“The new government, new minister, need to understand that the situation in the health care is not alarming, that is how it was ten years ago! Today we cannot say its alarming. Today we can play requiem!”, claims neurosurgeon Dr. Branko Blazevski, an expert with more than two decades of experience in operating rooms in the country and abroad. In the interview for CIVIL Media, published in two continuations, he speaks about the catastrophic situation in the public health care system in Macedonia, in which the patients are the biggest victims, but also the doctors and medical staff because of the lack of will among the authorities in independent Macedonia to finally deal with the tenders crime of the “white coats” and with the chaos in the supply of drugs, and the chances to find statehood consciousness to change something in the “non-system in which the life force – provision rules”!
“Not to be a skeptic, but I assume that the very next day after the new health minister is elected, that he will have his “teeth pulled”, figuratively speaking, if he even tries to “take a bite” out of someone’s interest. But, if he has the support of the entire government, of the prime minister, to be able to do something, then everyone can find their own place. For the private hospitals also to earn something, but also to fulfill the task of developing the public health care, because that is how our system should be like, and that is how it is throughout Europe”, says Blazevski.
CIVIL Media: Is there a cure for the devastated public health care? Is there a system for health care protection in Macedonia at all?
BLAZEVSKI: After 25 years as an independent state, in comparison to the EU countries, Macedonia, in fact, currently has no organized system of health insurance for its population. I can even allow myself to say that practically there is no system at all! The patients receive a cat in the sack for the money they pay into the Health Insurance Fund! The citizens have no idea what they will receive, and the solution to their problems depends solely on their personal engagement.
From the moment you walk out of your family doctor’s office, you cannot reach the next destination of medical treatment, let alone solve your problems without your personal engagement. You have to make phone calls, involve your friends, acquaintances, among else also “dealers” who work on taking patients from one institution to another. What is even worse here is that the patients additionally spend money. And in the end, when the results of that untimely health care protection are combined with the very questionable quality of health care services, we can say that Macedonia is in a very bad situation in terms of the health care system. What is even worse, I believe, is that in these 25 years we did not manage to lay the foundations for the development of a system, because in order to develop a functional system you need a minimum of 15-20 years. Hence, we do not even have the foundations set, the base on which it could be further developed and in 20 years to start to deliver quality results.
CIVIL Media: Even though the new government will have many priorities, such as reforms in the judiciary and the economy, improving the international position of Macedonia, do you consider that Macedonia has the strength and knowledge to undertake drastic reforms in the health care system?
BLAZEVSKI: Following all the events, entirely in the Macedonian society, at this moment I can say that the situation in the health care is the worst ever, because of several reasons. I believe it is also very bad in the judiciary, all those judges and their assistants are almost in the same situation, luckily for Macedonia they have not moved out of the country. The thing that it is happening to the health care system in Macedonia in the past ten years, as a result of all the policy being led form the nineties, with a slower or faster pace, is that the system is crumbling, which has resulted with an enormous number of doctors and nurses leaving Macedonia! Around 600 doctors have went abroad! And if we add surely another 200 highly qualified professors, doctors with experience, who have gone to work in the private hospitals and in no case will return to the public hospitals, then I believe that the health care system in Macedonia cannot be set as a priority, but rather as an urgent condition!
“The new government, new minister, need to understand that the situation in the health care is not alarming, that is how it was ten years ago! Today we cannot say its alarming. Today we can play requiem! We are in a situation of complete disorganization.
CIVIL Media: You mentioned the provisions. Not a single minister or government until now has managed to deal with the criminal structures, in the area of public health care, by favoring private health care and part of the pharmaceutical companies. What is your opinion?
BLAZEVSKI: How does the Macedonian health care function? Here we have three important parts. The first part is a criminal software that functions in that entire structure. The second one is an insufficient hardware and the third part is the – provision. Hence, in the countries that emerged from the former state – such as Croatia, Serbia, Macedonia, Montenegro, the doctors and medical workers were thrown on the margins. And an interesting, local, criminal software was introduced. Such a thing does not exist anywhere abroad! The citizens need to receive quality health care for the money they pay each month, and the state is very diligent in collecting the health insurance contributions! So, your health problems have to be solved in the best possible way. However, the thing that happens with that criminal software is that you, as a patient, when you have medical problems, you enter into a non-system, into a labyrinth in which you have to manage on your own. Here the state does not help you at all!
CIVIL Media: Having in consideration the state of the Macedonian health care, what are your recommendations? What should be done most urgently?
BLAZEVSKI: I think that the new minister, certainly with the support of the prime minister, has to immediately form a commission, which within a week (let’s not form commissions that will be working for a long time, and at the end for the results to be “ambiguous”) will have to summarize and scan the situation, to see the type of personnel and equipment it disposes with. This has to be known! In the meanwhile, a national strategy has to be developed and for us to see, according to the population that we have, what areas we need and which ones are threatened the most. We need to establish a new organization of the health care system, which is accepted around the world. I said, organizationally, we are still in 1970. So you have one clinic with all sorts of things and that by itself produces poor quality. I believe that the data that we will come to will be devastating!
First of all, in terms of the staff. The new minister will have to announce at least 300-400 specializations the first morning he comes to office, in order to cover all the areas that currently exist, and not including those that need to be additionally developed, the more specific fields. How he will do this I do not know, it is something that has to be immediately done. Secondly, the situation with the health workers needs to be solved. Because those specialists, certainly if you get them in five years, and if you estimate that they need at least ten years to be able to work independently, need to be kept in the public health care, at least 15 years. But, if you go with these salaries, then it is a waste of money, because once they finish their specializations they will leave the public health care and will be a driving force for the private health care.
