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Montenegro is located in South-eastern Europe, sharing its borders with Bosnia and Herzegovina, Serbia, Kosovo, Albania and Croatia. It has a population of 670,000 people and gained independence in 2006, after severing ties with Serbia.
Since gaining independence in 2006, the Government of Montenegro has put in place plans to further develop the country's healthcare system, with emphasis on improving the emergency healthcare services. The health sector in Montenegro is evolving, with major plans to improve and develop the healthcare system. This is being undertaken as a continuous process, with aid from international partners to effect improvements.
The healthcare system of Montenegro is comprised of private and public run healthcare facilities. There are well trained medical professionals in Montenegro, although hospitals and clinics are generally not particularly well equipped in comparison or maintained to the standards achieved in more advanced European nations. In the case of a non-medical emergency, privately and publicly run healthcare facilities will normally expect cash payments up-front before providing healthcare services. Ambulatory services across Montenegro are limited and will normally only be used in medical emergencies. For non-vital medical emergencies, a patient will normally have to make their own way to a Montenegro healthcare facility.
The Ministry of Health, Labor and Social Welfare (MHLSW) in Montenegro plays a stewardship role for the healthcare system of Montenegro. The MHLSW takes a centralized approach to delivering health services in the country and has been overseeing a reform of the healthcare system since 2003. A considerable amount of money and time has been invested in developing the healthcare system as part of a review initiated in 2001 - the ‘Health Services Policy in the Republic of Montenegro Up to the Year 2020’ - and the ‘Strategy for Health Care Development in Montenegro’ implemented in 2003. These initiatives focused on strengthening the overall health sector in Montenegro, with priority areas for the MHLSW being health policy, planning and regulation, with the aim of building further institutional capacity and improving quality, efficiency and access to primary healthcare. The overall objective being to ensure financial sustainability of the healthcare system, with improvements to governance of the health insurance system, general standards of healthcare and development of health information systems.
The compulsory Health Insurance Fund of Montenegro (HIF) is a Montenegrin institute designed to manage the compulsory social health insurance scheme operating in the country. The HIF is responsible for ensuring contributions are made by citizens in employment and employers. It is estimated that approximately 640,000 residents and citizens in Montenegro are insured through the compulsory state social health insurance scheme.
The healthcare system in Montenegro is primarily funded through social health insurance and the contributions made through payroll deductions. The compulsory health insurance is mandatory for all citizens of the country and is based on the principles of reciprocity and solidarity in order to fund the health sector. In 2008, the government of Montenegro budgeted 5.72% of GDP for expenditure on the health sector. Part of the reform of the healthcare system has been based on funding arrangements, with intervention measures having been adopted; a new payment model has been introduced at the primary healthcare level, which introduced fee-for-services for certain health services. The financing reform of the healthcare system in Montenegro has been necessary to ensure the health sector can be adequately funded.
The Montenegrin health insurance fund requires all employees and employers to make regular contributions to the social health insurance scheme. Contributions were set at 12% of earnings, but this was decreased to 10.5% to comply with changes in Montenegrin Law.
All citizens paying into the HIF will be covered for public healthcare services in Montenegro, along with their dependents. Vulnerable groups - pensioners, the chronically ill, pregnant mothers and the unemployed - will also be covered for publicly run healthcare services, including those citizens of Montenegro not making contributions to the health insurance funds. All dental care in Montenegro needs to be paid for out-of-pocket; most of the dentists in the country work in the private sector.
The health insurance fund will cover the cost of most healthcare services and provided by the state. Hospitalization, specialist medical treatment, rehabilitation, childbirth, maternity care and most prescriptions will be free of charge as part of the healthcare system in Montenegro. If citizens of Montenegro are not referred for specialized medical treatment , they will need to pay out-of-pocket for any further treatment. Montenegrin citizens have the option to take out private health insurance, as extra protection and to supplement their state-provided health cover, but private health insurance for residents is not currently very popular.
General practitioners (GPs) deliver primary healthcare services and are generally very well trained, but often lack modern facilities and adequate medical supplies. GPs in Montenegro are responsible for prescribing medication, making referrals, treating acute medical needs and helping patients with chronic illnesses. GPs operate from health centres (Dom Zdravljas), where nurses are also available, and provide preventive care such as immunization programmes and education on health issues. There are 18 health centres present across the country offering outpatient care, with a primarily role providing general medical care, maternity care, paediatric treatment, laboratory and radiological diagnostics and emergency services.
The hospital network in Montenegro consists of 10 facilities, with 7 being general hospitals and 3 being specialized hospitals. The hospitals are located in urbanized regions of Montenegro. Patients will be referred to a hospital or sent directly in the case of a medical emergency. If medical treatment is of a non-urgent nature, a patient may be required to wait for an extensive period of time. If a patient is not permitted free treatment by the state under prevailing regulations, they will be required to pay up-front for treatment provided.
Private healthcare in Montenegro is mainly comprised of independent practices. Private Montenegrin clinics are normally well equipped and doctors are well trained, with some medical specialists working jointly in the public and private healthcare sectors. Montenegrin private healthcare providers will normally be used by patients, when they do not qualify for free treatment under the state system. The capital Podgorica is home to most of the private healthcare providers, with most private healthcare providers expecting cash payment up-front. Waiting times in private facilities are usually reduced, as they not as busy as publicly run facilities.
Private clinics in the capital Podgorica - the Clinical Center of Montenegro and Ars Medica - offer patients a range of healthcare services, which do not require long waiting periods. They also provide ease of access and a more patient friendly experience compared to publicly run healthcare facilities. Both private healthcare providers are still limited in the range of acute health services they can provide for patients, but in a case which is not critical, they offer an adequate medical service. A foreign national in Montenegro may feel more comfortable seeking medical treatment from a private healthcare provider, as English may not be widely spoken in public healthcare facilities.
Foreign nationals in Montenegro must pay for all healthcare services in either public or private healthcare facilities, and it recommended that you have adequate funds available to pay for healthcare services up-front. While the standard of care and treatment available across the Montenegrin healthcare system is limited, a patient can expect to be treated by a doctor who is well trained with basic health services delivered satisfactorily. However, for more extensive and advanced medical treatment, a patient will probably need to be treated outside the healthcare system of Montenegro. It is advisable to include air ambulance services and medical repatriation in international health insurance policies for Montenegro.
As a foreign national in Montenegro, you need to be aware that the healthcare system in the country can suffer from a shortage of medical supplies and other essential items. This can affect delivery of medical treatment. If you are a short term visitor or expatriate in Montenegro, it is important to ensure medical evacuation is included in your international health insurance for Montenegro as, in the case of an extreme medical circumstance, you will probably need to be relocated to a country with a medical center of excellence for treatment. Also medical evacuation may be required if prolonged medical treatment is needed. To safeguard you and your family from possible extensive health service costs, it is strongly recommended that comprehensive international medical insurance for Montenegro is obtained to give you full cover for all eventualities including repatriation.
Having gained independence in 2006, Montenegro's healthcare system is in the early stages of major strategic policy reviews and implementing reforms. However an agenda has been set aimed at ensuring delivery of a good standard of healthcare services in the country.
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