Government of Montenegro

Ministry of Health of Montenegro

HEALTH CARE SYSTEM

2017-2018

Podgorica, November 2018

 We invest into human resources...
- There are 2,061 medical doctors
working within the health care system
of Montenegro
- In the past 2 years, a total of
o 150 specialty residencies and
o 20 subspecialty fellowships
have been approved.
- The number of medical doctors per 1,000
inhabitants has increased to 3.3 (2018),
- The program of Continuous Medical
bringing us closer to the European
standard (3.4)
- In the past 2 years, a total of 93 medical
doctors have returned from specialty
residencies
Investments into education are realized
through:
- The program of Continuous Medical
Education – EUR 550,000 (2017/18)
- International cooperation (WHO,
TAIEX, relevant ministries in other
countries…)
Education in 2017/18 included:
o Education of 3,730 health workers
o Organization of 1,452 trainings and
workshops
Investments are also made into the living
standard of health workers:
- Construction of 70 residential units in
NK and 97 residential units in PG is in
its final phase
- Agreement was signed on providing
funds for solving the housing needs of
health workers (EUR 1.2 million,
2018-2020)
Around 160 families of health workers are
moving into their apartments in early 2019
 We are improving the working conditions and the quality of health care services...

Investments into reconstruction and A total of EUR 5 million has been invested for
Investments into medical equipment
adaptation of buildings adaptation of 6 health care facilities through the
amounted to
amounted to energy efficiency program, and EUR 6 million
more has been provided for 18 health care
EUR 9.3 million facilities
EUR 3.1 million

Among other, the following facilities were The following facilities have been fully adapted:
Among other, the following have been built/reconstructed: - CCM
purchased: - Institute for Children’s Diseases at CCM
- Cardiac Surgery Clinic at CCM - GH Cetinje
- Linear accelerator (Clinical Centre - ORL and MFS Clinic at CCM - GH Kotor
of Montenegro - CCM) - Neurology Clinic at CCM - HC Cetinje
- 3T MRI (CCM) - Orthopaedic Clinic KCCG - HC Kotor
- Angiography apparatus (CCM) - Paediatric Department at HC Kotor
The following ones have been partially adapted:
- Gama camera (CCM) - Physical Therapy Units at HC Nikšić,
- HC Nikšić
- 4 CT scanners (GH NK, BP, BA and HC Berane and HC Plav
- HC Kolašin
SH Risan) - Ophthalmology out-patient clinic at
- HC Andrijevica
- ... HC Plav
- HS Petnjica
- …
 Investments into staff, equipment and health care facilities have resulted in:

SHORTER WAITING LISTS FOR CERTAIN SURGICAL PROCEDURES INCREASED NUMBER OF SERVICES PROVIDED UNDER SPECIALIST-
Dec-17 CONSULTATIVE HEALTH CARE IN GENERAL AND SPECIAL HOSPITALS
558 Oct-18 1,63 mil
600 1,800,000 2016 2017
1,5 mil 1,15 mil
Number of patients

500 1,600,000
1,400,000 1,13 mil
400 292 1,200,000
300 1,000,000
167
200 106 73
800,000
124,793
100 44 27 0
600,000
400,000 123,716
0 200,000
Kardiohirurške Kardiološke Terapije zračenja Operacije 0
Cardiac surgery Cardiology Radiation Cataractkatarakte
intervencije
interventions procedure
procedures therapies surgeries ClinicalKCCG
Center MNE Opšte bolnice
General Hospitals Specijalne
Special bolnice
Hospitals
Types of interventions

FOR THE FIRST TIME IN MONTENEGRO, NEW STATE-OF-THE-ART REDUCED NUMBER OF PATIENTS REFERRED TO TREATMENT
INVERVENTIONS HAVE BEEN PERFORMED OUTSIDE MONTENEGRO
- In CCM, biopsy of muscles and nerves was performed for the first time (June 4,00 0 (7 ,000,0 00.00 )

2017) 3,468
2,869
3,50 0
(6 ,000,0 00.00 )

- In CCM, a state-of-the-art treatment of cardiac rhythm disorder was 3,00 0

(5 ,000,0 00.00 )

