No. 07-00-110/2026-02   Date: 25.2.2026.

REPUBLIC HEALTH INSURANCE FUND

Sanja Radojević – Škodrić, Acting Director

11040 Belgrade

2 Jovana Marinovića Street

Dear Ms. Radojević – Škodrić,

An association addressed the Commissioner for the Protection of Equality, by way of a request submitted on behalf of a large number of citizens living with diabetes, concerning unequal treatment in the exercise of the right to sensors for continuous glucose monitoring, as well as the consequences that such practice has for public health and the healthcare system as a whole. As stated in the letter of the Diabetes Association, although modern medical standards and recommendations of relevant international professional bodies recognize continuous glucose monitoring as a fundamental tool for safe and effective diabetes management, in practice the right to these sensors is restricted on the basis of age or administrative criteria, rather than on the basis of patients’ actual medical needs. The association particularly pointed to the following problems:

– The right to sensors is predominantly linked to children and youth, while adults with long-standing diabetes and developed complications are denied this right;

– Patients with the longest duration of the disease are precisely those at the highest risk of severe and costly complications, yet they are left without modern devices that have been proven to reduce the number of hypoglycemic episodes, hospitalizations, and emergency interventions;

– Recommending sensors that are not included on the RFZO list shifts the financial and health risk entirely onto patients and their families, thereby further deepening social and health inequalities.

According to the association, such practice does not only constitute a violation of patients’ rights and discrimination on the grounds of health status, but is also inefficient from the perspective of public policy and healthcare system management. Namely, numerous studies and the experience of other healthcare systems show that timely and continuous diabetes management is significantly less costly for society than treating the secondary consequences of poorly controlled disease, such as: cardiovascular complications; renal failure and dialysis; amputations; loss of working capacity and disability; frequent hospitalizations and emergency interventions. In other words, denying sensors to those who need them most does not lead to savings, but rather to the postponement of costs that later arise on a much larger scale, placing an additional burden on both the healthcare system and the budget. According to further statements by the Diabetes Association, in addition to direct health and fiscal costs, the deterioration of the condition of persons with diabetes produces a significant invisible burden in the sphere of social reproduction, as care, assistance, and supervision are shifted onto family members, most often women, outside the institutional support system. Such a transfer of responsibility from public institutions to the private sphere leads to a loss of work productivity, an increase in unpaid labour, and long-term social instability, making this practice harmful not only for individuals but for society as a whole. As further indicated in the Association’s communication, combating discrimination in the field of healthcare has long-term positive effects on society as a whole: it increases public trust in institutions, improves health outcomes, reduces social disparities, and strengthens the principle of equal access to healthcare as a foundation of the public interest. It is particularly concerning that persons with the most severe forms of the disease, for whom continuous glucose monitoring is most necessary, are systematically placed in a less favorable position, thereby calling into question the very purpose of preventive healthcare policy. The association calls on the competent institutions to:

– Review the criteria for exercising the right to sensors through the RFZO and ensure their provision in accordance with medical needs and risk assessments, rather than base eligibility solely on age or administrative constraints;

– Ensure that only sensors with valid international certifications and evidence of safety and effectiveness are included on the list of approved aids;

– Prevent the practice of shifting financial and legal responsibility onto patients in cases where devices not included on the RFZO list are recommended to them;

– Provide clear and transparent information to the public on patients’ rights, decision-making criteria, and mechanisms for protection against discrimination.

The association emphasized that diabetes is not a personal choice, and that modern therapy and medical devices must not be a privilege, but rather an investment in public health, the reduction of future costs, and the preservation of patients’ dignity.

In accordance with the Law on the Prohibition of Discrimination,^[1] the Commissioner for the Protection of Equality is mandated to monitor the implementation of laws and other regulations and to initiate the adoption or amendment of regulations with a view to improving equality and protection against discrimination, as well as to issue recommendations of measures to public authorities and other entities, based on the identified situation, for the purpose of achieving equality and protection against discrimination.

As you are aware, the Constitution of the Republic of Serbia^[2] prohibits any discrimination, direct or indirect, on any grounds, and in particular on the grounds of race, sex, national affiliation, social origin, birth, religion, political or other belief, property status, culture, language, age, mental or physical disability. The constitutional prohibition of discrimination is further elaborated in the Law on the Prohibition of Discrimination, which stipulates in Article 2 that an act of discrimination means any unjustified distinction, unequal treatment, or omission (exclusion, restriction, or preferential treatment) toward individuals or groups, as well as their family members or close associates, whether overtly or covertly, based on race, skin color, ancestry, citizenship, national or ethnic origin, language, religious or political beliefs, sex, gender, gender identity, sexual orientation, sex characteristics, income level, financial status, birth, genetic characteristics, health status, disability, marital and family status, criminal record, age, appearance, membership in political, trade union, or other organizations, or any other actual or presumed personal characteristics^[3].

Pursuant to Article 6 of this Law, it is prescribed that direct discrimination exists if a person or a group of persons, due to their personal characteristic, in the same or a similar situation, by any act, action, or omission, are placed, or have been placed, in a less favorable position, or could be placed in a less favorable position. By the provisions of Article 27, discrimination against a person or a group of persons on the basis of their health status is prohibited, while the provisions of Article 23, Paragraph 1 and 2 of this Law prescribe the prohibition of discrimination against persons on the basis of age, with the indication that elderly persons have the right to dignified living conditions without discrimination, and in particular, the right to equal access and protection from neglect and harassment in the use of healthcare and other services.

