JUL Getting Into the Blessing Business

In last weeks reshuffle the Yugoslav Left, a party with probably the larders number of atheists, took up religious work: Dr. Leposava Milicevic, Minister of Health in the Serbian Government and a prominent official in this party, was appointed to the position of Federal Minister of Religion.

The very act of appointment in the Cabinet run by Momir Bulatovic, President of Federal Government, is explained the federal government's intention to continue to develop its relationship with the Church and with religious communities.

For now this sudden reshuffle has not been explained, at least not publicly, by the Yugoslav Left.  Either JUL wants more power, beside that which it undoubtedly already has in the health care system - an imposing number of directors of important hospitals and clinics come from the ranks of the JUL - or simply Dr. Milicevic has been diverted in her skyrocketing career to a more placid position.  She entered the Serbian Government in 1994, after 18 years of medical practice in Pozarevac and Kladovo.  During six years in the position of minister, she never once showed any inclination toward religious issues, if her public statements and appearances are anything to go by.  However, a directive is a directive, and only several days after her appointment to her new job, she already made a public statement of her priorities in her job in the future: establishing official ties with all religious communities in Yugoslavia.  "There are many problems and certainly I will continue to work on everything that could potentially be a problem, and the FRY will continue to hold to resolving problems as much as problems are close to the heart of religious communities in Yugoslavia, and they will be as much a part of the FRY..."  Belgrade's newspapers reported the quoted statement, while state television news were content with a laconic announcement from the latest session of the Serbian Government.

The JUL generally perceives itself as a party of educated individuals with superior qualities who, regardless of their actual professions and their education, are ready to jump in the fire at the shortest notice. Thus far there was no such portfolio on the federal level as the portfolio of minister of religion.  There used to be the Federal Committee for Relations with Religious Communities, with the president of that Committee usually having been the top man in some ministry.

Thus, for instance, the job of president of that Committee was done by the former Minister of Sport, Zoran Bingulac.  Previously such jobs were carried out by the same people who used to be heads of the Ministry of Tourism, for instance.  That is why the appointment of Dr. Milicevic to the position of Minister of Religion could only be interpreted as a sign of gratitude for good party work, but under no circumstances could it be intrepreted as acknowledgment.  For the feisty fight the JUL waged in keeping its clutches over health care clearly indicates where their priorities lie.

PARTY ACCOMPLISHMENTS:  Minister Dr. Leposava Milicevic's work as government minister in the past six years could prove fruitful both for her as well as for her party: the health care system is centralized, along with distribution of medical drugs; she dealt successfully with two strikes by health care workers, she entered into battle with private medical practice and opened up channels for the influx of medical drugs and supplies from India and China.  In the interest of keeping social peace, she spared large enterprises that are run by various government officials from having to pay health care contributions, of course, on the basis of decrees passed by the Serbian Government.

In under four years she managed to appoint and fire four Directors of the Serbian Helthcare Institute, while one of them, otherwise her fellow party official, Dr. Nenad Djordjevic was even put behind bars.  The last big move made by the Ministry of Health, while she headed it, was the takeover of ICN Galenika by the Serbian Government.  Perhaps the only stain on her party record could be accusations leveled at her by the said Dr. Djordjevic during his trial that supposedly Minister Dr. Milicevic took a very active part in the import of medical drugs, for which he is now serving time.  No one at JUL offered to deny or verify Dr. Djordjevic's accusations.

The fact that Dr. Milicevic is not immune to anxiety and worldly cares is reflected by the visible drop in her enthusiasm and love of her job which transpired in the period of her government service.  The offer made by the present Serbian Prime Minister Mirko Marjanovic in 1994 for her to take over the Ministry of Health was commented at the time by Dr. Milicevic in the following terms: "The challenge came more from fear, and was something I could not resist.  If I manage to not be a worse minister than my predecessors, I will be satisfied."  Five years later, at the end of 1999, at the session of the Serbian Council of Helthcare Workers' Unions, she stated: "Had someone told me in 1999 that this would happen, I would have spit in his face with full force."

As far as spitting in the face goes, medical doctors used the opportunity to do that very thing through their medical worker's unions and directed their invective at the Minister herself.  Because of miserable and irregular salaries, her resignation was demanded.

Naturally, their demand was not met, nor were their salaries raised. Four years later health workers are poorer than they ever were, while the good Minister is getting a new portfolio. Her name, for who else could be accountable for the tragic state of the Serbian health care system, was mentioned in a negative context by the ailing as well, because the longer Dr. Milicevic took care of our health care, the harder it became for the sick to get access to medical care.

