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Support to the Implementation of Capitation Payment in Primary Healthcare in Serbia |
Republic of Serbia
Ministry of health |
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Conference “Strengthening Management in Primary Health Care: From Capacity Building Towards better performance“ The Conference “Strengthening Management in Primary Health Care: From Capacity Building Towards better performance“ was held in Sava Center in Belgrade on 22 April, 2010. The conference was organized by the joint project of the Serbian Ministry of Health and the European Union “Support to the Implementation of Capitation Payment in Primary Healthcare in Serbia”. Main speakers at the conference were Dr. Tomislav Stantic, State Secretary of Serbian Ministry of Health, Dr. Maja Vuckovic-Krcmar, programme manager of the Delegation of the European Union to the Republic of Serbia and Dr. Brian Potter, Project Team Leader. Speakers also were Mr. Vukašin Radulović, Executive Director for the development, Health Insurance Fund, Prof. Dr. Vesna Bjegović-Mikanović and Prof. Dr. Sandra Šipetić-Grujičić, Medical Faculty Belgrade and Dr. Bojana Milošević, Project National coordinator. The conference was attended by numerous health representatives from the Dom zdravlja’s and health institutions in Serbia. The main goal of this conference was to present the management strategic plans and to awarded the most successful managements teams in development of excellent strategic plans of their institutions included in this Project. Dr. Tomislav Stantic, State Secretary of Serbian Ministry of Health presented awards to the most successful management’s teams from Dom zdravlja Smederevo, Subotica, Šabac and Voždovac special awards to Dom zdravlja Ada. All the DZs involved in the project (28 DZ) and the associated DZ Ada was dedicated to project activities in the previous period. A three-member committee of the Project had a difficult and responsible task to make the selection of those who deserve recognition. The criteria for selection of DZs that have received recognition, above all, were based on the parameters of excellence management team in strategic management and planning. Excellent DZs were provided:
Additional criteria for the selection of the most successful DZs are related to:
The conclusion at the conference was that the primary health care has great importance in the health system of Serbia - the patient/user of health service is at the centre of the health system. Also, it was stressed that the management in DZs is even more important because there comes a time changing of financing system in PHC in Serbia.
February 2nd, 2010 Belgrade The training for management in Primary Health Care Change Management was held in Belgrade on 8, 9, 10, 11, 12 and 16th of February. Management teams from Dom zdravlja’s included in the project were attended at the seminars. The seminar is accredited by the Program Council for Continuing Education, Faculty of Medicine, University of Belgrade at the meeting held on 19th January 2010th. The accreditation of the seminars by the National Health Council of the Republic of Serbia is in the process. The aim of the seminar is that students understand change management and to ensure the effective conduct of the organization during the implementation of changes. Lecturers and instructors were Prof. Dr. Dejana Vukovic, Prof. Dr. Vesna Bjegovic-Mikanović and Prof. Dr. Sandra Sipetić-Grujičić from the Medical Faculty in Belgrade.
January 29th, 2010 Belgrade
The Association of Primary Health Care Managers in Serbia was founded in Serbia in Belgrade with the aim of contributing to the development and improvement of management practices in primary health care (PHC). It represents a partnership between management teams and local governments, to promote an interdisciplinary approach and promotes all aspects of good management practices and standards in PHC. The main speakers at the founding assembly which was held in Belgrade hotel Zira were Prof. Dr. Tomica Milosavljevic, Serbian Minister of Health, Dr. Maja Vuckovic-Krcmar, Programme Manager Delegation of the European Union to the Republic of Serbia, Dr. Brian Potter, Project Team Leader, Ms. Ana Bovan, Executive Vice President of Serbian Association of Managers and Dr Milan Manojlovic, Director of the DZ Nis. The Association of Primary Health Care Managers in Serbia is an independent non-profit organisation and was founded in order to contribute to the development and improvement of management practices in PHC. The Serbian Minister of health Dr. Tomica Milosavljevic welcomed the initiative supported by the EU. He pointed out that the health system in Serbia was improved after reforms were implemented, noting that the process of reform is still in progress. This year according to the minister there will be a new method of financing PHC. The Minister said that strengthening the preventive activities that are performed in PHC is more necessary than ever before. Dr. Maja Vuckovic-Krcmar, Programme Manager Delegation of the European Union to the Republic of Serbia recalled that the EU, since 2001, has invested in health in Serbia more than 130 million Euros. She added that the EU supported the establishment of the Association and believes that investing in managerial skills and education managers in PHC contribute to further improvement and development of the whole health system of Serbia. The initiative for the establishment of such associations was created within the activities of the project "Support to the implementation of Capitation payment in Primary Health Care in Serbia." The project team provided the technical and organizational support to the establishment of the Association. Representatives of the medical centers involved in the project attended the Founding Assembly. Representatives of health institutions and private sector were also participated at the Conference. Dr. Milan Manojlovic, director DZ Nis was elected as President of the Association. Dr. Ruzica Crnjaković, director DZ Subotica and Dr. Danka Zivanovic, director DZ Valjevo were elected as the Vice President.
