The 2nd Round Table, 2nd December 2010. 

EU Supported Health Projects – How to Achieve Goals?

EU Supported Health Projects – How to Achieve Goals?

Summary of the Round Table Presentation

Date and Time: Thursday, 2nd December, 2010, 11:00-13:00

Venue: Press Centre, Knez Mihailova 6/III, Belgrade

Participants and Topics:

• Professor Dragana Jovanovic: Introduction

• Mr. Miroslav Petrovic: Projects on tertiary health care reform and patients rights: Oncology

• Professor Dragana Jovanovic: Analysis of implementation and impact of some EU supported health projects

• Dr Drasko Karadjinovic: Outcome of the Health Insurance Fund (HIF) and health financing system reform project: Fiction of the National Health Account (NHA)

• Professor Zoran Radovanovic: Achievements: Capitation as an example

Round table was organized by the non-governmental organization „Doctors against corruption“ (with participation of the NGO „Club Health“) in order to assess the results of health-related projects financially supported by EU. Analysis was based on information collected from different sources, including the Final Report of ECORYS, Rotterdam entitled “Assessment of International Assistance in the Serbian Health Sector”, prepared on request of the EC Delegation to Serbia and submitted in April 2010.

Introduction-Professor Dragana Jovanovic

said in her introductory remark that UNDP in November, 2010 published new results of its on-going research on corruption, showing that over the previous 6 months corruption in the health sector further increased for a few percentages. Even more important result of interviewing citizens is their mistrust in EU donations, as well as in NGOs (apparently due to GONGOs). Shaken confidence in EU, in spite of its donation of 1.3 billion € (out of which 130 million € were earmarked to projects aimed to transform health), should be due to the fact that many of these projects were poorly designed and/or implemented or their results were missing/catastrophic. According to the insight of Doctors against corruption into numerous documents, a considerable number of such projects were falsely presented as successful by local partners and then evaluated by external experts either: a) positively (due to distorted information) or b) negatively. Consequences of forged results and low real impact of EU projects are as follows: discredit to EU in the eyes of the Serbian public, discredit to Serbia in the eyes of EU donators, major harm to the population health care, impeded prospects of the Serbian integration into EU, as well as compromise of IPA and all future EU financed projects, whose realization and control will be fully transferred to the Serbian government in the year 2011/2012.

Mr. Miroslav Petrovic, the vice-president of the Association for protection of patients’ rights “Club Health”, explained that his Association, along with cancer patients and families of deceased cancer patients, informed the Ministry of Health in June, 2009 that the Vojvodina Institute of Oncology (IOV) rented its already insufficient resources for radiotherapy of malignant disease patients in order to obtain unlawful financial gains. Foreign patients who paid for services got an advantage over locally insured patients on waiting lists, thus jeopardizing their right to timely treatment (right to live). Afterwards, they contacted without success governing bodies of the IOV - its management, Administrative Board, Inspecting Committee, as well as the director of the Serbian HIF, Serbian Medical Chamber and its Court of Honour, Regional Secretary of Health of Vojvodina, and MoH inspection. In July, 2010, Board of the Health and Family of the Serbian Parliament requested all circumstances and responsibilities of individuals and institutions to be fully clarified. Following several appeals, the Ombudsman of Serbia in November, 2010 formulated his recommendations, emphasizing numerous law violations concerning unlawful supplementary work, payment of employees, and protection of whistle-blowers, while the violation of the right to timely treatment and a just compensation of several hundreds of damaged cancer patients and their legal inheritors was not set up as a priority.

Professor Dragana Jovanovic provided examples of some controversial projects, such as:

- 2002 – M€ 5.5: Reorganisation of Blood Transfusion Services. Reforming and upgrading the existing blood transfusion system through the provision of TA and equipment. The initial goal was to enhance blood donation, but the concept was later modified. National centre for plasma fractioning was abolished. Instead of special vehicles, a van was bought. The reform resulted in jeopardized blood donation.

- Two projects related to the health information system development: 2003 – M€ 6.2: Computerization of hospital pharmacies and health institutions in Serbia and 2003/4 – M€ 3.6: Development of Health Information System (HIS). The aim was to create: (a) Integrated National HIS, and (b) Electronic health records. The project was assessed as nearly catastrophic, turning into a “never ending story”. On countless occasions tenders for computers and (sometime unnecessary) software programs were announced. Different incompatible pilot projects have been introduced.

