Indicators of the Effectiveness of the Health Care Financing System in the Western Balkan Countries-Critical Analyze

VOJNOSANITETSKI PREGLED VOJNOMEDICINSKA AKADEMIJA Crnotravska 17, 11 000 Beograd, Srbija Tel/faks: +381 11 2669689 [email protected] ACCEPTED MANUSCRIPT Accepted manuscripts are the articles in press that have been peer reviewed and accepted for publication by the Editorial Board of the Vojnosanitetski Pregled. They have not yet been copy edited and/or formatted in the publication house style, and the text could still be changed before final publication. Although accepted manuscripts do not yet have all bibliographic details available, they can already be cited using the year of online publication and the DOI, as follows: article title, the author(s), publication (year), the DOI. Please cite this article INDICATORS OF THE EFFECTIVENESS OF THE HEALTH CARE FINANCING SYSTEM IN THE WESTERN BALKAN COUNTRIES- CRITICAL ANALYZE POKAZATELЈI EFIKASNOSTI SISTEMA FINANSIRANJA ZDRAVSTVENE ZAŠTITE U ZEMLЈAMA ZAPADNOG BALKANA-KRITIČKA ANALIZA Authors Vladislava Stojić*, Dr Jevto Eraković†, Dr Nela Eraković‡,Vojnosanitetski pregled (2020); Online First April, 2020. UDC: DOI: https://doi.org/10.2298/VSP191107046S When the final article is assigned to volumes/issues of the Journal, the Article in Press version will be removed and the final version appear in the associated published volumes/issues of the Journal. The date the article was made available online first will be carried over. 1 INDICATORS OF THE EFFECTIVENESS OF THE HEALTH CARE FINANCING SYSTEM IN THE WESTERN BALKAN COUNTRIES-CRITICAL ANALYZE POKAZATELЈI EFIKASNOSTI SISTEMA FINANSIRANJA ZDRAVSTVENE ZAŠTITE U ZEMLЈAMA ZAPADNOG BALKANA-KRITIČKA ANALIZA Vladislava Stojić*, Dr Jevto Eraković†, Dr Nela Eraković‡ *University of Kragujevac, Serbia, Faculty of Medical Sciences †Clinic of Neurology, Clinical Center of Montenegro, Montenegro ‡Institute for Blood Transfusion of Montenegro, Montenegro USTANOVE I AFILIJACIJE University of Kragujevac, Serbia, Faculty of Medical Sciences Clinic of Neurology, Clinical Center of Montenegro, Montenegro Institute for Blood Transfusion of Montenegro, Montenegro Correspondent to: Vladislava Stojić, University of Kragujevac, Faculty of Medical Sciences, Svetozara Markovića 69, 34000 Kragujevac, Serbia. E-mail: [email protected] 2 Abstract Background/Aim. The main objective of the health system is to preserve and improve the general level of health of the population. Every country is making considerable efforts to ensure a sustainable health care financing system that would enable the qualitative realization of basic social security rights, rights to health care. The aim of the research is to determine the difference between the health system and the concepts of financing through the critical analysis of the system/model and indicators of financing health care in the Western Balkan countries. Methods. An overview of the current state of the health care system in the Western Balkan countries will be based on data collected from sources such as the World Bank, World Health Organization, UNDP reports, health ministries, finance ministries and statistical institutes of all countries in the analysis. Following the classification of the data, some categories were created to identify differences and similarities between the funding methods used in the Western Balkan countries. The analysis will be performed by measuring the effect of healthcare funding on variables by measuring performance. Because it is impossible to measure the relationship between variables in a single regression analysis model, several regression functions are used in the study to accurately determine the relationship results. Results. The two indicators: a total expenditure on health services and institutions as a percent of GDP, and health expenditure per capita shows weak positive correlation (p = 0.3) indicating that a higher amount of GDP per capita does not have a positive impact on the percentage of health expenditure in the Western Balkan countries observed. Despite differences in expenditures, all countries have a relatively similar funding method with different regulation that has impact on effectiveness of health system and resources used. Conclusion. The health sector in the Western Balkans is characterized by a lack of adequate administrative resources, legislation and regulations, as well as significant constraints in securing the necessary budget. Considering the resources devoted to the health sector in the Balkan countries, it can be said that the authorities in these countries do not see the health system as an important pillar of the country's development, as they do not devote sufficient financial resources to ensure the functioning of the health system. Key words: health care, financing, indicators, Western Balkan 3 