Seminars on capitation Within the project activities, the last in a series of seminars dedicated to introduction of health care financing and payment to health care providers to management teams for Primary Health Care (PHC) was held in Belgrade in 6th November 2009. Management teams from Dom Vožodvac, Valjevo, Zemun, Kikinda, Požarevac, Pančevo, Šabac i Ćuprija participated in the training. The lecturers and instructors in these training sessions were Prof. Dr. Vesna Bjegovic-Mikanović, professor of health management at the Faculty of Medicine, University of Belgrade and project expert, Mr. George Boulton, a Project Expert and Mr. Vukasin Radulovic, Executive Director of the Health Insurance Fund. In addition to the general financing system, the training focused on the financing of PHC and the methodology of CP as well as practice and performance of doctors in PHC and some comparison of different countries. The participants are enabled to recognize the (potential and actual) effects of payment systems and financial incentives for physicians for implementation of capitation. They were provided the opportunity for further analysis of specific case studies related to the upcoming changes in their institutions.
October 14th and 15th 2009 Belgrade Financing of Primary Health Care and better use of capitation The Seminars introduce management teams from Primary Health Care to the basic health-care financing and payment systems for providers of health services. In particular claryfying potential effects of payment mechanisms and financial incentives to the doctors in primary health care. They have been held in Belgrade under the auspices of project activities. Management teams from Dom zdravlja’s Ada, Novi Sad, Sombor, Sremska Mitrovica i Subotica i iz domova zdravlja Vračar, Zvezdara, Novi Beograd, Palilula i Savski Venac participated in the training which were held on 15th and 16th October 2009. In addition to the general financing system, special attention at the training was focused on the financing of Primary Health Care. The main focus of the training was the mechanism of payment by capitation and the relationship between such payments, the functioning and performance of doctors in primary health care, and some comparison of different countries. After the seminar, participants are trained to recognize the (potential and actual) effects of payment systems and financial incentives for physicians in the implementation of capitation. During the training they have the opportunity for more analysis of concrete case studies related to the upcoming changes in their institutions. Lecturers and instructors in these training sessions were Prof. dr Vesna Bjegovic-Mikanović, professor of health management at the Faculty of Medicine, University of Belgrade, Mr. George Boulton, a Project Expert, Mr. Vukasin Radulovic, Executive Director of the Health Insurance Fund and Mr. Vladan Ignjatovic from the Health Insurance Fund also. The following seminars, which will be attended by representatives of the pilot Dom zdravlja’s, will be held on 28th and 29th October and 6th November in Belgrade and on 3rd November in Sabac.
Ambassador of Finland visits the Project H.E. Kari Veijalainen, Ambassador of Finland in Belgrade, visited the project "Support to the Capitation Implementation in Primary Health Care in Serbia". The meeting with H.E. Veijalainen was attended by Dr Maja Vuckovic-Krcmar, program manager of the Delegation of the European Commission to the Republic of Serbia, Mr. Timo Sorsa, Project Director, Dr Brian Potter, Project team Leader, Dr. Bojana Milosevic, National coordinator, Prof. Dr. Vesna Bjegovic-Mikanović the Medical Faculty in Belgrade who is an expert with the project and other project team members. On this occasion, Dr. Potter informed the Finnish Ambassador of the current activities and results of the project, which began in September 2008. In his presentation Dr. Potter pointed out the importance of reform of financing of Primary Health Care (PHC) and the introduction of capitation as a new way of financing and improving the clinical activity and outcomes. The Finnish Ambassador, who earlier in his career worked in the Finnish Ministry of Health and Social Affairs, was interested in the current situation in the health system of Serbia and mentioned reform of financing of PHC has also taken place in Finland.. Representatives of the project introduced the work of the project to the Finnish Ambassador and that it is being implemented by THL consultant from Finland and funded by the European Union. They added that among the first experts who were involved in EU projects in the field of health care in Serbia after 2000 was one Finnish expert in public health.
June 5th, 2009 Leskovac Communication between the nurse and patient The second workshop "Communication - nurse and patient" (the role of nurses in the registration process) was held on 5 June 2009 in Dom Zdravlja Leskovac. The workshop was attended by representatives of the pilot Dom Zdravljas (DZ) involved in the Project and included the DZ head nurse and department head nurses from paediatrics, general medicine and gynaecology. DZs Valjevo, Smederevo, Pozarevac, Cacak, Kragujevac, Cuprija, Krusevac, Zajecar, Nis, Leskovac, Pirot and Vranje were all represented. Attendees were welcomed by the Deputy Mayor of Leskovac, Branislav Djordjevic, Director of Dom Zdravlja Leskovac, Dr. Nebojsa Dimitrijevic, and Dr. Bojana Milosevic, the National Coordinator of the Project. Dr. Milosevic stressed the importance of communication between nurses and patients in order to successfully accomplish the registration process of patients with chosen doctors. Workshop presentations and discussions on the experiences of nurses communicating with patients were held by Vesna Žambok, head nurse of DZ Sremska Mitrovica, and Milijana Videnović, head nurse of DZ Zajecar. Through group work and open discussion it was emphasised that communication between nurses and patients is very important for the successful registration of patients with their chosen doctors.