- Support to the public health (PH) development aimed to development of a network of PH institutions. It has been estimated that the intended changes did not lead to the PH reform.

- 2002/3 – M€ 2.5 and 2002 – M€ 0.5: Strengthening the capacity of MoH to run the health system reform, including preparation for the implementation of a M€ 50 EIB loan for reconstruction of 20+1 Serbian hospitals, as well as M€ 200 EIB loan for the reconstruction of four Clinical/Hospital Centres (CHC) in Serbia. Results of the projects are catastrophic, e.g. reconstruction of the Belgrade’s CHCs extended over years with enormous amount of money spent. Another example is the reconstructed Medical Centre in Kraljevo which sustained heavy structural damage in a recent earthquake. Reconstruction of the Institute “Torlak” was also a failure. Particular attention deserve organization and equipment supply for the Serbian oncology service, for which foreign experts (Helsinki CG) still in 2004 developed a project of reconstruction over the next 15 years, taking into account disturbing statistical data that we rank among the top European nations in terms of morbidity and mortality from the leading preventable malignant diseases, such as cervical, breast and lung cancer. Serbia is the only European country without hospices.

- 2004 – M€ 3.8: Development of the Preventive Health Care Service by establishment of 25 Preventive Centres within the Primary Health Service (PHS), along with the provision of related equipment. In reality, these preventive centres practically do not function, except for a few activities. There is an official initiative to bring back counseling for diabetes to the PHS. In its conclusions and recommendations, the ECORYS group found that a high commitment on the part of MoH is necessary in forcing and financing preventive activities.
- Twinning project on establishing Medicines and Medical Devices Agency of Serbia (ALIMS). It was considered one of the best projects in terms of the design and implementation. The plan of ALIMS development comprised employment of 34 people in the period 2008-2010 in order to regulate the health products sector in Serbia. Instead, 70 employees were fired!

- Institute Torlak. A couple of projects comprised reconstruction and support to establish a long-term production of the flu and oral polio vaccines. The idea was to attract investments and get a market orientation. Financial sustainability of the support was a problem: the first phase of reconstruction was over but there was no money for the phase two. EIB and WB kept providing financial support, but critical turned to be MoH opinion on insufficient funding to accomplish the already commenced project of vaccine production! The result is an unaccomplished reconstruction. Torlak does not produce any vaccine and is falling apart.

Dr Draško Karađinović presented results of the HIF and health financing system reform project, i.e., a fiction of the NHA. He explained that NHA is not feasible due to system-inherent fallacy in the set up of the Serbian health care, which has been apparent since 2003. In spite of the fact, simulation of NHA development has been extended over 7 years, and accompanied by direct and indirect expenses. Information coming out from this quasi-NHA have been frequently used by the MoH Sector for EU integration and international cooperation as a basis for planning and financing projects, as well as for research. They have been also used for presenting the Serbian health system, both locally and abroad, and for various forms of communication with EC. Mystification of NHA hides the non-existence of HIF reforms and health financing system. Absence of NHA prevents control of money flow within the health system, follow up of trends of expenses, rational allocation of resources, determination of priorities... NHA fiction supports systemic health corruption.

Professor  Zoran Radovanović in his presentation on corruption referred to the report “Assessment of International Assistance in the Serbian Health Sector”, prepared by independent external experts (ECORYS, Rotterdam).He emphasized that the capitation project, due to the exclusion of private sector, led to a direct violation of the European Charter of Patient Rights (No. 5 Right to Free Choice) and that such a state monopoly does not exist in other countries (OECD 2010 Report). ECORYS explicitly states that the “project suffers from lack of readiness of the domestic partners for practical changes in financing and remuneration mechanisms”, cites WB experience on HIF capacity building (“disagreement on formula rationale was so deep that further collaboration was impossible”), assesses MoH international cooperation by the words “There is a history of unresolved conceptual differences that frustrated parties (e.g. the methodology for PHC capitation)”, etc.

Discussion involved several doctors and pharmacists, including Dr. Paja Momčilov, Member of Parliament and Chairman of its Committee on Health and Family.

Projekti u zdravstvu finansirani od strane EU – kako konačno postići ciljeve?

Projekti u zdravstvu finansirani od strane EU – kako konačno postići ciljeve?