Apstrakt Uvod/Cilj. Glavni cilј zdravstvenog sistema je očuvanje i pobolјšanje opšteg nivoa zdravlјa stanovništva. Svaka država ulaže značajne napore da osigura održiv sistem finansiranja zdravstvene zaštite koji bi omogućio kvalitativnu realizaciju osnovnih prava na socijalno osiguranje, tj. prava na zdravstvenu zaštitu. Cilј istraživanja je utvrditi razliku između sistema i koncepata finansiranja kritičkom analizom sistema/modela i pokazatelja finansiranja zdravstvene zaštite u zemlјama Zapadnog Balkana. Меtоdе. Prеglеd trеnutnоg stаnjа sistеma zdrаvstvеnе zаštitе u zеmlјаmа Zаpаdnоg Bаlkаnа zаsnivаćе sе nа pоdаcimа prikuplјеnim iz izvоrа kао štо su Svеtskа bаnkа, Svеtskа zdrаvstvеnа оrgаnizаciја, izvеštајi UNDP-а, ministаrstavа zdrаvlја, ministаrstavа finаnsiја i zаvоda za statistiku svih analiziranih zеmаlја. Nаkоn klаsifikаciје pоdаtаkа, kreirane su nеkе kаtеgоriје dа bi sе identifikovale rаzlikе i sličnоsti izmеđu metoda finаnsirаnjа u zеmlјama Zаpаdnоg Bаlkаnа. Аnаlizа ćе sе izvršiti mеrеnjеm efekata finаnsirаnjа zdrаvstvеnе zаštitе nа prоmеnlјivе mеrеnjеm učinka. Kаkо је nеmоgućе izmеriti оdnоs izmеđu prоmеnlјivih u јеdnоm mоdеlu regresione аnаlizе, u studiјi sе kоristi nеkоlikо regresionih funkciја kаkо bi sе tаčnо utvrdili rеzultаti оdnоsа. Rеzultаti. Dvа pоkаzаtеlја: ukupni izdаci zа zdrаvstvеnе uslugе i ustаnоvе kао prоcеnаt BDP-а, i zdrаvstvеni izdаci pо glаvi stаnоvnikа pоkаzuјu slаbu pоzitivnu korelaciju (p = 0,3), štо ukаzuје dа vеći iznоs BDP pо glаvi stаnоvnikа nеmа pоzitivаn uticај nа prоcеnаt trоškоva zа zdrаvstvо u posmatranim zеmlјаmа Zаpаdnоg Bаlkаnа. Uprkоs rаzlikаmа u trоškоvimа, svе zеmlје imајu rеlаtivnо sličnе nаčinе finаnsirаnjа sа rаzličitоm rеgulаtivom kоја utičе nа еfеktivnоst zdrаvstvеnоg sistеmа i rеsursa kојi sе kоristе. Zаklјučаk. Zdrаvstvеni sеktоr nа Zаpаdnоm Bаlkаnu kаrаktеrišе nеdоstаtаk аdеkvаtnih аdministrаtivnih rеsursа, zаkоnоdаvstvа i prоpisа, kао i znаčајnа оgrаničеnjа u оsigurаvаnju pоtrеbnоg budžеtа. Uzimајući u оbzir rеsursе pоsvеćеnе zdrаvstvеnоm sеktоru u zеmlјаmа Zаpаdnоg Bаlkаnа, mоžе sе rеći dа vlаsti u tim zеmlјаmа nе vidе zdrаvstvеni sistеm kао vаžаn stub rаzvоја zеmlје, јеr nе izdvајајu dоvоlјnо finаnsiјskih srеdstаvа zа оsigurаnjе funkciоnisаnjа zdrаvstvеnоg sistеmа. Klјučne reči: zdravstvena zaštita, finansiranje, pokazatelji, Zapadni Balkan 4 Introduction Modern health care systems differ the most in the methods of raising funds for health care, as well as in the payment methods of health care providers. Health care costs vary from country to country depending on its development. They are measured by the issue of per capita health supplies or as a percentage of total national income. The sources of financing the health care system are: state budget - general and specific taxes, insurance fund - compulsory health insurance (contributions), voluntary/private insurance (insurance premiums), participation (personal participation of the health insurer in the costs of using the health service), full price of the service (private practice) and donations and voluntary contributions from institutions, groups and individuals. The issue of defining healthcare financing involves not only the method of payment, but also the persons contributing to its payment, how the beneficiaries and providers are involved in the transaction and how much is spent on healthcare. Consequently, the way the health sector is financed is quite sensitive, as it can be a deciding factor for the various implications of the overall health care system. The health care system must provide physically, geographically and economically accessible, integrated (vertical connection of primary, secondary, tertiary level and horizontal connection in the system and in relation to the local community) and high quality health care (continuous improvement of the quality of health care and the right of beneficiaries’ physician choice and awareness), personal development of employees working in a health care system, sustainability of financing, decentralization of management and financing of health care, and placement of citizens at the center of the healthcare system end protection. Given the demographic trends present throughout Europe, including the countries of the Western Balkan, and especially the increase in the proportion of the elderly, it is a fact that a larger number of individuals require some health care. Also, the advancement in the field of medicine requires the application of new and more expensive treatments, including new medicines and modern equipment. All this implies, in the long run, an increase in costs and the need for greater investment in the health care system. The healthcare system in the Western Balkan countries is currently facing a number of issues related to health care financing. In particular, some of

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