May 29th, 2009 Sremska Mitrovica The importance of communication between nurses and patients Representatives of the Dom Zdravljas in Vojvodina and Belgrade who are included in the pilot Project "Support to the Implementation of Capitation Payment in Primary Healthcare in Serbia“ participated in the workshop "Communication - nurse and patient" (the role of nurses in the registration process) held on 29 May 2009 in Sremska Mitrovica. The hosts of this workshop, themed around the importance of communication between nurses and patients to successfully register patients with their chosen doctors, were representatives of DZ Sremska Mitrovica. Head nurses, department head nurses from the primary healthcare disciplines determined by the capitation formula - paediatrics, general medicine and gynaecology - and Project team members were greeted by Srdjan Kozlina, Deputy Mayor of Sremska Mitrovica. He pointed out that the city government was investing significant funds in the health sector to provide better quality services to about 400,000 health service users in the Sremska Mitrovica area, the regional centre of Srem and Mačva. Natasa Kopcic, head of the municipal administration of sports, preschool education, health and social care, stressed the importance of DZ Sremska Mitrovica being included in the Project. Dr. Nada Zec Petkovic, Director of DZ Sremska Mitrovica, stressed the importance of prevention services offered in the DZ and the importance of primary healthcare in general. Dr Brian Potter, Project Team Leader, welcomed the attendees and emphasised the role of nurses in the process of patient registration with their chosen doctors. He stressed the importance of communication in general, as well as between healthcare employees and patients. He also stated that communication is key to successfully implementing reforms within the health system of Serbia. Dr. Potter highlighted the importance of the chosen doctor scheme and added that all nurses should endorse these reforms during their everyday work and in the process of patient registration. Vesna Žambok, head nurse of DZ Sremska Mitrovica, underlined the value of having good communication between the patient and nurse, as well as within the DZ, and the need for significant changes in attitude towards patients. Ana Pavlovic, head nurse of DZ Vracar, held a presentation on the work of the nurses in the DZ reinforcing their role in the process of registering patients with a chosen doctor. Evaluation of the professional performance of nurses has shown examples of good and bad practice in their daily work with patients. They agreed that motivation and team work are essential for the further success of patient registration in all the DZs. A large number of local and regional media attended the press conference, which was held in the local Municipal Assembly.
Europe Day
On Saturday, 9th of May, 2009, the Vice-president of Serbian government, Mr. Božidar Đelic, and Head of the Delegation of the European Commission in Serbia, Mr. Josep Lloveras, officially opened the “European Street” in Belgrade as part of celebrating “Europe day” in Serbia. In the city center, in Knez Mihajlova Street, Belgraders had an opportunity to meet EU member countries whose tents were disposed along the entire street, and to gather plenty of information on the EU and its projects currently taking place in Serbia. Representatives of dom zdravlja included in pilot project „Support to the Implementation of Capitation in Primary Healthcare in Serbia“ – DZ Voždovac, DZ Savski Venac and DZ Vračar, participated in celebrating Europe day on the tent of Delegation of the European Commission in Serbia where other projects in Serbia financed by the EU were also presented. Prof. Dr Tomica Milosavljević, Minister of Health in the Government of Serbia, and ambassador Lloveras visited the “health tent” and conversed with gathered citizens in the presence of project team. Doctors and nurses from dom zdravlja distributed informational leaflets on the chosen doctor to the the citizens and measured their blood pressure.
