Uemo’s eHealth Policy

Dr. Pierre Louis Druais – Head of Delegation

Dr. Patrick Ouvrard – Member

Dr. Jean Pierre Jacquet – Member

Role of  General practitioners  in Serbia Healthcare system

Dr Branka Lazić

Serbian Medical Chamber

The Republic of  Serbia is a country situated at the crossroads of Central  and Southeast Europe with a population of about 7 000 000 citizens covering an area of  88 361 km2.  Its capital, Belgrade, ranks among the oldest   and largest cities in Southeastern Europe. Serbia is a member of numerous organizations such as the United Nations, Council of Europe, Organisation for Security and Co-operation  in Europe, Partnership for Peace, Organisation of  the Black  Sea Economic Cooperation , and Central Europian Free Trade Agreement , it has been  an EU membership candidate since 2012.

Serbia is a parliamentary  constitutional  republic  composed of municipalities/cities, districts, and two autonomous provinces –  Vojvodina in the north, and Kosovo and Metohija in the south.There are 138 municipalities  and 23 cities , which form the basic units of local self-government. Apart from municipalities, there are 24 districts, with the City of Belgrade constituting an additional district.

Organisation and financing of health care

Serbia’s health care system  is organised by the Ministry of Health  and  is managed   by the National Health Insurance Fund, which covers all citizens and permanent residents. All employees, self-employed persons, and pensioners must pay contributions to it. Contributions are based on a sliding scale, with wealthier members of society paying higher percentages of their income.

The state fund covers most medical services including treatment by specialists, hospitalisation, prescriptions, pregnancy and childbirth, and rehabilitation.

The aim of the organisation is to make the health system equal for every citizen no matter what their status.

Private healthcare is also available for those citizens who can afford it (pay from pocket and private insurance). The largest number of private institutions are small specialized clinics.  Private practice still not included in national healthcare system. Still there is  lot of space for developing in private practice.

Hospitals and clinics exist in all major towns and cities of Serbia. Patients are admitted to hospital either through the emergency department or through a referral by their doctor.

Dental care in Serbia is in the private ownership  and is of a good standard. Prescription medicine is only available from a qualified and registered  pharmacy  or from a hospital pharmacy. There are two types of pharmacy, state-owned and private.

Primary level of health care in the Republic of Serbia is provided in 157 state-owned primary health centres  (PHC) , which cover the territory of one or more municipalities or towns . PHC is based on a selected doctor, or “chosen doctor”, and a team of chosen physicians, which consists of doctors of general medicine and occupational medicine specialist for the adult population, pediatrician for children of preschool and school age (including antenatal care, immunizations, preventive programs in the health care of children ), gynecologists for women over 15 years and dentists  for children and students under the age of 26 . Citizens can register  with the doctor of their choice.

In addition there are emergency services, diagnostic services, certain specialist-consultative out-patient health care services, community nursing services etc.

A selection of various services in a primary (community) health centre depends on the number of citizens in a municipality, as well as on their health needs and distance to the nearest general hospital. From about 20.000 doctors (public service) in Serbia, 18{cabf78295431282ca1bec49ffbe2c87b89a1285ae102b2d0687184fc21af24ba} are working in PHC. Per doctor in PHC there are approximately  1450 citizens ( in urban area about 2000 and in rural  400). Total visits per doctor in PHC are 5876 (varies from service to service).

Position of GP

GPs make referrals, prescribe drugs, treat acute and chronic illnesses, and provide preventive care and health education. The 4031 doctor works in general medicine in state institutions, only 44{cabf78295431282ca1bec49ffbe2c87b89a1285ae102b2d0687184fc21af24ba} are general practitioner specialist.

The strengthening of the Department and the Health Center as a teaching base would increase the interest of young doctors for the specialization in general medicine and the acquisition of academic titles.

There is a shortage of all kinds of doctors in Serbia  especially GPs, so there is an urgent need to create the way to keep young doctors in family medicine in Serbia.

Education and training for GP

There are five undergraduate medical schools in Serbia. They are situated in Belgrade  and the regional centers Kragujevac, Niš , Novi sad  and  Priština. The University of Belgrade was founded in 1808. Since 2012. it has held a place on the Shanghai world ranking list of 500 best universities, in 2016. it was listed among the top 300 World universities

Medical school is completed over six years. Before  practicing, graduates must take a half-year internship and pass the state exam. Further specialization takes place after the internship.

Medical training for a GP specialist  according to the new law lasts 4 years. It consists of a theoretical part  ( 12 months ), a period of visiting hospital departments (12 months)  and a period with a teacher (“mentor”) in family practice (24 months  ). At the end of training there is a specialist final exam.However, a licenced doctor can practice as a GP without postgraduate medical training and without a mentor.

CME and relicensing

A GP gets the license for work by the Serbian Medical Chamber (SMC) and the SMC is a national authority for the CME. The condition for relicensing is collecting 140 points  during 7  years. It can be done through a few ways – CME courses, participating in local or international professional medical meetings or conferences, publishing  papers in magazines or books. In case of not collecting the needed points a GP  needs to pass the exam after a period of 7 years.

Medical Chamber of Serbia

MCS is an independent, professional, self-contained,self-financed  organization, re-established in 2006 together with the chambers of other healthcare workers. Its status is defined by the Law on Chambers of Health Workers published in the “Official Gazette of the Republic of Serbia” 107/2005. All doctors of medicine who, as a profession, perform healthcare activity must be members of the SMC . In Serbia, the Medical Chamber was founded in 1901. at a time when chambers were established in other European countries, as professional associations, which can perform self-regulation and control of their membership. But  at 1945.  SMC`s work was subsequently interrupted by the decision of the Goverment

At present,  32 643 doctors are registered in the directory of medical practitioners, who hold a valid license, who carry out health care activities in state and private health institutions and private practice as a profession. One of the main strategic goals is to improve the status of a doctor of medicine as well as raising the level of expertise and ethics within the  proofs. SMC  join and actively participate in all international medical organizations such as CPME, WMA, ZEVA, EFMA, UEMS, and  UEMO.