2,50 0

performed for the first time (June 2018) 2,00 0

6,65 (4 ,000,0 00.00 )

- In CCM, endovascular intervention on the blood vessels of popliteal region 1,50 0

mil EUR 4,75 (3 ,000,0 00.00 )

mil EUR
(2 ,000,0 00.00 )

1,00 0

was performed for the first time (October 2018) 500

(1 ,000,0 00.00 )

- At the Institute for Children’s Diseases, CCM, a new method of treatment of - -

hypospadias was introduced (May 2018) 01.01.-30.09.2017 01.01.-30.09.2018

- In GH Kotor, laparoscopic surgery of malignant sigmoid colon tumor was Allocatedsredstva
Izdvojena funds Number
Broj of referred patients
upućenih
performed (April 2018)

QUANTITY OF MEDICAL WASTE IN HEALTH CARE INSTITUTIONS HAS BEEN USE OF ANTIBIOTICS HAS BEEN RATIONALIZED
REDUCED
315.5 t Reduction in
320 - In the period from September 2016 to September 2017, we achieved a
2018-2016
310 by 14% (43.4t)
reduction of the total consumption of antibiotics by 3.8%
Tons

300 - In the period from September 2016 to September 2018, consumption of

289.0 t
290 spare antibiotics at the CCM was reduced by about 30% which accounted
280 272.1 t for the savings in the amount of about EUR 200,000
270
- In the period from February 2017 to April 2018, an increase in the number
260
of patients receiving peri-operative antimicrobial prophylaxis was
250
recorded, from 20% to 80%
jan-sept 2016 jan-sept 2017 jan-sept 2018
 We make health care more accessible ...

We have networked 177 Hyperbaric medicine

dental clinics providing
services of dental health
care covered by the HIF
(27 March 2017)
services are available in
Berane for the insured in
10 municipalities in the
north covered by the HIF
(3 March 2018)
Gastroscopy and colonoscopy
services for the population in
Autism Centre the north of Montenegro are
was opened available at GH Pljevlja
(30 March 2018) (23 May 2018)
Physical therapy services
for the population of
Nikšić, Šavnik and Plužine
are available at HC NK
(13 Sept. 2018)
Physical therapy services
for the population of Plav
are available at HC Plav
(10 Oct. 2018)

(March/June 2017) (12 Sept. 2017) (16 March 2018) (12 April 2018) (4/5 Sept. 2018) (5 Oct. 2018) (31 Oct. 2018)

We have networked 17 We have Pediatrists in all HCs Hemodialysis is also At CCM, explantation CT diagnostics services on CT diagnostics services on state-
private health care networked 167 perform ultrasound available in Cetinje of 5 organs was state-of-the-art scanners for of-the-art scanners for the
institutions and 27 private examinations of performed the population of Nikšić, population of BP and Mojkovac
suppliers of medical- pharmacies baby hips (agreement signed Šavnik and Plužine are are at a higher quality level at
technical aids for services providing with Eurotransplant) available again at GH NK GH BP
covered by the HIF prescription
medicines covered
by the HIF
We extend the rights of the insured...