April 3rd, 2009 Sombor Registration of patients - a team of doctors and nurses working together Representatives of the Dom Zdravljas (DZs) in Vojvodina and Belgrade involved in the Project "Support to the Implementation of Capitation Payment in Primary Healthcare in Serbia” participated in the second workshop, "Day for Registration”, which was held on 3 April 2009 in Sombor. Representatives of DZ Sombor were the hosts of this workshop, which was also attended by representatives of the DZs in Pancevo, Pozarevac, Zvezdara, Sremska Mitrovica, Subotica and Kikinda. The workshop covered the daily problems encountered by DZ employees when registering patients with a chosen doctor. At the beginning of the workshop attendees were addressed by Dr. Ljiljana Sokolova-Djokic, District Chief, who pointed out the necessity of reforming the health sector in Serbia and expressed her gratitude for the assistance that the European Union has so far invested in the Serbian health system. The Director of DZ Sombor, Dr. Milos Božičković, welcomed the guests and colleagues and emphasised that the mutual cooperation and exchange of experiences and ideas was very important for the improvement of patient-oriented care delivered by the chosen doctors. Dr Brian Potter, Project Team Leader, noted the significant progress in the number of patients who had already chosen their doctor compared to figures recorded from last year. He once again stressed the importance of the chosen doctor scheme and said that all employees in the health sector should enable the reform through hard work and creative solutions to everyday problems associated with the process of registering patients. Vesna Žambok, head nurse of DZ Sremska Mitrovica, held a presentation on the registration of patients in her DZ. This DZ had had a very high increase in the number of registered patients in comparison to the previous year (2008). She particularly stressed that the team work between doctors and nurses was essential to successfully implementing this process. During the open discussion participants presented several problems which they are facing in their everyday work. Many pointed out the difficulties in increasing the number of registered patients due to the absence of healthy and young people using the DZs, as well as with doctors who have registered more patients than is currently possible. All participants agreed that motivation and team work would be vital to the success of patient registration in all DZs. A large number of local and regional media attended the press conference organised during a break in the workshop.
March 21st, 2009 Belgrade Information Meeting on Capitation Payment The Project of the Ministry of Health of the Republic of Serbia "Support to the Implementation of Capitation Payment in Primary Healthcare in Serbia" funded by the European Union, was presented at a meeting held on 21 March 2009 in the municipality of New Belgrade. Presentations were given by Dr Brian Potter, Project Team Leader, and Dr. Bojana Milosevic, the National Coordinator of the Project. Speakers pointed out the importance of reforming the financing of primary healthcare in Serbia and said that the registration of patients with a chosen doctor was required for the implementation of this new financing model. The aim of this reform is the reorganisation and upgrading of the Dom Zdravljas to provide each patient with access to quick, efficient and quality health services. The meeting was organised by the Serbian Medical Chamber.
March 20th, 2009 Cuprija Workshop: About Registration The workshop "Day for Registration” was held on 20 March 2009 at the College of Health Education in Cuprija. The hosts of this workshop were representatives of DZ Cuprija. Representatives of other DZs who are involved in the pilot Project "Support to the Implementation of Capitation Payment in Primary Healthcare in Serbia" – Uzice, Cacak, Kragujevac, Krusevac, Nis, Zajecar, Leskovac and Pirot – also attended the workshop. The topic under discussion was the registration of patients with a chosen doctor and the associated problems that employees face during the course of their daily work. At the beginning of the workshop Dr. Svetlana Miljkovic, Director of College of Health Education and District Chief, welcomed the attendees and emphasised the importance of the involvement of DZ Cuprija in this Project for the region. The Director of DZ Cuprija, Zoran Milivojevic, said that it was a great honour to host colleagues from the other DZs in order to exchange experiences and ideas on increasing the number of patients registered with a chosen doctor. Dr Brian Potter, Project Team Leader, spoke about the importance of patients registering with a chosen doctor and stressed how this will provide every patient with the best in health services through a personal relationship with the doctor. "Primary healthcare is the centre of the health system," said Dr. Potter, who added that doctors who work in the DZs could do much to assist in the reform of healthcare in Serbia. Dr. Bojana Milosevic, the Project’s National Coordinator, explained that the first stage of capitation will happen at DZ level but she stressed that, in financial terms, there will be no losers among any of the DZs. “It is very important that before applying capitation, 80 per cent of our citizens choose their doctor. You need to work pro-actively and explain to citizens why it is important to have a chosen doctor". Most of those present said that the major problems revolve around registering patients with doctors of various specialisations who are not always present in the DZs. In particular, doctors working in the more rural areas of Serbia will be on-duty to see patients just once or twice a week. This causes additional difficulties in the registration process because there is a lack of a permanent doctor at these rural clinics and a low response of patients to registering. In the coming period, all DZs will cooperate more closely with local media to promote the chosen doctor scheme to the public. It is very important to engage more nurses and conduct more home visits, and to appoint a person responsible for public relations (PR) to strengthen the patient registration process.The participants also stressed the need for better cooperation with local governments. Local and regional media attended a press conference organised during a break.
