Healthcare in Bosnia and Herzegovina: A Complicated System

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SEATTLE, Washington — Bosnia and Herzegovina has changed a lot since the 1990s. The country continues to try to improve many aspects of life for its citizens, but unfortunately, there are still significant issues. The Balkan country still has much to improve on when it comes to education, GDP, and even healthcare.

Bosnia and Herzegovina’s History

Before the Bosnian War in 1992, Bosnia and Herzegovina was a part of Yugoslavia. Yugoslavia had a good healthcare system that provided the majority of people coverage. It also linked healthcare to the state, so almost the entire population received health insurance. Yugoslavia even had one of the lowest infant mortality rates at less than 15 births per 1,000 live births in the country.

The Bosnian War caused massive causalities for all the countries involved. Bosnia and Herzegovina lost more than 100,000 people with 80% being Bosniaks. After the Bosnian War, hospitals and healthcare in Bosnia and Herzegovina never entirely returned to normal. In 2001, only about 10-20% of patients were treated with primary healthcare, even though the healthcare plan was supposed to cover about 80% of the population. Today, within cities, most citizens have adequate healthcare coverage, but in rural areas, hospitals are few and far between. Hospitals are still largely underfunded and understaffed as well. Although the system has improved within the last two decades, healthcare in Bosnia and Herzegovina still needs further reform.

Statistics About Healthcare

Bosnia and Herzegovina currently has a population of more than 3 million people and it has been declining ever since the war ended in 1995. Additionally, Bosnia and Herzegovina’s life expectancy is increasing. Life expectancy is higher now than it was before the war at around 77 years.

Primary coverage, such as hospitals, takes up less than half of medical goods consumption for Bosnia and Herzegovina. In 2017, over half of the total $1.6 billion expenditures came directly from the public.

The Complicated Healthcare System

Healthcare in Bosnia and Herzegovina has drastically changed over the years. The country operated under a centralized system when it was part of Yugoslavia. Now, two main health care systems split Bosnia and Herzegovina. Those two factions are the Federation of Bosnia and Herzegovina and Republika Srpska.

There are 13 different subsystems of healthcare insurance in the Federation that provide three different levels of healthcare. Plus, two separate laws govern all of this. One law covers the medical side of healthcare while the other covers the legal side. Out of the 13 sub-systems, there are 10 cantonal health systems and one federal. For the 10 cantonal health systems, each canton is responsible for paying for the health of its citizens.

It is mandatory for everyone in Bosnia and Herzegovina to have healthcare coverage and insurance, but the government does not pay for that insurance. It mainly finances insurance through contributions by the people. In 2014, more than 90% of the revenue collected came from out-of-pocket expenses. Republika Srpska, on the other hand, has a more centralized healthcare system. It involves one ministry that handles finances and the business side while the second ministry handles medicine. However, similar to the Federation, Republika Srpska also funds its healthcare through contributions by the people.

Overall, healthcare in Bosnia and Herzegovina is not ideal. Citizens end up spending their own money on procedures that are often inadequate. In return, the government poorly funds its healthcare system. During the Bosnian War, many international agencies agreed Bosnia and Herzegovina was in need of help. Agencies sent over doctors, medicine and equipment that was lacking at the time. However, the main reasoning for the lack of proper care in the country is poor medical education. In response, humanitarian organizations are still present there, providing medical assistance and training for healthcare officials in the country. Although the situation has improved significantly since the end of the Bosnian War, there is still much to do.

– Hena Pejdah
Photo: Flickr

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