Prikaz izlaganja sa okruglog stola

Datum i vreme: četvrtak 2. decembar 2010.11:00-13:00 u 

Mesto: Press centar,Knez Mihajlova 6/III,  Beograd

Učesnici i teme:

• prof. dr Dragana Jovanović: Uvodna reč

• Miroslav Petrović, Udruženje korisnika zdravstvenih usluga “Klub zdravlje”, član IAPO: Projekti reforme tercijarne zdravstvene zaštite i prava pacijenata - Onkologija

• prof. dr Dragana Jovanović: Analiza uspešnosti nekih zdravstvenih projekata finansiranih sredstvima EU

• dr Draško Karađinović: Rezultati projekta reforme RZZO i finansiranja zdravstva - Fikcija Nacionalnog zdravstvenog računa

• prof. Zoran Radovanović: Dometi tekućih projekata - Projekat Izabrani lekar - Kapitacija

Nevladino udruženje „Doktori protiv korupcije“ je organizovalo okrugli uz učešće NVO „Klub zdravlje“ na kome su analizirani efekti projekata u zdravstvu finansiranih od strane Evropske unije. Analiza se bazirala na materijalima prikupljenim iz brojnih projekata, kao i na izveštaju „Ocena međunarodne pomoći zdravstvenom sektoru Srbije“, Ecorys, april 2010.

Uvod-profesor Dragana Jovanović

Krajem novembra je UNDP objavio rezultate nastavljenog istraživanja na temu korupcije, kojim se pokazuje dalji rast korupcije u zdravstvu od nekoliko procenata tokom poslednjih 6 meseci. Još važnija činjenica proizašla iz izveštaja je diskreditacija EU donacija - raste nepoverenje građana u donacije, a takođe i u NVO (nesumnjivo zbog lažnih NVO, tzv. GONGO). Poljuljano poverenje građana u EU, uprkos donacija od 1,3 milijarde evra pomoći, od toga oko 130 miliona evra za projekte koji je trebalo da reformišu zdravstvo, proizilazi iz činjenice da je značajan broj tih projekata loše koncipiran i/ili implementiran, pa su rezultati izostali ili su katastrofalni. Na osnovu uvida udruženja „Doktori protiv korupcije“ u brojna dokumenta, značajan broj takvih projekata je lažno prikazan uspešnim od strane domaćih partnera, pa su ga nezavisni strani stručnjaci ocenili bilo (a) pozitivno (zbog netačnih izvora), ili (b) negativno. Posledice pogrešno prikazanih rezultata i realnog impakta EU projekata su upravo: diskreditacija EU u srpskoj javnosti, diskreditacija Srbije u očima EU donatora, velika šteta po zdravstvenu zaštitu građana, otežana integracija Srbije u EU, kompromitovanje IPA i svih budućih projekata koje finansira EU, a čija realizacija i kontrola prelaze potpuno na vladu Srbije u 2011/2012. godini.

G. Miroslav Petrović, potpredsednik Udruženja za zaštitu prava pacijenata “Klub Zdravlje”, rekao je da su se ovo udruženje i pacijenti oboleli od malignih oboljenja i porodice preminulih, obratili juna 2009 god. Ministarstvu zdravlja dopisom da Institut za onkologiju Vojvodine u Sremskoj Kamenici rentira svoje inače nedovoljne kapacitete za radioterapiju obolelih od malignih oboljenja radi sticanja protivpravne materijalne dobiti. Strani pacijenti, koji plaćaju usluge, imaju prednost nad domaćim osiguranicima koji su na listama čekanja, čime su ugrožena prava na pravovremeno lečenje (prava na život). Potom se „Klub Zdravlje“ bezuspešno obraćao upravi IOV, Upravnom Odboru IOV, Nadzornom Odboru IOV, direktorki RZZO, LKS i sudu časti, Pokrajinskom sekretaru za zdravstvo, Inspekciji MZ. Jula o.g. Odbor za zdravlje i porodicu Skupštine RS je tražio da se utvrde tačno okolnosti i odgovornost pojedinaca i institucija. Nakon više obraćanja Ombudsmanu RS, on je u novembru konačno sačinio preporuke sa akcentom na brojna kršenje zakona u pogledu nezakonitog dopunskog rada, plaćanja zaposlenih, zaštite duvača u pištaljku, dok samo kršenje prava na blagovremeno lečenje i pravično obeštećenje više stotina oštećenih pacijenata obololelih od raka, odnosno njihovih pravnih sledbenika nije u preporukama istaknuto u prvi plan. 

