In addition to knowledge, expertise and commitment, a good managerial organization and the engagement of experts from certain fields are needed in order to reduce the waiting lists in Montenegro to an acceptable level.
Last week, the citizens of Montenegro failed to schedule appointments with several specialists. Among the selected doctors who refer patients to the only clinical center, there were no free appointments for gastroenterologists, rheumatologists, ophthalmologists, and for months neither for endocrinologists and hematologists.
On Thursday and Friday, patients could not make an appointment with a psychiatrist and psychologist at the Clinical Center of Montenegro (KCCG), and in the next four months there are no appointments in the cabinet for a holter ECG, so cardiology patients are forced to pay for this type of service privately.
When it comes to operations, there were 340 patients on the waiting lists for orthopedics and traumatology in April, and 83 on the list of the Clinic for Cardiac Surgery.
Cardiac surgeon Aleksandar Nikolic, who previously managed the Cardiac Surgery Center of KCCG, claims that the main reason for the large waiting lists for operations is the insufficient number of centers. However, he says that the state gives a monopoly to certain state centers and assesses that this leads to the possibility of manipulation of patients by individual doctors.
Nikolić reminds that during his mandate at KCCG there were no waiting lists and that this problem, among other things, can be solved by hiring experts from certain diseases in state clinics.
However, he reminds that in Macedonia, Bulgaria and Greece, the waiting lists have been reduced by the introduction of private hospitals into the system and on an equal footing with the state ones. This, he claims, leads to stronger competition, but also to better quality medical services. Such a practice exists in developed European countries.
At the expense of the Health Insurance Fund, citizens of Montenegro can now have certain procedures performed by private individuals, such as magnetic resonance examinations, part of dental and ophthalmological examinations and procedures, hyperbaric oxygen therapy, in vitro fertilization...
Waiting lists in Montenegro are a decade-long problem, which during the previous years was mainly solved by supplementary work, by banning supplementary work for private sector employees who work in organizational units where the waiting period is longer than 30 days for a health service, and sometimes by introducing private sector workers, which was paid by the state.
According to earlier Government analyses, waiting lists are a possible source of corruption. It was precisely the action plan for the fight against corruption that provided for the public publication and regular updating of waiting lists on the websites of Montenegrin health institutions. To this day, neither general nor special Montenegrin hospitals do that.
Croatia: Almost 120.000 Croatian insured persons are currently waiting for their first examination
Long waiting lists are the scourge of Croatian healthcare. Ministers change, but the situation has not improved for years. Appointments are often waited for an absurdly long time, so even though basic health insurance in Croatia is mandatory on one of several grounds, the insured are more and more often forced to seek help in private health institutions, of which there are more and more. The covid-19 pandemic made matters even worse.
Minister of Health Willy Berosh is trying to tackle waiting lists, so a little more than a year ago it launched a pilot analysis of the waiting list, after which it claims that there was a reduction in the number of waiting days in certain categories of health services.
However, it can only be viewed in this way if control examinations are singled out, for which, according to the logic of things, a certain passage of time is necessary. Allegedly, several IT systems are unified, but in reality hospitals still have their own ordering IT system, so examples from practice show that double ordering is still possible.
It is true that there are waiting lists in the health care system richer than the Croatian one, but some factors are still the result of our insufficiently organized system. Multiple ordering of a patient for one examination in several institutions is one of the reasons why the lists for an examination or diagnostic-therapeutic procedure are so long. It is also a fairly common form of defensive medicine in which doctors resort to a whole series of unnecessary procedures, meeting the patient's expectations and avoiding the risk of accusations of treatment failures.
It is also true that some doctors employed in public health work in private clinics. This practice is also applied in other European countries and is not a problem in itself, if this supplementary work does not take place at the same time as their work is recorded in the home hospital or if they perform it without a prescribed permit, as the health inspection recently discovered in several cases. Equally, this practice turns into a problem if patients are referred to private surgeries "because they will get their turn there faster", as well as in the case when other doctors in the system have to 'pull' more because of the private work of their colleagues.
