we explore the key challenges facing the process of modernising the Serbian health system, including decentralisation, fragmentation, corruption and the lack of a transparent and comprehensive system for health technology assessment.

1. Modernising the Serbian health system
Future improvements
SOURCES: Eurostat; Health Policy Institute; IMS Health; Serbian Association of the Manufacturers
of 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’s
public healthcare system, but progress on HTA has been slow. Serbia wants to join the EU by 2020
Healthcare covered under Chapter 28 (consumer and
health protection) in accession negotiations. Serbia has
recently joined the EU’s health programme for 2014-20,
which, among other things, seeks to contribute to
innovative, efficient and sustainable health systems.
Serbia encapsulates many of the health challenges facing less developed Balkan countries.
Itshealthcaresystemisdecentralisedandfragmentedinplaces,andlevelsofout-of-pocket
payments and corruption are high. The country lacks a transparent and comprehensive
system of assessing the value of its healthcare investments and determining how to pay
for them. All of these issues undermine access to healthcare and contribute to relatively
poor health outcomes.
SERBIA
BOSNIA & HERZEGOVINA
SLOVENIA
BULGARIA
CROATIA
REPUBLIC OF MACEDONIA
MONTENEGRO
ALBANIA
ROMANIA
10.4
9.6
9.2
8.4
7.8
6.5
6.4
5.9
5.6
Healthcare spending as % of GDP
The key problems Major concerns about corruption in healthcare, the public health
fund and the process of evaluating new health technologies
Lifeexpectancyanddeathrates
Poor financial situation
of the public health
fund undermines the
sustainability of the
healthcare sector.
Absenceofasustainable,comprehensive
and 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 Technology
Assessment (EUnetHTA).
Issues with corruption:
out-of-pocketspending
mostly in the form of “informal”
co-payments, estimated to be
36.6% of total
healthcare expenditure.
The consequences Weak patient access to healthcare
Access to medications in Serbia is restricted Patientsarenotgettingthecaretheyneed
Example: justBetween 2010 and 2012 justoneofthe139
new medicines to receive market authorisation was
approved for reimbursement in Serbia,
compared with 44 in Bulgariaand 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 expectancy
at birth is more than
5yearsshorter
than in EU
(2013 data).
Serbian standardised
death rate from cancer is
50%higher
thaninEU
(2012 data).
Efforts to improve healthcare efficiency, quality and
health technology assessment need to be stepped up