Modernising the Serbian health system

Future improvements

SOURCES: Eurostat; Health Policy Institute; IMS Health; Serbian Association of the Manufacturersof Innovative Drugs (INOVIA); World Bank; World Health Organisation.

Supported by

Second Serbia Health Project(approved by World Bank in 2014)

Efficiency improvements:

US$40m

capitation system in primary care & payment mechanisms based on diagnosis-related groups (DRGs) in hospital care.

The context Healthcare spending is not delivering the expected health outcomes

aims to improve the efficiency and the quality of Serbia’spublic healthcare system, but progress on HTA has been slow. Serbia wants to join the EU by 2020

Healthcare covered under Chapter 28 (consumer andhealth protection) in accession negotiations. Serbia hasrecently joined the EU’s health programme for 2014-20,which, among other things, seeks to contribute toinnovative, efficient and sustainable health systems.

Serbia encapsulates many of the health challenges facing less developed Balkan countries.Its healthcare system is decentralised and fragmented in places, and levels of out-of-pocketpayments and corruption are high. The country lacks a transparent and comprehensivesystem of assessing the value of its healthcare investments and determining how to payfor them. All of these issues undermine access to healthcare and contribute to relativelypoor health outcomes.

SERBIA

BOSNIA & HERZEGOVINA

SLOVENIA

BULGARIA

CROATIA

REPUBLIC OF MACEDONIA

MONTENEGRO

ALBANIA

ROMANIA

10.49.6

9.28.4

7.86.56.4

5.95.6

Healthcare spending as % of GDP

The key problems Major concerns about corruption in healthcare, the public healthfund and the process of evaluating new health technologies

Life expectancy and death rates

Poor financial situationof the public health

fund undermines thesustainability of thehealthcare sector.

Absence of a sustainable, comprehensiveand transparent system

to evaluate and procure new health technology.No national Health Technology Assessment (HTA)agency exists, and Serbia is not a member of the

European network for Health TechnologyAssessment (EUnetHTA).

Issues with corruption:out-of-pocket spendingmostly in the form of “informal”

co-payments, estimated to be

36.6% of totalhealthcare expenditure.

The consequences Weak patient access to healthcare

Access to medications in Serbia is restricted

Patients are not getting the care they need

Example: just Between 2010 and 2012 just one of the 139 new medicines to receive market authorisation was

approved for reimbursement in Serbia,

compared with 44 in Bulgaria and 27 in Croatia.

200-300 patients are getting prescribed treatment for

hepatitis C out of 2,000 potentially eligible (excluding new-generation drugs).

Serbian life expectancyat birth is more than

5 years shorterthan in EU(2013 data).

Serbian standardised death rate from cancer is

50% higherthan in EU(2012 data).

Efforts to improve healthcare efficiency, quality and health technology assessment need to be stepped up