1. Dr Tatjana Radosavljević,Serbian medical Chamber COUNTRY REPORT : SERBIA - AUTUMN 2011 THE HEALTH CARE SYSTEM IN SERBIA -THE PLACE AND ROLE OF THE SERBIAN MEDICAL CHAMBER

2. 18th Symposium of Central and East European Chambers of Physicians(ZEVA),Cracow,2011 The Health Care System in Serbia includes of the following stakeholders: The Ministry of Health of the Republic of Serbia Republic Found for Health Insurance Health care institutions(hospitals,dom zdravlja) Institutions and Institutes of Public Health Chambers of health profesionals(Serbian medical chambers included) Government agencies: GA for the accreditation of healthcare institutions GA for drugs and medical devices GA for biomedicine

3. 18th Symposium of Central and East European Chambers of Physicians(ZEVA),Cracow,2011 Healthcare institutions (private and public) Primary health care – “dom zdravlja” Secondary health care – general hospitals, Tertiary health care– clinical centers The Military health care system is still a special system within the health care system. Private practice is practically not yet included in the healthcare system and health insurance.

4. 18th Symposium of Central and East European Chambers of Physicians(ZEVA),Cracow,2011 Demographics In 2007, the population of the Republic of Serbia was recorded at 7,381,579 people (3,588,957 men and 3,,792,622 women). This number is decreasing. The average age of the population is 40,9 years. Life expectancy is 73,5 years (70,7 years for men and 76,2 years for women). The mortality is increasing (the mortality rate was 13,9/1000 inhabitants in 2007), and the population growth rate in decreasing (4,7/1000 inhabitants in 2007). The number of women in fertile age (15 – 49 years) was 1,718,428 in 2007, which represents 23,3 % of the population.

5. 18th Symposium of Central and East European Chambers of Physicians(ZEVA),Cracow,2011 FOUNDING HEALTH CARE IN SERBIA Health care in Serbia is financed according to the Bismarck model, through the system of obligatory contributions, from wages of employees (12,3% of gross personal income), which amounts to, at the moment, 220 euros (average value). Uninsured persons are financed from the budget of the Republic of Serbia. Health care institutions within the public network of healthcare institutions are financed according to the contracts with Republic Found for Health Insurance insigned on an annual basis.

6. 18th Symposium of Central and East European Chambers of Physicians(ZEVA),Cracow,2011 FOUNDING HEALTH CARE IN SERBIA In Serbia there is no specified basic package of healthcare services. There is an ongoing attempt to introduce in the primary healthcare system a method capitation for paying health care services and in the secondary and tertiary health care a method diagnostic related groups. (DRG) This is, unfortunately, still at the beginning and within the projects of the World Bank and pre-accession funds of the European Union.

7. 18th Symposium of Central and East European Chambers of Physicians(ZEVA),Cracow,2011 Legislative Framework in Serbia LAWS: Healthcare law Health insurance law Law on medical chambers Law on blood transfusion Law on the transplantation of cell and tissues Law on organ transplantation Law on the treatment of infertility Law on public health

8. 18th Symposium of Central and East European Chambers of Physicians(ZEVA),Cracow,2011 PHYSICIANS IN SERBIA THE STRUCTURE OF PHYSICIANS IN SERBIA (THE MEDICAL CHAMBER OF SERBIA)

9. 18th Symposium of Central and East European Chambers of Physicians(ZEVA),Cracow,2011 Physicians in state hospitals : 24473 Physicians in Private Practices : 3093 MDs :6248 Physicians undergoing specialization training :2079 Specialists : 17845 Subspecialists : 1457

10. 18th Symposium of Central and East European Chambers of Physicians(ZEVA),Cracow,2011 Unemployed physicians in Serbia 1752 + 142 S (*)= 1894 Physicians over 50 years of age 9764 Physicians over 65 years of age 1480

11. 18th Symposium of Central and East European Chambers of Physicians(ZEVA),Cracow,2011 TerritoriesRepublic of Serbia No. of inhabitants 7381579 Number of licensed physicians 28413 Number of physicians per 100,000 inhabitants 385 (Belgrade 686)

12. 18th Symposium of Central and East European Chambers of Physicians(ZEVA),Cracow,2011 SOME FEATURES OF THE HEALTH CARE SYSTEM IN SERBIA The health care system in Serbia in the 21 st century is exposed to many challenges reflected in the sense of insecurity in patients and the public as well as health care workers, especially physicians. On the other hand, they loose faith in the management, especially related to the discharge of workers. In the fifties, years of socialism, the physicians have lost their elite status, but also the decision-making status, in their relationship with the state. In recent years, they have been constantly exposed to the public scrutiny and pressure, media hunt due to “malpractice” and incompetence. On the other hand, the development in technology and burst of knowledge represent new challenges for the medical profession.