March 11th, 2009 Belgrade Workshop Women's Health The Workshop "Women’s Health" was held on 11th March 2009 at the premises of the Delegation of the European Commission in Serbia. Presentations were given by Dr. Bojana Milosevic, National Coordinator of the Project “Support to the Implementation of Capitation Payment in Primary Healthcare in Serbia" and Dr. Tomislav Stantic, State Secretary of Ministry of Health. "Every day one women in the country dies from cervical cancer and every year 1.400 new cases have been detected. This is the second disease by frequency of mortality of women in the world and Serbia is among the first in the number of detected patients. Women in Serbia don’t go to preventive gynaecological examinations and therefore more likely to die from cervical cancer", said Dr. Milosevic. She pointed out that the so-called screening for cervical cancer, which is provided by Papanikolau test is an effective protection from the disease only if it’s performed regularly. "Women should visit their chosen gynaecologist at least once in three years. The most important factor for the development of cervical cancer is human papillomavirus (HPV). Screening is the only way to find such changes in the early stages when they can easily be removed before the disease appears", warned Dr. Milosevic. Serbian Ministry of Health launched a National program for detection of this disease. By mail women will receive calls for free preventive checkups. According to the National Strategy for Prevention of cervical cancer, which has recently been adopted by the Serbian Government, women at risk age 25 to 69 years, will have examination at DZs. In January 2009 Serbia was awarded in Brussels with “Pearl of wisdom 2009” for National Program for prevention of cervical cancer. Dr. Tomislav Stantic pointed out the importance of preventive examinations also for breast cancer. "Every day four women die in Serbia from breast cancer. It is a disease that you can not prevent but you can discover it at early stage. It is important that after 40 every woman goes to annual mammography, "said Dr. Stantic. Around 4.000 new cases of women suffering from breast cancer are detected in Serbia annually. Dr. Stantic said that every woman can do self checkups. "Cancer is a shame in Serbia, not a disease. Nobody speaks about cancer and this cultural heritage should be changed. The State can not solve this problem without changing the consciousness of women. Screenings are necessary and their goal is to reduce mortality. Women come to the doctor when a breast tumour is about 4 cm, "explained Dr. Stantic. He pointed out the importance of media campaigns that are ongoing in order to better inform the public about these diseases. Dr. Brian Potter, Team Leader of the project "Support to the Implementation of Capitation Payment in Primary Healthcare in Serbia” said that the preventive check-ups are important as such and concern of every woman. "You are here to tell your friends, mothers, daughters that it is important to have chosen doctor and go to regular checkups. It is necessary to share public awareness on prevention as much as possible. This can help that women in Serbia do not die from a disease that is a history of medicine in Europe such as cervical cancer, "said Dr. Potter. Workshop was attended by Mr. Ferenc Simon, Head of Operations at the Delegation of the European Commission (EC) in Serbia and Dr. Maja Vuckovic-Krcmar, Project Manager - Health & Social Affairs at the Delegation of EC.
March 4th, 2009 Belgrade Choose Your Own Doctor Serbian citizens will soon get a brochure on the importance and the right to choose their own doctor in the Primary healthcare. The brochure „Choose Your Own Doctor“ will be delivered by mail. Some three million copies of the leaflet produced under the project „Support to the Implementation of Capitation Payment in Primary Healthcare in Serbia“ financed by the European Union will be distributed to all Serbian citizens with the aim to better inform them about the advantages of the right to choose their own doctor. It was announcement at the press conference which was organized by Serbian Ministry of Health, Health Insurance Fund and project team. “To choose your doctor means to secure the entry to the health care system and it is the only way for our citizens to exercise all rights pertaining to healthcare security in the Serbian health care system,” said Serbian Minister of Health Prof. Dr. Tomica Milosavljevic. “Support for capitation payment means that all our citizens will get, by mail, a brochure explaining why capitation payment is important and why every Serbian citizen should have their own doctor,” added the Minister. In addition to the message delivered by mail, under the "Guide Forte" campaign all medical centres will install boxes with instructions on the health care system and the calendar of preventive check-ups. Pierre Dybman, Head of Operations Section I of the Delegation of the European Commission to Serbia, said that it was important that every patient had their own doctor, adding that health was a dynamic balance between genetic predisposition and environmental influences. Citizens should, said Dybman, choose their own doctor as he or she will know best how the patient will react to certain treatments, they will know the patient health history and, based on that, will be able to refer the patient to the specialist, if necessary. Five million Euros, which is the amount that the EU invested in this project, is part of EUR 130 million, which the EU invested in 2001 in the Serbian health care system. Dybman pointed out that investing in health and health care is any country’s best investment. According to the Project Team leader Dr. Brian Potter, to choose one’s own doctor means to establish a better relationship and communication with the doctor. He pointed out the importance of preventive check-ups that the doctor will be able to perform according to the set calendar. Half of Serbian citizens have chosen their doctor until January 2009. According to Svetlana Vukajlovic, Director of the Serbian Health Insurance Fund those are usually sick people who need to see a doctor, choosing one’s doctor is an obligation and if someone is not happy with their choice, they can choose another doctor. If they are not satisfied, patients can chose another doctor.
