4. Paying for services
Adequate funding for health is important to manage the excess demands on the health system. This section considers how countries are PAYING FOR COVID-19 SERVICES. Health financing describes how much is spent on health and the distribution of health spending across different service areas. The section also describes who is covered for COVID-19 testing and treatment, whether there are any notable gaps (in population coverage and service coverage), and how much people pay (if at all) for those services out-of-pocket.
4.1 Health financing
On March 18th, the Government of Montenegro stated that all medical equipment required for SARS-CoV-2 prevention, treatment and control is going to be purchased from the central budget, as well as all equipment, goods and services required for quarantine and for returning Montenegrin citizens from abroad (decision number 07-2091 available online at http://www.katalogpropisa.me/azuriranje-od-19-03-2020/).
The National Coordinating Body created the Operative Headquarters for International Aid, with the intent to attract and supervise aid from international institutions (EU, European commission, UNDP, World bank, NATO etc.).
On April 1st, the World Bank agreed to provide 5 million EUR support to modernize the health sector and address the COVID-19 pandemic.
On April 2nd, the European Union and UNDP signed a contract to support Montenegro with 100 ventilators, 10 mobile X-ray machines and PPE (amounting to 3 mil EUR) (http://www.gov.me/vijesti/223526/EU-donira-3-miliona-eura-za-nabavku-sto-respiratora-deset-mobilnih-rendgenskih-uredaja-i-kontigenta-zastitne-opreme-za-zdravstve.html). These funds are allocated from the Instrument for European integration (a part of the IPA 2018 program).
The International Atomic Energy Agency (through the project INT0098) has announced donating immunological and molecular technology kits (derived from nuclear sources) amounting to 170,000 EUR to be used for SARS-CoV-2 testing in Montenegro.
The Government welcomed the launch of a Country Preparedness and Response Plan costed at 59 million EUR. According to the Plan, this amount is to be mobilized and provided through the Global Fund for Preparedness and Response within 3 months. These funds were planned to be directed to address the needs of the health care system and to contain the socio-economic impact of the epidemic. Ten key points in the Plan are: social and economic challenges; statewide coordination; risk communication; supervision; border-crossing; case examination; national system of laboratories; infection prevention and control; case-specific management; multi-sector action on mitigating social and economic difficulties; logistics and acquisition (description available at http://www.gov.me/ResourceManager/FileDownload.aspx?rId=402967&rType=2.) However, no support had been received by 19 May 2020.
Through cooperation with the European Commission, an additional 50 million EUR are allocated from the programs IPA 2016, 2018, 2019 and 2020. The intention of the Government of Montenegro and the European Commission is that 9.5 million EUR are dedicated to support the public health system, with the remaining funds aimed to support the private companies suffering the most during the COVID-19 pandemic (description available at http://www.gov.me/ResourceManager/FileDownload.aspx?rId=402967&rType=2).
On April 13th, the Government of Montenegro formally joined the Procurement Agreement to procure medical countermeasures (authorized by the European Union) to facilitate the acquisition of drugs, medical equipment etc. (http://www.gov.me/vijesti/223737/Crna-Gora-pristupa-mehanizmu-EU-za-zajednicke-nabavke-ljekova-i-medicinskih-sredstava.html).
Based on the needs reflected in the Country Preparedness and Response Plan, WHO provided support amounting to 750,000 USD to support the strengthening of surveillance capacities, laboratory capacities and the procurement of equipment.
The money donated to the National Coordinating Body for Combatting Infectious Diseases (by the Government of Montenegro) is used to purchase the medical equipment and drugs required for COVID-19. All donations are centralized (to the National Coordinating Body), and the Government and the Healthcare Crisis Response Team control the distribution of donations. The Government Health Fund also supports the acquisition of medical equipment. So far, 317 benefactors donated nearly 7 million EUR to the National Coordinating Body to combat COVID-19 (daily update available at https://www.coronainfocg.me/me/donacije).
There were benefactors who donated goods rather than money (e.g. ventilators) with a wish to distribute them to a certain healthcare institution; this wish was respected by the Government.
Regarding the capital investment projects that are planned to be undertaken from the donated money (besides purchasing ventilators, tests, PPE and other equipment), the reconstruction of the Clinic for Infectious Diseases (at the Clinical Center of Montenegro) is planned to start in the next several months.
All healthcare workers received a 15% pay rise in March and April (see Section 2.2).
All institutions from the private sector who cooperate with the public sector offered their services for the common good (without payment from the Government Health Fund or from patients). The private healthcare institution Codra provided all necessary gynaecological and obstetric staff and equipment required for the deliveries of COVID-19 pregnant women. The private healthcare institution “Filipovic Polyclinic” provided their ambulance vehicles (for transporting patients from their home to the hospital and back, as well as for transporting citizens from the borders to the quarantine locations). The private healthcare institution “Milmedika” offered their laboratory equipment for all laboratory analyses of patients in field hospitals.