Prof Dragana Jovanović je iznela neke od primera takvih projekata:

- 2002– M€ 5.5: Reforma i unapređenje transfuziološke službe kroz tehničku pomoć i nabavku opreme. Cilj je jačanje dobrovoljnog davalaštva krvi. Koncept projekta je promenjen u odnosu na prvobitni. Nacionalni centar za frakcionisanje plazme je ugašen. Nisu kupljena specijalna vozila, već kombi. Rezultat reforme je i ugroženo dobrovoljno davalaštvo krvi.

-Dva projekta vezana za razvoj zdravstvenog informacionog sistema: 2003– M€ 6.2:. Kompjuterizacija bolničkih apoteka i zdravstvenih ustanova Srbije i 2003/4 – M€ 3.6: Razvijanje zdravstvenog informacionog sistema (ZIS). Cilj je bio da se naprave: (a) Integrisani nacionalni ZIS, i (b) Elektronski zdravstveni karton. Projekat je ocenjen kao skoro katastrofalan. Postaje “Never ending story”. Nebrojano puta se raspisuju tenderi za kompjutere, i(ponekad nepotrebnе) softverskе programе, uvode se razni međusobno inkompatibilni pilot projekti.

- Projekat podrške razvoju javnog zdravlja sa ciljem razvoja mreže ustanova JZ. Procena je da, nažalost, željene promene nisu dovele do reforme JZ.

- 2002/3 – M€ 2.5 i 2002 – M€ 0.5 : Jačanje kapaciteta Ministarstva zdravlja da sprovodi zdrastvenu reformu, uključujući i pripremu za implementaciju kredita EIB od 50 miliona € za rekonstrukciju 20+1 bolnice u Srbiji, kao i kredita EIB od 200 miliona € za rekonstrukciju četiri KC u Srbiji. Rezultat je katastrofalno stanje rekonstrukcija, npr. u beogradskim KBC-ima, koje traju godinama sa enormno potrošenim sredstvima. Poslednji primeri su rekonstruisani MC Kraljevo u zemljoresu ili pak rekonstrukcija Instituta Torlak. Posebno je i pitanje organizacije i nabavke opreme za onkološke službe u Srbiji, za šta su strani eksperti (Helsinki CG) još 2004. godine uradili projekat restrukturisanja onkologije u Srbiji za narednih 15 godina, upravo imajući u vidu porazne statističke podatke da smo među prvima u Evropi po obolevanju  i smrtnosti od najčešćih preventabilnih malignih bolesti, poput karcinoma grlića, dojke i pluća. Mi smo jedina zemlja u Evropi koja nema hospise.

- 2004.– M€ 3.8: Razvoj preventivnih zdravstvenih službi formiranjem 25 Preventivnih centara u PZZ, uz nabavku odgovarajuće opreme. Stvarnost je da 25 osnovanih preventivnih centara praktično skoro i da ne funkcioniše, osim nekih izuzetaka.  Zvanično je pokrenuta inicijativa za “vraćanje Savetovališta za šećernu bolest” u PZU. Zaključci i preporuke Ecorys grupe: neophodna je posvećenost MZ da forsira i finansira preventivne aktivnosti.

- Twinning projekat osnivanja ALIMS –Agencije za lekove i medicinska sredstva. Smatra se jednim od najboljih sa aspekta dizajna i implementacije projekta. Planom razvoja ALIMS-a za 2008-2010. god. bilo je predviđeno da se zaposle još 34 neophodna saradnika radi regulisanja sektora zdravstvenih proizvoda u Srbiji, a umesto toga otpušteno ih je 70!

- Institut Torlak. Nekoliko projekata koji su obuhvatali rekonstrukciju i podršku uspostavljanju dugoročne proizvodnje vakcine protiv gripa i OPV, podršku kako da se privuku investicije i da se orijentiše ka tržištu. Finansijska održivost podrške Torlaku je bila problem: završena je I faza rekonstrukcije, ali bez novca za II fazu. EIB i WB su davali nadalje finansijsku pomoć za Torlak, ali prema mišljenju MZ, koje je bilo presudno, nema dovoljno investicija da bi se završio započeti projekat proizvodnje vakcina!!! Rezultat danas je nezavršena rekonstrukcija, Torlak ne proizvodi ni jednu vakcinu, propada.

