Do-It-Yourself Doctor

Prior to the Orthodox Easter and FRY national day in April, the Serbian government expanded the list of health care services that will have to be paid for in future. That list now has 32 items on it including medical tests, the check ups needed to enroll in school or university, detoxification, abortions due to reasons of health, ultra-sound diagnostics, interventions by gynecologists, emergency services if the doctors on call decide the call wasn't really needed, quality tests for water and food, hospitalization if it is deemed unnecessary.

That list was made public thanks to opposition MPs and the Health Ministry was quick to issue a statement denying the claims, adding that the unpopular measures were not imposed by the government but by the Serbian Health Care Insurance Department. The statement said the expanded list does not mean the rights under obligatory health insurance have been narrowed down. Just a few days later, Health Minister Leposava Milicevic spoke of "charging health care services for some new categories of health care" which she feels does not jeopardize the rights stemming from health care insurance. She added that "the decision hasn't taken effect yet and inspectors have been sent out to health care institutions to fine any individuals or institutions who are abusing or implementing the regulation".

The argument over the new regulation is going strong while Serbia's 150,000 health care services employees are preparing to go on strike because their March salaries still haven't been paid. Doctors and staff in Nis said they would continue their strike to the year 2004 to show their persistence and highlight their demand for fundamental changes in the system. Some hospitals in Vojvodina are also on strike while staff at the specialized psychiatric hospital in Gornja Toponica are preparing to go on strike as well.

The surgical wing of the Kragujevac hospital has postponed operations because of a fight between surgeons and anesthesiologists. The surgeons' board at that hospital has decided to operate only in emergencies after months of problems. The pediatrics department in Valjevo’s hospital had to cancel all operations for a day because their laundry wasn't operating due to a serious malfunction. Part of Belgrade's ambulance service is also on strike and the staff who are still working are just making a show because hospitals in the capital are undergoing shortages of everything. Sources at the Belgrade clinical center, the republic's best medical institution, told VREME that the Health Ministry recommended they operate only in the most urgent cases and lower the number of people they admit. A VREME source in that hospital said doctors were banned from speaking in public about those verbal instructions.

The latest diminishing of the rights of health care insurance beneficiaries are being interpreted by informed sources as just a general indication of things to follow: even greater restrictions and a complete abolishment of free health care. The left's pre-election pride -free health care- now exists only in the law and health-care funds are becoming increasingly rare.

Employees at a once-elite Belgrade import-export company (which will remain unnamed so that its ailing employees can finally get to see some doctor) have spent the past few months going around hospitals with all the paper-work they need to be admitted. None of them were ever admitted because their company hasn't been making payments into health care funds. That proves that lists of undesirables do exist.

The latest session of the Serbian parliament's health care board heard that there are 2,000 companies which the state freed of any obligation to make health care payments. The Finance Ministry explained that no one has been freed from that obligation but because of the bad situation in the economy "some subjects are delaying their payments". The Ministry cut the necessary funding down to 900 million dinars but not one dinar was paid into the clinical center's funds in the first two months of this year.

With a national income of 1,000 USD per capita and contributions of 14% which have been halved because of poverty, taking pride in free health care is complete nonsense. State health care institutions are facing bankruptcy. The Ministry owes hospitals, hospitals owe producers of pharmaceuticals (a debt totaling one billion dinars) and the debt to health care funds is estimated at 1.3 billion dinars.

For years, the rule for admission to hospital has been "bring everything you need from home" including blankets and pillows, a glass and pajamas and soap. Doctors make up lists of medication for patients to buy after examining them. That list has recently been expanded to include anesthetics for operations and antibiotics.

"Free health care is just a conditioned reflex from the times when the state earmarked over seven percent of the national product for health care. Today everything is paid for. Cancer patients buy citostatics themselves, invalids buy artificial limbs, diabetics do get free insulin but have to buy alcohol and gauze themselves before they can inject themselves. When you get sick you have to humiliate yourself and beg. That's obvious in health care. The population does not know how much is allocated toward health care or how the money is spent but they do know that they are sicker than ever and have a hard time getting admitted to hospital. If they do get in the care that they receive is humiliating because of lack of money," Dr. Milena Jaukovic, a member of the Belgrade city assembly health board, told VREME.

Even pregnant women are affected. Doctors claim that at least four ultra-sound checkups are needed during pregnancy. The state allows two and a third has to be paid for. All types of contraceptives are also paid for. The state seems to be stimulating the rise of abortions and even the price of those is astronomical for the conditions in the FRY. Artificial insemination is not done in any state hospital and the cost in private clinics runs into thousands of DEM.

The people are being asked to show understanding for the situation facing health care. It seems that the only people showing any understanding are people with the money to pay for care in private clinics.