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Healthcare Financing
After the split of former Yugoslavia, the Republic of Serbia, as well as other ex-Yugoslav countries, inherited healthcare system based on universal health coverage. It is financed by compulsory health insurance contributions from the National Health Insurance Fund. Insured in the health care system can be divided into two groups: the a) citizens who have income and therefore have a legal obligation to pay contribution and b) people without income or whose income is less than the established threshold, and whose insurance is funded from the budget of the Republic of Serbia from the contributions of employees. Private health insurance exists in supplementary form (covers faster access and enhanced consumer choice).
Financing of hospitals in Serbia is based on DRG system while primary health care is based on capitation. Health care of the population is directly provided through a network of health care institutions and divided to three levels: primary, secondary and tertiary health care.
Giving a chance to all citizens to access the health care is one of the characteristics of all post-communistic countries, regardless of social status. Poor quality of services that patients are facing is caused by lack of adequate devices and/or facilities. Serbian healthcare system (SHCS) has been severely under-funded for many years and consequently the standard of available healthcare has poor quality.
Health care for the population is directly provided through a network of health care institutions and depends on the level of organisational and operational development. In general, there are three levels of health care: primary, secondary and tertiary.
Health care at the primary level is provided by state-owned primary health centres, which cover the territory of one or more municipalities or towns. The primary health centre shall provide at least:
- preventive health care for all population categories
- urgent care
- general medicine
- health care for women and children
- health visitor service
- laboratory and other diagnostics
- prevention and treatment in dental care
- employee health care, i.e. occupational medicine
- physical medicine and rehabilitation
Primary health care in primary health centres is publicly provided by a chosen doctor who is either a medical doctor or a specialist in general medicine, or specialist in occupational medicine; specialist in paediatrics; specialist in gynaecology; and dentist (Article 98 of the Act on Health Care). General practice is a service within a primary health centre and the basic provider of health care for population over 19 years. According with the evidence, in 2011 in Serbia there were 157 primary health care centres.
If the primary health centre is unable to provide adequate health care the general practitioner will refer the patient to the specialist and secondary health care (hospitals). Each patient can get needed treatment in one of 77 general or special hospitals in Serbia. It might be outpatient treatment (medical check-up in the clinic) or inpatient treatment.
The tertiary level of health care has the highest specialized personnel and technological equipment and provides quality diagnostic and treatment. Thus, this level cooperates closely with the secondary level by providing technical assistance and support, engage in research and activities of medical education (Clinic Research Institute, Clinical Hospital Centre, Clinical Centre).
The Health Insurance Fund (HIF) operates and oversees the health service in Serbia. The aim of the organisation is to make the health system equal for every citizen regardless of their status. The state fund covers most medical services including treatment by specialists, hospitalisation, prescriptions, pregnancy, childbirth and rehabilitation trough health centres and smaller health stations.
Bismarck healthcare system model reflects publicly provided healthcare system financed through social healthcare insurance. National Health Insurance Fund (RZZO) of Serbia covers recurrent expenditure through input based provider payments. In 2010, majority of RZZO funding (income) originated from two major sources: 69.48% came from the employment contributions and 29.01% from the pension plan contributions (Zah, 2011).
Private health insurance exists in supplementary form (covers faster access and enhanced consumer choice).
Financing of hospitals in Serbia is based on DRG system while primary health care is based on capitation. In some special fields (such are dialysis, in vitro fertilization and hyperbaric chamber) private hospitals are hired to provide medical service to the patient based on the financial contract between hospitals as providers and the National Health Insurance Found. This is seen as a good example of involving private sector in the reduction of long waiting lists in Serbia.
