The national anti-corruption strategy



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3.7. HEALTH CARE SYSTEM
а) Description of the situation
The ACA Report on Forms, Causes and Risks of Corruption in the Health Care System from 2012 shows that the risk of corruption may exist in the field of public procurement, additional work of physicians, spending of funds (from the budget or grants), acceptance of gifts, conflict of interest, waiting lists, provision of non-standard services, as well as in the relation between pharmaceutical companies and doctors, and employment of health care workers and associates. The causes of these risks are primarily gaps in systemic laws. Therefore, it is conductive for cases of abuse that there are no clear procedures and lists of non-standard services; criteria and procedures for performing additional work whose incomes in cash are not returned to the budget but are allocated to health care institutions and their employees (existence of the so-called “own incomes”); loosely regulated relation position of the pharmaceutical industry in terms of the medical practice and training of employees in the health care system; imprecisely regulated legal conditions under which health care workers and associates employed in public institutions can provide health care services in private institutions, etc.

The current practice shows that there is no adequate accountability and transparency in terms of adoption of decisions about waiting lists, access to personal information or specific services, etc. Apart from an unclear provision of the Code of Ethics of the Medical Chamber (which prohibits to doctors to demand or receive awards in addition to the established criteria), there is no legally regulated identification, reporting and resolution of conflict of interest of health care workers and associates, as well as of public officials and persons performing functions in various committees and bodies that make decisions (and do not have the status of an official in terms of the Law on the Anti-Corruption Agency). In terms of donations to health care institutions, it has been noticed that there is no committee in practice which would first estimate whether equipment is necessary for work and which would inspect all costs of utilization. In terms of decisions on investments, renovation and acquisition of medicines and medical devices, accountability and transparency have been normatively increased with the adoption of the new Law on Public Procurements in January 2013, however, it is necessary to ensure its full implementation. Inadequate internal and external control of competent public authorities and health care institutions, as well as absence of efficient elimination of irregularities determined in their findings, is particularly favorable for the expansion of corruption. This is aggravated by the lack of proactive and efficient intersectoral cooperation and cooperation with repression authorities.

Verification of risks in integrity plans and analysis of successful self-assessment of public authorities, conducted by the ACA in January 2013, for the health care system, shows that the health care system is not supported by the information system, which results in non-transparent spending of the money of insured persons and provision of health care services. In addition, rights of beneficiaries of health care services are not clearly defined and published, nor are they sufficiently informed about the amount of fees and type of health care services. Development of the information system would make all health care services visible, in conformity with regulations on the protection o personal data and it would be possible to monitor and control their results.
b) Objectives
3.7.1. Identify and eliminate all deficiencies in the legal framework that are conductive to corruption, and ensure their full implementation.

3.7.2. Provide efficient mechanisms for integrity, accountability and transparency in the adoption and implementation of decisions.

3.7.3.Ensure a transparent information system in the health care system and participation of the public in the control of work of health care institutions, in accordance with legal protection of personal data.




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