Regression of Hard-Won Advances in Socialized Medicine: The Emergence of the Private Sector in Health Care in Serbia

Dual practice physicians are those who work in both the public and private sectors: for example, in the morning seeing patients in a state-run hospital, and in the afternoon seeing paying customers in a private facility. Dual practice is a legal but morally problematic practice that can lead to dual loyalty. In Serbia, dual practice has contributed to institutional corruption because physicians who work in both sectors siphon patients from public facilities into private ones and have little incentive to protect the public system. This problem is especially acute in the areas of psychiatry and the public mental health care sector. Private health care is unregulated, with no legal framework for psychotherapy, and there is widespread reliance on cheap anti-anxiety drugs in the population. All of this contributes to rising health care costs, poorer care in both the private and public sectors, overworked physicians, and the shortsighted complicity of the guilds. This is an attack on the right to health: the poor will often get insufficient care, while the patients who are financially better off are at risk of overtreatment and overdiagnosis.