Hospital in Beograd, Serbia (El Zoid, CC BY-NC-ND)
Zoran Savic, the president of Trade Union of Workers in the Healthcare Sector, told BIRN that several consecutive Serbian governments have ignored the brain drain. “On average, Serbia has fewer medical workers than most European countries,” Savic said.
There are around 300 medical workers per 100,000 people, while the European average is around 320 per 100,000, according to Savic. Meanwhile, the average salary for doctors in Serbia is around 450 euro and for specialists around EUR600.
The country lacks around 13,000 medical workers in various areas, but at the same time, there are around 13,000 redundant public sector employees, according to the Union of Doctors and Pharmacists of Serbia. Serbia mostly lacks pediatricians, surgeons, anesthesiologists, radiologists and pathologists, the Union of Doctors and Pharmacists has said.
The Serbian Medical Chamber says requests for ‘certificates of good reputation’ – necessary for working abroad – were increasing, with about 300 certificates issued in 2012, in 2013 rising to 435 and more than doubling to over 1,000 in 2015.
In 2014 the World Bank’s Board of Directors approved the Second Serbia Health Project of USD40m and the Deposit Insurance Strengthening Project of USD200m for Serbia aimed at improving the efficiency and the quality of Serbia’s public health care system.
Total health spending in Serbia accounts for about 10.4 per cent of GDP.
“We already have proof that such interventions will improve the efficiency of the Serbian health care system,” says Tony Verheijen, World Bank Country Manager for Serbia. “Centralized procurement was piloted during the preparation of the project for one-third of the drugs used in the public health care system. It reduced the cost by EUR25m for 2014. Lower-income groups will benefit from this efficiency as they cannot opt out of the public health care system. Cost savings should contribute to ensuring that public funds deliver a maximum level of service for everyone. ”
The Serbian government has not taken any significant measures to stop the negative trend, critics argue.
Finance Minister Dusan Vujevic told medical workers in 2014 to “find another country if they are not satisfied with this one.” The minister and union representatives had been arguing over planned salary cuts in the public sector.
Serbian Healthcare, for the second year in a row, took the last – 35th – place in Europe in the 2015 ranking of health care systems, according to a survey conducted for the European Parliament.
The research called “European Health Consumer Index” (EHCI) is conducted by expert organization based in Sweden. Serbia has not improved last year’s score by a point.
The Serbian healthcare system got 451 of possible 1,000, and the Netherlands received the most – 870. Serbia is at the bottom of the list with Romania, Latvia, Poland and Bulgaria.
Serbia was evaluated negatively because electronic prescriptions are not available for Serbian patients, they do not have the possibility of electronic appointments, because of waiting period for the cancer treatment longer than 21 days and more than seven days for the scanner examination, as well as the waiting time for major surgeries – more than 90 days.
Transparency International’s 2013 Global Corruption Barometer revealed that 81 per cent of Serbians feel that healthcare services in the country are corrupt. The President of the European Healthcare Fraud and Corruption Network had described the corruption in the Serbian healthcare system as “institutionalised”, emphasising how additional forms of payment for supposedly free healthcare services harm the system.
In Serbia’s case, many healthcare workers see bribery as a means to survive due to low salaries resulting from the government’s budget deficit. Salaries are also driven down by the country’s overall unemployment rate of over 20 per cent, including over 2,700 unemployed doctors and 13,000 unemployed nurses.