Citizens buy devices, private individuals fill their pockets

The Clinical Center (KC) will increase the number of magnetic resonance examinations per month by 200, in order to reduce the number of patients who are increasingly referred to private hospitals for this diagnostic procedure at the expense of the state.

In that institution, they are planning a new organization of the doctor's council and the appointment of emergency patients. They confirm that they too notice a trend of increasing the number of patients referred to private individuals for magnetic resonance (MR) examinations, which is "mostly not justified".

The head of the department for MR and CT (scanner) diagnostics in KC Žanka Cerović believes that supervision should be increased when it comes to sending patients to private patients.

KC has two magnetic resonance machines, one of which was purchased in October 2018, and the third is in the Children's Hospital. Patients who have been waiting for more than a month for an examination can be referred at the expense of the state to two private clinics - "Hippocrates" and "Tesla medical". Currently, patients wait between one and two months for an examination at KC.

"Vijesti" announced at the beginning of May that the state paid more than half a million euros to private individuals for MR examinations last year, despite the fact that KC became richer for another such machine in the fall.

"Hippocrates" received about 85 percent of the funds, that is, about 435.000 euros.

Allocations for the costs of MR examinations for private individuals increased more than twice compared to 2017, when 226.730 euros were spent for the same purpose.

The new "MR Skyra" MRI machine from Siemens, worth more than 1,4 million euros, was put into operation in KC on October 3 last year. The most money was paid to private individuals in the last quarter of the year. Observed by month, the most money from private individuals was invoiced in April, November and December 2018.

Health Minister Kenan Hrapović told "Vijesta" that one magnetic resonance machine was out of order for two to three months, which caused waiting lists.

He also explained that the new device required installation and staff training, so one of the ways to reduce waiting lists was to refer patients to private doctors.

KC: The increase in instructions is unjustified, we work overtime every day

KC told "Vijesta" that about 1100 MR examinations for adults are performed at the Center for Radiological Diagnostics per month, not counting the examinations of children at the Institute for Children's Diseases, which has a new 1.5 Tesla machine.

With the new, or the third device that KC received in October 2018, half of the inspection is performed. According to the KC, it is impossible to increase the number of examinations on this machine, because new, more sophisticated methods, which last much longer (up to an hour) than routine examinations, have been introduced.

"Employees at the Center for Radiological Diagnostics have been working in two shifts every day, except January 1, for years, all with the goal of providing our patients with diagnostics in the shortest possible time. Therefore, overtime work has already been introduced every working day, which means every weekend, and from June we may additionally increase the number of examinations to the limit of the technical capabilities of the apparatus", replied the institution headed by Jevto Eraković.

In the KC, they believe that "it is important to clarify that our Center for Radiological Diagnostics cannot control the referral of patients to private institutions, because the referral is issued by a selected doctor when the waiting period is longer than a month".

Selected doctors do not send patients independently, because only specialists can request it, based on which they then issue instructions.

The KC assesses that "there is a trend of increasing the total number of referrals for MR diagnostics, which is generally not justified".

"We hope that with the new organization of the consultation and scheduling of priority patients, which we are making in agreement with the Ministry of Health, we will improve the organization of work and that we will succeed in increasing the number of examinations by about 200 per month", emphasized the KC.

Cerović: The Center did not contribute to the outflow of money from the public system

Cerović, otherwise the vice-president of the Assembly of the Medical Chamber, believes that the Center for Radiological Diagnostics did not significantly contribute to a significantly higher allocation of state money for magnetic resonance examinations for private individuals.

She said that in KC in 2016, 13.565 examinations were performed on two machines, the following year 13.817, and last year 12.171 examinations. However, she clarified that in 2018, one of the two devices was out of order for four months (failure of one and installation of a new one).

"It is obvious that the reduction in the number of examinations per year from 1.400 or 1.600, which is done in KC in 1,5 months, could not significantly, and certainly not in this amount, affect the outflow of money to the private hospital," Cerović pointed out.

She said that from this there is a need to strengthen supervision and the question of whether and in what way the regulations on sending patients to private hospitals are respected.

Cerović also assessed that there is a need for the Center for Radiological Diagnostics to be conceived in a different way in the future, i.e. to control the appointment of patients, and therefore the sending to private hospitals, based on the received documentation.

"... By directly scheduling priority patients, and referring those whose check-ups are scheduled for a period of three to six months to the KC according to those deadlines... In this way, possible abuses will be prevented," said Cerović.

She also concluded that only KC owns a 3 Tesla device that is intended to significantly improve the quality of diagnostic examinations, not their number.

"Incomparably better to buy a new device"

"I consider it incomparably more beneficial for patients and for the healthcare system as a whole to buy a new device than to pour money into private hospitals like this," said Cerović.

In 2017, the state audit institution found that the Ministry of Health did not develop a strategy for the procurement of medical equipment and did not implement all legal measures to ensure the procurement of equipment needed by the health care system. The SAI report states that contracts with private individuals for magnetic resonance examinations were concluded without prior analysis and cost-effectiveness assessment.

The SAI did not conclude whether it is more profitable to conclude a contract with private health institutions or to acquire new equipment and provide service in the public system for disputed examination.

They stated, however, that from April 2015 until the end of that year, 223.931,47 euros were paid to a private institution, and that according to data from the website info.blockimaging.com, magnetic resonance devices (GE, Siemens, Toshiba, Hitachi, Philips ) can be purchased for 150.000 to 400.000 euros.