“You can’t go see a doctor because of a common cold and end up having a head MRI scan that’s very expensive, as it’s done at private institutions. We will control what is done at both state-owned and privately-owned institutions. Digitalization in the healthcare system will be completed in a year or two, which means that there will be e-records and a huge increase in control, seeing as now we have a relatively few inspectors, both health, sanitary, and border-health ones,” Professor Danica Grujičić, Minister of Health, says in her interview with Kurir.
Do private healthcare institutions openly rip us off?
“Perhaps I wouldn’t say ‘rip off’, but sometimes they run expensive analyses without proper justification. I cannot say that this is not being done in the state sector too, but it’s because they are overburdened, with GPs seeing 40 patients per day.”
So what will the penalties be?
“Fines, because they’re the most efficient. What do I get from shutting down a practice run by a doctor who is competent?! That said, this means amending the law on insurance. Just like in the West. Patients pay an insurance, and report a case where they went to see a doctor because of a common cold, and had the MRI scan done, which detected no abnormalities. Then we’ll see why the doctor had made that call, with the next step being the insurance and the experts: ‘Now you will return the money to the patient, or the insurance won’t cover it!’. We need to teach people to take care of their own health. Why shouldn’t patients be able to have private insurance as well now?”
Because it costs an arm and a leg, and they are already making contributions to their state healthcare.
“This is why everyone’s e-record will contain how much money has been spent treating them, and then you’ll be able to see that they’d been making contributions deducted from his wages for 30 years, and that all of it was spent on three courses of chemotherapy.”
BOY WHO KILLED 10 AT RIBNIKAR STILL UNDER OBSERVATION
Is there any news about the boy who committed a massacre at the Vladislav Ribnikar Elementary School?
“The boy is still at the Neuropsychiatry Clinic for Children and Young Adults, and he is under observation. When all the forensic and forensic-medical evidence is analysed and added to the psychiatric examination – not only at Ribnikar Elementary, but also in Mladenovac – we will know all the circumstances. Nothing that you’re reading in the papers is true, it’s all hearsay.”
And the truth is?
“What the experts will say, but we have to give them time.”
Whatever has come of the musical therapy case at Ribnikar Elementary?
“Nothing, a lot of fuss over nothing. The female colleague was publicly shamed with no justification whatsoever. Some children had a good response to that, and one girl did not, so it appeared as if all they had been doing there was singing, which isn’t true. When you want to use something for political purposes, then you badmouth even the people who were there first and wanted to help. Everyone has the right to respond differently to a therapy than the majority. But there must also be trust in the experts.”
You went to Ribnikar Elementary too?
“When I moved from Užice to Belgrade in my sixth grade, I went to the Aleksa Šantić Elementary School, and that building is now part of the Ribnikar Elementary. The shooting occurred at the entrance facing Desanke Maksimović Street, whereas the entrance of my school faced Svetozara Markovića Street. These emotions from my school days came back to me on 3 May.”
Will you charge them then? Make us all go into private health insurance?
“No, but people must understand that the healthy finance the ill everywhere in the world. We have a fund. But everyone says, ‘I’ve been paying in for 40 years.’ You have, but that money, together with the interests, was spent on four courses of chemotherapy that you have received. You will continue to receive chemotherapy because we want you to have a good life and be well, but you must know that this is now paid by the state. No one wants to understand this. Everyone has rights, but no one has duties. And when I call you in for an examination, you don’t want to – you have more important business to attend to. And I’m not penalizing you, but I will in the future.”
What is that future?
“I need to have a perfect healthcare service in order to be able to impose penalties. In a situation where you must travel 30 km to get a mammography, I cannot penalize such a woman. But I will rearrange the healthcare centres instead. Why would people from Sjenica go to Užice or Novi Pazar, given that it’s so far away. Healthcare centres located many kilometres away from hospitals need to have greater authorities, a small inpatient ward block, and equipment that includes even CT scanners. Bajina Bašta is an hour and a half from Užice and it needs everything, but Požega and Čajetina do not, given that they are 20 minutes away from Užice, which is well-equipped, so all they need is an X-ray scanner and an ultrasound machine.”
But in Užice the MRI is out of service, and there is a waiting list for the CT scanner.
“They will get an MRI machine – repairing doesn’t pay off. All three CT scanners are operational, and if someone says they aren’t, that means that the radiologists are doing work at Lune’s or in Požega. I advocate the centralization of everything requiring high technology and expensive devices, and making everything else more accessible to patients. This is why healthcare centres need to have specialists in psychiatry, neurology, otorhinolaryngology, etc.”
