Patients, insured by the Health Fund, who need medical rehabilitation at the Simo Milošević Institute, and who, according to the regulations, must pay a 40 percent co-payment for the costs, are massively giving up on going for therapy, "Vijesti" has learned.
The reason for this is that in November, the Institute doubled prices for patients of the Health Fund, so that now the patient's participation of 40 percent for 21 days of therapy amounts to over 900 euros. Full board with therapies until November cost from 40 to 63 euros, and since then it has been from 80 to 126 euros.
The Health Fund told "Vijesti" that the Government can change the regulations on who is entitled to have their rehabilitation costs paid in full, and they see the solution to the problem in giving them greater authority in determining the amount of participation.
Last year, the government and the Institute's management agreed to increase prices for Health Fund insured persons, with the explanation that the previous prices were below the Institute's costs, but also as unofficial but legal help for the Institute to save itself from bankruptcy after it lost patients from Norway in 2023. Guests from this country brought the Institute around 2,7 to three million euros annually, or about a quarter of total revenue, and until two years ago, prices for them were twice as high as for domestic insured persons.
Although the November price increase for the Fund's policyholders will help the Institute reduce costs, it has led to a significant increase in costs that some domestic policyholders must pay through co-payments.
Several insured people confirmed to "Vijesti" that they are giving up rehabilitation due to the increase in the amount they have to pay.
The Health Fund told "Vijesti" that the amount of costs for an insured person when going for rehabilitation at the Simo Milošević Institute in Igalo was determined by the Decision on the Participation of Insured Persons in the Costs of Health Care Treatment, which was adopted back in 1991.
"The current Law on Mandatory Health Insurance from 2021 stipulates that the Ministry of Health, in accordance with Article 15 of the Law, prepares a proposal for the decision in question, which is ultimately adopted by the Government of Montenegro. Therefore, the competence for amending, or adopting a new decision, is given to the Ministry, or the Government of Montenegro. Last year, the Health Insurance Fund of Montenegro initiated amendments to the aforementioned decision precisely because, through certain cases in practice, we have recognized inconsistencies and the need for amendments to existing solutions," the Fund said.
They state that they see the solution to this problem in giving the Fund greater authority in determining patient participation fees for rehabilitation, as this would enable its insured persons to exercise these rights in a more efficient manner.
"Given that the decisions of the Government of Montenegro in 2024 increased the prices for rehabilitation at the Igalo Institute, the amount that our insured persons allocate through participation in the costs of rehabilitation has automatically increased. All of the above once again indicates the need for the Health Insurance Fund of Montenegro to have significantly greater powers than currently established, which has been emphasized on several occasions by the Director of the Fund. In this way, these and similar situations, which prevent our insured persons from fully exercising their rights, would be resolved in a more efficient and systematically higher-quality manner," the Institution stated.
According to the current rules, the Fund fully finances the costs of rehabilitation in Igalo for children of insured persons, women during pregnancy, childbirth and one year after childbirth, for those over 65 years of age, donors of organs, tissues and cells for the purpose of treatment, voluntary blood donors who have donated blood more than ten times, beneficiaries of social protection rights and their family members, beneficiaries of the lowest pension, veterans, military invalids, civilian invalids of war and beneficiaries of material security for veterans, the unemployed, persons serving prison sentences and who have been imposed a measure of mandatory psychiatric treatment, blind and deaf-mute persons and persons with autism.
"For all other insured persons, the amount of participation depends on the diagnosis determined by the specialist and can be from 0,25 euros per hospital day to 40 percent participation in relation to the total amount of rehabilitation costs. In the specific case, which you mention in your question, it is important to emphasize that there is a price list of the Institute in Igalo which stipulates that, based on the total amount of the costs of a 21-day stay, the Fund participates with 60 percent, and the insured person with 40 percent, in the total rehabilitation costs," the Fund's responses stated.
If the number of patients decreases, the recovery plan will be jeopardized.
According to the Institute's restructuring plan, which is intended to save it from bankruptcy, the Institute is expected to have 100 patients annually who are insured by the Fund with an average daily price of 90 euros, which would generate a total of nine million euros in revenue from them. This is double the income the Institute currently receives from fund patients.
If the trend of the Fund's insured persons giving up rehabilitation at the Institute due to the higher costs of their participation continues, the Institute's expected revenue plan in the coming years will be jeopardized, and thus the effects of the Restructuring Plan itself.
The new restructuring plan, according to the agreed changes, should be adopted by February 20th.
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