The Economist Intelligence Unit (EIU) published a case study on Serbian healthcare system revealing that, in many respects, it is in a critical situation. Due to high levels of corruption and inefficiency in the healthcare system, it is not rare that patients are forced to make out-of-pocket payments. Although Serbian total expenditure on health as a percentage of GDP is the highest in the region, we are among the lowest-ranked in Europe as regards access to therapy.Patients do not have access to proper and innovative drugs and this is best shown by the fact that new medicines haven’t been added to the Serbian reimbursement list for five years and that only one from 139 new medicines was approved for reimbursement in the period 2010 – 2012. Because of all above stated, treatment outcomes in Serbia are relatively poor, life expectancy of Serbian population is more than five years shorter than that in EU1, and cancer mortality rate is 50% higher.
“The data shown in the Economist study absolutely confirm the need that Serbia without delay improves the accessibility of innovative medicinesin the country by introducing a systematic and transparent mechanism for health technology assessment and reimbursement decision. This is exactly what our Initiative has been suggesting for some time already“, Gorjana Ajzinberg, the Initiative for Innovative Approach to Improving Access to New Medicines in Serbia and member ofthe Association of Patients with Rare Tumours said when the Study was published. “It is of critical importance that, at government level, we make every effort to overcome the situation where many patients are left to cope alone and try to provide money for the medicinesthey need, and others are forced to resort to outdated therapies that are not likely to cure them or improve their quality of life, and all this while being aware of the existence of a newer, innovative, medicine that is available in most countries in our surroundings“, she added.
The study entitled “Modernising the Serbian Health System: The need for a reliable decision-making compass“ showed that the accessibility level of innovative medicinesin Serbia is much lower than in other countries in the region, namely that pharmaceutical spending accounted for 18% of expenditure by the National Health Insurance Fund (NHIF), with generics making up the majority of dispensed medicines, and that, over the 2010-12 period Serbia approved just one of the 139 medicines given market authorisation, compared with 44 in Bulgaria and 27 in Croatia. The Study cited Jelena Čugurović, from the CML Association of Serbia and a member of the Initiative, who talked about the importance of innovative therapies which for some patients mean a better quality of life, for others a new chance, and for a third group the life itself, because they do not have any therapy.
The World Health Organisation data provided in the Study reveal that, compared with eight other Balkan countries2, Serbia ranks only fourth in terms of total health spending per capita. Yet, as the Study showed, due to the systematic weakness of Serbian healthcare system: high levels of out-of-pocket payments and corruption and the fact that the country lacks a transparent and comprehensive system of assessing the value of its healthcare investments and determining how to pay for them, even this spending results in relatively poor health outcomes and inadequate access to healthcare.
In a 2014 EIU Study which compared health spending and outcomes in 166 countries, Serbia was ranked lower than Bosnia and Hercegovina, Croatia and Slovenia and was placed in the group of countries which were ranked more highly for healthcare spending than for outcomes, unlike Albania and Macedonia. The 2013 data presented in the Study suggest that pharmaceutical spending in Serbia amounts to only EUR 85 per capita, which is almost 3.5 times lower than EU average and significantly less than in surrounding countries. Pharmaceutical spending in Bulgaria is EUR 117 per capita, and in Slovenia it amounts to as much as EUR 246.
In the end of their study, the EIU concluded that, as Serbia continues its preparations for full EU membership, its ability to implement much-needed reforms of its health system and modernise its healthcare system will be increasingly more in the spotlight.
The “Modernising the Serbian Health System: The need for a reliable decision-making compass“ Case Study was published on the Economist Intelligence Unit’s website, link: https://www.eiuperspectives.economist.com/sites/default/files/images/ModernisingSerbianhealthsystem.pdf
1 Data for 2013
2 Albania, Bosnia and Hercegovina, Bulgaria, Croatia, Macedonia, Montenegro, Romania and Slovenia