The biggest problems in Serbian health care are the poor equipment of state hospitals and the lack of doctors and medical staff, which results in longer waiting lists for certain examinations and a decline in the quality of health services, writes the monthly “Business and Finance”.
In order to reverse such trends, the state must, according to experts, increase annual investments in health care to at least 0.5 percent of gross domestic product (GDP), and this type of investment must be one of the priorities in fiscal policy.
In 2021, a total of 3.2 billion euros will be allocated for health, which is about 635 million euros more than the previous year and 847 million euros more than in 2019.
With total investments in health care of about 0.3 percent of GDP in 2018, Serbia was already close to the multi-year average of Central and Eastern Europe (CEE), but they were a third lower than in those countries for more than a decade. Therefore, it is not enough for investments in Serbia to be at the level of the CEE average, but they must be higher in order to compensate for the long-term backlog, they point out in the Fiscal Council.
Decades of low investments in health care have reflected on the insufficient equipment of health care institutions. Eurostat data show that Serbia lags behind the CEE countries in the number of diagnostic medical devices. Observed per 100,000 inhabitants, the state health care in Serbia has half as many CT scanners, gamma cameras and radiotherapy units and as much as three to four times fewer PET scanners, magnetic resonance imaging and angiography units than is the case in CEE countries.
In addition to medical equipment, Serbia does not have a sufficient number of hospital beds for certain types of care. According to Eurostat data, 560 beds per 100,000 inhabitants in state hospitals in Serbia is slightly higher than in CEE countries, where the average is 550 hospital beds per 100,000 inhabitants.
Serbia has a smaller number and worse structure of medical staff than CEE countries. Although doctors and other medical staff are not directly related to capital investments, staff availability and its structure represent the most important resource of the health system, they point out in the Fiscal Council.
A comparative analysis with CEE countries indicates that Serbia lacks specialist doctors and better trained nurses. Namely, in 2018, Serbia had about 300 doctors per 100,000 inhabitants, which is one fifth less than in the CEE countries, where the average is about 360 doctors per 100,000 inhabitants. Looking at the structure, the most lacking are specialist doctors and surgeons, while the number of general practitioners is even slightly higher than in the CEE countries.
When it comes to nurses and midwives, their number is somewhat higher than in CEE countries (550 in Serbia versus 540 in CEE countries), but their structure differs significantly. According to Eurostat data, Serbia has significantly fewer highly trained nurses, and a relatively high number of nurses with lower levels of education compared to CEE countries.
Insufficient investments, poor equipment and lack of medical staff have had a negative impact on waiting lists for various medical procedures and procedures, which are becoming longer. In Belgrade alone, according to the reports of the City Institute for Public Health, in the period from 2016 to 2018, about 30,000 people waited for some of the examinations a year, and that number did not include scanner diagnostics. That is an increase of 30 percent compared to 2007.
At the same time, the average length of waiting for examinations for which waiting lists are kept is growing. Thus, for example, the installation of a total hip or knee prosthesis takes as long as 582 days, which is twice as long as in 2009, when the average wait for these procedures was 280 days.
According to this report, the number of new patients on the waiting lists is also growing for all analyzed examinations. On the other hand, Trampoline reports show that the average waiting time for an MRI scan is more than 80 days, and for a CT scan for 34 days.
The fact that the reconstruction and equipping of clinical centers has been delayed for 14 years also indicates the inadequate attitude of the state towards health care. The project was formally started in 2006, when the initial funds of the European Investment Bank (EIB) were approved for those purposes, but only the ratification of the loan in the National Assembly took two years. The first concrete works and withdrawal of funds began in 2009, but due to poorly prepared project documentation, it did not go far, stated the monthly “Business and Finance”.
Although the deadline for the realization of the project and the reconstruction of all four clinical centers was 2012, at the end of 2017, only the reconstruction of KC Nis was completed. The upgrade and reconstruction of the Clinical Center of Serbia and the Clinical Center of Vojvodina in Novi Sad is in progress, and the works on the reconstruction of the Clinical Center in Kragujevac have not started yet. Bearing in mind that the value of the project is around 400 million euros, as well as its importance for improving the quality of tertiary health care, the state’s negligent attitude towards this project has no justification, the Fiscal Council estimates.
In order to reach an investment of at least 0.5 percent of GDP per year, as recommended by the Council, the money needed could be provided by lower expenditures to equip the security sector.
According to the data of the Ministry of Finance, out of this year’s 3.2 billion euros intended for health care, the largest part is planned for the Republic Health Insurance Fund (RHIF). The total amount does not include investments related to the Office for Public Investment Management, where an additional 128 million euros are planned for health.
It was officially announced that part of the allocated funds will be spent on equipping the Institute for Mother and Child “Dr Vukan Cupic”, the Institute of Oncology, as well as the Institute for Infectious and Tropical Diseases. The funds will also be used for works on the construction of the Dedinje 2 hospital, for general hospitals in Arandjelovac, Loznica, Vrbas, Surdulica, Smederevska Palanka, Vranje, Kikinda, Pirot and Prokuplje.
Also, those funds are intended for KC Vojvodina and Health Center Novi Sad, for health centers in Valjevo, Veliko Gradiste, Vrnjacka Banja and Majdanpek, as well as for the Institute for Public Health in Kraljevo, Danas reports.
