Almost half of the total of 27,717 patients waiting for hip or knee replacement in Serbia at the beginning of July 2025 were on the waiting lists at orthopaedics wards in Belgrade, and more than a third at the Orthopaedics Institute Banjica.
On top of the evident decrease in the number of patients in the first six months of 2025, quite eye-striking are the almost unchanged ratios between the numbers of patients on the respective waiting lists for all of Serbia, Belgrade and the Orthopaedics Institute Banjica (“Banjica Institute”) compared to those as of December 31, 2024.
A third of all patients from Serbia and two-thirds of all patients from Belgrade are on the waiting lists of the Banjica Institute.
According to the 2022 Census, a quarter (1,681,405) of the total population of the Republic of Serbia lives in Belgrade. The average age of the population in Belgrade is 42.7 years, which is below the national average.
Of the 33 healthcare institutions in Serbia with waiting lists for hip replacement surgery, and 24 with waiting lists for knee replacement in July 2025, six are in Belgrade – the Orthopaedics Institute Banjica, the University Clinical Center of Serbia (“UKCS”), the Clinical and Hospital Centres (“KBC”) Bežanijska kosa, Zvezdara and Zemun and the Military Medical Academy (“MMA”).
According to the reports of the City of Belgrade Institute of Public Health, the Banjica Institute employs the largest number of orthopaedic specialists, has the largest number of operating rooms and hospital beds, i.e., the largest capacities. The load on this healthcare institution is demonstrated by the fact that at the beginning of July 2025, more than a third of all patients on the orthopaedic waiting lists in Serbia, and more than two-thirds of all patients on the orthopaedic waiting lists in Belgrade, were actually on the waiting lists of the Banjica Institute.
Savo Pilipović from the Patients’ Association of Serbia says that this is „fine and completely logical“, because the Banjica Institute is the reference institution in orthopaedics for entire Serbia.
„It’s not about the numbers, it’s about the ratios. (…) It’s okay that most patients are there. The problem is that they have not been able to serve such numbers of patients for decades. Whether they can’t or won’t, that’s another question. (…) Just as everyone wants to live in Belgrade or Novi Sad, everyone wants to be treated in Belgrade or Novi Sad. (…) The problem with health care is that the best doctors from central Serbia are also in Belgrade. (…) And all citizens from central Serbia are looking for a way to get to Belgrade. Most, of course, find a way, since „life takes precedence over regulations,“ explains Pilipović.
Open doors to corruption
The Rulebook on Waiting Lists (the “Rulebook”) prescribes the waiting periods for the hip and knee implant surgery of up to six and up to twelve months, respectively, depending on the priority of the required procedure on the insured.
An attorney at law specializing in the protection of patients’ rights and MP Marina Mijatović believes the waiting lists show that healthcare in Serbia is not well organized. According to her, such a schedule extends the period of waiting for medical services, which violates the rights of patients, because the wait is longer than the maximum period set by the Rulebook.
„It is clear that this situation with waiting lists increases the opportunities for corruption. (…) In my opinion, there are also elements of the public healthcare system disintegration and destruction so that patients would turn to the private sector. Evidently, more and more private institutions provide services defined by the Rulebook. So as not to wait several years for medical services, patients decide among the following three options: to wait regardless of the fact that their health gets impaired, to opt for a private sector institution and pay for the surgery, or to resort to bribery and corruption in order to receive the service sooner,“ says Mijatović.
The NGO „Doctors Against Corruption“ Coordinator Draško Karađinović says that the „poorly structured healthcare system“ is the cause of the problem with waiting lists. According to Karađinović, the lists are a manifestation of the „monopoly of the mandatory insurance that finances only the public healthcare“, on the one hand, and the conflict of interest being legalized with the permission „for a public healthcare system doctor to work as a private doctor at the same time“, on the other.
„The consequences are clear: (too) long waiting lists for elective surgery services in public hospitals directing patients to the private sector, often with the same doctor who cannot be reached in a public hospital due to the long waiting list,“ explains Karađinović.