‘700 BEDS IN CASE OF A NEW PANDEMIC OUTBREAK, 150 FOR PALLIATIVE CARE’
The Covid hospital in Batajnica is empty. When exactly will it get a new use, and what will this use be?
“Once two-bed rooms with bathrooms are made after reconstruction, it will partly be used for palliative care. But it cannot be converted into a care home. People suffering from Alzheimer’s disease unfortunately won’t be able to be placed there, but rather those in the terminal stages of illness, so that they wouldn’t pass away at home. There’s a great number of people who need extended hospital care. The sections that will not be in use will be conserved for a rainy day, so that they could be activated at any given point. How should I know if some idiot comes up with the next pandemic, or a new biological weapon is developed? For starters, Batajnica will have some 700 conserved beds because we’re starting off with 150 beds for palliative care. However, if they fill up quickly, we will expand the capacity. All this should be taken care of by the end of the year.”
What about the other two hospitals?
“Vojvodina is in charge of Mišeluk, and we’ll see about Kruševac.”
2 TIRŠOVA STREET AND ONCOLOGY 2
Whatever’s happened with 2 Tiršova Street and Oncology 2?
“As for Tiršova, I expect that the construction process will be continued very soon. The start of the construction of the regional oncology institute is expected in a year or two. We have sent a memo to the Government proposing that the entire complex between the highway, Bulevar Oslobođenja Street, Pasterova Street, Resavska Street, and Kneza Miloša Street be declared a healthcare complex.”
‘MMA SHORTENED THE WAITING LIST BY 30 PERCENT’
Things remain the same when it comes to waiting lists – 76,000 people, most of whom are waiting to get an artificial hip or knee.
“Yes, but here’s a good example of the MMA – after examining all the orthopaedics patients, 30 percent of them were taken off the list immediately – they don’t have to have a surgery.”
How come?
“Sometimes patients plead that they be put on the list, and sometimes the doctors do it themselves, so that in 10 years, when it’s their turn, a surgery just might be necessary. The Banjica Institute will soon perform their review, and we’ll take it from there.”
But there are not enough of them?
“There are. Just ask the Eye Diseases Clinic how many there are and how many do surgeries. What are those who don’t do surgeries doing at the Clinic?
They are unlikely to go to Aleksinac or Majdanpek.
“Well, is this the result of Dana Grujičić, who took office eight months ago?! I cannot solve everything at once. I don’t have a magic wand. But I do have an idea. First I must change the laws – and how they will fare in the Government and then the Parliament sessions is anybody’s guess – and then the rulebooks. There are 1,920 available jobs in the healthcare system according to the existing job classification. So, now we can employ about 2,000 people. But I must send that to the Ministry of Finance for approval.”
Are these jobs mostly available in the provinces?
“Both in the provinces and in Belgrade. Moreover, many people will be retiring soon. So, the situation is that one third of paediatricians in Kragujevac – mind you, not a place like Trgovište – are retiring. You need to have a well-trained and equipped family doctor to have a good healthcare system.”
What has happened with that? When will this pilot-project be implemented?
“Now, when we get the World Bank loan. GPs must have small laboratories, X-ray and ultrasound machines, ECGs, and defibrillators, and then they will know if the patient needs further treatment, and make an appointment for them if that’s the case. If the GP thinks that a patient cannot with for two weeks, they pick up the phone, and the patient goes immediately.”
And now the readers will say that the Minister is telling a utopian tale.
“It’s not a utopian tale, it can happen in two to three years, especially in rural environments, where we intend to build 100 healthcare stations.”
And who will you employ?
“Medical doctors.”
No one wants to go the countryside.
“In Denmark, when you graduate, you are randomly assigned a city or a village that you go to for a year as a GP. If I were to do that, they’d say I was the worst enemy of this people and that I would chase away all the doctors. We will try to conduct a survey among the nurses and doctors in collaboration with NALED regarding the conditions under which they would accept to work in a rural environment or at least spend five years there – whether they want an apartment and a good salary, whether it’s important what tools will be available to them, etc.”
When can we expect the results?
“Soon. However, specializing general medicine must change too. A general practitioner must attend certain courses for one or two months every year – ultrasound, ECG, hypertensions, Type 2 diabetes. In developed countries, specialists don’t deal with such things. 15 to 20 such courses and the final exam – that’s specialization. There must be a prevention plan as well, in addition to the equipment.”