January 28th, 2009 Novi Sad Choose Your Own Doctor The press conference organised by the Project of the Ministry of Health of the Republic of Serbia "Support to the Implementation of Capitation Payment in Primary Healthcare in Serbia" financed by the European Union was held in the presence of a large number of media in Dom zdravlja Novi Sad. Project Team Leader Dr. Brian Potter said that for all patients in Serbia it is important to have a chosen doctor who will take care of their health. He added that the prevention of health is of great importance because, as he said, "every day in Serbia a woman dies from cervical cancer which is curable disease if detected on time and disease from which in Europe woman are no longer dying." Dr. Bojana Milosevic, National Coordinator of the Project noted that pilot project in which are involved 28 Dom Zdravljas’s (DZs) across Serbia aims to provide technical and expert assistance in the reorganization and improvement of DZs to provide each patient the rapid and efficient health services with guaranteed quality. "Reorganization of the DZs is based on the principle of the chosen doctor. A new way of financing of Primary Healthcare (capitation) will follow this reform. One of the basic conditions for the introduction of Capitation is that as many citizens as soon as possible choose their doctor ", said Dr. Milosevic and added that all patients can choose their doctor. Dr. Zivota Lazarevic, Acting Director of DZ Novi Sad thanked the media on their support for providing information to the citizens that chosen doctor is their responsibility. According to recent data of the Serbian Health Insurance Fund (HIF) the average level of registration of patients with chosen doctor is 44.30 percent. In DZ Novi Sad, according to recent data, half the users of health services were choose their doctor.
December 10th, 2008 Belgrade Introduced a New Guide for Good Clinical Practice The annual Conference of the National Committee for Guidelines Development and Dissemination (RSK) was held on 10 December 2008 in Belgrade's Sava Centre. The new guide "Guidelines for preparation, development and implementation of good clinical practice" which will be the basis for the development of the next guide was presented at the Conference. RSK was appointed by the Ministry of Health of the Republic of Serbia and is composed of eminent experts of different profiles of Healthcare in order to standardize, adopt policies, uniform approach to patient treatment in all parts of Serbia. Prof. Dr. Tomica Milosavljevic, Serbian Minister of Health said that the adoption and implementation of local and global guides required in each country as guides carry out the dimension of the division of professional and political responsibility. The Minister pointed out that the global position based on evidence and local support, can significantly change health policy. Comparing examples from other countries, the Minister said that screening programs are a good example of reducing the rate of many diseases. Doc. Dr. Nikola Milinić, President of the RSK stressed that the purpose of guidelines is to standardize and unify access to patients in all parts of Serbia. The ultimate goal of application of the guide is to satisfy the standards in the diagnosis and treatment and also reducing the cost of treatment. Mr. Ferenc Simon, Head of operations of the EC Delegation in Serbia, stressed that the EU has so far allocated 120 million Euros to help the health sector in Serbia and announced continued support for several new projects. Dr. Brian Potter, Team leader of the project "Support to the Implementation of Capitation Payment in Primary Healthcare in Serbia", Prof. Dr. Nebojsa Lalic and Assistant Professor Ljiljana Beslać Bubmaširević were also speakers at the Conference. The conference was attended by a large number of health employees from all over Serbia. Work on creating the first National guidelines for clinical practice in Serbia started in 2001. Five guidelines were maid to provide best services to patients. Dr. Brian Potter was project Team leader of that Project. Project was funded by the European Union managed by the European Agency for Reconstruction. Conference at the Sava Centre was financially and organizationally supported by the project "Support to the Implementation of Capitation Payment in Primary Healthcare in Serbia" financed by the EU. Existing guidelines could be found on the website of the Ministry of Health www.zdravlje.sr.gov.yu.
November 19th and 20th, 2008 Palic Trainings in Management The training “Health care management: principles, applications and methods” was held in hotel Prezident, in Palic, 19th and 20th November 2008. Training was organized for employees in management and was attended by representatives from the Dom zdravlja’s (DZs) from Vojvodina - Sremska Mitrovica, Kikinda, Subotica and Sombor. Training was jointly organized by the project "Training in Health Service Management in Serbia” and “Support to the Implementation of Capitation Payment in Primary healthcare in Serbia”. The workshop was led by Michael O’Rourke, Team leader of the project “Training in Health Service Management in Serbia”. The main task of the Project is to develop and implement a comprehensive, sustainable, national health management training programme (including a Master’s degree, the Master of Health Management) consistent with international standards. Project main task is also to provide short courses in management in health for about 1,500 health workers. The health management education programme is aimed at overall improved system effectiveness of health care. Dr. Anneli Milen, training, expert on the project "Support to the Implementation of Capitation Payment in Primary Healthcare in Serbia was led the workshop of the importance of new ways of financing Primary healthcare (capitation) as well as the importance of registration of patients with chosen doctor and preventive activities in DZs. Teams of the two projects will organise three workshops for employees in management in next period.
