enabling patients to be seen by private medical practitioners, namely GPs, paediatricians and gynaecologists.
• When do you expect to include other levels of healthcare?
• You have also announced the reform of primary healthcare.
of Serbia's healthcare system.
- Yes, that's right. The goal of this reform is to help doctors at local health centres, who sometimes perform up to 60 check-ups a day. The quality of their work is compromised when there is such a huge workload. By completing and implementing an IT system which these doctors will use, they will see a lower number of patients with chronic diseases (like chronic respiratory diseases, diabetes or chronic cardiovascular diseases). The plan is for these patients’ medication to be waiting for them at pharmacies that are to be linked through the same network with health centres and secondary/tertiary healthcare facilities.
• What else will this reform entail? - Reforming primary healthcare entails everything done in health centres. Also, we are planning to re-establish diabetes counselling and bring patients with mental disorders closer to their local communities, which were outlined in the 2007 Strategy for Mental Health Protection and the Law on Protection of Persons with Mental Disorders from May 2013. The Ministry of Health conducted the psychiatric care reform together with the OSCE mission in Serbia.
• How far ahead are you in terms of implementing this IT system? - Hardware and software have already been installed in 158 health centres under the DILS project. Over half of all secondary healthcare facilities have already been installed, or will be fitted, with software thanks to the EU-IHIS project. Both of these are steps towards completing computerisation of the Republic
The Rare Diseases Foundation has received the first requests. Professional commissions at the state level will determine what constitutes an urgent case
• Could you tell us something about the work done by the Rare Diseases Foundation? - The Foundation is now operational and all administrative procedures have been completed. The Serbian government has transferred the first million euros to the Foundation, while many companies and donors have donated funds too. The Foundation has received the first requests, while professional commis-
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sions at the state level will determine what constitutes an urgent case. The Foundation will provide funds for children who need treatment abroad, providing no such treatment is available in Serbia. The parents of children with rare diseases need huge amounts of money for medical treatment and medical treatment abroad is the only chance for these children. I think we are going to steer clear of practices that have been agitating people so far, like a lack of transparency in the flow of money that has been raised.
• What accomplishment are you proudest of in 2014? - In the last seven months the newly appointed officials at the Ministry of Health have carried out changes and amendments to the Law on Healthcare and Health Insurance, while the Law on Medical Documentation and Health Records, which was written 35 years ago, was finally ratified. We have established the Rare Diseases Foundation. We have delivered 35 top quality ambulances to various medical facilities across the Republic of Serbia. In accordance with the standards of the World Health Organisation (WHO), we have taken measures to prevent the Ebola virus from spreading. During the floods in Serbia this May we undertook all required measures to prevent an epidemic of infectious disease and we were commended by the WHO for that. In September and October we started working on applications for EU grants under projects like TAIEX, Twinning and IPA. We have written a specialisation and sub-specialisation ordinance. A Cardiovascular and Transplantation Surgery Clinic was opened in Niš. We have reconstruct-
ed several clinics and hospital units, including the Children’s Unit at the Ophthalmology Clinic of the Clinical Centre of Serbia. We have approved a sig-
and nurses, and a month ago, following a decision by the Government’s committee for new jobs, another 343 doctors and 333 medical nurses and medical technicians were hired.
• Could you reveal some of the plans
We are going to continue improving and finalising installation of the IT system. This is our priority in 2015 nificant number of specialisations compared to previous years – 1,207, to be precise – of which 1,207 are specialisations, 220 are sub-specialisations, 833 are general specialisations, 7 are pharmaceutical specialisations, 127 are dentistry specialisations and 13 are health associate specialisations. Close to 1,000 new jobs were also created. Several months ago we gave approval to hire 312 doctors
for 2015? - We are going to continue improving and finalising installation of the IT system. This is our priority in 2015. We are also close to purchasing a Gamma Knife and we expect a Gamma Knife centre to open in Belgrade in the first quarter of next year. Another important decision to make was the purchase of five linear accelerators with money from a World Bank loan. Once we buy these, the waiting lists for radiation therapy are going to be shortened. We also need to embark on reforming primary healthcare and engaging private healthcare in the state system, which we discussed earlier. We are also going to work on completing the Law on Medicines, the Law on Infectious Diseases, the Law on Controlled Psychoactive Substances and the Law on Precursors. We are also awaited by amendments to the Law on Health Insurance, devising new staffing plans for 2015, developing and extending transplantation and transfusion programmes, defining more efficient implementation of the national screening programme, continuation of activities on shortening waiting lists and activities on establishing departments for palliative care in general hospitals. We are certainly going to continue fighting corruption in healthcare, with zero tolerance. These are just some of the activities the Ministry of Health will engage in during 2015. •
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Niš is well underway. The clinical centre in Belgrade remains the biggest challenge. We plan to launch a tender in February 2015 and start works in June 2015. We hope there will be no complaints lodged regarding tenders and that no tenders will be annulled, which would slow down our plans. The blueprint of reconstruction of the Clinical Centre of Serbia is completed and is currently being reviewed by CIP (Institute of Transportation) and the Interior Ministry's Fire Protection Department,” says Professor Berislav Vekić.
www.jgl.hr
INTERVIEW
PROFESSOR VIŠESLAV HADŽI-TANOVIĆ
MD, President of the Association of Private Physicians of Serbia
Patients Increasingly
GO PRIVATE
Private healthcare professionals have progressed significantly in the last few years. Top doctors and medical professors have continued working in the private sector after retiring
“P
rivate healthcare in Serbia today can offer patients some of the best health services around, as most private physicians in Serbia are renowned worldwide and the quality of medical equipment here complies with the highest EU standards. Patient rights are observed strictly and patients get top notch healthcare for their money whenever they want it, provided by a doctor of their choice, nationwide,” says Professor Višeslav Hadži-Tanović, MD, President of the Association of Private Physicians of Serbia, speaking at the beginning of his interview for CorD.