The Law on Healthcare^[4] prescribes the principles of healthcare, among which is the principle of respect for human rights and values. This principle stipulates that, in healthcare, it includes, among other things, ensuring the highest possible standard of human rights and values in the provision of healthcare, primarily the right to life, the inviolability of physical and mental integrity, and the inviolability of human dignity (Article 20). The provisions of Article 21 prescribe the principle of fairness in healthcare, which implies the prohibition of discrimination in the provision of healthcare on the grounds of race, sex, gender, sexual orientation, gender identity, age, national affiliation, social origin, religion, political or other beliefs, financial status, culture, language, health status, type of illness, mental or physical disability, as well as any other personal characteristic that may be a cause of discrimination.

Article 3 of the Law on Patients’ Rights[5] prescribes that a patient is guaranteed equal right to quality and continuous healthcare in accordance with their health condition, generally accepted professional standards, and ethical principles, in the best interest of the patient, and with respect for their personal views. Furthermore, Article 6 of the same Law defines that, in the process of accessing healthcare, the patient has the right to equal access to healthcare services, without discrimination based on financial capabilities, place of residence, type of illness, time of access to healthcare services, or any other difference that may be a cause of discrimination. Finally, Article 8, Paragraph 1 of the Law prescribes that the patient has the right to appropriate healthcare services for the preservation and improvement of health, prevention, suppression, and early detection of diseases and other health disorders, while Article 10, Paragraph 2 prescribes that the healthcare institution is obligated to ensure safety in the provision of healthcare, as well as to continuously monitor risk factors and take measures to reduce them, in accordance with the regulations governing the area of quality in healthcare. Supervision over the implementation of this Law is carried out by the ministry responsible for health affairs.[6]

The Public Health Strategy of the Republic of Serbia for 2018–2026[7] aims to enable people to achieve their full health potential and equity in health. One of the Strategy’s objectives is to improve health and reduce health inequalities. As specific measures, the Strategy plans to enhance the health of vulnerable social groups through the development and implementation of additional measures to reduce health inequalities, as well as to ensure equal availability and accessibility of healthcare services for the entire population.

The right to health is one of the fundamental human rights; however, members of groups at increased risk of discrimination face limited access to healthcare services due to a combination of various factors, as stated in the Strategy for the Prevention and Protection Against Discrimination for the period from 2022 to 2030. For instance, older women more frequently report difficulties in accessing healthcare services, particularly those living in rural areas.

In the regular Annual Report of the Commissioner for the Protection of Equality for 2024,^[8] it was noted that health status was the third most frequent ground for discrimination, and that this ground is often cited in combination with another personal characteristic, most commonly age, but also disability, sex, and others. When it comes to areas of social life, the majority of complaints regarding discrimination based on health status were submitted in the field of healthcare. The Commissioner’s practice is diverse and highlights various issues in the provision of healthcare. Some of the complaints and other citizen submissions pertained to difficulties in exercising the right to emergency medical care. Citizens reported that assistance was not provided in a timely manner, or was not provided at all, because the individual was elderly, because the location was a remote rural area, an informal Roma settlement, etc. Although in most cases there was no violation of the rights under the Law on the Prohibition of Discrimination, the Commissioner’s practice indicates that regulations in this area need to be improved to ensure the provision of adequate and timely assistance across the entire territory of the country.

In the aforementioned report, the Commissioner pointed out that the issues in this area also relate to the criteria for prescribing certain medications covered by the budget, which the Commissioner has repeatedly addressed to the Republic Health Insurance Fund during 2024 and in previous years. The report emphasizes that past practice shows that the Fund thoroughly and comprehensively considers all recommendations and initiatives of the Commissioner and accepts and implements them at a high rate.

In light of the Fund’s previous activities and its responsiveness to the Commissioner’s recommendations and initiatives in finding adequate solutions and ensuring accessible and available healthcare, we are addressing you with an initiative to consider the aforementioned suggestions of the Association, which would contribute to improving the position of persons living with diabetes.

We kindly request that you inform us of the actions taken following this submission and the conducted analysis.

[1] “Official Gazette of the Republic of Serbia,” Nos. 22/09 and 52/21, Article 33, Paragraph 1, Item 7, in relation to Item 5.

[2] “Official Gazette of the Republic of Serbia,” Nos. 98/06 and 115/21

[3] “Official Gazette of the Republic of Serbia,” Nos. 22/09 and 52/21, Article 2, Paragraph 1, Item 1.

[4] “Official Gazette of the Republic of Serbia,” Nos. 25/19, 92/23 – authentic interpretation and 29/25 – decision of the CC

[5] “Official Gazette of the Republic of Serbia,” Nos. 45/2013 and 25/2019 – other law

[6] Law on Patients’ Rights “Official Gazette of the Republic of Serbia,” Nos. 45/2013 and 25/2019 – other law), Article 48.

[7] “Official Gazette of the Republic of Serbia,” No. 61/18

[8] https://ravnopravnost.gov.rs/izvestaji/

COMMISSIONER FOR THE PROTECTION OF EQUALITY

Milan Antonijević