1. Chapter 19: Social Policy and Employment M O N T E N E G R O Negotiating Team for the Accession of Montenegro to the European Union Chapter 19: SOCIAL POLICY AND EMPLOYMENT M O N T E N E G R O Negotiating Team for the Accession of Montenegro to the European Union Working Group for Chapter 19 – Social Policy and Employment Bilateral screening: Chapter 19 PRESENTATION OF MONTENEGRO Brussels, 11-23 March 2013

2. Chapter 19: Social Policy and Employment M O N T E N E G R O Negotiating Team for the Accession of Montenegro to the European Union Chapter 19: SOCIAL POLICY AND EMPLOYMENT Chapter 19: Social Policy and Employment M O N T E N E G R O Negotiating Team for the Accession of Montenegro to the European Union Chapter 19: SOCIAL POLICY AND EMPLOYMENT HEALTH AND LONG-TERM CARE Tatjana Bulatovic Independent adviser Ministry of Health tatjana.bulatovic@mzd.gov.me

3. Chapter 19: Social Policy and Employment M O N T E N E G R O Negotiating Team for the Accession of Montenegro to the European Union Chapter 19: SOCIAL POLICY AND EMPLOYMENT Chapter 19: Social Policy and Employment M O N T E N E G R O Negotiating Team for the Accession of Montenegro to the European Union Chapter 19: SOCIAL POLICY AND EMPLOYMENT CONTENTS:  Health care  Health Insurance

4. Chapter 19: Social Policy and Employment M O N T E N E G R O Negotiating Team for the Accession of Montenegro to the European Union Chapter 19: SOCIAL POLICY AND EMPLOYMENT EU Legislation Celex: 32000Y0112(04) Celex: 32004D0689 Celex: 52005DC0706

5. Chapter 19: Social Policy and Employment M O N T E N E G R O Negotiating Team for the Accession of Montenegro to the European Union Chapter 19: SOCIAL POLICY AND EMPLOYMENT National legislation Normative framework The Constitution of Montenegro ("Official Gazette of Montenegro", No. 1/07), Article 69, stipulates that everyone shall have the right to health care. Law on Health Care ("Official Gazette of RoM", No. 39/04 and "Official Gazette of Montenegro", No. 14/10) Law on Heath Insurance ("Official Gazette of RoM ", No. 39/04 and "Official Gazette of Montenegro", 14/12)

6. Chapter 19: Social Policy and Employment M O N T E N E G R O Negotiating Team for the Accession of Montenegro to the European Union Chapter 19: SOCIAL POLICY AND EMPLOYMENT Institutional framework 1. Ministry of Health 2. Health Insurance Fund 3. Network of health institutions -Public health institutions (health centres, general hospitals, special hospitals, Clinical Centre of Montenegro, Public Health Institute, Blood Transfusion Institute, Institute for Urgent Medical Assistance)

7. Chapter 19: Social Policy and Employment M O N T E N E G R O Negotiating Team for the Accession of Montenegro to the European Union Chapter 19: SOCIAL POLICY AND EMPLOYMENT Institutional framework – Private health institutions (with which the Fund concludes a contract on the provision of health services from the compulsory health insurance in order to provide more accessible health care) 4. Agency for Pharmaceuticals 5. Chamber of Physicians (for doctors and dentists) 6. Chamber of Pharmacists 7. Directorate for Inspection Affairs (Department for Health and Sanitary Inspection Activities)

8. Chapter 19: Social Policy and Employment M O N T E N E G R O Negotiating Team for the Accession of Montenegro to the European Union Chapter 19: SOCIAL POLICY AND EMPLOYMENT The concept of health care and health insurance Health care represents a set of measures and activities for preservation, protection and promotion of health, prevention and fighting illnesses and injuries, early detection of illnesses, timely medical treatment and rehabilitation. Health insurance provides the citizens with the exercise of the right to health care, right to wage compensation during temporary inability to work; right to compensation of travel expenses regarding the use of health care.

