Health Financing and Expenditures in Balkan countries: the case of North Macedonia, Serbia, Bosnia and Herzegovina and Montenegro
Journal
Medical Preview, Journal of the Macedonian Medical Association, 2025 Suppl 1
Date Issued
2025-04
Author(s)
Vasilevska, Hristina
Filipche, Milcho
Abstract
Introduction. The health financing model and health spending should meet the population health
needs. The aim of this paper is to analyze and compare the financing of the health systems in the
selected Balkan countries: North Macedonia, Serbia, Bosnia and Herzegovina and Montenegro.
Material and method. Data from World Health Organization HFA-DB and World Bank has been
used as well as from Health in Action Reports for the selected countries. Desk review of official
documents and websites of government and health institutions and the literature has been
applied.
Results. All countries had a socialist system in Yugoslavia and the same health system. The system
was reformed later in the transitional period. The Bismarck model of mandatory health insurance
is dominant in all countries with recent reforms in Montenegro. Montenegro introduced major
health insurance reforms, shifting from a contributions-based system to a fully tax-funded system.
In North Macedonia Healthcare spending is relatively low compared to European Union (EU) and
Southeastern European countries, current health expenditure as % of GDP is 8.5% in 2021. The
health expenditures in 2021 in Bosnia and Herzegovina with 9.6% of GDP, in Serbia 10.01%, and
in Montenegro 10.5% are at the level of the average of the European region and EU countries
(10.95%). Out-of-pocket (OOP) payments of health spending in 2021 are high, in North
Macedonia is accounted for 41.7%, in Montenegro 38.08%, in Serbia 35,86% and in Bosnia and
Herzegovina 30.71%.
Conclusion. The financing of health systems in the Balkans has improved in the last decade
following a series of transition reforms and socio-political challenges. However, inequalities in
health systems between countries, as well as with EU countries, persist.
needs. The aim of this paper is to analyze and compare the financing of the health systems in the
selected Balkan countries: North Macedonia, Serbia, Bosnia and Herzegovina and Montenegro.
Material and method. Data from World Health Organization HFA-DB and World Bank has been
used as well as from Health in Action Reports for the selected countries. Desk review of official
documents and websites of government and health institutions and the literature has been
applied.
Results. All countries had a socialist system in Yugoslavia and the same health system. The system
was reformed later in the transitional period. The Bismarck model of mandatory health insurance
is dominant in all countries with recent reforms in Montenegro. Montenegro introduced major
health insurance reforms, shifting from a contributions-based system to a fully tax-funded system.
In North Macedonia Healthcare spending is relatively low compared to European Union (EU) and
Southeastern European countries, current health expenditure as % of GDP is 8.5% in 2021. The
health expenditures in 2021 in Bosnia and Herzegovina with 9.6% of GDP, in Serbia 10.01%, and
in Montenegro 10.5% are at the level of the average of the European region and EU countries
(10.95%). Out-of-pocket (OOP) payments of health spending in 2021 are high, in North
Macedonia is accounted for 41.7%, in Montenegro 38.08%, in Serbia 35,86% and in Bosnia and
Herzegovina 30.71%.
Conclusion. The financing of health systems in the Balkans has improved in the last decade
following a series of transition reforms and socio-political challenges. However, inequalities in
health systems between countries, as well as with EU countries, persist.
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