TOTAL CONTROL:  In the first year of her mandate as Minister of Helthcare, Dr. Milicevic very clearly let private medical practitioners know that there is absolutely no chance of them ever becoming part of the national health care system, and that under no circumstances should they harbor hopes that the state will ever give them a single dinar, given the general conditions in the country.  In the meanwhile, Ministry of Health care inspectors were busy inspecting private practices and laboratories, as Dr. Milicevic was announcing a cleanup of the Serbian health care system.  The approach was one of centralization in which all health institutions were placed under a government "umbrella", that is to say under the direct control of the Ministry of Health care.  The order of the day became and still is total control in which hospitals lost all independence over their activities, while the Ministry appointed all directors and administrators of hospitals and other health care institutions.

The incessant complaint about a surplass of medical doctors in the Serbian health care system bore fruit.  According to 1997 figures, Yugoslavia used to have 22,480 medical doctors.  By contrast with 1996, the reduction in numbers was across the board and included reductions in the number of health care units by 12.6 percent, a reduction in the number of medical doctors by three percent, while the number of other health care workers was reduced by an additional seven percent.  The number of doctors working in institutions for the health care of preschoolers was reduced by as much as four percent.  That same year a total of 1034 doctors serviced the health care needs of preschoolers.

In 1994, when the good doctor Milicevic took on her ministerial portfolio, the number of hospital beds compared to 1991 was reduced by three thousand - one hospital bed to 184 citizens.  A little or a lot, depending on your point of view.  According to statistics, only 70 percent of hospital beds are actually in use.  At the same time, the waiting list for hospital beds increased, while a place in hospital for patients, except for urgent cases, became something completely subject to chance.

IMPORTING MEDICAL DRUGS:  The result of the disciplinary actions carried out against the pharmaceuticals industry and the retailers of medical drugs is an atmosphere in which large pharmaceutical companies with established reputations simply cannot survive.  The worst consequence of the good doctor's reforms of Serbian health care has been a shortage of medical drugs which has become alarming since last year. Every time the state pharmaceutical lobby decided to institute order into chaos, the result was a trickle of vital medications into pharmacies.

The biggest chaos in the market for medical drugs, for which the Yugoslav population naturally footed the bill, has been the looting and takeover of Milan Panic's ICN Yugoslavia, which supplied 50 percent of the Yugoslav pharmaceuticals market.  While Panice credited the Government out of personal interest (the Governments debt to Mr. Panic reached 320 million dollars), things somehow tumbled along.  When he decided to collect on his credit, the Ministry of Health care initially prohibitted the sale of his pharmaceutical products in state pharmacies, where in any case medication is acquired by prescription and without payment, as well as in health care institutions, where the principle is the same.  Following this, they shut down ICN Yugoslavia.  The whole matter has been taken to court without too much hope of resolution.  If anything in this state can be categorized as a scandal, after everything that happened here, than the looting and shutting down of ICN Yugoslavia certainly qualifies, given that this company opened the first factory here with foreign investment.

In September of 1998, after the first serious fight with ICN, the bidding for a tender for the importing of pharmaceutical products in the value of 120 million dollars was opened.
Of the 68 pharmaceutical products opened for import trading, as many as 40 are replacements for products formerly manufactured by ICN.  20 antibiotics are included under the importing quota.  It should be remembered that of the 420 pharmaceutical products which were included on the positive list (free medication with a prescription), ICN products made up 112 of those, packaged in 230 different ways.  Of these, 43 medical drugs packaged in 128 different ways did not have any substitutes on the local manufacturing market.  To put it more precisely, what is at issue is production of 22 million packages of various ICN pharmaceutical products which needed to replaced by four million packages of medical drugs manufactured locally.

The move made by the Serbian Government further deepened the breach of logic initiated by the Federal Minister of Health care, who for unknown reasons took all pharmaceutical products manufactured in Macedonia of the so-called "positive medical drugs" (prescription drugs) list drawn up by Healtcare Insurance of Serbia.

The remaining domestic manufacturers of pharmaceutical products, who are also crediting the Government by two billion dinars (according to official figures, but unofficially by four billion dinars), are being warned that if they stop manufacturing pharmaceutical products or if they demand retail price hikes, the Government will have to look beyond our borders for pharmaceutical products.

Behind scene preparations for the importing of Indian, Pakistani, Mexican and Chinese drugs were made in this way.  The toughest problem in doing the story on the importing of pharmaceutical products in Serbia  refers to the list of importing companies which seems to be the closest guarded secret here.  According to the Health Minister herself, there are 300 companies who import pharmaceutical products into Yugoslavia, but her memory fails whenever asked who these companies are: "The Federal Ministry of Health care and Social Policy is in charge of the production and trade of medical drugs, and it just so happens that this is precisely an area in which I worked in 1994 and 1995."

Already in prison for charges that he amassed wealth at the expense of the state, the former high official of JUL and former Director of the Institute for Health care Insurance mentioned Dr. Leposava Milicevic in a negative context, criticizing her for the contract that the Ministry of Helathcare made with a Viennese company Biorena.  According to Djordjevic, the Institute guarantees that "these companies will purchase medical drugs and sanitary materials and equipment in the amount of one hundred million dollars, while there is no specification of the actual medical drugs, the actual sanitary materials and equipment which the Viennese company was supposed to deliver."  That contract marked the beginning of Djordjevic's conflict with the Minister.

