A pensioner from Montenegro, with serious heart problems, has been waiting for months at the Clinical Center of Montenegro (KCCG) to have a defibrillator implanted, a device intended for people at high risk of sudden cardiac death.
The patient, whose heart is functioning at only 20 percent, and who has previously had several interventions, including carotid artery surgery, has "advanced" by only 20 places on the waiting list in four months. Judging by his position on the list for implantable cardioverter-defibrillator (ICD) implantation at the Cardiology Clinic, which currently has about 70 patients, at this rate, he will not be in line for the intervention until the end of the year.
"When my father was put on the waiting list in March, the doctors told us that everything should be done as urgently as possible. Unfortunately, there is no possibility of implanting a pacemaker in Montenegro, because no private health institution provides this type of medical service. In Serbia, this intervention costs around 8.000 euros," says Milica, the daughter of a cardiology patient.
Other citizens on the waiting list also claim that they are forced to raise money for surgeries with private providers or abroad, but that none of the staff gives them a code that would allow them to track whether their scheduled procedure is approaching.
Around 700 patients are waiting for artificial hip and knee replacements at the Clinical Hospital Center of Montenegro (KCCG) alone - 200 more than last year, although the largest healthcare institution promised in August 2024 that the problem would be solved by opening a new operating room, as well as by caring for patients from the north at the Clinical Hospital Center (KBC) Berane.
Despite the fact that patients on the list for hip replacement or prosthesis are not candidates for emergency surgery, many decide to have surgery abroad, most often in neighboring Serbia, because their quality of life is impaired due to arthrosis (ossification).
Shortcomings in the organization and management of waiting lists
The state does not have data on how many Montenegrin citizens are currently waiting for a specialist examination, surgery or diagnostic procedure. Although regulations require health institutions to post a written waiting list in a visible place every day and to submit this information to the Ministry of Health and the Health Insurance Fund, most do not do so.
The Ministry responded to "Vijesti" that they are conducting checks on compliance with the regulations on waiting lists in health institutions and that they have noticed shortcomings in organization and management, from an inconsistent method of scheduling to a lack of up-to-date records.
They claim that in response, they have launched a comprehensive analysis of the causes of waiting lists, conducted by a renowned consulting firm from Geneva. The analysis is also foreseen in the Action Plan of the Quality Control Strategy, and aims to identify the main problems and compare them with European standards, and on that basis, they will propose specific and systemic measures to improve this area.
"The lack of updated data on waiting lists on the Ministry and Fund websites is a result of outdated practices and technical limitations. That is why we are working on introducing new digital solutions, including an electronic appointment system and SMS cancellation of appointments, to prevent missed appointments and increase efficiency. An electronic registry for monitoring the private sector is also being developed, which will further contribute to the transparency of waiting lists," the department said.
The Ministry of Health, they claim, has data on waiting lists for specialist examinations, diagnostics, and surgical procedures, which it regularly submits to the KCCG.
"According to the report for May 2025, there are several hundred patients on the waiting lists, for example, for elective procedures - 804 at the Eye Clinic, 614 at Orthopedics, while at the Heart Clinic, 88 patients are waiting for elective coronary angiography procedures, while 3 patients are waiting for 166D ablation procedures. The waiting list for pacemaker control, cardiac electrophysiology and CRT-D implantation is 16 patients, for ICD implantation 71 patients, for EF and RF ablation procedures 191 patients," said Vojislav Šimun's department.
They explain that, thanks to contracts with private institutions, there is generally no wait of more than three months for radiological procedures if they are marked as a priority, but that emergency and oncological cases are handled immediately.
Lack of transparency opens the door to corruption
The Head of the Public Policy Research Department at the Center for Monitoring and Research (CeMI), Nemanja Stankov, believes that any system that is based on non-transparent rules opens up space for corrupt practices, and the health sector is no exception.
"When there is disorganization and lack of transparency in the formation of waiting lists and when patients are not informed in advance about their rights, irregularities in the distribution of medical services can occur. Such a context creates a corruption risk, especially in situations where there is a long wait for a specialist examination or intervention, given that those with money or connections can provide themselves with better treatment and faster access to health services, thus violating the principle of equality and fairness. On the other hand, patients who do not have these resources may be forced to wait longer or seek help abroad. Therefore, it is essential to establish a transparent system in which it is clear who, when and under what conditions exercises the right to medical services, as well as how health resources are distributed," Stankov emphasizes.
He says that measuring the prevalence of hidden phenomena such as corruption is extremely demanding, which is why research most often relies on citizens' perceptions.
According to a field survey by CeMI, conducted in late May and early June on a representative sample of Montenegrin citizens, 67,7 percent of respondents believe that corruption is present to some extent or to a large extent in the healthcare system.
"When the perception of corruption is measured at the level of specific interactions with healthcare workers, 51,5 percent of respondents recognize corruption in the patient-doctor relationship to some extent and to a great extent, while this is significantly less pronounced in relation to nurses and technicians, 26,2 percent," he points out.
