93828 July 17, 2012 In Montenegro: Making Patient Care Healthier Dragana Varezic of the World Bank Office in Montenegro offers this story. Photo Gallery Dr. Olivera Vojvodic Vlahovic has been practicing medicine for over 30 years. She spent many of those years working under the health care system in the former Yugoslavia. Now she works at a primary care center in Podgorica, Montenegro, under an entirely new kind of system. She says that reform is the best thing that could have happened to health care in Montenegro. Looking back at the days when the government introduced the new health care system, she says, "at first it seemed like a huge amount of Related Links work, and it was, since it is not easy to take responsibility for 2000 people. That's the average number of patients that a The World Bank in Montenegro chosen doctor has." But now, she says, even though there Montenegro Health System are many of them, she alone is responsible for organizing her Improvement Project patients' careā€”and that makes all the difference. Ministry of Health Taking Responsibility Health Insurance Fund Dr. Vlahovic's nurse, Ana Vujacic, agrees. She says the best part is the responsibility and autonomy she carries in her job. "I work with the patients, help them with making appointments and follow up on the prescriptions, this is my responsibility only. I also file their charts, and I take care of the medicine supplies." Montenegro's health care reform, which is centered in Podgorica, aims to streamline and improve primary care. The reform, which is supported by the Dr. Olivera Vojvodic World Bank, will also improve the regulation and quality of pharmaceuticals, Vlahovic introduce new clinical protocols, and cut down on waiting times for patients. It aims to increase general satisfaction with health care services. Under the old system, health care workers often complained of weak oversight, low pay and a lack of motivation. Some patients relied on an informal, unregulated payment system. And more alarming, key overall health indicators stagnated, as Montenegrins' wellness failed to keep pace with the rest of Europe. Doctors focused on curing or relieving patients' illnesses, instead of teaching the value of preventative care. Now, they do both. Certainly, in Dr. Vlahovic's office, the staff and patients are happier. "I can Ana Vujacic organize myself the best way I can and I think it is also optimal for the patients, because you monitor them from the moment they come to the doctor for the first time, " says Ana Vujacic. "I know that the patients appreciate the orderliness that the system promotes." Knowing Your Doctor, Knowing Your Patients In addition, patients and doctors can often form a bond. Patients used to bounce around from doctor to doctor; now they can choose their own doctor, who is then responsible for all of their basic health care needs. Sometimes a group of family members will chose the same doctor; then the doctor can deal with all the hereditary health issues within one family. And, better still, offer preventative care and life style tips to keep illness at bay. "It is very important, both for the patient and the doctor, to have the time to deal with the issues and talk about them. The patient needs time to explain everything properly and the doctor needs time to ask questions and check things. This is how you gain patients` trust: by dedicating time to them. This is what I like the best about the reformed system," explains Dr. Vlahovic. Brano Bajagic agrees. He is one of Dr. Vlahovic's patients. "It is nice to be recognized by your doctor, to be a familiar face for them, you develop a proper relationship and you feel more at ease with the doctor,. You have their full attention," he says. "It also gives your doctor full responsibility over your health, they know they will see you again and that they have to work with you." Taking Reform Nation-Wide Brano Bajagic's closer relationship with Dr. Vlahovic is just one of the goals of this project, which is supported by the World Bank. In addition, the project focuses on efficiency at Montenegro's key health care institutions, from the Ministry of Health to the Montenegro Drugs Agency, which oversees the country's pharmaceutical supply. Another goal is more specialized training for the country's medical faculty and an expansion of the reorganized system outside of Podgorica, starting with the renovation and expansion of the health center in Bijelo Polje. Brano Bajagic Of course, though, the ultimate objective of the reformed health system is to improve care; as a part of that, the day-to-day interactions between doctors and their patients are crucial. And under the old system, waiting for office time was a huge issue for patients, says Dr. Vlahovic. "The first thing I did was to put a very simple work schedule on my door; it explained when people can come to have preventative check-ups, when they can come for prescriptions and referrals, when they can come for consultations, and of course the main slot was left for the patients with health issues," she explains. "The good thing is that the new system allows you to do things in such a way." Patients appreciate the change as well. "Before the reform I used to wait for hours in the waiting rooms," says Brano Bajagic. "You would go from one GP to the next, and none of them was familiar with you, it was frustrating. It is a completely different story now." Keeping Watch on Prescription Drugs The new system also allows doctors more control over their patients' medicines. Because patients generally see only one doctor, they can't go from office to office asking for more of the same medications. And having one doctor in charge means that that doctor can monitor medicine intake, and make sure a patient doesn't take too much of any one prescription. Under the old system, Montenegro lacked a national drugs policy, and lax record-keeping meant that keeping track of medicines and dosing was often difficult, if not impossible. Next for Montenegro, the expansion of the system that began so successfully in Podgorica. More training and autonomy for doctors and their staff, and more choice and less waiting for patients.