According to estimates, revenues from health tourism in Montenegro in 2019 amounted to 16,17 million euros, i.e. less than half of one percentage point of the gross domestic product from that year.
According to the latest data, about eight percent of tourists come to the country for health and wellness services, mostly for dental services, cosmetology and recreation.
This, among other things, is stated in the Health Tourism Development Program from 2021 to 2023, which was prepared by the Ministry of Economic Development and Research on the State and Potentials of the Development of Sustainable and Health Tourism, which was presented in July at the session of the Health Tourism Coordination Board.
In the Development Program, published two years ago, it is pointed out that Montenegro does not keep official statistics on health tourism, but that the data is based on estimates. However, it is stated that the problems for the development of this sector are numerous, among them an insufficient number of hotels that provide wellness services, a shortage of labor, low wages and poor air connections in the off-season.
"Montenegro allocates huge sums for treatment outside the country, according to the data from the budget from 2009 to the end of 2020, 183 million euros were allocated for this treatment," the Development Program states.
"Simo Milošević" has no alternative
The key link in the healthcare of Montenegro and tourism related to this sector is the "Simo Milošević" Institute in Herceg Novi. The Development Program states that this institution is the founder of health tourism in the country, but that it has been dealing with financial problems for a long time and, among other things, requires investments of 60 million euros.
That the Institute "Simo Milošević" has not been invested in for the last 40 years, and that it has now come to pay, said the president of the Trade Union of that institution Marija Obradović. In her statement to "Vijesti", she emphasized that the offer of medical services at the Institute is at a very high level, but that the infrastructure is old and devastated, which is why the price of the service is low and insufficient for positive business. She added that the problems are long-standing and expressed through the carelessness of the owner.
"The price according to the Health Fund has not been corrected from 2009 until this year. The employees of the Institute have the lowest wages of all healthcare workers, which led to the initiation of lawsuits in which the workers sought their rights to wages under the Branch Collective Agreement and received judgments. Lawsuits are being withdrawn to this day with immeasurable expenses for the collection of interest, court and attorney's fees", she pointed out.
Obradović said that in addition to the fact that the Institute has been in the privatization process for almost 15 years, the corona crisis in which it served as a quarantine without compensation and in which patients from the region and Europe were not accepted, brought the institution to its current situation. He also states that the Institute is the only institution that deals with the medical rehabilitation of citizens of Montenegro and that there is no alternative to it.
She explained that the treatment in that institution is based on the principle of "know how" and that medicinal mud, mineral waters and climate therapy are also used, and that citizens of Norway, Sweden, the Netherlands and the former Yugoslavia come to the Institute for rehabilitation this year and in previous years. .
On the other hand, a member of the working group for Sustainable and Health Tourism Snezana Pantović during the presentation of the Research on Potentials in July, said that the data show that further growth in investment in scientific research activities and personnel education, encouraging development, but also strengthening and promotion of health tourism is necessary.
"The current state of health tourism offers is such that 34,5 percent are dental services, 30,9 percent are fitness, cosmetology and recreation, 14,5 percent are wellness and spa (non-medical), 10,9 percent are treatment and rehabilitation, and 10,9 percent are aesthetic and plastic surgery", explained Pantović.
Serbia is increasingly visible on the map of medical tourism
With its staff of highly qualified medical experts, some state-of-the-art facilities and competitive prices compared to Western countries, Serbia has strategically positioned itself as an attractive option for health tourists in recent years.
On the international level, Serbia is building its reputation in the world of medical tourism through active participation in medical research, contributions to medical journals and the organization of international medical conferences. Serbia offers a variety of medical procedures, but some of the most popular include dental treatments, cosmetic surgery, orthopedic surgeries, such as knee and hip replacements, and fertility treatments. Cardiology and oncology services are also increasingly attracting foreign patients. Serbian medical institutions are also known for their expertise in cardiology, especially minimally invasive heart procedures.
Most of the well-known hospitals in Serbia have international accreditations and are connected to renowned universities and medical institutions around the world, which further contributes to the increase in the confidence of foreigners in medical institutions in Serbia. So, for example, foreigners in Kragujevac most often use scanner and magnetic resonance examination services, in Subotica tonsils are operated, and in Šabac they come for gynecological examinations.
As told to "Danas" earlier, it pays for foreigners to come to Serbia, pay for a plane ticket and a hotel for 15 days, because the differences are so great that even with these costs, certain health services are several times cheaper than in their home countries.
One of the main reasons why Serbia stands out on the map of medical tourism is its economy. The prices of dental procedures can cost up to 75 percent less than in most European countries and the USA, while more complex operations such as knee replacement can cost between 4.000 and 7.000 euros, which is significantly less than in some countries of the region. There are also cosmetic surgery services that are also, depending on the type of procedure, cheaper than in Western European and North American countries.
Also, Serbia is rich in thermal springs that have spa facilities, although many services are related only to rehabilitation and diagnostics, and only a few leading spas in recent years have introduced modern, non-invasive medical treatments that contribute to the recognition of our country as a medically attractive destination.
However, what sets Serbia apart is its focus on specialized treatments in the field of dentistry, as well as aesthetic surgery.
Doctor of dentistry from Belgrade Goddess Tomčić for "Danas" he points out the fact that dentists and doctors from Serbia are highly regarded in Europe and beyond.
"We have a very high-quality staff when it comes to all specialties. In addition, check-ups do not take long, dental services in Belgrade are of very high quality, and the prices are still affordable, unlike highly developed countries, which also have great staff, but also very high prices, almost unattainable for an ordinary person," he tells "Danas" Tomčić.
She states that one of the reasons why foreigners recognize Serbia as an attractive destination in terms of dental services lies precisely in good education.