Vili Beros declared that such a practice was unacceptable to him, and asked the director of hospitals to analyze the effectiveness of doctors who work privately, which would then be the basis for obtaining or revoking licenses for supplementary work. We'll see if anything really comes of it. As part of the health reform under the motto "patient at the center", the minister announced the norms of acceptable waiting times for each individual health service. A bright example from KBC Split, where a cardiac surgeon from Rebar came to head the institution and with his team solved the waiting list in a year, shows that organization is the key and that it can be done.
It should also be said that the Croatian Health Insurance Institute (HZZ) contracts a certain number of health services with private services every year, so patients can go there with a referral.
The reduction of the waiting list was supposed to be influenced by the procurement of expensive radiotherapy equipment, the financing of which was approved by the European Commission in Croatia as part of the National Recovery and Resilience Plan (NPOO). Public procurement for 21 linear accelerators and 9 CT simulators should soon be announced, which would bring the Republic of Croatia up to the EU average with five devices per million inhabitants. The deadline is the end of 2025, with the fact that preparations have been delayed.
Currently, almost 120.000 Croatian insured persons are waiting for their first examination in some of the institutions (hospital and outpatient). On average, the wait for the first examination in hospitals of the first category is 128 days, the longest for the first examination by an allergist and clinical immunologist - 320 days. The wait for the first rheumatological examination is 288 days, while in the largest hospitals (KBC Zagreb, Sestre milosrdnice, Osijek, Rijeka, Split and KB Dubrava and Merkur), the average wait for the first examination by a pediatric ophthalmologist is 258 days, and for a speech therapist or for dermatological oncology 233 days.
In hospitals of the second category (Sveti Duh, Dubrovnik, Pula, Slavonski Brod, Varaždin, Zadar) the average wait for the first examination is 166 days, and in those of the third category (Bjelovar, Gospić, Karlovac, Koprivnica, Sisak, Šibenik, Virovitica, Zabok, Požega, Vinkovci, Vukovar, Čakovec) and the fourth (Knin, Nova Gradiška, Ogulin, Našice, Pakrac) 108 and 67 days respectively.
There is an average waiting time of 242 days for therapeutic procedures in first-category hospitals, for example, 458 days for the installation of a total knee endoprosthesis or 561 days for the start of orthodontic therapy and 361 days for cataract surgery.
On average, the wait is 205 days for diagnosis, 375 days for breast ultrasound, and 230 days for heart ultrasound. MR of the large joint is awaited for 519 days, and ME of the lower extremities 405 days.
In hospitals of the second category, it is even longer, an average of 243 days, while in smaller hospitals it is still possible to find an appointment for which the wait will be shorter. This is also an option in some health centers that have managed to keep diagnostics under their roof for the past thirty years, as primary health care has been neglected and disintegrated, so many people are surprised that, for example, they can go to a health center for a cardiology or dermatological examination at all and that with significantly less waiting.
BIH: Even oncology patients wait two months for operations
A lot of money from the cantonal and federal budgets in Bosnia and Herzegovina is poured into health institutions every year, and patients, even those seriously ill and with life-threatening diagnoses if not treated in time, wait for months to get a specialist examination.
With a specialist, many findings and tests are needed, and for them, the waiting lists are getting longer and longer. It is no better with the waiting lists for operations, but the specific data of the health care institutions are hidden, they don't even have them, considering that the analyzes of these lists are done periodically.
However, there are examinations and findings that patients wait for from three to four months to a full nine. President of the Renaissance Association, persons suffering from and treated for breast tumors in Sarajevo Canton, Enida Glušac she confirmed to "Oslobođenje" that oncology patients, people with established cancer and in whom there is always a possibility of disease progression, are waiting for some specialist examinations. The basic examination, she explains, is an ultrasound of the breast and a mammogram, for which you have to wait three to four months, sometimes longer. It takes four months for a breast MRI, and another month for a lung CT - when it is done in case of suspicion of metastases.