Dr Draško Karađinović je izložio rezultate projekta reforme RZZO i finansiranja zdravstva - Fikciju Nacionalnog zdravstvenog računa (NZR). Objasnio je da NZR nije moguć zbog sistemski pogrešno postavljenog srpskog zdravstvenog sistema, što je očigledno još od 2003. Uprkos činjenicama, simulacija izrade NZR traje 7 godina sa direktinim i indirektnim troškovima. Informacije koje su proistekle iz ovog kvazi NZR često je koristio Sektor za EU integracije i internacionalnu saradnju Ministarstva zdravlja, bile su osnova za planiranje i finansiranje projekata i za dalja naučna istraživanja. Ove informacije su takođe korišćene u okviru predstavljanja zdravstvenog sistema Srbije, kako u okviru same zemlje tako i u inostranstvu, te i za ostale vidove komunikacije sa Evropskom komisijom. Mistifikacija NZR prikriva nepostojanje reforme RZZO i sistema finansiranja zdravstva. Nepostojanje NZR sprečava kontrolu tokova novca u zdravstvu, praćenje trendova troškova, racionalnu alokaciju resursa, određivanje prioriteta… Fikcija NZR podstiče sistemsku korupciju u zdravstvu.

Prof Zoran Radovanović u svom izlaganju o projektu kapitacije se poziva na rezultate izveštaja koji su pripremili nezavisni inostrani stručnjaci (Ecorys). Navodi da projekat izabranog lekara, iz kojeg je isključen privatni sektor, predstavlja direktnu povredu Evropske povelje o pravima pacijenta (pravo na slobodan izbor). Takav državni monopol ne postoji u drugim zemljama (izveštaj OECD za 2010. god.). Što se tiče projekta kapitacije, izričito se navodi „odsustvo spremnosti domaćih partnera da u praksi sprovedu promene finansiranja i nagrađivanja“, citira se iskustvo Svetske banke („neslaganje o osnovnim načelima bilo je tako duboko da je onemogućilo dalju saradnju“ u pogledu izgradnje kapaciteta Fonda zdravstvenog osiguranja), za međunarodnu saradnju sa Ministarstvom zdravlja se kaže kako „postoji istorijat konceptualnih razlika koji je frustrirao učesnike“ itd.

U diskusiji je, pored više lekara i farmaceuta, učestovao i dr Paja Momčilov, narodni poslanik i predsednik Odbora za zdravlje i porodicu Narodne skupštine Srbije.

Professor Dragana Jovanović, Mr. Miroslav Petrović, Dr. Draško Karađinović and Professor Zoran Radovanović presented an analysis of success of health projects in Serbia financed by the European Union in 2002-2010 from the point of view of doctors and patients.

Along with many of their colleagues, the Round Table was attended by Members of Parliament, Dr. Paja Momčilov, Chairman of the Committee on Health and Family and Dr. Miša Dimitrijević, member of the Committee.

Several doctors of different specialities and pharmacists from public and private sector took place in the discussion, pointing to numerous major shortcomings of the health care system that contradict European standards.

Health care system is one of the most corrupt sectors in Serbia which results in grave consequences for the citizens of Serbia. 

Due to above reasons, the Association "Doctors Against the Corruption" organized the 1st Round Table which was on the topic :"Corruption in Health Care - Is there Any Medication for It ?" on Thursday, 27th May 2010. in Belgrade. At the round table  the causes of systemic corruption in Serbian health care system were analyzed as well 

as the possible strategies in fight against corruption by NGO's and private sector.

Round Table   on "Corruption in Health Care - Is there any Medication for it?" held  27th of May, 2010. in Belgrade at the Press Center of Association of Serbian Journalists, (UNS), ul. Kneza Mihajla 6/III, Beograd, beginning at 11h Organized by the Association
"Doctors against Corruption" (“Doktori protiv korupcije”).

