Towards More Efficient Public Health Sector in Serbia
On May 10th 2005, PALGO Center organized, in cooperation with LGI/OSI Budapest, the International Conference on Public Health Reform, in Hotel Palace in Belgrade.
The morning session was dedicated to the issue of Decentralization of Health Care System in Serbia, while the afternoon session related to the Possibilities for Establishment of Financially Sustainable Health Care System in Serbia.
Professor Mijat Damjanovic, Director of PALGO Center greeted the guests and delivered the introductory note, and in the morning session the speakers were professor Snežana Simic, expert for health policy and planning (“Decentralization of the Health care System”, 2.3Mb), professor Ken Davey, LGI expert for public policy sector and Mr Silviu Radulescu (“Decentralization of Health Sector in Romania”), WB expert, Bucharest office. In the afternoon session the speakers were professor Tomica Milosavljevic, Minister of Health and Mrs. Svetlana Vukajlovic, Director of the Serbian Health Insurance Fund (“Financing of the Health Insurance System in Serbia”).
Conference Findings
Health Care System in Serbia – Discrepancy Between Wishes and Capacity
Decentralization is desired alternative to the centralized administration, alienated from the users, and incapable to properly provide services and satisfy existing needs.
The main advantages of the decentralized system are better health protection of the people, better allocation of resources. Inclusion of the community in the decision-making process regarding priorities in the health care system and fighting inequalities in health care.
One can not decentralize following: 1. Formulation of the basic framework of health policy; 2. Monitoring and analysis of the peoples’ health; 3. Strategic decisions on resource development (human resources in particular); 4. Legislation related to public security, including accreditation and licensing.
Health care system is still very centralized at the level of republic, all the public health institutions are being established sole by the Government, while Ministry of Health and Government are authorized to set the Directors of the public health institutions.
Existing strategic plans concerning health care policy in Serbia are: 1. Self-sustainable health care system, with sufficient transparency and selective decentralization in the field of allocation and usage of resources, and with extending of sources for financing the system; 2. Increased participation of the private, profit and non-for –profit sector in providing health care services; 3. Adoption of the system laws for effective decentralization in the sector.
Financing of the health Care System
The Health Insurance Fund provides resources for financing salaries of 127.000 employees in the health sector, and expenditures of 350 health institutions, as well as the funds for covering costs of drugs and medical materials for the insured people.
Health Insurance Fund has on its disposal 140 € per capita (total amount of available funds is 1,000.000.000 €)
Existing finance system does not provide neither satisfactory quality of health services nor rational usage of the available resources. The Fund is forced to finance more health facilities than it is normally needed for health care delivery.
„It is necessary to reform health care finance system, both in terms of implementation of insurance mechanisms (instead of financing the capacities, the services should be financed) and in terms of vesting of the insurance function to the Fund.“. (Svetlana Vukajlovic, Director of Health Insurance Fund).
Minister Tomica Milosavljevic emphasized the following problems:
1. „System is medically oriented instead on focusing on prevention. There is no sufficient awareness of the risk factors and no strategic approach in education of the health care providers.“.
2. The licensing system is underdeveloped and the system of supervision and control is generally problematic.
3. There is a need of the more restrictive policy on education in the sector.
4. Primary health care facilities should be the pillars of the health care system and primer targets for financing.
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