Healthcare – a business sector that is measured in billions

An interesting overview of the healthcare sector in Bosnia and Herzegovina is brought to us by Bloomberg Adria with an article on “Healthcare – a business sector that is measured in billions”.

The Director of the ASA Hospital project, Doc. dr. sci. Rasim Jusufović. On that occasion, he emphasized that in the transition of the health system, which is unquestionable and which is ahead of us, in which we are galloping compared to neighboring countries, the private health system can play a significant role and, in partnership with the public sector, contribute to the strengthening of the health system in Bosnia and Herzegovina.

 

Healthcare is a “difficult” sector in Bosnia and Herzegovina worth several billions, but fraught with problems and chronic dissatisfaction of service users. Private initiative is looking for its opportunity there, and it is realistic to expect that part of the sector to be a solution to part of the problem.

Although health care in BiH is formally based on the principles of solidarity, comprehensiveness, continuity, efficiency, availability and comprehensive access, it is evident that the possibility of access to health services, as well as their quality, are not equal throughout BiH. The use of medical services is especially difficult for those who live outside of large health centers, and obtaining health services in certain areas is made impossible by the inadequate equipment of the institutions, as well as the lack of professional staff.

Health care at a bad level

All analyzes show that health care in Bosnia and Herzegovina is at a very poor level, and that even for routine checkups, you have to wait for hours, and for specialist checkups, you have to wait for months. Also, the question arises as to how long such a system will be sustainable. After all, health institutions are the places where cases of corruption most often occur.

“Precisely due to the fact that health is literally a ‘matter of life and death’, and that those who answer that question are not satisfied with the system of financial rewards for their work, and that the citizens themselves are aware of this, our healthcare is facing a pronounced problem of corruption. Citizens are the least willing to report it, and corruption in health care is rarely a direct extortion of a bribe, but through tacit (implicit) actions of the medical staff, the patient or family is ‘made aware’ that a bribe is necessary,” according to the study of the Center for policies and management (CPU).

A special problem is the departure of doctors and medical personnel to Western European countries, mostly to Germany.

“There is no accurate record of doctors who left Bosnia and Herzegovina. According to the data of Harun Drljević, president of the Medical Chamber of the Federation of Bosnia and Herzegovina, 267 doctors left our country in 2018 alone, and 362 in 2017, from the territory of the Federation of Bosnia and Herzegovina,” the CPU study states.

It is for this reason that a more significant role must be given to the private sector, which is why it is necessary to reform the method of financing.

“Private and public health sector in the Federation of Bosnia and Herzegovina and Sarajevo Canton are completely legally equal and their main role is treatment and provision of health care. The key difference between these two sectors is the method of financing, that is, the fact that the private health sector invests its own material resources for the procurement of health equipment and staff payment, while the public sector does it from public funds, should be taken into account. By introducing the private health sector into the health system itself, certain shortcomings of the public sector can be replaced, i.e. achieve that these two parts complement each other in terms of a better response to the provision of adequate medical services to our citizens,” Adria  Haris Vranić told Bloomberg, Minister of Health KS.

The private sector can replace certain shortcomings of the public sector, says Vranić/Facebook

Economic analyst Faruk Hadžić said at the round table ‘The role of the private health sector in the healthcare system of Bosnia and Herzegovina’ that it is very important that the role of the private health sector be greater in the future, for the reason that payments through contributions to public health in general may be reduced in some way. because of the problems we have with population emigration.

Asst. Ph.D. Rasim Jusufović from the Department of Health Economics of the Faculty of Medicine SSST in Sarajevo, the director of the ASA Sarajevo Hospital project, said that in the transition of the health system, which is unquestionable and which is ahead of us, in which we are galloping compared to neighboring countries, the private health system can play an important role role.

According to him, the agility of the private healthcare system gives it the ability to be much faster and more flexible when we talk about the overall healthcare system, especially in the area of ​​promoting healthy lifestyles and health prevention.

The private healthcare system is faster and more flexible, says Jusufović/ASA

“I think this is an area where the private healthcare system can play a key role. On the other hand, where there are large costs due to the increase in the cost of high-tech advanced instruments, equipment, pharmacotherapy, etc., I think that the assessment of health technologies, pharmacoeconomics as a science and a profession that can keep all these costs under control, should be exploited for a little better way,” Jusufović said.

He added that the private health sector has a certain advantage in that field, because it is agile, decisions are made faster because the administrations are smaller and simply the private health system is not subject to public procurement tenders, which slow down and destroy the agility of the public health system.

“There is great potential hidden in the private healthcare sector and there are unlimited opportunities for its development in the area of ​​Sarajevo Canton. Cooperation between the public and private health sectors would create the conditions for better, faster and more efficient provision of health services to insured persons of Sarajevo Canton, which is the ultimate goal and task of the Ministry of Health of Sarajevo Canton,” said Minister Vranić.

According to the data of the BiH Statistics Agency, in 2020, the total expenditures in healthcare in BiH amounted to three billion and 384 million KM, of which 71 percent were public and 29 percent private expenditures.

Public healthcare in Bosnia and Herzegovina is financed mainly from mandatory health insurance, while the share of budgetary funds in public healthcare is very low (municipal, cantonal, entity, and state budgets).

“Almost all private consumption (99 percent) falls on direct household expenditures, while only a small part of private consumption (one percent) goes to voluntary payment of health care. Direct household expenditures, i.e. out-of-pocket payments, include formal and informal payments. Formal payments include co-payments in public health services and co-payments for medicines, other direct payments to private health workers (dentists, specialists, diagnostics, purchase of glasses, etc.) and payments for non-prescription medicines and other therapeutic aids,” the press release states. Agencies.

In Bosnia and Herzegovina, healthcare spending is continuously growing. In 2016, the total spending on healthcare amounted to two billion and 759 million KM, which is about 624 million less than in 2020.

In 2020, in Bosnia and Herzegovina, more than half of the total spending on healthcare was spent on treatment and rehabilitation services, while one quarter of the funds were spent on medical resources. On preventive care, which includes programs of information, education and counseling, programs of immunization, early detection of diseases, monitoring of the health status of the population, epidemiological monitoring and control of the risk of diseases, and programs of preparation for responding to disasters in 2020, two percent of the total was spent funds for healthcare. The data also includes costs related to the Covid-19 pandemic (vaccination, costs related to PCR testing and contact tracing).

Hospitals are the largest providers of health care services in Bosnia and Herzegovina and account for about 38 percent of total spending on health care. The second largest provider of health care is outpatient clinics, with a share of about 28 percent of total health care spending. The share of retail and other providers of medical goods is also large, amounting to about 27 percent of total healthcare spending.

According to Dun&Bradstreet,there are 826 institutions (public and private) that provide health care services in BiH. The largest revenues are generated by public institutions, which is expected considering the way of financing.

Thus, the first five on the list earned 886.6 million KM last year and employed 13,611 people. The highest revenues in the amount of 265.3 million KM were achieved by the University Clinical Center in Sarajevo.

When it comes to private healthcare institutions, Medical Institute Bayer from Tuzla generated 17.2 million KM, PZU “Dr. Al Tawil” from Sarajevo 8.7 million KM, while in third place is ZU “Dr. Kandić”, which last year generated revenues in the amount of 7.5 million KM.

The International Dialysis Center (IDC) Banja Luka and the Center for Radiotherapy – IMC Banja Luka, established on the basis of a public-private partnership, earned 18.3 million KM and 13.7 million KM, respectively.