• What does the private healthcare sector in Serbia comprise? - This is a system that runs parallel to the staterun health sector and has been developing independently in line with free market principles, namely those of supply and demand. The sector comprises doctor’s offices, clinics, hospitals, diagnostic centres and laboratories, where patients can receive all sorts of check-ups, diagnostic methods, therapies and operations, including neurosurgical procedures. Cardiologists and internists dominate the sector, which is understandable considering Serbia is the third country in the world when it comes to the number of cardiovascular diseases like high blood pressure, heart attack and stroke. Private gynaecologists carry out over 50% of the total number of check-ups because female patients like to have their own personal gynaecologists that they can reach at a moment’s notice. This applies to obstetricians too.
• What about surgery? - Plastic surgery – namely facelifts, Rhinoplasty and Otoplasty, breast and lip silicone augmentation, and stomach and buttock lifts – is the most
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popular, followed by eye clinics where patients can undergo all sorts of vision correction procedures and lens replacement. Private hospitals also carry out orthopaedic surgery, such as hip and knee replacements and post-trauma surgery. Surgical clinics carry out endoscopic hernia surgeries, tumour removal surgery, liver surgery and urological surgery.
• What would you say about the quality private healthcare sector staff? - Private healthcare professionals have progressed significantly in the last few years, since many top physicians from the state sector have crossed over into private healthcare for various reasons, including better pay and because
The Association of Private Physicians of Serbia was established 24 years ago and has been promoting private healthcare in Serbia successfully ever since top doctors and medical professors have continued working in the private sector after retiring. Patients were quick to notice this progress and the number of those using private healthcare services began to grow.
• Can patients afford these services? - Unfortunately, patients pay twice for the same health service – the first time when they pay for the mandatory state health insurance and the second time when they visit a private medical practitioner. The reason for this is the fact that a patient’s money doesn’t work for them and there is no will for the state health sector to hire
private physicians. This constitutes a direct violation of a patient’s rights, in the sense that they cannot use the services of private doctors for the money they pay for state health insurance. The current health minister did accept some of our suggestions and proposed primary healthcare physicians, i.e. general practitioners, paediatricians and gynaecologists, be made available through state healthcare insurance. The Association of Private Physicians of Serbia lends its support to this initiative, but at the same time we also want faster changes to happen.
• How is this issue regulated in the EU? - In every single EU country private health services are covered by state healthcare insurance. There are different formats that have all been performing well. We shouldn’t be “reinventing the wheel”, but rather implementing one of the healthcare systems that is most applicable to the economic potential of our country. If we are talking about the most developed EU countries, I would like to mention the healthcare systems in Germany and France, and there are also those in nearby countries like Slovenia and Macedonia.
• So what do you suggest? - My suggestion to the Serbian government and the health minister would be to invite the best EU healthcare experts to come to Serbia and give them the task of putting together a health system that can provide Serbian citizens with the opportunity to choose one of several mandatory health insurance policies, as well as to be given the right to choose their doctor, be that a private or state doctor.
• What are the tangible benefits of including private healthcare in the state health insurance system and the overall healthcare sys-
tem in Serbia? - It’s a win-win situation. Patients will be able to choose a private or state doctor. There will be no waiting lists and, considering that competition will be fair, patients will be seen by their chosen doctor whenever they need. In such a set-up, private doctors will get more patients, while the doctors in the state healthcare sector will be stimulated to work in the private sector, as that would provide them with a higher overall income.
• How can the state benefit from that? - The state will benefit through spending much less on the health care sector, be it through reducing investments or by purchasing less new equipment since the equipment needed already exists in the private sector. The most important thing is that corruption in the Serbian healthcare system will be reduced. Corruption is currently at an alarmingly high level. The number of nonmedical health workers will be reduced by 30% which, again, will reduce the burden on the state healthcare budget. The biggest obstacle to all of this actually being implemented is bureaucracy, which stalls any kind of reform.
• What is the best way to accredit health facilities? - The best model of accreditation for private healthcare facilities is offered by private healthcare insurance, because whoever gives money and creates jobs is the one that sets the
The state will benefit through spending much less on the healthcare sector, be it through reducing investments or by purchasing less new equipment, since the equipment needed already exists in the private sector rules of the game. Since we are talking about private insurance here, contracts will only be offered to those medical facilities which have the highest professional, organisational and structural standards. The fallen state healthcare sector in Serbia needs to be reformed immediately, since – according to the Euro Health Consumer Index (EHCI) – Serbia dropped to last
(34th) place in the EU in the last two years.
• What are the most pressing issues? - My suggestion to the Serbian government is to change the healthcare system urgently. That is crucial for reforming healthcare in Serbia overall. The current state health insurance is monopolistic at its core; it hasn’t changed at all for the last 70 years and is the biggest obstacle to development of Serbian healthcare. It is dragging Serbian healthcare down with it. We need to change it immediately. Let’s use positive experiences from other countries and let’s apply the best possible model, while engaging the managers from the best health insurance sectors in the EU. Secondly, I would like the Serbian government to urgently create a better environment that would be conducive to establishing and using private health insurance. This would significantly disencumber the Serbian healthcare budget. Similar formats are being used in regional countries. If we start implementing the proposed reforms to Serbian healthcare right now, and if we start changing the system, I am confident we will not be ranked last in the EU next year. •
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