Moderators were prof. Dr Dragana Jovanović and dr Draško Karađinović

Introduction lectures:

-Legal and Economic aspects of Health Corruption -dr Draško Karađinović

-Corruption in Health and Patients Rights  -Miroslav Petrović, Udruženje korisnika zdravstvenih usluga “Klub zdravlje”, član IAPO

-Supplies, International Projects and Corruption in Health -prof.dr Dragana Jovanović

-Health, Corruption and Medias-Zorica Marković, novinar, sekcija izveštača u zdravstvu UNS

-Medical Associations and Corruption-prof.dr Višeslav Hadžitanović

Draško Karađinović (1/2 part) has pointed to the fact the corruption in Serbian Healthe Care System is of systemic occurrence, because it is associated  also with  Health Care and Healt Insurance Policies and  legislative and  Medical Chamber legislative. He has warned that corruption  is the number one problem in our country, and according to UNDP Gallup public survey, it is increased comparing with the period 6 months ago.  That is why and how it became possible for public health institutions to obtain for provided "extra" health care services (not so-called standard=basic, essential health care services) more than 350 million euros per year. What is even more important (2/2 part), directors of these institutions thus deceive  patients making them pay for in fact essential (basic Health basket) diagnostic and/or therapeutic services that otherwise should be normally provided, in total more than 350 million euros per year.It was also pointed to the fact that several "quasi" NGOs being in fact GONGOs are partners-participants  in Health Projects financed from European Community Funds.  Losses due to fraud and corruption in Serbian Health Care System exceed 500 million euros per year, the fact which obviously urge activities by all relevant institutions. 

Miroslav Petrovic on behalf od Society for Patients Rights Protection "Klub Zdravlja" has presented  a convincing and extraordinary  case of  Institute of Oncology Sremska Kamenica: although being public institution, it has rented own radiotherapy capacities to the foreign Health Insurance Funds so that foreign citizens had the advantage for the radiotherapy over Serbian inhabitants who then were put on the long "waiting lists" for Radiotherapy. Beside some sporadic comments of  relevant authorities in media,  even after one year has passed, there is no official  comment on suspicion of thus systemic corruption  that consequently jeopardised the oncology patients rights and lives. The Citizen Rights Protection Ombudsman did not express any activity in spite of received  numerous complaints.

Professor Dragana Jovanović (1/2 part) has pointed to the systemic corruption in the field of  supply of key medical equipment and building or reconstruction of hospitals, with the possibility of  fraud and corruption in every step of  purchase process. The outstanding example of misuse of  bylaws concerning  supply,  is  so called urgent purchase of enormous value equipment through direct negotiation with few invited providers, not announcing anything, for the reason of forthcoming reconstruction of the Gazela bridge. She noted (2/2 part) also how reconstructions of several  hospitals  financed  by EIB and NIP were incompletely and  badly performed  with the delay of few years, because the were done without previously made adequate necessary technical documentation.

The journalist dealing with Health Care System problems, Zorica Marković has told they  were facing the critics of the MoH very often when they publish true facts and informations. Markovic has pointed to the different figures and numbers  on Serbian Health expenditure  depending of the source of statement: from 6% of GDP (stated by the director of Serbian Health Insurance Fund), then 8,2% of GDP (stated by MoH), app. 9,6% stated by Republic Institute for Public Health, up to 10,6% of GDP as iti is on the site of  the World Bank.

Professor Višeslav Hadžitanović  has underlined that nowadays again, we pose the question of human rights, patients rights to freely choose own doctor,  the right of  true information, the right to form freely association. The existing doctors associations like Serbian Medical Chamber  (SMC) whoose members are all 28.000 Serbian doctors  to be, does not have the positive impact on Health Care System. Enormous sum of money is collected as a membership fee last 4 years, but  that is being spent  inadequately and now there is even a lack of money. This Association has verified retroactively its Statut and Annual Financial  Reports through a kind of Phone Meetings. SMC  serves to make doctors obey everything. There is by SMC recognizable verbal delict with the consequent danger of subtraction of licence to work. He emphasizes we should have  more Associations so that doctors could make a choice. The problem is a system not creating an adequate atmosphere.

OBAVEŠTENJE O ODRŽANOM 1. OKRUGLOM STOLU I NAJAVA 2.OKRUGLOG STOLA ZA DECEMBAR 2010. :

Zdravstvena zaštita je jedan od najkorumpiranijih sektora u Srbiji sa teškim posledicama za građane Srbije. Iz tih razloga je udruženje "Doktori protiv korupcije" organizovalo je 1. okrugli sto sa temom "Korupcija u zdravstvo-ima li leka?" u četvrtak, 27 maja 2010. u Beogradu. Na okruglom stolu su analizirani uzroci sistemske korupcije u zdravstvu Srbije i razmatrane moguće strategije borbe protiv korupcije od strane NVO i privatnog sektora.