"And for cancer surgery, patients wait a month or two, although realistically basic preoperative findings can be done in less than a week. Waiting lists, it is evident, still exist, the biggest problem is actually that the Government of FBiH does not pay the funds it is obliged to pay. "According to the information we received from the FBiH ZZOR, an enormous number of 206 breast cancer patients and 179 other oncology patients are currently on the waiting lists," emphasizes Glušac.
And dr Adnan Jupić, former Minister of Health in the Government of the Zenica Doboj Canton, points to the problem of waiting that has followed us for many years.
In communication with our people who live outside and have contact with healthcare, the situation is similar to ours, claims Jupić, pointing out that the waiting lists at the healthcare facility where he works are not long.
"At SKB Mostar, the longest wait is for operative procedures at the Orthopedic Clinic. With the new organization of work in two shifts, on the MR and CT program, the lists of orders for radiological diagnostic tests at the Clinical Institute of Radiology have been reduced to a waiting period of 15 to 90 days for all", according to the Public Relations Office of SKB Mostar.
In the Department of Clinical Radiology of the University Clinical Center of the Republika Srpska in Banja Luka, the longest wait for a mammogram is about three months. Magnetic resonance imaging (MRI) and computed tomography (CT) are ordered by family physicians. At the Institute for Nuclear Medicine and Thyroid Diseases, the waiting list for myocardial SPECT is nine months, and for PET/CT it is three months. Myocardial SPECT is a test that requires two days of recording and a lot of time to perform. Currently, only one SPECT/CT machine is used, twice a week, when sufficient doses of radiopharmaceuticals are available.
Even in this health facility, the number of patients is significantly higher than the imaging possibilities, which are limited by the daily doses of radiopharmaceuticals.
"The installation of a new PET/CT machine is in progress, after which the possibility of examining patients will be doubled and the waiting list will be reduced", according to the UKC of the RS.
In the Cardiology Clinic, the waiting list for a 24-hour EKG holter is at the end of July 2023. There are no longer waiting lists for other examinations in the UCC of the Republic of Srpska.
But there are also good examples, even excellent ones: the management and doctors of the "Sveti Vračevi" Hospital in Bijeljina with the director Zlatko Maksimović at the head decided to abolish waiting lists for cardiology examinations. Doctors worked overtime and on weekends to examine all patients.
"We don't have a waiting list for heart surgery. We are in the process of acquiring another angiosala and hope to fulfill that plan in the coming months. There are no waiting lists in other fields of medicine. I will mention that there are no waiting times for cataract surgery, that we have introduced new procedures in abdominal surgery, otolaryngology and sinus surgery, and acquired valuable diagnostic equipment. "By introducing the second shift, we also reduced the waiting time for examinations at the polyclinic, for example rheumatology examinations from six months to one month... Seven cardiologists recently worked for free to empty the waiting list for examinations," emphasizes Maksimović.
This bright Bijeljina example is the darkest stain in Sarajevo: in the Federation, namely, as many as 769 patients are waiting for examinations by cardiologists and cardiac surgeons! For many of them, operations are imminent.
Serbia: The feat exposed the statistics
No good deed goes unpunished, it is planetary wisdom, manifested these days and by the example of the Niš Cardiac Surgery Clinic, which at the beginning of the month abolished waiting lists for operations, after working without financial compensation for 12 consecutive weekends, over a period of about a hundred days .
The initial shouts of "Bravo!", received from a good part of the lay public, quickly replaced the criticisms of the relevant minister and a certain number of doctors, who claim that the clinic has "collapsed the health system of Serbia" through this kind of work.
As far as is known, the enthusiastic example of Niš Cardiosurgery was not followed by any healthcare institution in Serbia, despite the fact that waiting lists are quite often their cancer.