In the conflict between Dr. Milicevic and Djordjevic in vital and also sensitive positions that are full of challenge, things could not end differently than by a falling apart.  They both had pretensions toward being the heads of the same house.  For now, absolute centralization and distribution of medical drugs in Serbia is associated with the former Health Minister, although unfortunately this did not result in the filling of state pharmacies with indespensable medical drugs, nor did she supply hospitals with equally indispensable medical goods. Nenad Djorjdevic is associated with absolute centralization of all financial transactions made by the Institute for Health care Insurance, an otherwise very powerful institution.  If endresults are anything to go by, it appears that end users were never taken into consideration.

ILLEGAL DOCTORS:  Restrictions with few visible results characterized the policies of the Health Ministry while Leposava Milicevic headed it. Two years ago, the Ministry passed a decree prohibiting all doctors from practicing privately outside of their jobs in state hospitals.  All who broke this rule were fired.  The greater majority of doctors regularly signed the decree when propmted by their hospital's directors, and continued to work in private practice outside of work, although with complete illegality.  Today this decree is never even mentioned, while nearly 10,000 of the 22,000 medical doctors in Serbia work privately in one way or another.  The most farcical element in this "cleanup" are the hospital directors or head administrators who also, as a rule have their own private practices, while some of them even advertise their expertise over the Internet as specialists who sometime work at private clinics.

This repressive measure would make sense if it was not authored by someone who is well aware of the fact that medical doctors in Serbia live on the verge of poverty on their small salaries, and that their knowledge is insulted by their hourly wages (the Institute pays a surgeon 10 dinars per hour, the equivalent of 25 American cents), with the result that they are constantly tempted by bribes.  Admittedly, bribes have become a matter of routine for some doctors.  But conditions under which they work are also insulting.  Hospitals are so poor that in the majority of them not even minimal conditions for health care have been insured.

Shortages at ever step: from band aids to surgical thread.  Equipment is a subject all unto its own.  According to data collected from Belgrade's Municipal Health care Centers, over 50 of x-ray equipment is older than 20 years, while a little less than half are older than ten years.  Old equipment threaten the health of doctors and patients alike.  Hospital employees receive humanitarian aid in soap, rice, cooking oil and other staples.  They also get humanitarian packages.  According to some estimates, in the past year Serbia received 700 million German marks of humanitarian aid.  Although the Minister stated that she is not against humanitarian aid in principle, she also stated that she has no intention of showing gratituted to donors like George Soros.  In all this, this kind of reaction could be included under the approach by her part toward everyone from the west.

THEORY AND PRACTICE:  In the Serbian health care system certain hospitals were always privileged over others because they have excellent reputations and because there is considerable investment in them.  Amid great poverty, one's eyes become large, as one's appetite grows.  Dr. Milicevic was hardly fortunate when she took the job of Health Minister.

She encountered a very inefficient, sluggish health care system, a pauperized state, and a nation that was increasingly more sick.  Still, she decided to invest enormous amounts of money into certain elite medical institutions, and at the cost of doubling capacity, she decided to support projects headed by her fellow party members.  It would be crazy if anyone were to be critical toward high medicine.  But it is difficult to imagine in a country where per capita annual investments in health care amount to around 100 dollars, that one can die in hospital from the simplest infections, that there would not be any prevention for tuberculosis which strike 30 out of 10,000 citizens.  At a time when at a children's' clinic the lives of babies were threatened because they were on a waiting line for heart surgery, another children's' clinic was celebrating the opening of a new diagnostic unit.  In recent years, Serbian medicine is a matter of extremes.  There are rumors about privatization in all this.

If the JUL support of free health care clashes with anything, it is with payment for checkups, prescriptions and the purchase of medical drugs. An even more drastic measure is the increase of the price of services which patients must pay themselves.  Women bearing children are under the gun, even though the birth rate is very close to the zero increment.  As things stand now, and according to the present policies of health care, the only thing that is free in hospitals is the actual bed.  Everything else, the food and an entire list of things needed to get for hospital, for operations or medical care.  Even critical patients are only protected on paper.  Of what use is a prescription when there are not medical drugs in pharmacies.  And there certainly are very mew medical drugs in pharmacies.  Chronic patients such as diabetics fair the worst.

1050 medical drugs are registered in Yugoslavia.  Dr. Milicevic encountered 500 of them on the positive list of medication.  At the time that she was doing her job, this list had been reduced to 385, with the tendency for further quietening down.

On several occasions citizens were asked to have patience for our situation.  Government documents and JUL policies continue to officially state that health care should be for free.  In any case, someone might even believe that.

Ultimately, Leposava Milicevic's taking up of the Minister of Religion portfolio seems only logical: health care like ours can only be saved by God himself.