Doctors in Macedonia demand health sector changes


Macedonia's health minister refuses to negotiate with the doctors on strike.

By Biljana Lajmanovska for Southeast European Times in Skopje -- 20/11/12


Low wages and the recent health reform that will pay doctors per treated patient are the main grievances of the doctors on strike in Macedonia. [Tomislav Georgiev/SETimes]

Hundreds of doctors in Macedonia are rallying against low wages and a health care program implemented in September, which they say puts too much emphasis on the number of patients seen, rather than the quality of care offered.

Physicians took their protests to the front of the Health Ministry on Monday (November 19th), waving signs that read, "We are not invisible."

The protests this week were a result of a statement by Health Minister Nikola Todorov, who said the strikes by 1,500 doctors have not caused work disruptions.

"According to legal provisions, strike means seizure of work activities. There was no such thing and I am really pleased and grateful for the consciousness shown by the doctors in Macedonia, especially the ones working in Skopje clinics," Todorov said.

The Independent Union of Clinical Hospitals in Skopje organised the strike last week, but without the supported of the main Union of Health.

The doctors' main complaint is their low wages, but also the recently-introduced health reform that will pay doctors per patients treated.

"Instead of stimulating quality healthcare, the current system does the opposite -- it stimulates only quantity of interventions," Dejan Stavric, president of the Independent Union of Clinical Hospitals in Skopje, told SETimes.

The Macedonian Health Ministry's performance-based pay system gives doctors a 20 percent monthly bonus if they meet a required number of patients. Those who do not meet the quota would have their pay cut by 20 percent.

Katalina Stardelova, one of the doctors on strike, said that she and her colleagues made several attempts to negotiate with Todorov, but without any success.

"Low wages are one of the problems we doctors are facing in health care, and the insistence that to lower those wages even more, based on the quantity, not quality of our services, is a complete disrespect for our profession," Stardelova said.

Todorov said that the demands of the union leadership are politically motivated.

"I would say that this is more a political decision of a group of people that want to benefit politically. I'm not including all doctors, because I don't believe that all are agree with the strike. I don't want to enter negotiations when, in the background, there is a political decision to go on strike and to undermine the talks," Todorov said.

Todorov said the reforms and the efficiency-based payment model have certain deficiencies, but that he is not ready to make instant changes to the existing pay system.

In order to improve the existing pay for the doctors, he said, he will hold talks with the Union of Health and health workers' representatives, but not the Independent Union of Clinical Hospitals.

Doctors said they attempted to negotiate with the health minister, only to be rebuffed.

"I feel offended as a professional, human being, and a woman at the same time. After years of experience they will not oblige us with a simple talk over the problems we have. I feel a neglected citizen who cannot voice her disagreement," Snezana Georgievska, a gynecologist, told SETimes.

Legally, in Macedonia, even when on strike, doctors cannot fully stop working, but must provide minimum healthcare.

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"Interventions that can wait will wait. Everything that is urgent is accepted and treated immediately," Stavric said.

However, some patients still worry.

"I need to do some tests. It's nothing urgent, but I already took the day off from work. Now I'm not sure if they will take me in. I'm not sure I understand their reasons for strike," Marija Antevska, 47, told SETimes.

"Some of them work too hard, treat a lot of patients. Others are just never there, and they get the same salary. There has to be a system in place," Milan Avramovski, 37, said.

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