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Features of the Bosnian Healthcare System

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Genetic Counseling and Preventive Medicine in Post-War Bosnia

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Abstract

This chapter describes the characteristic features of the Bosnian healthcare system, including the three levels of healthcare delivery in the country. The discussion anticipates the assessment of the healthcare system undertaken in Chap. 4.

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Notes

  1. 1.

    Paola Testori Coggi, “Foreword from the European Commission,” in Irene Papanicolas & Peter C. Smith, Health System Performance Comparison: An Agenda for Policy Information and Research (Maidenhead, UK: Open University Press, 2013), xi.

  2. 2.

    World Health Organization, The World Health Report 2000: Health Systems: Improving Performance (Geneva: World Health Organization, 2000), 1, 5; Mary Ko Zimmerman, “Comparative Health-Care Systems,” Encyclopedia of Sociology (updated Jan. 25, 2020), https://www.encyclopedia.com/social-sciences/encyclopedias-almanacs-transcripts-and-maps/comparative-health-care-systems. See also I. Gregory Pawlson et al., “Healthcare Systems,” Encyclopedia of Bioethics (updated Dec. 4, 2019), https://www.encyclopedia.com/science/encyclopedias-almanacs-transcripts-and-maps/healthcare-systems (stating that “[t]he goal of a healthcare system is to enhance the health of the population in the most effective manner possible in light of a society’s available resources and competing needs.”).

  3. 3.

    World Health Report 2000, note 2, p. 5.

  4. 4.

    Ibid. See also Marina Karanikolos et al., “Comparing Population Health,” in Irene Papanicolas & Peter C. Smith, Health System Performance Comparison: An Agenda for Policy Information and Research (Maidenhead, UK: Open University Press, 2013), 128.

  5. 5.

    Pawlson et al., note 2.

  6. 6.

    See United Nations High Commissioner for Refugees’ Office of the Chief of Mission in Bosnia, Health Care in Bosnia and Herzegovina in the Context of the Return of Refugees and Displaced Persons (Sarajevo: July 2001) [hereinafter Health Care in BiH], p. i (Executive Summary), p. 1 (introduction).

  7. 7.

    Marko Martić & Ognjen Đukić, Friedrich Ebert Stiftung Sarajevo, “Health Care Systems in BiH: Financing Challenges and Reform Options?” (October 2017), 6, https://library.fes.de/pdf-files/bueros/sarajevo/14124.pdf. Instructively, in their piece referenced repeatedly in this research, Martić and Đukić used the plural healthcare systems, rather than the singular.

  8. 8.

    Martić & Đukić, note 7, p. 6.

  9. 9.

    See generally Martić & Đukić, 7. The Bismarck model harks back to German Chancellor Otto von Bismarck (1815–1898), whose introduction of a statutory health insurance in 1883 in Germany paved the way for a comprehensive social insurance system. Bismarck’s goal was twofold: counter social unrest and socialism, as well as weaken economically the voluntary social insurance of the trade unions and church-run labor federations. “Bismarck versus Beveridge: A Comparison of Social Insurance Systems in Europe,” Cesifo Dice Rept. (April 2008), 69–70, https://www.ifo.de/DocDL/dicereport408-db6.pdf

  10. 10.

    Health Care in BiH, note 6, p. 2; Bosnia and Herzegovina, Third Report of BiH on Implementation of the European Social Charter [Revised] (Nov. 2012), http://www.mhrr.gov.ba/PDF/LjudskaPrava/III%20IZVJESTAJ%20GRUPA%202%20eng.pdf (“[For example,] [t]he Law on Health Insurance [in Republika Srpska] governs the system of mandatory and extended health insurance, insurance rights, [and] the exercise of rights and principles of private health insurance.”). See also Osman Slipicević & Adisa Malicbegović, “Public and Private Sector[s] in the Health Care System of the Federation [of] Bosnia and Herzegovina: Policy and Strategy,” Materia Socio Medica [J. of Acad. Of Med. Sciences of Bosn. & Herz.], 24(1) (2012), 54–7, doi https://doi.org/10.5455/msm.2012.24.54-57, ncbi.nlm.nih.gov/pmc/articles/PMC3633389/

  11. 11.

    See Health Care in BiH, note 6, p. 15 (relating to RS).

  12. 12.

    Ibid., p. 2.

  13. 13.

    Martić & Đukić, note 7, p. 8.

  14. 14.

    Ibid., p. 20 (quoting figures for 2011).

  15. 15.

    Health Care in BiH, note 6, p. 14.

  16. 16.

    Ibid., p. 7 & n.45, citing The Law on Health Care, Art. 39 (Official Gazette of Republika Srpska, No. 18/99) (mandating the organization of healthcare such that emergency medical assistance, including transportation, is available at any time).

  17. 17.

    See Health Care in BiH, note 6, p. 7, n. 45, citing FBiH Criminal Code, art. 246; and RS Criminal Code, Art. 204.

  18. 18.

    Health Care in BiH, note 6, p. 19.

  19. 19.