The Ministry of Health „intervened“ with a memo
In December 2024, the Minister of Health, Zlatibor Lončar, sent a memo to the directors of healthcare institutions in Serbia with instructions for reducing waiting lists (by updating the lists, calling and checking the data on the patients on the list, deleting some from the list…). Among them is the requirement that „newly enrolled in the waiting lists can only be enrolled within the home health insurance branch“ with a note that „this does not apply to the patients who are currently on the waiting lists“. At the end of the memo, it is underlined that „the director of the healthcare institution is responsible for all of the above and shall confirm the accuracy of the data with their signature and stamp.“
Mijatović believes that this is an attempt to solve the problem of waiting lists „quickly, and in a way unfavourable for the patients“.
„The memo to the directors is a form of pressure to reduce the lists, but according to the content of the memo, the methods to be applied will be to the detriment of patients. (…) Opportunities for abuse are thus created. (…) What would happen to a place on the waiting list if the patient failed twice to answer a phone call from an unknown number? Would they be punished by being removed from the waiting list?“ asks Mijatović and adds:
„It is clear to us that the waiting lists would not have been created if the Rulebook had been adhered to and if the healthcare system had been organized better. (…) Objectively, waiting lists cannot be resolved in the way that has been proposed and applied.“
Savo Pilipović believes that the memo is „formally correct, but essentially not“ and that we need a new healthcare system, which, he claims, he also spoke about at meetings at the National Health Insurance Fund.
„I explained to them that the ‘feudalization’ of Serbia, which exists in healthcare, while Serbia is an ultra-centralized state when it comes to healthcare, is not a normal solution. And this abnormal solution leads, among other things, to the problems that you and I are talking about now. Because Serbia is a fully centralized country. (…) But in order for a person from Novi Sad to come to Belgrade or one from Belgrade to go to Novi Sad for a treatment at a clinic, they have to find a connection and obtain a decision (from the competent committee of the National Health Insurance Fund). The same goes for people from Kragujevac, Užice, Čačak, Niš and other cities.“
Karađinović: Insureds from Belgrade receive services more slowly due to the pressure of a large number of patients
In the report „Quality Indicators of Waiting List Management in Hospitals in Belgrade 2024“, issued by the City of Belgrade Institute of Public Health (“GZZJZ Belgrade”), which TAF has had access to, the number of hip and knee replacement surgeries performed in Belgrade in 2024 was 5,481, the highest in the last ten years. For the patients operated on at the Banjica Institute in 2024, the waiting period for hip prosthesis surgery was about two years, and for knee prosthesis about four years.
However, GZZJZ Belgrade does not have data on the home branches of patients on the waiting lists in hospitals in Belgrade.
According to the data on the number of home branch patients from Belgrade, which TAF, upon request for information of public interest, received from the National Health Insurance Fund, and the data from the website of the National Health Insurance Fund, as of December 31, 2024, for almost a third of the patients (5,107 out of a total of 15,954) on the waiting lists at orthopaedics wards in Belgrade, the National Health Insurance Fund Branch for the city of Belgrade is not their home branch.
Some six months later, the total number of patients on the waiting lists at orthopaedic wards in Belgrade was reduced by 2,097 patients, while the number of patients who are not insured by the Branch of the National Health Insurance Fund for the City of Belgrade declined to slightly less than 30%.
According to Karađinović, insureds from Belgrade are „slower to receive service“ due to the significant numbers of patients from the interior of the country on the waiting lists at hospital orthopaedic wards in Belgrade and at the Banjica Institute.
„It is true that insureds from Belgrade (on the waiting lists at orthopaedic wards) are slower to receive service due to this situation, which creates dissatisfaction, due to the impression of discrimination, because of the pressure by the patients from the interior. This is just one of the countless harmful consequences of systemic failures in the healthcare system, which is burdened with bureaucratic arrogant cynicism with the predominant interest in keeping the status quo,“ says Karađinović.
Has the memo induced changes to the waiting lists?
To the question about the semi-annual data on the numbers of patients on the waiting lists at orthopaedic wards in Belgrade for whom the RFZO Branch for the City of Belgrade is the home branch, the Ministry of Health has not responded until the issue date of this text.