MEDICAL-TECHNICAL AIDS LIST OF MEDICINES

- The List includes 1,156 medicines

- The List now covers 114 new medicines
The rights of the insured have been extended in
- Among other, the following were included:
terms of:
modern medicines for hypertension,
diabetics, cancer, thrombolytic therapy, new
- Hearing aids (cochlear implants, digital bone
MEDICAL REHABILITATION medicines for infectious diseases (in
conduction device)
particular for HIV and hepatitis C), medicines
- Diabetes aids (insulin pumps)
for transplantation, autoimmune diseases,
- Breathing aids (non-invasive mechanical
psychiatric diseases...
ventilation respirator, electrical inhaler)
- The List for Specialized Medical Rehabilitation has - Therapeutic options have been extended for
- Visual and tiflotechnical aids (electronic Braille
been extended by 12 new diagnoses patients with malignant, autoimmune and
typewriter for the blind)
- For certain diagnoses from the List, the right in psychiatric diseases, as well as for gluten
- ...
terms of the period of use have been extended intolerance
(e.g. for persons suffering from cerebral paralysis - …
after the age of 18 it is now possible to go to
rehabilitation every two years – instead of every
three years as was prescribed under the previous
Reduced “out-of-pocket expenses” for the
rule)
Increased number of issued aids and purchase of medicines*
- ...
funds spent at the expense of the HIF 100
77,17
1,87 mil Number of persons referred to 70,57 mil EUR
1,77 mil 1,75 mil 80 66,17
2,000,000 EUR EUR
EUR rehabilitation and funds spent at the mil EUR
mil EUR
55,73
1,800,000 expense of the HIF 60 49,43 mil EUR
1,600,000 4,96 mil 44,95 mil EUR
6,000,000 4,19 mil 4,34 mil mil EUR
1,400,000 EUR EUR EUR
1,200,000 40
1,000,000 4,000,000
800,000 20
600,000 2,000,000
400,000 4,744 4,121 4,118
87,656 101,645 112,168 - -
200,000
- 2015 2016 2017 2015 2016 2017

70,05%
2015 2016 2017 Number of Ukupna potrošnja
Total expenses (EUR)
(EUR) Potrošnja
Expenses na teretby
covered sredstava FZO
the HIF funds
Number
Broj of aids
pomagala Iznos sredstava
Amount of funds Broj upućenih
referred patients Funds spent
Utrošena sredstva

*Effects of the application of the new List of Medicines

will be known in mid 2019
 We improve communication “patient-doctor-health institution” and between health care institutions
We introduced the service
of eScheduling specialist We introduced the We started the
examinations and service of eScheduling telemedicine project
diagnostic procedures at examinations with SDs (CCM and GH PV, BR
GHs and CCM by SDs and BA)

(15 June 2017) (11 Sept. 2017) (22 May 2018)

(1 March 2018) (15 June 2018)

(8 Dec. 2017)

We introduced Printed version of We introduced the service of

prescription is no confirming/cancelling specialist
ePrescription and
longer used examinations at CCM by patients
eReport service

…and, in that way, we save time and money

TRAVEL EXPENSES OF THE INSURED IN THE TERRITORY

3,78 OF MONTENEGRO
3.90 mil EUR Travel expenses reduced by about
3.70 30% (EUR 0.85 million)
3,17
3.50
mil EUR
3.30
2,93
3.10 mil EUR
2.90
2.70
2.50
2016 2017 2018 P
 We influence the awareness of the need for preventive action…

SCREENINGS
- Screening of cervical cancer is performed
for the first time in the entire territory of
Montenegro
- Screening of colorectal cancer is performed
in the entire territory of Montenegro
- Tender dossier is ready for the procurement
of 3 digital mammography machines in
order to extend the breast cancer screening
VACCINATION
- Continuous campaigns are implemented to
raise awareness of the importance of
immunisation
- Extraordinary vaccinations are organized
- Additional immunisations are implemented
in risk, hard-to-reach and mobile
populations
HIV/AIDS
- Grant funds have been provided by the
Global Fund for the treatment of persons
suffering from HIV/AIDS in the amount of
EUR 556,000 (2019-2021)
- A total of EUR 225,000 was allocated for
partner work with NGOs (2017-2018)
- The new List of Medicines provided for
adequate modern therapy for treatment of
patients suffering from HIV/AIDS

Results of screening programs

Increased coverage of vaccinated Allocations for the prevention of
(from the start of implementation)
200,000 children HIV/AIDS 125,000
153,913 140,000
90% 82% EUR
150,000 119,658 100,000
80% 120,000
EUR
100,000 70% 100,000
56%
18,415 60%
Coverage

12,477 8,743 46% 80,000

50,000 17,766 50%
42 3 60 40% 60,000
- 30% 40,000
Karcinom debelog Karcinom grlića Karcinom dojke 20%
Colon cancer Cervical cancer Breast cancer 20,000
crijeva materice 10%
0% -
Invited
Pozvano Responded
Odazvano Cancer detected
Otkriven karcinom
Oct-16 Nov-16 Sep-18 2017 2018
Everything we do is evaluated by citizens and international organizations…

INCREASED TRUST OF CITIZENS

According to the results of the CEDEM survey “Political PROGRESS BY 9 PLACES ON ECHI
public opinion of Montenegro” the trust of the citizens of
Montenegro in the health system institutions in our
country is continuously increasing – in 9 months, the We have improved our ranking on the Euro Health
trust increased by 11.7 percentage points Consumer Index (ECHI) list by 9 places – from the second
last, 34th place (2016) we improved our health care
 June 2017: 43.1%
system which is now at the 25th place
 Dec. 2017: 47.7%
 March 2018: 54.8%
WE WILL CONTINUE... AMONG OTHER...

