During the last year, health institutions earned less than 600.000 euros from the co-payments that citizens pay for services, which is almost twice less than ten years ago.
This is shown by the data of the Health Insurance Fund (FZO), submitted to "Vijesti".
The institution replied that the total income from participation in 2022 amounted to 599.677,78 euros, of which the Clinical Center (KC), Montefarm, the special hospital for orthopedics, neurosurgery and neurology "Vaso Ćuković" in Risno and Podgorica earned the most Health center.
Income from co-payments in public health institutions a few years ago amounted to around one million euros. The sources of "Vijesti" claim that there are several reasons for the decrease in income on this basis, given the fact that the price list has not been changed in the meantime.
"It is a larger coverage of categories of insured persons who are exempt from co-payments, a smaller number of health services and negligence of public health institutions when charging co-payments and inadequate records. If there was no change in the regulations, then it should be checked whether there was a significant drop in the number of services, and if no drop was recorded, then responsibility should be sought from public health institutions", said the interlocutor of "Vijesti".
The FZO replied to "Vijesta" that participation falls under the category of income from its own activity and that, accordingly, it is not within the competence of that institution to determine the way these funds are spent. Institutions mostly cover running costs, such as appliance repairs, from the income from participations.
The FZO reminded that, in accordance with the Law on Compulsory Insurance, co-payments are paid for examination, treatment and diagnostics at the primary, secondary and tertiary level of health care, dispensing of medicines in pharmacies, hospital treatment, medical devices that are implanted in the human body, medical- technical aids, sex change carried out in accordance with that law, specialized medical rehabilitation, treatment with hyperbaric oxygen therapy, non-emergency ambulance transport, accommodation and food costs for accompanying children from 15 to 18 years of age, in a hospital or in an institution for specialized medical rehabilitation and treatment abroad.
The amount of participation is regulated by an act adopted by the Government on the proposal of the Ministry of Health. The amount of co-payment for health services has not changed for more than a decade. So, for example, the co-payment for prescription drugs in state pharmacies amounts to 0,36 euros.
Who is exempt from paying the co-payment
Several categories of citizens are exempted from paying the co-payment, among them are pregnant women, women after giving birth for up to 12 months, pensioners over 65 years old.
The law also exempts organ donors, voluntary blood donors who have donated blood more than ten times, beneficiaries of social protection rights and their family members, if they are not insured on another basis, beneficiaries of the lowest pension in Montenegro for the previous calendar year, from paying the co-payment. combatants, military invalids, civilian war invalids, beneficiaries of the right to financial compensation for the material security of combatants, as well as members of their families, if they are not insured under another, blind and deaf-mute persons and persons with autism.
Patients with diagnoses of malignant disease, hemophilia, diabetes, cystic fibrosis, intellectual disability with an IQ of 69 and below, psychosis, epilepsy, multiple sclerosis, muscular dystrophy, cerebral palsy, paraplegia and quadriplegia, chronic renal insufficiency (dialysis), systemic autoimmune diseases, HIV and infectious diseases, hepatitis B and hepatitis C, congenital defects of the upper or lower extremities and developmental disabilities.
According to announcements from the Ministry of Health and the FZO, the rules for the participation of insured persons in the costs of treatment will be changed in the coming period, but it has not been explained what the changes will be, i.e. whether the amount will be corrected and in what way.
Supplementary insurance unprofitable
The increase in the amount of participation was announced four years ago, when the introduction of supplementary health insurance, which was prescribed by law, was abandoned. The assessment of the competent authorities was that with the introduction of supplementary insurance, they would have additional administration costs and unsatisfactory revenue collection, and that it is better to upgrade the participation institute.
Supplementary health insurance stipulates that citizens pay monthly premiums for part of the services that are now 100 percent covered. Those who would not "take" supplementary insurance, as it exists throughout Europe, would pay 20 percent of the cost of the health service, while the rest would be covered by mandatory insurance.
The FZO announced at the time that the supplementary health insurance proposed by the Law would not bring a greater volume of medical services to citizens and that they would only have additional levies.
According to the analysis of the working group, which consisted of representatives of the Ministries of Health, Finance, FZO and the Agency for Insurance Supervision, only 27,81 percent of insured persons in Montenegro could have supplementary health insurance. According to the law, the others, or about 458.000 citizens, could not be subject to the obligation to pay a surcharge. Most of the insured are children, members of the insured's family who are in regular education until the age of 26, over 65, organ donors and recipients, beneficiaries of social protection rights, people with disabilities, patients with cancer, systemic autoimmune diseases, diabetes...
Members of the working group in the analysis claim that the comparative experiences of other countries show that only 50 percent of insured persons who are potential candidates pay for supplementary health insurance.
"The level of coverage in some countries ranges from 20 to 70 percent, while in Croatia, about 700.000 citizens, after almost 16 years of implementation, are not in the supplementary health insurance system," the FZO pointed out at the time.
According to the document, all insured persons in Montenegro have the full scope of health care at the expense of mandatory health insurance.
In the analysis, it is written that a real problem would arise if the insured does not have to pay the additional costs, which can amount to up to 1.020 euros, even though he needed and was provided with health care:
"It is not possible to deny health care to the insured, especially if the Constitution guarantees it."
The definition of the service package was announced
And the director of the FZO Vuk Kadic earlier, he told "Vijesta" that they plan to define a package of services, given that the payment of mandatory health insurance, i.e. contributions at the expense of the employer and the employee, and therefore the possibility of supplementary insurance within public health, has been abolished.
"Today, we have a situation where each of us can do laboratory tests countless times, be referred to a specialist more than once, or perform diagnostic procedures, even though this is not necessary, which also affects waiting lists. It must be defined which services, depending on the patient's diagnosis, he is entitled to during the year", Kadić said in January of this year and explained that a commission has already been formed that should work on it.
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