Although the Regulations on waiting lists determined that on hip surgery and knees can wait a maximum of one year, some patients will wait 16 years for this intervention, she found State auditing institution (DRI). Another problem is the fact that hospitals do not respect the waiting list, so some patients were operated on before the queue, which caused additional waiting for other patients.
The SAI conducted an audit of business expediency on the topic "Management of waiting lists for the installation of hip and knee endoprosthesis in real time", with the aim of examining whether competent institutions manage waiting lists in an efficient and transparent manner, with the aim of reducing the number of patients and waiting for interventions, writes Dunja Marić for the New Economy.
SAI, as stated in the report, concluded that "the absence of efficient and effective internal controls, as well as monitoring of waiting lists, undermines equality in access to health care, trust in the health system and reduces transparency."
As it was determined, the health institutions that were audited - University Clinical Center of Serbia, University Clinical Center of Vojvodina and the Institute for Orthopedic-Surgical Diseases of Banjica, did not establish effective internal controls in the process of forming and managing waiting lists, "which leads to reduced transparency and undermines trust in the system and equality in access to health care."
"Insufficiently effective internal controls in all three health institutions led to the formation of waiting lists that do not comply with current regulations, which threatens the reliability of data, reduces transparency and causes mistrust of patients," the SAI report states.
Deadlines are not being met.
"The Law on Health Insurance stipulates that the health service provider who determines the waiting list for the insured person provides health services in accordance with that waiting list, i.e. a single waiting list. The longest waiting period for an intervention/health service for the installation of a hip endoprosthesis, i.e. a knee endoprosthesis is up to one year, depending on the assessment of the patient's state of health," states DRI.
However, in the audit process, it was established that there are patients on the waiting lists of all three health institutions who were not provided with the service within that period. The SAI determined that on June 23, 2025, on the waiting lists of IO Banjica for the installation of hip endoprosthesis and endoprosthesis knees found a total of 4.967 patients who had been waiting for this service for more than a year. These patients represent 51,4 percent of all patients on the waiting lists of this health facility.
In terms of percentage, the majority of patients who have been waiting for these services for more than a year are in the Vojvodina Medical Center (about 70,9 percent as of June 13, 2025).
The state auditors determined that there are several causes of this situation in health care. First of all, there is the impossibility of the health institution to provide services to a large number of patients within a year in conditions of limited personnel and space capacities. Then, DRI cites the epidemiological situation due to the covid pandemic, which in the period from 2020 to 2022 significantly increased the number of patients on waiting lists and the average time of service provision, because these health institutions were covid hospitals. Also, the next cause is "inconsistent application of the provisions of the Rulebook on waiting lists that refer to the order of calling patients and the longest waiting time".
"By prolonging the provision of the service in relation to the longest term established by the Ordinance on waiting lists, about 10.000 people did not receive the necessary health service within the prescribed period, which violated their right to affordable and quality health care within the framework of mandatory health insurance," states the SAI in the report.
Hospitals did not respect the order on the waiting list
All three health institutions, to a greater or lesser extent, provided hip endoprosthesis and knee endoprosthesis installation services out of sequence on the waiting lists. Namely, due to the large number of patients on waiting lists, these health institutions establish internal records of patients who should be operated on as a priority, with diagnoses that more or less correspond to the criteria from the Rulebook on waiting lists for surgery up to six months.
"The consequence of the above is that at least 49 patients were operated on in a period of three weeks out of order on the waiting lists, that is, the same number did not receive the necessary service within the prescribed period," states DRI.
Patients wait up to 16 years for surgery
DRI states in its report that over the years, the number of patients on waiting lists has increased sharply, especially due to Covid pandemic, when many health institutions suspended the regular provision of health services because they were covid hospital.
In 2023 alone, the total number of new patients placed on the waiting list that year was as high as 125.239. This number is 20.000 more than the previous year and represents the largest number of patients placed on the waiting list in the period from 2019 to 2023.
In October last year, the total number of people on waiting lists was more than 60.000.
According to the data Institute for Public Health Dr. Milan Jovanović Batut, the average length of waiting in 2023 was the longest for the construction of a knee prosthesis - 871 days, which is longer than two years. The average length of waiting for the installation of a hip prosthesis is 405 days, although the Rulebook stipulates that the maximum waiting time is one year.
Currently, patients have been waiting for certain interventions since 2011, with the expected intervention dates scheduled for 2027. This means that some patients will wait up to 16 years for surgery.
It should, however, be noted that the number of knee endoprosthesis installation services provided in 2024 increased by 62 percent compared to 2023, and a special growth can be seen since October. However, according to the representatives of health institutions, the growth was achieved mainly by reducing the provision of services for other operations, such as sports injuries. All other surgeries (except hip endoprosthesis and knee endoprosthesis) are recorded on the so-called surgery registration list. Currently, there are more than 12.000 patients waiting for other operations, and that's only in the IO Banjica.
So waiting lists aren't just forming for hip and knee surgeries. They are also made for CT examination of the head, neck, spinal column, chest, abdomen, small pelvis, as well as for magnetic resonance imaging of the head, spinal column, abdomen, small pelvis, musculoskeletal system and breasts. Diagnostic coronary angiography and heart catheterization, surgical and non-surgical myocardial revascularization, installation of pacemakers, cardioverter defibrillators, artificial valves, artificial material grafts and endovascular graft prostheses are also being awaited. Waiting lists are also formed for senile and presenile cataract operations with intraocular lens implantation.
Source: New Economy
This October, "Vreme" celebrates and honors - as much as 35 percent discount for our 35th birthday! Valid for semi-annual and annual subscriptions. Subscribe now!