We will regulate the matter of awarding

of health workers who posses expert
We will network the Clinical Centre of
knowledge and health workers who
Montenegro into the integrated health
achieve extraordinary results in their
care information system
work and give significant contribution to
the improvement of health protection

We will regulate the matter of

professional liability of doctors – We will introduce electronic medical
medical error insurance records (eKarton)

We will regulate the method of securing In 2019, we will invest additional EUR 5
funds for rare diseases and expensive million from the State Budget to procure
treatments new medical equipment

We will invest into construction and

reconstruction of health care facilities – we
will start the construction of the Clinic for
We will introduce new medical Infectious Diseases and the
technologies in a standardized manner Dermatovenerology Clinic, and furnish the
microbiology laboratories from the EU grant
funds – EUR 6 million

We will start the accreditation of health We will regulate the manner and the
care institutions and introduce place of disposal of patoanatomic waste
standardized operative procedures
 WE HAVE IMPLEMENTED ALL THE ABOVE LISTED DESPITE THE FACT THAT ...

SHARE OF EUROPEAN COUNTRIES' EXPENDITURES FOR HEALTH CARE IN

GDP AND WE ACHIEVED SUCCESS IN THE
Health care system budget accounts 8.70%
7.80% 8.00% INDICATORS MEASURING THE
6.10%
for 4.64% of the country’s GDP 4.64% 5.10%
EFFICIENCY OF THE HEALTH CARE SYSTEM
(2017)

Crna Gora
Montenegro Estonija
Estonia Slovenija
Slovenia Austrija
Austria Belgija
Belgium Njemačka
Germany

Dobijeni Budžet
Budget received Rashodi Fonda
Expenses of the Fund
INCREASED LIFE EXPECTANCY
It was not before 2015 that the
health care system budget was 2006 - 72.7 YEARS
established approximately at the
172.50

189.1

183.6

176.3

179.9

179.9

175.9

179.9

194.1

206.4

206.4

206.0
level of realized expenditures in 2017 – 76.7 YEARS
2009.
2008 2009 2010 2011 2012 2012 2013 2014 2015 2016 2016 2017 2018
Rebalans Rebalans

SPENDING PER CAPITA (IN EUR), COMAPRED WITH OTHER EUROPEAN REDUCED INFANT MORTALITY
COUNTRIES (2015-2016) RATE

436.96 405.68 2006 - 11

600 2015 2016
Spending for medicines per capita is 421.63 412.61

EUR 113.40 (2016) 400

131.54 188.31 2017 – 1.3
113.4 164.11
106.35 119.68
200

0
Montenegro
Crna Gora Serbia
Srbija Croatia
Hrvatska Slovenia
Slovenija Norway
Norveška

REDUCED MORTALITY RATE OF

BUDGET ALLOCATIONS PER CAPITA IN THE COUNTRIES OF THE REGION CHILDREN UNDER 5
1,376 €
2006 - 12.1
State allocations for health care per 753 €
capita is EUR 329 (2018) 329 € 374 € 2017 – 2.7

Crna Gora
Montenegro Srbija
Serbia Hrvatska
Croatia Slovenija
Slovenia
 In 2017 and 2018, we have strategically planned and normatively regulated the health care system, through the adoption of the
following documents:

1. Strategy for the development of the Integrated Health Information System and e-Health for the period 2018–2022
2. Law on Amendments to the Law on Health Care (Official Gazette of Montenegro No. 3/16, 39/16, 2/17 and 44/18)
3. Decision supplementing the Decision on the network of health institutions (Official Gazette of Montenegro No. 48/17 and 12/18)
4. Rulebook on the organization, manner of taking and the contents of professional exams of health workers and the composition and work of examining commissions
(Official Gazette of Montenegro, No. 23/17, 34/17, 62/18)
5. Rulebook on amendments to the Rulebook on Detailed Requirements for Performing Additional Work of Health Workers and Health Associates (Official Gazette of
Montenegro, No. 17/17 and 70/17)
6. Rulebook on the content and manner of keeping the license registry and the form of work licenses for a dental doctor (Official Gazette of Montenegro No. 59/17)
7. Rulebook on the content and manner of keeping the license registry and the form of work licenses for a pharmacist (Official Gazette of Montenegro No. 64/18)
8. Rulebook on the content and manner of keeping the license registry and the form of work licenses for a medical doctor (Official Gazette of Montenegro No. 39/18)
9. Rulebook on the content and manner of keeping the license registry and the form of work licenses for a physiotherapist (Official Gazette of Montenegro No. 6/18)
10. Rulebook on the procedure for issuance, renewal or revocation of the work license for a dental doctor (Official Gazette of Montenegro, No. 42/17) - Dental
Chamber
11. Rulebook on the procedure for issuance, renewal or revocation of the work license for a pharmacist (Official Gazette of Montenegro No. 57/18) – Pharmaceutical
Chamber
12. Rulebook on the procedure for issuance, renewal or revocation of the work license for a physiotherapist (Official Gazette of Montenegro No. 89/17) –
Physiotherapist Chamber
13. Rulebook on the procedure for issuance, renewal or revocation of the work license for a medical doctor (Official Gazette of Montenegro No. 36/18) – Medical
Chamber
14. Law on Amendments to the Law on Health Insurance (Official Gazette of Montenegro, No. 22/2017)
15. Decree amending the Decree on the criteria for including or removing medicines from the List of Medicines (Official Gazette of Montenegro, No. 70/17, 2/18)
16. Decision establishing the List of Medicines (Official Gazette of Montenegro, No. 02/18 and 23/18)
17. Decision on Health Card (Official Gazette of Montenegro No. 3/18) - Health Insurance Fund
18. Rulebook on the types of health services for which the waiting lists can be drawn up, as well as the manner and procedure of drawing up waiting lists (Official
Gazette of Montenegro, No. 38/17)
19. Rulebook on detailed conditions and manner of exercising certain rights from compulsory health insurance (Official Gazette of Montenegro No. 12/18, 42/18) –
Health Insurance Fund
20. Rulebook on the European Health Insurance Card (Official Gazette of Montenegro No. 73/17) – Health Insurance Fund
21. Rulebook amending the Rulebook on indications and method of using medical rehabilitation in health care institutions that provide specialized medical
rehabilitation (Official Gazette of Montenegro No. 81/16, 17/17, 42/18 and 50/18-corrigendum) – Health Insurance Fund
22. Rulebook on the criteria for pricing and the method of payment of health care services (Official Gazette of Montenegro, No. 42/18) – Health Insurance Fund
23. Rulebook on the manner and procedure for referring insured persons for treatment outside Montenegro (Official Gazette of Montenegro No. 57/17) – Health
Insurance Fund
24. Rulebook amending the Rulebook on the exercise of the right to medical-technical aids (Official Gazette of Montenegro, No. 82/16, 6/17-corrigendum, 17/17,
29/17) – Health Insurance Fund
25. Rulebook on the types, standards and indications for medical devices implanted into the human body (Official Gazette of Montenegro, No. 57/18) – Health
Insurance Fund
26. Law on the Provision of Safe Water for Human Use (Official Gazette of Montenegro No. 80/17)
27. Rulebook on parameters, conformity checks, methods, manner, scope of analyzes and implementation of monitoring of the safety of water for human use (Official
Gazette of Montenegro No. 64/18)
28. Rulebook on sanitary, technical and hygienic conditions, as well as conditions for the safety of water for recreational needs and other waters of public health
interest (Official Gazette of Montenegro No. 57/18)
29. Law on the Protection of Population against Infectious Diseases (Official Gazette of Montenegro No. 12/18)
30. Program of compulsory immunization of the population against certain infectious diseases in the territory of Montenegro for 2017, in cooperation with the Institute