    Ibid., pp. 3–4, 3 n.19, citing The Law on Health Insurance, Art. 31 (Official Gazette of the Federation of Bosnia and Herzegovina, No. 30/97, 7/02, 70/08, and 48/11) and The Law of Health Insurance, Arts. 18–19 (Official Gazette of Republika Srpska, No. 18/99).

  20. 20.

    Ibid., pp. 18, 18 n.102, citing The Law of Health Insurance, Art. 32 (Official Gazette of the Federation of Bosnia and Herzegovina, No. 30/97, 7/02, 70/08, and 48/11).

  21. 21.

    Martić & Đukić, note 7, p. 8.

  22. 22.

    Ibid.

  23. 23.

    Ibid.

  24. 24.

    Ibid.

  25. 25.

    See ibid., p. 7.

  26. 26.

    “Medicine in Bosnia-Herzegovina,” Best Country, http://www.best-country.com/europe/bosnia_herzegovina/medicine, archived at https://perma.cc/758U-J5DJ; The Law of Health Insurance, arts. 44–45 (Official Gazette of the Federation of Bosnia and Herzegovina, No. 30/97, 7/02, 70/08, and 48/11).

  27. 27.

    Ibid., p. 7.

  28. 28.

    Ibid.

  29. 29.

    Health Care in BiH, note 6, pp. 25–7 (covering RS alongside FBiH).

  30. 30.

    Martić & Đukić, note 7, p. 8.

  31. 31.

    Ibid., pp. 7–8.

  32. 32.

    Ibid., p. 8.

  33. 33.

    Martić & Đukić, note 7, p. 8. This structure of responsibility is consistent with the Statute of the District (its constitutional document) and the Health Insurance Law of Brčko District. Ibid.

  34. 34.

    Ibid.

  35. 35.

    Martić & Đukić, note 7, p. 8.

  36. 36.

    See ibid., citing Decision on the Base and Rate of Contribution for Health Insurance (Official Gazette of the Brčko District of BiH, 37/2009).

  37. 37.

    Health Care in BiH, note 6, p. 1 (“[W]hile the vast majority of the BiH population is nominally covered by a public compulsory health insurance scheme, in practi[c]e[,] many BiH residents experience difficulty in accessing health care.”). See also Martić & Đukić, note 7, p. 8.

  38. 38.

    Ibid., p. 8, n. 6.

  39. 39.

    Ibid., p. 8.

  40. 40.

    Ibid., p. 8, 9 tbl. 1 (including the methodological explanation under the table justifying the assessment of about 70% coverage for RS)

  41. 41.

    Ibid., p. 8.

  42. 42.

    Martić & Đukić, note 7, p. 27.

  43. 43.

    Ibid., p. 15.

  44. 44.

    Ibid.

  45. 45.

    Ibid.

  46. 46.

    See Martić & Đukić, note 7, p. 9.

  47. 47.

    See ibid. Romani people are the largest of the seventeen national minority groups that Bosnian law recognizes. More than other groups, majority or minority, the Romani people “suffer from poverty, discrimination[,] and social exclusion from childhood onward.” See Hoi Mun Yee, “Bosnia’s Roma Try to Break Out of Isolation, BalkanInsight (June 14, 2017), https://balkaninsight.com/2017/06/14/bosnia-s-roma-try-to-break-out-of-isolation-06-13-2017-2/

  48. 48.

    Martić & Đukić, note 7, p. 15. See also ibid., p. 25 (enumerating “[c]urrent initiatives for reform of health financing schemes” in the country). One of these suggestions for reform include the initiative by Jasmin Imamović, Mayor of Tuzla, who advocated rationalization of the healthcare system in FBiH by abolishing the system of healthcare management at the cantonal level and transferring competencies to the entity and local levels. Ibid., p. 25. However, the proposal triggered “different political reactions in FBiH and […] there is still no unanimous political opinion on the matter nor the willingness to implement the solutions” the initiative signifies. Ibid., p. 26.

  49. 49.

    This section draws from Health Care in BiH, note 6, pp. 25–7.

  50. 50.

    Ambulanta is Slovak for infirmary.

  51. 51.

    Dom zdravlje (DZ) equates to “House of Health” in Croatian language.

  52. 52.

    Hitna pomoc (HP) is Bosnian for ambulance.

  53. 53.

    Farmacia is Italian for pharmacy.

  54. 54.

    The term means a tale of medical history told by the patient himself or herself, especially at the beginning of the doctor–patient relationship.

  55. 55.

    This term refers to a devise used to measure blood pressure.

  56. 56.

    Health Care in BiH, note 7, p. 26.

  57. 57.

    Ibid.

  58. 58.

    Ibid., p. 27.

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  1. International University of Sarajevo, Sarajevo, Bosnia and Herzegovina

    Philip C. Aka

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Aka, P.C. (2020). Features of the Bosnian Healthcare System. In: Genetic Counseling and Preventive Medicine in Post-War Bosnia. Palgrave Macmillan, Singapore. https://doi.org/10.1007/978-981-15-7987-5_3

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