Okrugli sto 27.maja 2010.god. sa početkom u 11h u Press centru Udruženja novinara Srbije (UNS), ul. Kneza Mihajla 6/III, Beograd,sa temom:

Korupcija u zdravstvu Srbije-ima li leka? 

u organizaciji “Doktori protiv korupcije”.

Moderatori su bili prof. Dr Dragana Jovanović i dr Draško Karađinović

Uvodna izlaganja:

-Pravni i ekonomski aspekti korupcije u zdravstvu-dr Draško Karađinović

-Korupcija u zdravstvu i prava pacijenata-Miroslav Petrović, Udruženje korisnika zdravstvenih usluga “Klub zdravlje”, član IAPO

-Javne nabavke, međunarodni projekti i korupcija u zdravstvu-prof.dr Dragana Jovanović

-Zdravstvo, mediji, korupcija-Zorica Marković, novinar, sekcija izveštača u zdravstvu UNS

-Lekarska udruženja i korupcija-prof.dr Višeslav Hadžitanović

Dr Draško Karađinović (1/2 deo) je ukazao da je korupcija u srpskom zdravstvu sistemska pojava jer je „ugrađena čak i u zakone o zdravstvenoj zaštiti, zdravstvenom osiguranju, kao i o zdravstvenim komorama“.Upozorio je da građani korupciju u zdravstvu stavljaju na prvo mesto i da je prema istraživanju UNDP-Gallup ankete korupcija u zdravstvu veća nego pre 6 meseci.  Na osnovu lažnih vanstandardnih  usluga uprave državnih ustanova naplaćuju građanima 350 miliona evra godišnje . Tih 350 miliona evra su naplaćeni  iako se radi o uslugama koje su obuhvaćene osnovnim paketom usluga i koje bi po zakonu trebale da idu na teret obaveznog zdravstvenog osiguranja. Dr Karađinović (2/2 deo) je takođe upozorio na formiranje kvazi nevladinih organizacija tipa GONGO kojr učestvuju u projektima a koje se finansiraju iiz evropskih fondova. Gubici zbog korupcije i prevare u zdravstvu Srbije iznose više od 500 miliona evra godišnje, što zahteva urgentnu reakciju svih nadležnih organa.

Da su zbog korupcije ugrožena prava pacijenata, g.Miroslav Petrović iz udruženja korisnika zdravstvenih usluga  "Klub Zdravlja" ilustrovao je na primeru prošlogodišnje afere u vezi s onkološkim institutom u Sremskoj Kamenici, koji je kao državna institucija rentirala onkološke kapacitete stranim osiguravajućim fondovima i to tako da strani državljani imaju prednost u lečenju u odnosu na srpske pacijente, koji su stavljani na listu čekanja za zračenje. On je ukazao da, osim sporadičnih izjava nadležnih u medijima, ni posle godinu dana „nema zvanične reakcije države na sumnje o sistemskoj korupciji i ugrožavanju prava onkoloških pacijenata“.
Rečeno je i da su se predstavnici Udruženja pacijenata, ali i lekari, više puta obraćali zaštitniku građana, ali da on nije reagovao.

Prof dr Dragana Jovanović (1/2) iznela je primere  da su brojne javne nabavke u zdravstvenim ustanovama poslednjih godina stvarale prostor za korupciju i da se vrlo često dešavalo da su obavljane bez raspisivanja tendera, već  "direktnim pogađanjem". Prof Dragana Jovanović (2/2) ukazala je na korupciju u javnim nabavkama, koja je „sistemski omogućena“, a mogućnost krupne korupcije postoji u svakom koraku javnih nabavki; drastičan primer je i hitna nabavka direktnim pogađanjem, kada se tenderska procedura „preskače“. Istakla je i da su rekonstrukcije nekih beogradskih KBC-a finansirane od strane EIB-e i NIP-a, sprovođene bez adekvatne tehničke dokumentacije, i da zbog toga radovi nisu mogli da se završe kako treba niti u predviđenom roku.