for Public Health
31. Decision establishing the National Council for the Coordination and Prevention of Chronic Non-communicable Diseases in Montenegro (Official Gazette of
Montenegro No. 17/17)
32. Rulebook on detailed method of maintaining and keeping records of the amount of drugs produced, imported, used, possessed or to be destroyed by legal entities
and the delivery of reports (Official Gazette of Montenegro No. 43/17)
33. Rulebook on detailed conditions and criteria for the appointment and scope of work of the person responsible for organizing organ transplantation procedures
(Official Gazette of Montenegro No. 20/17)
34. Rulebook on detailed conditions and criteria for the appointment and scope of work of the hospital coordination team and hospital coordinator (Official Gazette of
Montenegro No. 20/17)
35. Rulebook amending the Rulebook on the content and manner of marking the outer and inner packaging of a medicinal product and the content of the instructions
for a medicinal product (Official Gazette of Montenegro No. 21/16 and 67/18)
36. Rulebook on the manner of monitoring the health status of a person who received an organ transplant (Official Gazette of Montenegro No. 40/17)
37. Rulebook on the manner, procedure and medical criteria for determining the death of a person whose organs can be taken for transplantation (Official Gazette of
Montenegro No. 40/17)
38. Rulebook on the form, content and method of granting consent for organ transplantation (Official Gazette of Montenegro No. 40/17)
39. Rulebook on the procedure for giving and the contents of a written statement opposing the organ recovery, as well as the contents and manner of keeping the
register of deceased donors (Official Gazette of Montenegro No. 40/17)
40. Rulebook on the procedure for giving and the contents of the consent for the recovery of organs of a juvenile deceased person and a deceased adult who is
incapacitated or incapable of reasoning and keeping the register of deceased donors (Official Gazette of Montenegro No. 40/17)
41. Rulebook on the procedure for giving, the contents and the manner of submitting a written consent for organ recovery from a living donor and the manner of
keeping the registers (Official Gazette of Montenegro No. 40/17)
42. Rulebook on the content of the request and documents necessary for obtaining an authorisation for the use of drugs, as well as the form and contents of the
authorization (Official Gazette of Montenegro No. 43/17)
43. Rulebook on determining the list of drugs, psychotropic substances and plants that can be used for the production of drugs (Official Gazette of Montenegro No.
41/18, 57/18)
44. Rulebook on determining the citizens’ health capability for deployment to civil protection units (Official Gazette of Montenegro No. 67/17)
45. Rulebook on the type, manner, scope and deadlines for performing medical examinations of employees in workplaces with special working conditions and with
increased risk (Official Gazette of Montenegro No. 43/17)
46. Action Plan for Implementation of the Strategy of Montenegro for the Prevention of Drug Abuse (2013-2020), for 2017
47. Action Plan for the Implementation of the National Strategy for the Prevention of Alcohol Abuse and Alcohol-related Disorders in Montenegro (2013-2020), for
2017-2018
48. Instructions for referring patients from the primary level of health care to the secondary and tertiary level of health care and a list of health services that must be
provided within 30 days and for which the waiting list is not established
49. Memorandum of Cooperation between the Ministry of Health of Montenegro and the Ministry of Health of the Republic of Albania (signed on 3 April 2017)
50. Agreement on financing the project “Strengthening the Health System in Montenegro” – Ministry of Health and the United Nations Development Program (UNDP),
signed on 12 July 2017
51. Agreement on financing the project “Strengthening the Health System in Montenegro” (Phase II) – Ministry of Health and the United Nations Development Program
(UNDP), signed on 17 October 2018
52. Biennial Agreement on Cooperation between Montenegro and the World Health Organization 2018-2019, signed on 22 February 2018
53. Partnership Agreement between the Ministry of Health of Montenegro and the Federal Ministry of Health of Bosnia and Herzegovina and the Croatian
Telemedicine Institute, signed on 18 October 2017
54. Memorandum of Understanding between the Government of Montenegro (represented by the Ministry of Health) and Steward Health Care International Limited,
signed on 24 May 2018
55. Agreement with Eurotransplant on the exchange of organs, signed on 4 September 2018