Acting Director of the Orthopaedics Institute Banjica, Prof. Dr. Zoran Baščarević, confirmed for TAF that the memo of Minister Lončar is being acted upon.
„In accordance with the memo of the Ministry of Health, dated December 10, 2024, the Orthopaedics Institute Banjica does not enrol patients who are not from the territory of Belgrade on the waiting list. Newly enrolled patients can be registered on the list only within the home branch territory, except in cases where a specific intervention cannot be performed in a regional hospital according to the patient’s place of residence. In order to solve the problem of a large number of patients on waiting lists, the Institute has increased the surgery program from four to six surgeries daily, so that the total number of these interventions is about 4,500 per year. This is a significant increase against prior years,“ highlighted Dr. Baščarević in his response.
In order to reduce the number of patients on the waiting list, according to the reports of the City of Belgrade Institute of Public Health, the sum of the number of the patients operated on and the number of those deleted from the waiting list must be higher than the number of newly enrolled patients.
According to data from the RFZO website, the patients newly enrolled on the orthopaedic ward waiting lists in hospitals in Belgrade from January 1 to July 7, 2025, totalled 3,761 patients.
In the same period, the waiting lists for hip prosthesis decreased in the number of patients for the Military Medical Academy, KBC Bežanijska kosa, followed by the Banjica Institute and the University Clinical Center of Serbia (“UKCS”). At the same time, the number of patients in both KBC Zemun and KBC Zvezdara increased.
On the waiting lists for knee prosthesis surgery in Belgrade, the number of patients was reduced at the Military Medical Academy, followed by the KBC Bežanijska kosa and the Banjica Institute. In KBC Zemun and UKCS, the number of patients increased.
With regard to a slight increase in the number of patients on the waiting list for knee prosthesis surgery at the UKCS, the head of the Clinic for Orthopaedics and Traumatology of the UKCS, Prof. Dr. Goran Tulić, pointed out that „in the first five months of the current year, a significant increase in the number of revision hip and knee implant surgeries was recorded, which additionally affected the surgery capacities and the schedule of taking care of the waiting list patients.“ Dr. Tulić also stated that in addition to the waiting list patients, a large number of post-traumatic complications, infections and other pathologies of the musculoskeletal system were addressed in July.
Should the name of the home RFZO branch be published on the waiting lists?
In the opinion of Marina Mijatović and the program director of the Transparency Serbia, Nemanja Nenadić, the name of the patient’s home health insurance fund branch is not personal information.
When asked whether, from the standpoint of the current situation in the healthcare system, the number of patients on the waiting lists and their transparency, this information should also be published on the waiting lists, they had different views.
„Patient data is particularly sensitive and maximum protection of such data is necessary. On the RFZO website there is a list of patients where a part of the patient’s unique personal identification number is displayed – the date of birth and the last digit, as well as the date of entry on the list and the expected date of admission. I think that more data should not be published, but that it is necessary for the patient to have a certificate on them stating the time of waiting list enrolment and that the intervention date assigned is not „expected“, but accurate“, Marija Mijatović said.
Nemanja Nenadić believes that, although it is „some kind of personal data“, there is no reason why the information on the RFZO home branch of the patient should not be published on the waiting lists.
„I see no problems there, because based on the branch info, one cannot identify who a particular individual is. On the other hand, reviewing those databases may result in obtaining information that is useful to the public.“
The text was produced as part of the „wAIting for health“ Project, which is carried out by the Center for Investigative Journalism of Serbia – CINS. TAF analysed the data from the waiting lists posted on the website of the Republic Health Insurance Fund. The data was collected daily in the period from December 19, 2024 to July 18, 2025, then analysed with the help of a special tool created by CINS for this purpose, which is based on AI application. AI was used in accordance with the Code of Conduct for Journalists of Serbia (Chapter III, para. 7). The facts and information in the article have been verified by an external fact-checker.
Journalist: Jasmina Prodanović
Photos: TAF, Media Center
Infographics: Anđela Jovanović