Director of Cardiosurgery dr Dragan Milić namely, on his Facebook profile on April 10, he announced that the clinic eliminated the waiting list, which had 149 patients at the beginning of this year, through free surgeries on weekends that they have been doing since January 21 this year, at the initiative of young doctors.
Instead of patients waiting for operations for three to six months, and some of them lose their battle with the disease during that time, in the future they will enter the operating room no later than 15 days after the anesthesiological examination, he announced.
Eager for attractive and beautiful news, the media and social networks exploded after Milić's announcement on Facebook. The "Kreni- change" team asked the President of Serbia Aleksandar Vučić, through an online petition, which was signed very quickly by 25.000 people, for the employees of Niš Cardiosurgery to receive medals for heroic deeds.
The coalition "Niš, my city" requested to be awarded the highest city recognition, the award "11. January".
The movement of free citizens supported the initiative of 114 employees at Niš Cardiosurgery, submitted to President Vučić and the Government of Serbia to urgently establish an Institute for Cardiovascular Diseases in Niš, thereby significantly increasing the quality of service provision, and citizens "get the same treatment conditions as the residents of Belgrade and Novi Sad ".
And then the Minister of Health Dr Danica Grujicic and acting director of UKC, Dr. Perišić, criticized what the Niš cardiac surgeons did. Grujičić said that their elimination of the waiting list at Niš Cardiosurgery is "debatable" because, as she said, the doctors "performed about 702 of the serious surgeries" in about a hundred days. During that time, for example, the Dedinje Institute for Cardiovascular Diseases performed XNUMX operations.
Dr. Perišić refused to comment on this Cardiosurgery action for Danas, but he presented identical data on the results of Niš and other health institutions on Niš Television "Bela mi". A little later, a member of the Main Board of the Union of Physicians and Pharmacists of Serbia, Dr. Rade Panić, said on Television N1, among other things, that he believes that someone ordered the Cardiosurgery doctors to work overtime, and that there is a well-founded suspicion that behind the whole action lies the intention of the clinic's management to obtain some directorships. .
"For the patients, they are heroes, but for the healthcare system in Serbia - they are collapsing it," concluded Dr. Panić, adding that the doctors from Niš cleared their waiting list after "wisely sending more complicated cases to a higher center." Doctor Milić announced a lawsuit against Doctor Panić.
In the shadow of this kind of media ping pong, the warning data of the RFZO remained that more than 74.000 citizens are waiting for a diagnosis, procedure or operation. With these numbers, the last patient on the waiting list at the "Banjica" Institute will only have his turn in ten years, that is, in 2033. Minister Grujičić said that she believes that it will not come to that and that citizens "will have their turn for surgery even earlier."
According to RFZO data, there are now a total of 4.549 people on the waiting lists for the most common cardiac surgeries and interventions at the University Clinical Center of Serbia, University Clinical Center Niš, IKVB "Dedinje" and IKVB Vojvodina-Sremska Kamenica. 2.901 patients are waiting for cardiac surgical interventions at the "Dedinje" Institute, 809 at UKCS, and 532 at the Institute in Sremska Kamenica.
The responsible minister said that one of the ways to shorten such waiting lists is the introduction of supplementary work in health institutions, for which a platform has been prepared. Lists will be reduced by diagnosing patients who will be able to wait a month or two, as well as by providing adequate equipment. A new way of scheduling and simplifying the procedure for visiting a specialist doctor is also one of the ways. The longest waiting lists, for orthopedic operations, should be controlled at six months, and the priority for the operation should be determined by the patient's complaints, she stated. So far, however, the state has not done nearly enough to eliminate some of these measures from the list.
There is no doubt that this kind of problem should be solved systemically, and that health workers should not work for free, they also say at Niš Cardiosurgery. It is not disputed that the circumstances or the background of their humane action should be subjected to criticism or verification. It is bad, however, if the message is sent to the public that they should not do good deeds.
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