‘THE NIŠ DOCTORS’ PROPOSAL IS POPULISM,’
The doctors from Niš, who have cleared the waiting lists, propose that healthcare workers be declared a national treasure. What do you say?
“My colleague Dragan Milić is a cardio-surgeon, I respect his work, and there are things that we agree about, and things that we don’t. But there are often populist proposals as well. For starters, let’s pay for the doctors’ and nurses’ internships. The Serbian Medical Society, the only society that has been around for 150 years under the same name, ought to be ranked the same as Matica Srpska. And it should be a team player, but I think it isn’t – Milić would have proposed it.”
‘SMOKING BAN LAW NOT BEFORE NEXT YEAR’
What has come of the law on smoking ban in closed spaces?
“It’s being worked on, it needs to go through all the sectors of the Ministry of Health, then all the government ministries, the Government, and then the Parliament.”
Will we live to see it?
“Next year is realistic.”
So late?
“If there are no elections, perhaps even sooner. As many as 76 percent of doctors and citizens have supported this law. So, three quarters of people don’t smoke, and we are all victims of one quarter.”
In relation to prevention, when will I receive an invitation to my home address to get a mammography?
“You will be contacted by phone or email.”
When?
“When we get organized. But that‘s not utopia, but a perfectly normal thing and, most importantly, it doesn’t require huge funds.”
Well, that’s most depressing, with an invitation not coming.
“That’s right, but it’s not my fault that no one has taken it up until now. We also need to bring prosthodontics back to the healthcare centres.”
When?
“Bringing specialists back to the healthcare centres and organizing primary healthcare within five years.”
Medical students request paying doctors for their internships. Will you make it possible?
“Internships for both nurses and doctors should be paid, and I am already working on this together with the Government. This needs to apply not only to doctors, which is a selfish request, but also to nurses. We’ll work with the State Health Insurance Fund to work out the amount, but we once again face the Ministry of Finance, which needs to approve it. I understand that Serbia’s budget isn’t bottomless.”
CONGRATULATIONS TO KURIR
“Twenty years is a great anniversary for a media outlet, which now includes a television channel as well. Sadly, Kurir hasn’t always risen up to its tasks and popularity, which is something I felt personally, but I was resilient. May Kurir be what it always should have been – objectively reporting on what is going on in the country and abroad.”
AFTER KURIR’ STORY – THE DIABETES PROTOCOL
You have drawn up a protocol for schools with children who suffer from diabetes after Kurir ran the story.
“Yes, it was done by the State Expert Committee for Diabetes and the public health sector, with a significant contribution made by Minister Husein Memić. Thank you very much for your great support in the public sphere.”
Are nurseries next in line?
“Why not. I have an excellent idea for nurseries – children should engage in physical activity for an hour or an hour and a half, but not less than 15-30 minutes, twice or three times a week. This will make them request that when they go to school. PE classes should be scheduled in the morning if other classes are in the afternoon, and vice versa, so that it is a proper physical activity, and not some sort of class break, as is the case now. I’d like for all school to have swimming pools, in order to eliminate scoliosis and kyphosis and make sure the knees and hips don’t deteriorate. Someone will say that Dana is daydreaming again. But that’s not daydreaming – it’s far cheaper than treating someone.”
You have been a government minister for eight months. Are you satisfied?
“I’m not satisfied at all because I’ve had to deal with things that a minister should not deal with, but I won’t go into any detail.”
What are the compromises that you’ve had to make?
“I must admit that I had a naïve belief that I’d be able to cut things like in surgery. Not possible! Everything takes time. As well as compromises. What I would like, no matter how long my term in office lasts, is to pave the way for the development of the Serbian healthcare system for the next 20 years, to lay the foundations in the forms of laws, which can happen by September, and that no one deviates from that path. At the moment, I would only like to find a common solution with Siniša Mali, fill up the available jobs, and increase the number of doctors wherever necessary.”
What about personnel solutions?
“I’d better say nothing. You have institutions with exceptional managers – UMCS’s Professor Milika Ašanin, HCS Valjevo’s Dr Marija Krstivojević Mirković, UMC Kragujevac’s Professor Slobodan Milisavljević, UMC Vojvodina’s Professor Edita Stokić. But you have some, particularly specialist hospitals, where people slack off, they should long since have gone into retirement, but you cannot move them. And then there are also the party solutions.”
Jelena S. Spasić
