Health care system of the Republic of Serbia in the period 2004-2012

Abstract

Introduction The backbone of Serbian health system forms the public healthcare provider network with 355 institutions and around 112,000 employees, owned and controlled by the Ministry of Health and financed mainly by the Republican Health Insurance Fund. The law recognizes private practice that was not included, till recently, in the public funding scheme. New Health Insurance Law (2005) decreased the number of entitlements in the basic health service package. It abolished the right to dental health care for adults (exceptions are: children, older than 65, pregnant women and emergency cases) as well as the right to compensate travel expenses. The aim of this study was to evaluate the effects of health care system of the Republic of Serbia and indicate parameters that determine the state of health of the population, on the ground of data obtained by the Institute of Public Health of Serbia. Results In the period 2004-2012, cardiovascular diseases represented the main cause of illness in Serbia (50%). In 2012 digestive system diseases were on the second place. Neoplasm and nervous system diseases were on the third place. From 2007 to 2012 there was slight decline in the birth rate and number of deaths, but the death rate increased from 13.9 to 14.2. Health care system in Serbia is funded through the combination of public finances and private contributions. Primary care is provided in 158 health care centres and health care stations, secondary and tertiary care services are offered in general hospitals, specialized hospitals, clinics, clinico-hospital centers and clinical centres. Conclusion A significant but not satisfactory progress has been achieved in the field of health status indicators as the most important outcome of the final performance of the health system. The transition of public health care system in Serbia since the communist period to present and slow integration with European Union is unfinished process.

Uvod Osnovicu zdravstvenog sistema Republike Srbije čini zdravstvena mreža od 355 državnih zdravstvenih ustanova i oko 112.000 zaposlenih koji su pod kontrolom Ministarstva zdravlja, a finansiraju se preko Republičkog fonda zdravstvenog osiguranja. Zakon poznaje i privatni sektor, koji doskora nije bio uključen u shemu javnog finansiranja. Zakon o zdravstvenom osiguranju iz 2005. godine smanjio je prava u osnovnom zakonu zdravstvenih usluga i ukinuo pravo na stomatološku zdravstvenu zaštitu (s izuzetkom dece, osoba starijih od 65 godina, trudnica i hitnih slučajeva), odnosno pravo na naknadu putnih troškova u vezi s ostvarivanjem prava na zdravstvenu zaštitu. Cilj ovog rada je bio da se na osnovu podataka Instituta za javno zdravlje Srbije 'Dr Milan Jovanović Batut' procene efekti zdravstvenog sistema Republike Srbije i ukaže na parametre ovoga sistema koji određuju stanje zdravlja stanovništva. Rezultati Od 2004. do 2012. godine kardiovaskularne bolesti su bila najčešća oboljenja u Srbiji (50%). U 2012. godini bolesti digestivnog sistema bile su na drugom mestu. Na trećem mestu su maligne i bolesti nervnog sistema. U periodu 2007-2012. zabeležen je i blag pad nataliteta, smanjio se i broj smrtnih slučajeva, ali je stopa mortaliteta porasla sa 13,9 na 14,2. Sistem zdravstvene zaštite u Srbiji se finansira kroz kombinaciju državnih finansija i privatnih doprinosa. Primarna zdravstvena zaštita se odvija u 158 domova zdravlja, zdravstvenih stanica i ambulanti, a sekundarne i tercijarne službe rade u opštim i specijalnim bolnicama, institucijama, klinikama i kliničko- bolničkim centrima. Zaključak Značajan, ali nedovoljan, napredak postignut je u oblasti pokazatelja zdravstvenog stanja, kao najvažnijeg konačnog ishoda učinka zdravstvenog sistema. Tranzicija državnog sistema zdravstvene zaštite u Srbiji od komunističkog perioda do danas i usporeno integrisanje s Evropskom Unijom je nedovršen proces.