Free on paper, but in practice, pregnant women pay for examinations by chosen gynecologists

Some pregnant women paid for examinations by chosen gynecologists, although according to the Law they are entitled to free gynecological and microbiological examinations, and biochemical analyses. These measures were introduced by the Ministry of Health in November 2015. Even women who have no health insurance are entitled to free examinations and delivery in public health institutions. Officials from the General Hospital Kumanovo confirmed that deliveries are free. Women from Kumanovo, but from other towns in the country as well, talked about their experiences of visiting chosen gynecologists during pregnancy.

17-year-old Resmija from Kumanovo, a mother of one-year-old daughter, said that in the first five months of the pregnancy she paid for all examinations, ultrasounds, gynecological examinations and swabs. She added that she had no health insurance because of misunderstandings in the family and the fact she was a minor. After five months, she succeeded in clearing up the misunderstandings and in obtaining health insurance.

Resmija said, “When I did not have a healthcare leaflet, the chosen gynecologist was paid about 800 denars per month, for instance, 400 for an ultrasound, 400 for swabs.” Also, she paid the lab per 400 denars. She said that she paid up to 1,000 denars for examinations in a month. And, that is a lot for her family budget since her partner and she live in an extramarital community and both are unemployed.image

Later, when she solved the issue of health insurance, the chosen gynecologist charged per 100 denars for each ultrasound, each examination. Resmija said, “I am informed that examinations are free during pregnancy. Once I told that to the doctor, but he said it was not true, it was made up by the state, and even charged 400 denars for swabs.” She said that she contacted with other pregnant women who said they were charged the same price. Still, she as the others did not change the chosen gynecologist. She said that she had a normal and an easy pregnancy. In hospital, she did not pay a denar for the delivery and found this measure to be a good one, especially for those being poor. Lidija K. from Skopje shared a similar experience from the chosen gynecologist. She said that it was her second pregnancy. She explained that she paid 300 denars for the first ultrasound to determine pregnancy. She had doubts whether or not to mention to the gynecologist that the examination is to be free. In addition, she felt shame, and also a fear that he will get revenge and will not monitor the pregnancy with full attention. Afterwards, she had two additional ultrasounds done on her own initiative and also paid per 300 denars for those.

Lidija said, “Still, I was not charged for the microbiological check-ups i.e. swabs, maybe because I had additional ultrasounds.” She added that she was not charged for blood and urine tests in the laboratory where she was administered by the chosen gynecologist.

A good example of visiting a chosen gynecologist during pregnancy is the case of 29-year-old Daniela Z. who is her 12th week of pregnancy. This is her first pregnancy and wanted, because her husband and she have been married for four years. Her problem is that she is employed in a private company in Kumanovo, but she does not receive a salary regularly, so she has no health insurance regularly.

Daniela said, “We wanted a child so much, and it happened, but I must confess it is in a very bad year because I do not have health insurance regularly. The salary is three months late, so I have no health insurance by default.”

She visited her chosen gynecologist immediately after she did the first test at home. Daniela said, “I was afraid that I will have to pay a large amount of money, but he said that pregnant women are not to pay for an examination. I did not expect that because I was charged 850 denars for a Pap test during the previous regular check-up.”

She said that she had the first blood and urine tests done and she was not charged in the laboratory having a contract with the Health Insurance Fund. After a week, she had an ultrasound to check heartbeat of a fetus and she did not pay for it to the chosen gynecologist. Also, the patronage nurse gave her folic acid and iodine tables for the first three months. But, she said that she took pills previously from some pharmaceutical company and paid for those 120 denars privately in pharmacies.

Daniela said, “Every visit of a doctor started by borrowing money from my husband’s parents, because we were afraid of being asked money. But, I must underline that I am pleasantly surprised by free examinations and tests which are obligatory in this period of a pregnancy.”

Daniela is one of the rare good examples when a chosen gynecologist did not charge a denar for examinations during pregnancy, as it is a legal liability, in contrast to Resmija and Lidija who said they paid chosen gynecologists for the examinations. Both added that official services have to take stricter controls and to check how chosen gynecologists acknowledge legal liabilities, especially in the field of examinations of pregnant women.

Free gynecological and microbiological examinations for pregnant women, biochemical analyses including delivery, advising of pregnant women when being visited by patronage nursing service, giving advice and one free gynecological examination for women of Roma ethnicity are some of the measures introduced by the Ministry of Health in November 2015.