Austria Modal

EMO member: Austrian Medical Chamber (Österreichische Ärztekammer), www.aerztekammer.at

Head of Delegation: Dr Martina Hasenhündl (general practitioner)

The Austrian Medical Chamber

According to the Austrian Medical Act, the Austrian Medical Chamber represents the professional, social and economic interests of all doctors engaged in medical activities in Austria. Furthermore, it acts as umbrella association under public law for its nine members, the medical chambers in the Austrian provinces. Membership is obligatory for every doctor wishing to pursue medical activities in Austria.

Activities and Services

Legal responsibilities of the Austrian Medical Chamber include, besides others, admission to and administration of the medical register, as well as recognizing foreign medical qualifications. Furthermore, the Austrian Medical Chamber is the competent authority for issuing medical diplomas and for conducting specialist and GP qualifying exams. Further competencies comprise the elaboration of concepts, expert opinions and proposals regarding the Austrian health care system, including the right to comment on draft bills or enacting guidelines on medical fees, on the medical code of conduct etc., as well as concluding contracts with social insurance institutions and collective agreements. Executing disciplinary legislation and arbitration also belong to the responsibilities of the Austrian Medical Chamber. Moreover, the Chamber is involved in the elaboration of specialist and GP training programs, and it has its own institution offering CME/CPD for Austrian medical doctors called Austrian Academy of Doctors (Akademie der Ärzte). The Chamber provides counselling for its members in issues relating to professional law and in international matters. Information for members is provided on the website and in the journal of the Austrian Medical Chamber (Österreichische Ärztezeitung).

Education and training

Medical training in Austria is characterized by a dual system. Degree courses in medicine, which have a minimum duration of at least six years, can be taken at public and private medical universities. In the course of a comprehensive reform, obligatory practical training was integrated into medical university studies, in order to better prepare students for medical practice.

In order to work as a general practitioner, the medical training regulations currently prescribe 42 months (3 ½ years) of training, structured in 36 months of hospital training and 6 months of training in a GP practice or a group practice recognized by the Austrian Medical Chamber. However, the total duration will be raised to 45 months in 2022 and subsequently to 48 months in 2027.

At the end of training or after 30 months of training at the earliest, the GP trainees have to complete a written final qualifying exam in general medicine. The completion of the examination is a prerequisite for engaging in independent medical practice.

CME/CPD

In Austria, the practice of the medical profession is subject to mandatory CME/CPD requirements. This requirement is established both in the Austrian Medical Act and by the Regulation on CPD (DFP-Verordnung), a decree issued by the Austrian Medical Chamber. Since 2016, every licensed doctor, GP or specialist has to provide evidence of CME/CPD to the Austrian Medical Chamber on a regular basis. Within a period of 5 years, at least 250 DFP (CME) credits have to be collected. CPD activities can be documented in an online CPD account to which the CPD provider transfers credits. CME/CPD events are accredited by the Austrian Medical Chamber via the “Austrian Academy of Doctors”. Accreditation is given both to CPD providers and individual CPD activities. Non-compliance with CME/CPD requirements entails sanctions which may range from a written reprimand to an occupational ban in the case of firm refusal to meet the CME/CPD obligations.

E-Health (e-card, ELGA, e-Medikation)

In 2005, the so-called “e-card” has been introduced in Austria. The e-card is a personalized chip card of the electronic administration system of the Austrian social insurance institutions (health, pension, accident or unemployment insurance). The system supports administrative processes between the insured person, the employer, the contracting parties (doctors, hospitals, pharmacies etc.) as well as the social insurance funds. The card provides personal identification data such as name and insurance number and every patient is obliged to show it when visiting a doctor or hospital. By reading the e-card via the secure data network the doctor or hospital checks if a person is insured and which health insurance institution is responsible for paying the medical treatment. This data is requested online from the e-card system and is not stored on the card.

As the e-card is based on a key card principle, it also allows access to ELGA, the Austrian electronic health record (Elektronische Gesundheitsakte). ELGA aims to elaborate an information system that provides doctors, hospitals, care facilities and pharmacies access to a patient’s health record. Various health care facilities create different health records such as medical reports. ELGA processes this data and makes it accessible electronically for different users via a link. Since December 2015, hospitals in Austria are obliged to implement this system.

In Austria, the project of introducing “e-Medikation” as a feature of the electronic health record (ELGA) is in progress. E-Medikation is an application in the form of a database containing information on the medications that have been prescribed and dispensed. However, e-Medikation is not equivalent to purely electronic prescribing, and the patient will continue to receive an ordinary paper prescription. It will be mandatory for all self-employed doctors under contract with a health insurance fund. Physicians practicing only on a private basis, without holding a contract with a health insurance fund, can decide voluntarily if they want to use it. Patients have the possibility to opt out from the e-Medikation feature, or from ELGA as a whole.

Quality assurance

The obligation of medical quality assurance is stipulated in the Austrian Medical Act. For this purpose, the Austrian Medical Chamber established the Austrian Society for Quality Assurance and Quality Management in Medicine (ÖQMed) which is legally required to perform quality evaluation and quality control of medical practices at least every five years. Further responsibilities of ÖQMed include the elaboration of quality criteria for single practices and group practices, as well as the maintenance of a quality register on national level.