Serbian Eurosong candidate Konstrakta addresses the limited availability of healthcare

Who has access to healthcare in Serbia?

In corpore sano, the Eurovision 2022 winning song written and performed by Ana Konstrakta Đurić has stirred up the public. In a spectrum of messages that the song which will represent Serbia at this year’s Eurovision contest conveys, the most obvious one resonated the most.

In her statements for the media, the artist herself points to the fact that the song is a part of a larger art project called Triptych, which speaks out on a variety of issues, and not just the most obvious one, i.e. the limited availability of health insurance in Serbia. Still, the opportunity is perhaps ideal to address this very topic.

Health expenditure accounts for roughly 10% of Serbian GDP, which represents an average share of GDP allocated to healthcare in Europe. However, in absolute numbers, domestic healthcare spending falls far behind the developed countries’ expenditures because the Serbian GDP is small. According to the data provided by the Institute of Public Health of Serbia, public health expenditure has been declining since 2002, while World Bank data point to the fact that almost 40% of healthcare spending in Serbia comes from private persons’ payments, while the remaining 60% is financed by the Republic Fund of Helth Insurance (RHIF). According to these data, Serbia belongs to a group of the poorest countries in the world, and such parameters contribute to citizens’ unequal access to health services.

Bearing in mind that the availability of public health insurance depends primarily on citizens’ employment status, it should be noted that fewer and fewer employees in Serbia have employment contracts that guarantee full health care. All unemployed, self-employed, precariously employed, those who work illegally or have a special status (such as independent artists) either don’t have health insurance or face obstacles in qualifying for public health insurance.

According to the domestic labour legislation, healthcare and the right to sick leave are guaranteed to employees, i.e. those who have permanent or fixed-term employment contracts. Healthcare is becoming increasingly unavailable even to such “chosen” few. For years, public healthcare has been suffering blows such as insufficient financing and cuts. They have been legitimized by the alleged inefficiency of the public sector, which only paved the way to further privatization of public healthcare. Since the beginning of the 2000s, numerous changes have been introduced, including patient participation, abolition of various specialist services from the list of primary health care services covered by public health insurance, etc. Today, after several pandemic waves that acted as a huge blow to public healthcare facilities, it is difficult to reach any diagnosis or medical advice without turning to privately-owned medical facilities.

All other categories of the population, especially the most vulnerable ones – the unemployed, the elderly without social protection, marginalized groups – experience significant restrictions regarding the availability of healthcare.

Do independent artists have health insurance?

Independent artists, commonly known as freelance artists, are precarious workers who survive on part-time, temporary, and occasional jobs, and whose employment status is regulated through local self-government. According to the Serbian Law on Culture, local self-governments cover taxes and contributions (equal to those paid by workers earning a minimum wage) for independent artists, on the basis of which they should enjoy minimal social protection. However, things work differently in praxis. For example, the City of Belgrade is often late with the payment of taxes and contributions, so that independent artists become tax debtors, and thus lose the possibility to exercise the right to health care.

Women with the status of independent artists had their situation further complicated by the adoption of the still valid Law on Financial Support to Families with Children. Prior to the adoption of this Law in 2018, the costs of maternity leave (for independent artists) were covered by the RHIF, but the legislative changes led to discrimination against entire categories of women, including independent artists. With the adoption of the new law, independent artists, in addition to women entrepreneurs, self-employed women, freelancers, hairdressers, etc., became part of the category of women who lost the right to maternity leave and leave for child care. The new law thus forced independent artists, the self-employed, and entrepreneurs to continue to work during maternity leave.

The bug in the Law on Financial Support to Families with Children has remained even after the last changes, according to which the status of entrepreneurs in a broader and narrower sense has not changed at all. They still don’t have the right to maternity leave and childcare leave, which by law belongs to all other employed women. Despite the fact that women entrepreneurs organized, forming an initiative called “Women entrepreneurs are also mothers”, for now, there are no prospects for changes in the discriminatory law provisions.

“I don’t have health insurance” is not just a verse, it is a reflection of the harsh reality that many women and men live in Serbia. The ruthlessness of such a reality has been further increased during the pandemic and by the overall neglect of public healthcare so that experts warn that the end of the pandemic could bring additional unavailability of healthcare and initiatives towards its full privatization.

Translation from Serbian: Iskra Krstić

This article was ORIGINALLY PUBLISHED in Serbian on Mar 8, 2022.

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