October 9th, 2008 Pirot Fight for Each Patient to a Successful Registration The second workshop "Registration of patients by chosen doctor - results and problems" was held on 9th October 2008 at the Dom zdravlja (DZ) in Pirot. Participants at the workshop were representatives from 12 DZs from Central and Southern Serbia which are included in the pilot project "Support to the Implementation of Capitation Payment in Primary healthcare in Serbia." The topic of this workshop was the registration of patients by chosen doctors, ideas for successful registration and the daily problems encountered during the registration process. Dr. Vesna Jankovic, director of DZ Pirot held the introductory presentation for DZ Pirot and the results of registration. Dr Brian Potter, Team leader of the Project and Dr. Bojana Milosevic, Project National Coordinator emphasized the importance of the introduction of Capitation in Primary Healthcare (PHC), but also pointed out the importance of the number of patients who will choose their doctor. The high level of registered patients in each DZ (80 percent) is a precondition for implementation of Capitation payment. Dr. Mirjana Krcevinac, director of DZ Kraljevo held a presentation about very successful registration of the patients (73.60 percent) and how that led to a successful result as they are in the DZ Kraljevo. Dr. Danka Zivanovic, director of DZ Valjevo held a presentation about registration of patients in DZ Valjevo. Ms. Dejana Jesic, PR of DZ Valjevo spoke about cooperation between DZ and media. She stressed the importance of PR in the process of registration. Useful examples of successful cooperation with local media were shown by Gordana Jovanovic, PR of Health Center (HC) Zajecar. In cooperation with local media HC Zaječar realized the two TV and radio jingle about the registration of patients. Open discussion was followed after workshop and was led by Prim. Dr. Radmila Mihajlovic, Deputy General Director of HC Valjevo for Primary Healthcare. Participants were agreed that the registration of patients is of great importance for the reform of PHC which will lead to new ways of financing. "We chose this road. Unified salaries of employees in the PHC will not exist after the introduction of Capitation. Fight for your patient’s by providing quality of service and knowledge you have", said at the end of the workshop Dr. Milosevic. A large number of local media attended the workshop.
September 10th, 2008 Subotica Doctor is the Best Medicine for a Patient The workshop "Registration of patients with chosen doctor - results and problems" was held on 10th September 2008 at the Dom zdravlja (DZ) Subotica. Representatives of the DZs in Belgrade and Vojvodina involved in the project "Support to the Implementation of Capitation Payment in Primary Healthcare in Serbia" participated in the workshop. The topic of this workshop was the registration of patients with chosen doctors, ideas for successful registration and the daily problems encountered during the registration process. "The reform of Primary Healthcare (PHC) will lead to major changes in the relation between doctor and patient. The best medicine that you can provide to your patients is high quality of care for their health, "said Dr. Brian Potter, Project Team leader addressing the audience. He stressed that the Serbian Government and the Ministry of Health decided to introduce the reform of PHC and to implement changes in funding. All patients have to register with their chosen doctor before introducing Capitation. After the introductory presentation about the importance of Capitation and PR in this process, presentations about the ways that led to a large number of registered patients were held by Dr. Vesna Vujcic, Head of general practice from Belgrade DZ Savski Venac and Dr. Danka Zivanovic, Director of DZ Valjevo. Ms. Dejana Ješić, PR of DZ Valjevo held a presentation about cooperation between DZ and media and stressed the importance of PR in the process of registration. Useful suggestions for improving relations with the media were presented by Zeljko Crnjaković, from "PIAR" agency. Bojan Pavlicevic, Project IT expert spoke about communication with patients via web site. Open discussion was followed after workshop and was led by Prim. Dr. Radmila Mihajlovic, Deputy General Director of HC Valjevo for Primary Healthcare. Representatives from DZs were agreed that a good PR, team relationship (doctor-nurse) and a personal relationship with patients and doctors are recommendations to improve the number of patients which will choose their doctor. According to recent data of the Health Insurance Fund about 35 percent of users of Health care choose their doctor.