"The Faculty of Dentistry of the University of Belgrade is one of the highest ranked on the Shanghai list when it comes to the University of Belgrade. The quality of the teaching is at an enviable level, and the most modern protocols are used, which in no way lag behind the world standards", says our interlocutor.
Tomčićeva emphasizes that this is the situation in almost the entire Balkans, pointing out that Sarajevo and Zagreb universities have also produced great experts in this field, and that Balkan medicine and dentistry "never faltered in quality".
Unofficial data show that Serbs living in Germany, Austria and Switzerland most often come to our country for treatment, and although the exact number of users of medical services is not known, it is estimated that around ten thousand people visit Serbia for these purposes annually.
When it comes to citizens of Serbia in the role of medical tourists, the Republic of Serbia concluded with 25 states and one province an international agreement defining cooperation in the field of health insurance. The types of cooperation are divided into three categories - according to the principle of insurance, according to the principle of reciprocity and according to the principle refunds. Certainly, appeals for the collection of humanitarian aid, most often for the youngest, and for interventions that are not covered by the insurance covered by the RFZO, are often encountered on social networks.
Also, foreign citizens, as well as our citizens who live and work abroad, have the right to emergency medical assistance during their temporary stay in Serbia. Foreign citizens who are chronic or acute patients (on dialysis, insulin, etc.) or who are referred for treatment in Serbia need special certificates in order to be provided with such health services without payment.
From the Republic Health Insurance Fund (RFZO) to "Danas" until the publication of the text, there were no answers or any data on what procedures foreigners, as well as our people who live and work abroad, are most often subjected to.
In the end, although there is a certain amount of interest in Serbia in terms of medical tourism in the world, it seems that this branch of the economy is still not fully developed, above all in terms of the development of strategies at the national level. Obstacles in further development are certainly represented by the fact that Serbia is not a member of the European Union, as well as that there are clear discrepancies in the definition of health care standards.
BiH: Cooperation is getting better
The cooperation of health care institutions with the countries of the region, when it comes to the treatment of our citizens outside of Bosnia and Herzegovina, is more pronounced every year, and especially in emergency cases, they are always ready to help each other in caring for patients. The willingness of doctors in neighboring countries to treat our citizens is not questionable in most cases, although financial resources are often a problem.
Entity institutes only have business cooperation contracts with a few of them, but when it comes to transferring money to health institutions in neighboring countries, unfortunately, patients suffer again.
In the Institute of Health Insurance of the Federation of BiH, as they told us, patients are treated abroad on the basis of bilateral agreements on social insurance, and they have signed contracts on business cooperation with certain medical institutions in the region, without specifying which ones.
In the Republika Srpska Health Insurance Fund, according to the spokeswoman Darije Filipović Ostojić, insured persons of the Fund have the right to treatment outside the Republika Srpska, when health institutions in the entity cannot provide treatment, that is, when a certain health service is not provided in health institutions in the RS.
"Insured persons are then referred to institutions with which the Fund has signed contracts, mostly in Serbia. Patients are generally referred for treatment outside the Republika Srpska for cardiac surgery, i.e. heart disease, then cancer, leukemia, and neurological diseases," says Filipović-Ostojić.
The public health institution "Sveti vračevi" Hospital in Bijeljina records successful business cooperation with colleagues and health institutions in the region, above all in the Republic of Serbia, with the Institute for Cardiovascular Diseases in Dedinje, the Institute for Cardiovascular Diseases of Vojvodina from Sremska Kamenica, the Clinical Center of Serbia and the Military Medical Academy from Belgrade, the University Children's Clinic Tiršova from Belgrade and the Institute for Mother and Child Health Care of Serbia "Dr. Vukan Čupić".
Approval for referring patients to these institutions is exclusively within the competence of the University Clinical Center of the Republic of Srpska.
The Bijeljina hospital ensures the arrival of experts from the aforementioned clinics for the treatment of citizens, but also for staff education.
For years, Bijeljina hospital has been trying to sign a contract on business cooperation with ZZOR FBiH so that patients from the Federation of BiH could be treated in this health facility in the RS. There is no support from the Institute for signing the contract because, as they stated, "The Federal Ministry of Health has verified the health institutions for the provision of services in electrophysiology and interventional cardiology in FBiH with which the Institute concluded contracts, and there was no possibility of concluding a contract with JZU Hospital "Sveti vračevi".
"On the territory of Bosnia and Herzegovina, a law on public procurement is applied, and we believe that the Bijeljina hospital in the mentioned case was excluded from public competition without a proven basis. We reacted to the decision of the Institute of Health Insurance and Reinsurance of FBiH with an appeal, but we have not yet received an answer, stated the "Sveti vračevi" Hospital.
Dr Igor Hudić, the assistant director for medical diseases of the UCC Tuzla emphasizes that the regional cooperation of health institutions is important to them, especially in cases where emergency situations and urgent transportation of patients are involved. This is how it happened to them that in the last few weeks they had to urgently transport children due to conditions that they could not solve in KC Tuzla.
"These were cases when we urgently transported them for further treatment to the Mother and Child Institute in Belgrade, with which we have excellent cooperation. Colleagues accepted our patients and cared for them in the best possible way, completely professionally. As for the professional part of patient care, the procedure is prescribed, strict and clear, and is carried out in that way," says Dr. Hudić.
In Tuzla, they emphasize scientific cooperation with colleagues, university professors in medical centers in Croatia and Serbia, along with numerous educations and operative procedures.
From the Clinical Center in Ljubljana, and their Clinic for Plastic and Reconstructive Surgery, there are constant visits by doctors to UKC Tuzla, where they jointly perform demanding operations.
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