2024-11-05

Experts Call for Reforms: Improved Planning of the Healthcare System Needed

Centre Dialogue – Social Forum

Waiting lists, dual employment arrangements, and a lack of transparency are the main issues plaguing Serbia’s healthcare system, according to participants in the debate ‘(In)equality in Access to Healthcare Services and Waiting Lists’ organised by the Center for Democracy Foundation on 5 November 2024 in collaboration with the Friedrich Ebert Foundation.

“Waiting lists are at the core of the issue and represent a legalised system of corruption,” said Dragan Milić, Head of the Cardiac Surgery Clinic in Niš. He added that Serbia’s healthcare system is in disarray, with parallel systems prioritising personal interests over patient care.

“The healthcare system has been dismantled to its foundations. Parallel systems exist that cater to private interests, while focus should be on patients, who are no longer within the system’s line of sight,” said Milić.

He identified dual employment as the root cause of the healthcare system’s challenges, pointing to doctors working simultaneously in both public and private sectors.

“Everyone wants to work privately, using the public sector as a recruitment ground for private practice. Wealthy individuals no longer go to public hospitals, while the poor have no other choice. What about those who cannot afford private care? How many lives have been lost due to delayed interventions? We will never know,” Milić added.

Snežana Simić, Retired Professor of Social Medicine and former Assistant Health Minister under Tomica Milosavljević, noted that while waiting lists have become more transparent, the sheer number of people waiting to undergo medical interventions remains excessive.

“Resolving this issue requires significant financial investment, whether through increased healthcare system funding or budget reallocations. However, it is unlikely this will happen in our country,” Simić said, attributing the problem to inefficiencies within the public healthcare system.

“There can be no equitable healthcare system in an unjust society,” she concluded.

Dragoslav Popović of the Serbian Public Health Association stressed that while the private sector cannot be ignored, public healthcare must act as a corrective force to address inequalities in access to services.

“The public sector must ensure that those who cannot afford care receive life-saving services or interventions that improve their quality of life,” Popović stated.

He added that waiting lists are symptomatic of both corruption and inequality, which also manifest in limited access to preventative services and a lack of public awareness.

Draško Karađinović from the NGO Doctors Against Corruption highlighted that a series of laws adopted in 2005 exacerbated corruption and created waiting lists.

“Strong corruption networks have developed, obstructing any reform efforts. We find ourselves in a checkmate situation,” said Karađinović, emphasising the need to integrate the private and public sectors.

Green-Left Front MP and Attorney Marina Mijatović, highlighted that patients are poorly informed and insufficiently aware of their rights.

“When one reads the Health Care and Health Insurance Act, it seems as though everything is accessible, and there is no need to worry. However, this solidarity is essentially a façade, as nothing is truly accessible in the public healthcare system,” said Mijatović.

She pointed to public health insurance as the root of the issue.

“People don’t even know who to complain to about healthcare workers. When you look at the official complaint statistics, they’re practically non-existent. One might think all patients are satisfied, but in reality, we are far from that,” she emphasised.

Mijatović also stressed the importance of establishing databases to enhance transparency and access to healthcare information.

Branko Matejić from the Independence Trade Union of Health and Social Protection attributed the issue of waiting lists to systemic failures in public healthcare.

“As a union, we believe the proposed solution, which involves weekend work, cannot simply be compensated with days off. We insist that all healthcare workers must be adequately paid for their work, in accordance with legal regulations,” Matejić said.

He underscored the need to revise the salary coefficient for healthcare professionals, arguing that such a change would significantly reduce the outflow of skilled staff from the public health sector.

Participants in the debate agreed that better planning of the healthcare system is urgently needed. Key proposals include: eliminating dual employment arrangements, introducing salary scales, financing healthcare through alternative reserves, enhancing transparency, and strengthening preventative healthcare measures.

The debate ‘(In)equality in Access to Healthcare Services and Waiting Lists’ was organized by the Center for Democracy Foundation in collaboration with the Friedrich Ebert Foundation as part of the Centre Dialogue – Social Forum project.