9. Chapter 19: Social Policy and Employment M O N T E N E G R O Negotiating Team for the Accession of Montenegro to the European Union Chapter 19: SOCIAL POLICY AND EMPLOYMENT The aims of the Law on Health Care 1.preservation, protection and improvement of health of citizens of Montenegro and improvement of health condition of the population; 2.improvement of the quality of life in relation to health; 3.provision of accessibility to health care, under equal conditions, for all citizens of Montenegro;

10. Chapter 19: Social Policy and Employment M O N T E N E G R O Negotiating Team for the Accession of Montenegro to the European Union Chapter 19: SOCIAL POLICY AND EMPLOYMENT The aims of the Law on Health Care 4.special care for the health and socially vulnerable categories of the population; 5.sustainability of the health system; 6.improvement of the functioning, efficiency and quality of health services, along with the defining of special programs in the area of human resources, network of institutions, technology and medical supplies;

11. Chapter 19: Social Policy and Employment M O N T E N E G R O Negotiating Team for the Accession of Montenegro to the European Union Chapter 19: SOCIAL POLICY AND EMPLOYMENT The aims of the Law on Health Care 7.better functional linking of health system institutions of Montenegro, as well as the harmonisation of private and public interest in this area; 8.incentives for performing health activities in accordance with national and international standards.

12. Chapter 19: Social Policy and Employment M O N T E N E G R O Negotiating Team for the Accession of Montenegro to the European Union Chapter 19: SOCIAL POLICY AND EMPLOYMENT The aims of the Law on Health Insurance 1.provision of compulsory health insurance; 2.stable financing of health care through harmonisation of health service consumption and actual financial possibilities; 3.introduction of additional health insurance.

13. Chapter 19: Social Policy and Employment M O N T E N E G R O Negotiating Team for the Accession of Montenegro to the European Union Chapter 19: SOCIAL POLICY AND EMPLOYMENT 3 levels of health activities Primary level – primary health care is the basis of the health care system and the first level on which a citizen implements health care or where he/she enters the process of the implementation of health care on other levels Secondary level Tertiary level – On the secondary and tertiary levels of health care, citizens shall be provided with specialized and highly specialized health care, which cannot be provided on the primary health care level

14. Chapter 19: Social Policy and Employment M O N T E N E G R O Negotiating Team for the Accession of Montenegro to the European Union Chapter 19: SOCIAL POLICY AND EMPLOYMENT Primary level of health care By the reform of primary level, the concept of the selected medical doctor shall be present in the whole territory of Montenegro. Support to the selected team or selected medical doctor shall be provided by the health centre through support centres and specifically organised units. Units for patronage and ambulance transportation units for physical therapy of the primary level Selected medical doctors for: adults children (paediatricians) women (gynaecologists) Support centres for: diagnosticsprevention mental health children with special needs pulmonary diseases and TBC day centres

15. Chapter 19: Social Policy and Employment M O N T E N E G R O Negotiating Team for the Accession of Montenegro to the European Union Chapter 19: SOCIAL POLICY AND EMPLOYMENT Dental care Services of the selected dentist shall be provided at the primary level within the service package of compulsory health insurance The network of health institutions also includes private dental activities The following services have also been provided from compulsory health insurance: – examinations, diagnosis and medical treatment of mouth and teeth diseases, for children, pupils, students, and latest by 26 completed years of age, for women during pregnancy, for persons older than 65 years of age, for persons suffering from mental illnesses and persons with developmental disabilities, in accordance with the criteria regulated by special regulations;

16. Chapter 19: Social Policy and Employment M O N T E N E G R O Negotiating Team for the Accession of Montenegro to the European Union Chapter 19: SOCIAL POLICY AND EMPLOYMENT Dental care – removable orthodontic appliances and, in medically justified cases, fixed appliances for children up to 18 years of age and removable and fixed prostheses for persons older than 65 years of age;