Stankov claims that the worrying fact is that as many as one in four residents who used the services of health institutions in the previous 12 months stated that one of the employees asked for or expected money, a gift or a favor in return for the health care that they are entitled to by law.
More than half of doctors also work privately
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 data from June this year, more than half of the doctors in the largest health institution have permission to work part-time for private individuals. According to the latest statistical yearbook of the Institute of Public Health, the largest health institution employs 495 doctors, of whom 356 are specialists.
The KCCG responded that 267 doctors work privately, while 107 have received approval to perform additional work in another public health institution. However, they did not respond to whether and how many doctors have been denied the right to additional work outside the institution until the waiting list in their organizational unit is eliminated. They announced that doctors who have approval for additional work in the private sector are also engaged in additional work in the KCCG, especially in clinics with longer waiting lists.
CeMI believes that extra work is one of the most pronounced risks of corruption in the healthcare system.
"The new draft of the Health Care Law, which was subject to public debate at the beginning of this year, provides for a ban on overtime work, but with exceptions to the general rule, which allow healthcare workers to exercise the right to overtime work after obtaining the opinion of the director of the healthcare institution," Stankov reminds.
He says that the key to reducing the risk of corruption in this area will be the way in which the Ministry of Health will prescribe the criteria for exercising this right through a regulation. The current regulation, he believes, is too general and does not clearly define the criteria or results that health workers should meet in order to acquire this right, but rather leaves wide room for discretionary decision-making.
Stankov cites the example of Croatia, according to which until 2016 it was stipulated that approval for additional work could be obtained by a healthcare worker who significantly reduced the waiting list in the home institution, with the restriction that the total right to additional work could not be exercised by more than 50 percent of employees in a given institution. In the case of a larger number of requests, a ranking would be carried out, whereby only the 50 percent of the most successful medical workers would obtain this right.
Unavailable appointments for specialists and ultrasound
In addition to patients who complain about long waits for surgery or intervention, there are also many who will not be able to get an appointment for a specialist examination or an ultrasound scan at a health center in the next six months.
In the healthcare system, there are generally no available appointments for endocrinologists and rheumatologists, cardiologists, gastroenterologists. KCCG is the only institution that updates the lists of the first available appointments for examinations and diagnostic procedures on a daily basis.
This institution explains that waiting lists for specialist and diagnostic examinations are formed based on available appointments that are periodically distributed to the central scheduling system and thus become available to selected and secondary-level healthcare doctors, who assign them to patients in chronological order.
Responding to questions from "Vijesti", the KCCG, headed by Dr. Aleksandar Radović, said that last year, around 850.000 appointments were made through the central scheduling system, of which around 250.000 failed because patients did not show up for their appointments.
Due to the large number of missed examinations, they have established a system of confirming appointments via SMS messages since March this year. The KCCG said that from the beginning of March to June 20, around 320.000 examinations and diagnostic procedures were performed, and around 88.000 were not performed, which, they claim, is still a high number.
"A total of around 1.800 appointments were cancelled during the period. It is relevant to show the trend in the use of the service, i.e. 120 appointments were cancelled in March, with a growing trend resulting in 500 cancellations in April and May, and over 500 in June," the response reads.
The Ministry of Health believes that the unavailability of appointments for specialist and diagnostic procedures for six months or more is the result of years of neglect of the system.
"We inherited a system in which scheduling was disorganized and non-transparent, with appointments being opened for a month or two, without realistic insight into the number of patients on the lists, which made it difficult to plan additional clinics and consulting teams," the department claims.
They explain that they are now working on opening appointments six months in advance or more, and they have clearly identified priority groups, so oncology patients and those waiting for their first examination for acute conditions and preparations for surgery are no longer waiting with the others.
In the capital, around 1.800 patients are waiting for ultrasound examinations in the first quarter of 2026. The Ministry of Health claims that none of them "are oncology patients, nor are they preparing for surgery." They say that, thanks to the additional engagement of radiologists, patients have started being called in from mid-June and the plan is to complete the examinations planned for 2026 six months earlier.
Pilot project starting this fall at the Children's Hospital
The pilot project at the Internal Clinic of the KCCG involves the allocation of the first, first control and control examinations and their availability in three and six months, and has already yielded results, so it has been expanded to the Clinic of Neurology, where now, unlike the previous period, an average of seven free appointments for examinations are opened daily. This, the Ministry claims, has effectively reduced the waiting list for neurological examinations. They explain that with the arrival of doctors from the vascular surgery specialization, a new outpatient clinic was opened, which is already operating at full capacity. The pilot project should be introduced in the Institute for Children's Diseases of the KCCG from the fall. Data from the largest health institution show that even the youngest are not spared from long waits for health services, because there are no available appointments for a psychiatrist, neurologist, ENT, certain magnetic resonance imaging, or scanner.
This article was created as part of the project “Speak Up: for a Montenegro without Corruption” implemented by the Center for Monitoring and Research CeMI, with the support of the INL Office of the US Embassy in Montenegro. The article was funded by a grant from the United States Government. The views, findings, and conclusions expressed are solely those of the author and do not necessarily represent the views of the United States Government.
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