13. 18th Symposium of Central and East European Chambers of Physicians(ZEVA),Cracow,2011 THE PLACE AND ROLE OF THE SERBIAN MEDICAL CHAMBER IN THE HEALTH CARE SYSTEM OF SERBIA The Serbian Medical Chamber was founded in 1901. The Chamber was abolished by a decret in 1945. Initiatives for the re-establishment of the Serbian Medical Chamber arose in late eighties of the last century, but the conditions for the foundation of the Medical Chamber of Serbia were not set until December 2005, when several laws on health care were adopted, among others also the Law on Chambers of health professionals.

14. 18th Symposium of Central and East European Chambers of Physicians(ZEVA),Cracow,2011 The Chamber was founded pursuant to the law and was assigned the following public authorities: (Article 7, Law on Chambers) 1. To adopt the Code of Professional Ethics 2. To register health care profesionals under conditions set forth by law and to keep a directory of all members of the Chamber 3. To issue, renew and revoke licenses of members, who are registered in the directory of the Chamber according to item 2 of this paragraph and to keep a directory on issued, renewed and revoked licenses 4. To act as an intermediate agent in disputes between members of the Chamber or between members of the Chamber and patients

15. 18th Symposium of Central and East European Chambers of Physicians(ZEVA),Cracow,2011 UNFORTUNATELY, KEY REGULATIONS FOR PUBLIC AUTHORITIES ARE REACHED BY THE MINISTER OF HEALTH, INCLUDING THE REGULATION ON THE ISSUANCE AND RENEWAL OF LICENCES AND THE REGULATION ON CONTINUING MEDICAL EDUCATION. The Chamber is, at the moment, not involved in the continuing medical education, though licenses should be renewed every seven years based on the continuing medical education. The Health Care Council of the Republic of Serbia approves CME credits.

16. 18th Symposium of Central and East European Chambers of Physicians(ZEVA),Cracow,2011 THE DEVELOPMENT STRATEGY OF THE SERBIAN MEDICAL CHAMBER DEVELOPMENT OF A STRATEGY PLAN FOR THE SERBIAN MEDICAL CHAMBER FOR THE FOLLOWING FIVE YEARS CREATION OF A BUSINESS PLAN FOR THE SERBIAN MEDICAL CHAMBER FOR THE FOLLOWING FIVE YEARS AS A GUARANTEE FOR ITS FINANCIAL INDEPENDENCE UPGRADE OF THE INFORMATION SYSTEM OF THE SERBIAN MEDICAL CHAMBER, CREATION OF A WEB PORTAL WITH COMMUNICATION NETWORKING ELEMENTS, INTRODUCTION OF THE SMART ID CARDS SYSTEM FOR PHYSICIANS

17. 18th Symposium of Central and East European Chambers of Physicians(ZEVA),Cracow,2011 INCREASE IN PUBLIC AUTORITIES OF THE SERBIAN MEDICAL CHAMBER (CLINICAL ODIT, SPECIALIZATION TRAINING) COMPLETE INVOLVEMENT OF THE SERBIAN MEDICAL CHAMBER IN THE CONTINUING MEDICAL EDUCATION AND CONTINUING PROFESSIONAL DEVELOPMENT OF PHYSICIANS STRENGTHENING OF THE INFLUENCE OF THE SERBIAN MEDICAL CHAMBER IN THE DECISION MAKING PROCESS AND IN THE ADOPTION OF LAWS RELATED TO THE HEALTH CARE SYSTEM OF SERBIA (LOBBING, CIVIC INITIATIVES) PLANNING AND UPGRADE OF THE TRAINING SYSTEM FOR JUDGES IN THE COURTS OF HONOR OF THE SERBIAN MEDICAL CHAMBER

18. 18th Symposium of Central and East European Chambers of Physicians(ZEVA),Cracow,2011 INTRODUCTION OF CLINICAL PROTOCOLS AS OBLIGATORY AND AS A MUST IN ORDER TO DEFINE THE TERM MEDICAL MALPRACTICE DEVELOPMENT OF A NATIONAL STRATEGY FOR THE PREVENTION OF PROFESSIONAL AND MEDICAL MALPRACTICE INTRODUCTION OF INSTITUTIONS FOR CLINICAL AUDIT AND PEER REVIEWS AS A PART OF THE LICENCING PROCESS PARTICIPATION IN THE DEVELOPMENT OF THE NATIONAL ANTI-CORRUPTION STRATEGY

19. 18th Symposium of Central and East European Chambers of Physicians(ZEVA),Cracow,2011 INSTEAD OF A CONCLUSION What awaits us in the autumn of 2011 considering our reality? The famous Serbian politician and the Prime Minister of Serbia at the beginning of the 20th century and Prime Minister of Serbia during the first World War – Nikola Pasic used to say: “THERE IS NO SALVATION FOR US, BUT WE WILL NOT FALL DOWN.”

20. 18th Symposium of Central and East European Chambers of Physicians(ZEVA),Cracow,2011 Another Serbian Prime Minister at the beginning of the 21 st century, tragically deceased Zoran Djindjic used to say: IF IT WAS EASY, SOMEBODY ELSE WOULD HAVE TO DO IT …

21. 18th Symposium of Central and East European Chambers of Physicians(ZEVA),Cracow,2011

23. AFTER THE AUTUMN OF 2011,SPRING 2012 AWAITS US !