May 28th, 2008 Valjevo Chosen doctor – care about each patient’s health „The process of choosing a doctor represents a big change in the health system in Serbia and which will underline the partnership between the doctor and his patient. We hope that through these changes, undertaken by the Serbian Ministry of Health and Health Insurance Fund (HIF), doctors will be able to educate their patients on how to prevent serious diseases like cervical cancer. It is a fact that every day in Serbia one women dies of that type of cancer“, said Dr Brian Potter, Team Leader of the „Support to the Implementation of Capitation Payment in Primary Healthcare in Serbia” an EU-funded project, managed by the European Agency for Reconstruction. He was addressing the opening session of the seminar „PR as a function for the improved registration of patients with a chosen doctor“, in Valjevo. The seminar took place in the Education Centre of Valjevo hospital with participants coming from Dom Zdravljas located all over Serbia and who are involved in the Project. The seminar was dedicated to highlighting the problems and opportunities of the patient registration process ongoing across the country. According to the latest figures from the HIF, the national registration rate was just 30 per cent. Dr Ilija Tripković, manager of the Valjevo Health Centre, and Dr Radmila Mihajlobvić, assistant director for primary care, welcomed participants at the ceremonial session. „Capitation is a payment mechanism where the doctor or health institution are allocated a known and fixed amount of funds for a limited period for each patient that is registered to a chosen doctor or by the health institution. These steps are important to secure all necessary health services for patients“, said Dr Bojana Milošević, National Coordinator of the Project. She explained that it’s important for „all citizens in the Valjevo municipality to choose their doctors and secure him or her to look after their needs in the coming year“. HIF representatives also participated at the seminar. They answered many questions about the legal regulations pertaining to the process of implementing capitation, the capitation formula and financial aspects of this activity. „In acordance with the Health Insurance Law and HIF’s Code, the HIF’s branch office is obliged to monitor all changes in the process of choosing a doctor“, said Slobodanka Fafulić, Director of HIF’s Health Insurance Sector. She explained in detail the process of a patient choosing a doctor and the practical and legal status of that activity. Many countries in the world have long ago introduced and established different mechanisms of financing healthcare. Their experience shows the need to select mechanisms to pay doctors that are stimulative and reflect the quality of services provided. „Talking about Primary Healthcare, the chosen doctor has an important role in the system because he should contribute to more effective and better quality medical care, satisfaction of the insuree, and better overall medical care“, said Milica Miletić, Director of the HIF’s Contracting Department. DZ Valjevo had made advanced offsets in registration in a short time. A few interesting case studies that increased the number of patients registering with a chosen doctor (56,46 percent) were presented by Dr Danka Živanović, DZ Valjevo’s Manager. Dejana Ješić, Valjevo Health Centre PR Assistant, spoke of the importance of using PR tools and relationships with the media to achieve better registration results. The importance of internal comunication between employees and how to improve registration rates in the DZ was presented by Veliborka Staletović, the Project’s PR Officer. Suzana Miličić, PR Expert from the „Imelda“ Agency, emphasised the importance of and solutions for building good relations with the media. At the end of the seminar, attendees divided into groups and participated in a workshop. They exchanged their ideas and possibilities for solutions. The workshops were prepared and conducted by Dr Radmila Mihajlović.
Second Conference: New Financing Model for Primary Healthcare March 4, 2008. Sava Center, Belgrade For Implementation Teams in 28 pilot Dom Zdravljas The Serbian Ministry of Health’s project “Support to the Implementation of Capitation Payment in Primary Healthcare in Serbia” funded by the European Union and implemented by the European Agency for Reconstruction was part of the Conference held in Belgrade on March 5, 2008. The goal of the Project is to provide technical and expert support to the reorganisation and improvement of services provided by Dom Zdravljas (DZ) in order to deliver efficient and quality health services. The plan for the reorganisation of the DZs is based on a formula of patients registering with a chosen doctor. This new form of financing the primary healthcare system (capitation) will facilitate this reform. The Conference began with an address by the Serbian Minister of Health, Tomica Milosavljević, who stressed that reform of primary healthcare should provide, as a key result, a situation whereby every citizen would know name of his doctor. “It is the way to bring back confidence in the health system, while capitation is one of the tools used to implement reform of the system”, Milosavljević said. The Project’s partners are the Serbian Health Insurance Fund (RZZO) and Serbian Public Health Institute. The General Manager of the RZZO, Svetlana Vukajlović, said that the “capitation system should bring more satisfaction to both doctor and patient - to the doctor through adequate financial compensation for invested work and to the patient through complex care for his health”. Vukajlović added that the new system represents an opportunity for the doctor to be paid on the basis of the number of patients that choose him as their chosen doctor. Patients will choose their doctor on the basis of the quality of services they receive. It is expected that patients will choose a doctor who will have enough time for them and who will be able to look after them according to their best interests. At the Conference there were representatives from the European Agency for Reconstruction and the 28 DZ that are participating in the Project. For the up-coming reform that implements capitation, it is of vital importance to successfully implement the registration process and also create an adequate electronic health information system. Just 25 per cent of patients in Serbia are registered so far. To help stimulate the registration process, it was announced at the Conference that doctors who register more patients will receive an additional 1 dinar per patient. «Simply it means that the doctor who registers 1.000 patients will get an extra 1.000 dinars in addition to their salary. It is not that much but is significantly different to his or her colleague with 20 registered patients», Vukajlović explained. The latest data on the registration process in Serbia were presented at the Conference, which showed that the DZs in Kraljevo, Savski Venac and Valjevo were among those with the highest rate of registered patients. The Project’s activities were launched in September 2007 and will last until mid 2010. As part of these activities, all the incorporated DZs will receive IT equipment worth EUR 2, 5 million. The Head of the EC delegation to Serbia, Ambassador Josep Lloveras, participated in the conference and confirmed that the European Commission will continue to support the reform process of the Serbian Health System.
First Conference “Reform of Primary Healthcare in Serbia” December 11, 2007, Sava Centre, Belgrade For managers of all 157 Dom Zdravljas
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