Public healthcare in Bosnia and Herzegovina is financed mainly through mandatory health insurance, while the share of budgetary resources (municipal, cantonal, entity, and state budgets) in it is very low. Health care in Bosnia and Herzegovina is overburdened, and if citizens need a routine examination, they must be prepared to wait all day, and wait for months, even for the simplest of services.
The pressing issue in public health is corruption.
” Our healthcare is facing a pronounced problem with corruption, precisely due to the fact that health is literally a “matter of life and death”, and that, as the citizens themselves are aware, those who provide an answer to that question are not satisfied with the system of financial rewards for their work. Citizens are not willing to report corruption, and, in health care, it rarely occurs in the form of a direct extortion of a bribe, but rather through the tacit (implicit) actions of the medical staff, the patient or the family is “made aware” that a bribe is necessary,” according to the study of the Centre for Policy and Governance (CPU).
One of the pressing issues is also the immigration of doctors and medical staff to Western European countries, mostly Germany.
“There are no accurate records on doctors who left Bosnia and Herzegovina. According to the data provided by Harun Drljević, the president of the Medical Chamber of the Federation of Bosnia and Herzegovina, 267 doctors left our country in 2018 alone, and 362 left it in 2017, just from the territory of the Federation of Bosnia and Herzegovina,” the CPU study states.
For these and other reasons, citizens are increasingly turning to private healthcare institutions. The role of the private healthcare system was also discussed at the round table titled “The role of the private health sector in the healthcare system of BiH”, within the 13th day of BHAAAS in BiH, organized by the Bosnian-Herzegovinian-American Academy of Arts and Sciences.
Minister of Health of the Sarajevo Canton prof. Ph.D. Haris Vranić said that it is extremely important to establish a public-private partnership between the public and private healthcare sectors, especially in the segments where there is a deficit in the services to which the public healthcare cannot respond to.
“Along with the public-private partnership, I hope that the public healthcare will ‘wake up’ and join the game and race to provide better services and thus attract patients.” When you attract patients, then you logically attract money to those institutions,” said Minister Vranić.
Director of the Health Insurance Institute of Sarajevo Canton, M.Sc. of Economics Muamer Kosovac said that the private sector as a whole has a significant role in the health system, although in terms of the funds of the Health Insurance Institute, more than 90 percent of the funding goes to the public healthcare institutions.
“There is a number of regulations, laws and by-laws that regulate this. By law, the private and public healthcare sectors have the same treatment, and the partnership between the private and public sectors is very important. The private sector has simplified procedures, there are no formal – legal barriers. Let’s say that, they don’t have to act according to the Law on Public Procurement, and they are more operative in achieving their mission,” said Kosovac.
Macroeconomic analyst dr. sci. cand. Faruk Hadžić said that, it is of great importance, that in the future, the role of the private health sector must be greater, due to the reason that, in some way, there might be a reduction in payments through contributions to public healthcare in general, due to the problems we have with the emigration of the population.
“So we definitely have to look for new ways to finance healthcare in Bosnia and Herzegovina,” Hadžić believes.
Assoc. Ph.D. Rasim Jusufović, from the Department of Health Economics of the Faculty of Medicine SSST in Sarajevo and the director of the ASA Hospital Sarajevo project, said that in the transition of the healthcare system, which is unquestionable andahead of us, in which we are already far behind, compared to neighboring countries, the private healthcare system can play a significant role.
According to him, the agility of the private healthcare system gives it the ability to be much faster and more flexible, in terms of the overall healthcare system, especially in the area of promoting healthy lifestyles and health prevention.
“I think this is an area where the private healthcare system can play a key role. On the other hand, in situations with large costs due to the increase in the price of the high-tech advanced instruments, equipment, pharmacotherapy, etc., I think that the healthcare technology assessment, pharmacoeconomics, as a science and profession that can keep all these costs under control, should be exploited in a slightly better way,” Jusufović said.
He added that the private health sector has a certain advantage in that field, due to its agility, 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 healthcare system.