17. Chapter 19: Social Policy and Employment M O N T E N E G R O Negotiating Team for the Accession of Montenegro to the European Union Chapter 19: SOCIAL POLICY AND EMPLOYMENT Secondary level of health care reform and establishment of health centres integration of primary and secondary level The aim of establishing health centres is to respond to the needs of citizens for health services, ensure the provision of care, but also improving the efficiency, that is achieving better results and improving health outcomes, for a similar amount of resources, in a quality and prompt manner. – 8 health centres will be formed in: Podgorica, Kotor, Pljevlja, Niksic, Bijelo Polje, Berane, Bar and Cetinje. – By integration of health institutions, the citizens will be provided with more accessible and higher quality specialist protection – Model of organisation of health care provision will be characterized by the principle of concentration of provision of certain specialist services at the level of health centre and mobility of the specialist staff. This will lead to improvement of health care quality, standardisation of the medical treatment process, and efficiency and effectiveness in service provision.

18. Chapter 19: Social Policy and Employment M O N T E N E G R O Negotiating Team for the Accession of Montenegro to the European Union Chapter 19: SOCIAL POLICY AND EMPLOYMENT Health insurance In accordance with the reform of the secondary level of health care, the introduction of the DRG payment system (Australian model) for hospital treatment is also in progress Means payment per diagnosis for services provided Enables financial sustainability of the system

19. Chapter 19: Social Policy and Employment M O N T E N E G R O Negotiating Team for the Accession of Montenegro to the European Union Chapter 19: SOCIAL POLICY AND EMPLOYMENT Accessibility to services Health care is implemented on principles of comprehensiveness, continuity, accessibility and integral approach in the primary health care, and specialized approach in the specialist-consulting and hospital health care.

20. Chapter 19: Social Policy and Employment M O N T E N E G R O Negotiating Team for the Accession of Montenegro to the European Union Chapter 19: SOCIAL POLICY AND EMPLOYMENT Accessibility to services Accessibility of health care means ease of access to offered health services through: – Physical access – The range of services according to the needs – Waiting for the service – Adaptation to cultural and spiritual needs

21. Chapter 19: Social Policy and Employment M O N T E N E G R O Negotiating Team for the Accession of Montenegro to the European Union Chapter 19: SOCIAL POLICY AND EMPLOYMENT Quality Quality of health care is the level of fulfilment of health needs of citizens from the aspect of the condition of means, equipment and conditions for health care, staff capacity, expertise and skills and their application, improvement of health status, removal of causes and diminishing harmful influence of risk behaviour and environmental factor, as well as quality of life;

22. Chapter 19: Social Policy and Employment M O N T E N E G R O Negotiating Team for the Accession of Montenegro to the European Union Chapter 19: SOCIAL POLICY AND EMPLOYMENT QUALITY OF HEALTH CARE Adopted National Strategy for Improving Health Care Quality and Patient Safety with the Action Plan (January 2012) National Strategy for Improving Health Care Quality and Patient Safety contains a system of measures aimed at ensuring: – High level of health services; – High safety of health care and minimum risk for patients; – Higher patient satisfaction; – Improvement of health outcomes; – Efficient use of resources.

23. Chapter 19: Social Policy and Employment M O N T E N E G R O Negotiating Team for the Accession of Montenegro to the European Union Chapter 19: SOCIAL POLICY AND EMPLOYMENT Health education Evaluation is a systematic method of learning through work and the use of acquired experiences in order to improve the performance of current health care activities and promotion of better planning at all levels of the health system; Health workers and associates shall have the right and obligation of capacity building in order to maintain and improve the quality of health care they administer. The health institution shall be obliged to provide expert capacity building of health workers and associates, in accordance with this law. In order to improve the primary level of health care, specialization in family medicine has been introduced

24. Chapter 19: Social Policy and Employment M O N T E N E G R O Negotiating Team for the Accession of Montenegro to the European Union Chapter 19: SOCIAL POLICY AND EMPLOYMENT Thank you for your attention. QUESTIONS