Reorganization is another issue, which needs to be the work of an expert commission together with the Macedonian Medical Association, for each area. And each area has to be standardized. Currently, every hospital has a director over which there is absolutely no control and he can do whatever he wants to, always driven by the thought that he can get to procurement of ultra-expensive equipment. Hence, it is very easy in a hospital to buy equipment in the amount of three or four million euros, with a utilization of 10%, only to get to that imagined ideal position of receiving a certain provision. The moment when a real national strategy is developed is when we will be able to see which areas will be developed, what kind of equipment will be purchased, and the directors will be able to make the organization in this area. They will not be able to participate in the expansion of hospitals or clinics, without it having some support.
CIVIL Media: Is decentralization, regionalization of the public health care possible?
BLAZEVSKI: In 1991 we organized a strike of the health workers in Bitola, I was the president of the Strike Committee, and even then we predicted what was going to happen and all the things that happened to us. Even then, we claimed that Skopje cannot be the center of the entire health care in Macedonia, and for everything else to be marginalized. And now Skopje is the center of the Macedonian health care, but everything else is destroyed. We have to start all over again. What Macedonia needs to do at this moment is precisely reorganization. Hence, there also has to be one center in Bitola, one in Stip, one center in western Macedonia, it could be in Tetovo, even though personally I would prefer for it to be in Gostivar, because of the positioning and communications. And those centers need to be completely, or at least nearly equipped in order to be able to cover the secondary prevention, and certainly go to Skopje for the third prevention.
Much has been debated on the social networks about “My term”. I personally consider that it is an exceptionally good and smart idea, because in times of mass communications, they need to be utilized in order to create order in the examinations, during which the doctor can also plan his time and the time of the staff that works with him. However, in Macedonia the project is planted on poor soil and the results are devastating. This project can be implemented and will succeed in Serbia, for example, and here it is a total collapse. Why? Because there is no regionalization. Since 1992 when I was in the Bitola hospital, not a single new area has been introduced there. In Bitola there is general surgery, abdominal surgery, but once plastic, thoracic, vascular surgery are also introduced, in that context, the system “My term” will function. Patients from the surrounding areas will not have to come to Skopje, because they will solve their problem in Bitola, at almost the same level as in Skopje. Of course, if something is more complicated, a patient will be sent from Bitola to the higher level, where greater experience is needed, more knowledge and team work.
By establishing those three regions, they will also have competition among each other. As it is now, Skopje is the “God” for medicine in Macedonia, everything else is devastated, and so all the patients gravitate towards Skopje, and this is where the chaos occurs. Neither the patients, nor the doctors profit. And all of that can be taken care of, but first of all there needs to be some vision, and second of all, there needs to be will and guidelines. To know what we want to do in the health care in the first five years. Not to sound like the “Five-Year Plan” in Yugoslavia, but it is absolutely necessary.
CIVIL Media: At first sight, it seems possible and and something that can be implemented…From where and from whom are the strongest resistances and obstacles expected?
BLAZEVSKI: No, it probably isn’t and will not be easy. If all of this, as a strategy, is accepted, we come to the biggest problem – the resistance of many powerful companies and many powerful individuals whose business interests will be affected, and who are contenders for the slice of the cake of around 360 million euros that annually flow into the Health Insurance Fund. There will be many big problems here, and I think that only the firm political will and clear determination to survive and succeed can create a clear concept, by opposing the current principle of work. Now, we get the impression that the Health Insurance Fund is a party treasury for solving the problems of the current party in power. And nobody gives this up, because there, with all the losses they make, there are 360 and even up to 400 million euros, and nobody wants to give this up. There are party employments there, and then every director buys equipment, depending on how close he is to the party that is in power, without a clear strategy and a large portion of the money are flowing out into undefined relationships.
On the other hand, Skopje has a larger number of private clinics than Dubai has, per capita, and all of them function! These are not clinics with just stationary, internal medicine, but rather hospitals with neurosurgery, cardiac surgery that is extremely expensive, and they all function in the poorest country in Europe, where the average salary is 150 euros! Slovenia has a budget for health care that is ten times larger, but they are not even thinking of creating private clinics for cardiac surgery, neurosurgery. Do you know why? Because there they have control over the money that come out of the Health Insurance Fund. And in Macedonia, everything goes according to the principle – he who gets quicker to the girl can have the girl, he who gets quicker to the money – he will get them, without any control. And there is no strategy, except for the system to cover a local hole, just enough for the ship to continue to sail…
And Macedonia is also Eldorado for foreign doctors. Around ten million euros annually, that is a lot of money. There are also doctors who have no idea, they do not know a single Macedonian word, and yet they treat patients, which is something that is unimaginable elsewhere. Licenses can and should certainly be issued because of the expertise of some of the doctors, but there are just so many doctors over which there is no control. And all of the are contenders for that slice of cake worth 300-400 million euros. And they are all satisfied. Except for the patient, who first pays into the Health Insurance Fund, and then to the public clinics, and every ten meters in those labyrinths, someone takes their money. And in the end, they still have to go the private clinics!
So this is a lot of money. I believe that up to a billion euros are lost annually, while the quality of the health service that is most important, is absolutely at the very bottom of Europe! And that Bolshevik statement that Macedonia will have free health care – is catastrophic! Nowhere in the world, nobody asks for free health care, that is impossible, everyone strives for quality health care. And quality health care is exceptionally expensive.
Maja Ivanovska
Photo: Biljana Jordanovska
Camera: Dehran Muratov