Novinar Zorica Marković iz Sekcije izveštača u zdravstvu Udruženja novinara Srbije (UNS) kazala je da se novinari suočavaju sa problemima i da su vrlo često izloženi kritikama kada objave istinitu informaciju.Marković je ukazala na različite podatke o tome koliko Srbija troši za zdravstvo: zvanični podaci o tome koliko Srbija troši na zdravstvo su oprečni zavisno od izvora: kreću se od šest odsto (direktorka RZZO) do 10,6 odsto bruto domaćeg proizvoda - BDP (sajt Svetske banke) i navela da je ministar zdravlja je svojevremeno navodio da na zdravstvo odlazi 8, 2 odsto, direktorka RZZO Svetlana Vukajlović govori o šest odsto, a Institut za javno zdravlje Srbije govori o 9, 6 odsto BDP.

Profesor dr Višeslav Hadžitanović je ukazao da se danas ponovo postavlja pitanja ljudskih prava, prava slobodnog izbora pacijenta, pravo slobodnog informisanja, pravo na slobodno udruživanje. Postojanje lekarskih asocijacija kao što je obavezna Lekarska komora Srbije nema pozitivnog dejstva na zdravstvo, 28000 lekara su članovi, prikupljena su ogromna sredstva od obavezne članarine za četiri godine koja se neracionalno troše i sada se iskazuje gubitak. Ova asocijacija retroaktivno usvaja na telefonskim sednicama Statut i finansijske izvestaje. LKS služi disciplinovanju lekara pa zato nema mladih lekara na ovakvim skupovima jer bi to bio kraj njihove karijere.I u LKS postoji verbalni delikt i opasnost da se lekaru oduzme pravo na rad.Nije vreme za ćutanje, vreme je za konkurenciju, trebalo bi da imamo više asocijacije kako bi lekari mogli da biraju gde će učlaniti.Problem je sistem koji nije stvorio pogodan ambijent.

U radu okruglog stola su učestvovali ( s desna na levo) professor Višeslav Hadžitanović, Udruženje privatnih lekara, gospođa Zorica Marković, Udruženje novinara Srbije sekcija izveštača iz zdravstva, profesorka Dragana Jovanović, moderator, dr Draško Karađinović, moderator, i godpodin Miroslav Petrović, Udruženje za zaštitu prava korisnika zdravstvenih usluga “Klub Zdravlja”

The participants of the Round Table on "Corruption in Health Care - Is there any Medication for it?" held  27th of May, 2010 in Belgrade (from right towards left): prof dr V.Hadžitanović, Z.Marković, prof.dr D.Jovanović, dr D.Karađinović, M.Petrović.

Prof Tomica Milosavljević, Ministry of Health of Serbia was invited to participate Round Table on "Corruption in Health Care - Is there any Medication for it?" as well, but he has not come.

Panelisti su ukazali na oblike korupcije u zdravstvu iz aspekta različitih sfera, lekarske, od strane pacijenata, novinara...

Panelists have pointed to the different modalities of corruption in Serbian Health Care System from several different aspects: doctors, patients, journalist...

U debati su učestovali i dr Paja Momčilov, narodni poslanik i predsednik Odbora za zdravlje i porodicu Skupštine Srbije i narodni poslanik dr Miša Dimitrijević, član Odbora za zdravlje i porodicu. Okrugli sto su pratili brojni novinari i izveštači nacionalnih televizija (Javni servis RTS, TV Pink, TV Fox)

Dr Paja Momčilov, Republic Parlament Member and President of Republic Parlament Commitee for Health and Family, and dr Miša Dimitrijević - Member of  Republic Parlament  Commitee for Health and Family have taken part in discussion. Numerous journalists and  national TV reporters ( Public RTS, TV Pink, TV Fox) have been present.

Ombdusman Republike Srbije Saša Janković objašnjava zašto Kancelarija Zaštitinika prava nije reagovala na više informacija o kršenju prava pacijenata na lečenje od malignih bolesti.

Ombdusman of Republic of Serbia Saša Janković explains why the Office of Rights Protector has not undertake anything at all inspite of numerous received  complaints concerning violated patients rights  to be treated of malignant disease.

Učesnici okruglog stola sa pažnjom slušaju objašnjenja o razlozima izostanka reagovanja ombudsmana Republike Srbije posle žalbi i informacija o kršenju prava pacijenta  na lečenje od malignih bolesti.

The Round Table participants are listetning with the utmost attention to the explanations of
Ombdusman about the reasons for not undertaking any activity after receiving complaints and informations concerning violated patients rights to be treated of malignant disease.