Health system in BiH 3.pptx

Health care system in BiH Organisation and insurance Danijel Pravdic, MD, PhD Associate professor Health care levels and subsystems • Primary level • Secondary level • Tertiary level Primary health care • Primary Health Care - Health care institute, Private Health Professionals, UHMP, Pharmacie...

Health care system in BiH Organisation and insurance Danijel Pravdic, MD, PhD Associate professor Health care levels and subsystems • Primary level • Secondary level • Tertiary level Primary health care • Primary Health Care - Health care institute, Private Health Professionals, UHMP, Pharmacies, ZJZ Offices • General / Family Physician and Associates • Level of municipality • 1 500 to 50 000 Secondary health care • General Hospital (cantonal / county), special hospitals, polyclinics • Doctors specialists • Canton / County • 50 000 to 500 000 Tertiary health care • Clinical Hospital (UKC, SKB), entity institutes (public health, transfusion medicine ...) • Physicians are subspecialists • Region / Country • 500 000 and over Health system in BiH • State level: Ministry of Civil Affairs • Federation of BiH: decentralized system • Republika Srpska: centralized system • Brcko District • 13 different subsystems Federation of BiH • 11 ministries of health (10 cantonal and 1 federal) • 11 health insurance institutes (10 cantonal and 1 Federal Office of Health Insurance and Reinsurance) • 11 Public Health Institutes (10 cantons and 1 federal) Brčko district • Department of Health • Health Insurance Fund • General Hospital Brčko, Health Centers (Brčko, Bijela, Maoča) Health Institutions in FBiH • 3 clinical centers (UKC Sarajevo, UKC Tuzla, SKB Mostar) • 7 cantonal hospitals (Bihać, Orašje, Zenica, Travnik, Gorazde, Livno, Mostar) • 8 general hospitals (Sarajevo, Sanski Most, Gračanica, Tešanj, Bugojno, Nova Bila, Jajce, Konjic) • 2 special hospitals (Psychiatric Hospital Sarajevo and TBC Travnik Hospital) • 4 medical clinics (Bihać, Gradačac, Fojnica, Olovo) • 11 institutes for specific health care • 79 health centers, with organizational units • 19 pharmacies with associated organizational parts • 11 public health institutes (1 federal and 10 cantonal) • 1 Institute for Transfusion Neighborhood of the Federation of BiH Health care providers in FBiH • MD 4.755 • Dentistry 596 • Master of Pharmacy 326 • Other health care professionals (VSS) 767 • Health technicians 12575 • TOTAL 19.018 • (26,540 employees in health care) Republic of Srpska • Ministry of Health and Social Welfare • Institute for Health Protection • Health Insurance Fund Health Institutions in RS • 1 clinical center • 11 general hospitals • 1 special hospital • 6 institutes • 6 Institute of Public Health • 53 Community health centers • 24 pharmacies • 1 Institute of Physical Medicine and Rehabilitation Health care providers in RS • Doctor of Medicine 2185 • Doctor of Dentistry 202 • graduated pharmacists 87 • employees with higher education 892 • employees with SSS 5459 • Health Associates 190 • administrative and technical staff Indicators • Population • 2.8 or 3.2. or 3.8 milions Indicators • Expected lifespan of BiH EU - Women 78.78 82.40 - Men 74.06 76.40 • The difference between the expected life expectancy and the expected healthy life expectancy in BiH - Women 17 years old - Men 11 years old Indicators Indicators Contributions to health insurance • Federation of BiH – 17% gross salary • Republic of Srpska – 15% gross salary Indicators Indicators Problems • Inequality and lack of equity in healthcare (unequal access to health services by regions and user categories, especially for poor citizens) • Insufficient coverage of health insurance and control of collection of contributions (contributions through the Institute for Unemployed and Pension Funds, farmers on their own) • Poor functional correlation between entity and county systems (treatment options outside of their own county) Problems • Inequality of healthcare packages (what is the basic health care package?) • Inefficiencies in system organization and service delivery (when will PHC teams in BiH be trained to handle 80% of needs?) • Corruption in health (public procurement, redirecting to private practice, paying "below the table") Problems • Reduced preventive and primary protection, and expensive expensive specialist sector grew • Problems of measuring and stimulating the quality of health services • Sickdays? Problems • Complexity of health and increase in health costs • Large, accumulated debt for years • Lack of investment in new health facilities and equipment • The consumption of drugs, especially antibiotics, has risen sharply Strategic reforms • ... Political commitment to Bosnia and Herzegovina to establish "an uncompetitive regionally based system of social health insurance" ... The reforms are necessary for: • Health • Health • Health • Health • Health System care policy insurance care staff