Brošura u pdf. formatu - PALGO centar

prikazuju u bilansu Zavoda.
- Sredstva namenjena za tekuće finansiranje, koriste
se za pokriće dugova iz prethodnog perioda. Često
se na osnovu starih dugova utužuju ustanove
i izvršenjem presuda vrši blokada sredstava
opredeljenih za druge namene (a nije redak
slučaj da ustanove budu utužene od strane javnih
preduzeća i to onih kojima je Vlada u prethodnom
periodu otpisala ili reprogramirala dugove po
osnovu doprinosa za zdravstveno osiguranje).
- U bilansu Zavoda, sačinjenom u skladu sa
pravilima koje nalaže budžetsko knjigovodstvo,
prihodi i rashodi su uravnoteženi. U ovom bilansu
ne može se iskazati deficit Zavoda, koji je u
2004. godini iznosio preko 7 milijardi, ne mogu
se iskazati dugovi zdravstvenih ustanova, nastali
usled nedovoljnog obima finansiranja, a koji su
se u 2004. uvećali za 3 milijarde dinara, takođe
se ne mogu iskazati potraživanja Zavoda od
Budžeta u iznosu od preko 7 milijardi dinara, kao
ni potraživanja za dospele a neuplaćene doprinose
za zdravstveno osiguranje od preko 17 milijardi
dinara.
2. Način sprovođenja finansiranja i funkcionisanje
sistema zdravstva
Zavod sprovodi finansiranje zdravstva po sistemu finansiranja
( zatečenih) kapaciteta.
To znači da Zavod obezbeđuje sredstva za finansiranje
zarada za 127.000 zaposlenih u zdravstvu u 350 zdravstvenih
ustanova, troškove prevoza, utrošene energije i ostalih troškova
funkcionisanja zdravstvenih ustanova, zatim za troškove lekova,
sanitetskog i ugradnog materijala, ishrane i drugih potreba
osiguranika.
Ovakav sistem finansiranja ne obezbeđuje potreban
kvalitet pružene zdravstvene usluge
niti zainteresovanost ustanova za
pružanjem većeg broja usluga, odnosno
racionalnijim odnosom u korišćenju
prenetih sredstava.
S druge strane Zavod je prinuđen
da finansira višak kapaciteta, čime
se neracionalno i suprotno interesu
osiguranika troše sredstva osiguranja.
S obzirom na sve navedeno može se
zaključiti da je neophodno reformisati
sistem finansiranja zdravstvene zaštite,
kako u pogledu načina sprovođenja
osiguranja, odnosno prelaska na sistem
finansiranja usluge umesto finansiranja
kapaciteta, tako i u pogledu vraćanja
Zavodu funkcije osiguranja.
U protivnom, Zavod će se i dalje
nalaziti između želja Ministarstva
zdravlja, u čijoj je ingerenciji
definisanje obima prava osiguranika,
i finansijskih mogućnosti, diktiranih
merama Ministarstva finansija,
bez realnih mogućnosti da utiče na
održivost finansiranja. ■
assessed possibilities.
In the health care system it is not possible to reduce
spending as a consequence of reduced sources of
financing, but only by reducing the scope and content of
health care.
– The Administration and the institutions can not
procure loans from banks and other financial
organizations, however institutions in fact incur
debts to suppliers of medicines and medicinal
devices, and providers of services within the
health care system, without these debts appearing
in the balance sheet of the Administration.
– Funds for current financing are used to settle debts
from the previous period. Institutions are often
subject to legal actions, and the implementing
of the verdict, traps funds designated for other
causes (with instances when institutions are
subject to proceedings as a consequence of
actions initiated by public enterprises – the very
enterprises for whom the Government had written
off or reprogrammed debts based on contributions
for health care).
– In the balance sheet of the Administration,
prepared in accordance with regulations pertaining
to budget accounting, income and expenditures are
balanced. This balance can not present the deficit
of the Administration, which was over 7 billion
dinars in 2004, it can not present debts of health
care intuitions incurred as a consequence of the
insufficient level of financing, which have grown
by 3 billion dinars in 2004, it can not present
accounts receivable of the Administration from
the Budget amounting to over 7 billion dinars,
nor can it present claims for due, but uncollected
contributions for health insurance of over 17
billion dinars.
2. The manner of implementation of
financing and the functioning of the
health care system
The Administration finances health
care based on a system of financing
(existing) capacities.
This means that the Administration
provides funds for financing salaries for
127,000 employees in health care, in 350
health care institutions, for traveling costs,
energy, and for other costs of functioning
of health care institutions, as well as for
costs for medicines, sanitary and other
materials, nutrition, and other needs of
beneficiaries.
Such a system of financing does not
provide the required quality of health care
services nor does it ensure the interest of
institutions to offer more services, i.e. to
use transferred funds more rationally.
On the other hand, the Administration
is forced to finance surplus capacities,
thus using insurance funds unreasonably, and contrary to the
best interests of insurance beneficiaries.
In view of all of the above, it can be concluded that a
reform of the system of financing of health care is inevitable,
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