Scientific Online Resource System

Scripta Scientifica Medica

Household health care spending and health care reforms in Serbia

J. Arsenijevic, M. Pavlova


Acknowledgement:The study is financed by the European Commission under the 7th Framework Programme, Theme 8 Socio-economic Sciences and Humanities, Project ASSPRO CEE 2007 (Grant Agree- ment no. 217431). The views expressed in this publication are the sole responsibility of the authors and do not necessarily reflect the views of the European Commission or its services.
Abstract: The aim of this paper is to provide empirical data on out-of-pocket, indirect and informal payments in ambulatory health care and state hospitals and to study the catastrophic effects that these payments can produce for households` budget. For this purpose, household data collected in Serbia in 2007 are used. The health care system in Serbia, inherited compulsory health insurance from SFRJ (Socialist Federal Republic of Yugoslavia) based on 12.3% payroll taxes. In 2002, after the political change in the country, the Ministry of Health officially introduced the health care reforms as a part of transitional reforms. One of the aims of these reforms was to obtain a clear picture about the flow of the money in health care system. In 2005, it became clear that Serbia spent 5.33 % of GDP on public health services, and 8 % of GDP for total health expenditure. This was comparable to other countries in the region but higher than in EU countries. This paper focuses on the relation between out-of-pocket payments by Serbian households and poverty that can be related to health care spending. Although it is expected that official co-payments will decrease informal payments, this is not al- ways observed in practice. Some patients use service that required co-payment, but do not pay. This might im- ply possible informal payments. The recent research has shown the catastrophic effects of out-of-pocket payments not only in low and middle income countries, but also in some OECED countries. Our results also indicate that out-of-pocket patient payments have a catastrophic effect on poor households in Serbia. More- over, households that are above the absolute and relative poverty lines respectively, after the subtraction of out-of-pocket payments fall below these poverty lines. Thus, our research shows, that no matter which ap- proach we apply, the out-of-pocket patient payments in Serbia create a substantial burden on households. Nevertheless, it is important to apply different approaches since the nature of poverty is more complex and also includes subjective perceptions. Future policy in Serbia should aim to protect vulnerable groups, espe- cially chronically sick patients and people from rural areas.


household health care expenditure; health care reforms; Serbia

Full Text


Balabanova D., McKee M., Pomerleau J., et al.,(2004). Health service utilization in the Former Soviet Union: evidence from eight countries. Health Services Research, 39, 1927-1949.

Bredenkamp C., Mendola M.,& Gragnolati, M.,(2010).Catastrophic and impoverishing effects ofhealth expenditure: new evidence from the Western Balkans. Health Policy and Planning, article in press: doi: 10.1093/heapol/czq070 First

Gajic-Stevanovic M., Dimitrijevic S., Vuksa A., & Jovanovic D., (2010). Health care system and expenditure in Serbia from 2004 to 2008 (in Ser- bian). Belgrade: Institute of Public Health of Serbia.

Ensor T., (2004). Informal payments for health care in transition economies. Social Science & Medicine, 58, 237-46.

Foster JE., (1998). Absolute versus relative poverty. American Economic Review, 88 (2), 335-341.

Habicht J., Xu K., Couffinhal A., & Kutzin J.,(2006). Detecting changes in financial protection: creating evidence for policy in Estonia. Health Policy and Planning, 21 (6), 421-431.

Knaul FM., Arreola- Ornelas H.,

Mendez-Carniad, O., Bryson-Cahn C.,

Barofsky J., et al.,(2006). Health System Reform in Mexico 4 - Evidence is good for your health sys- tem: policy reform to remedy catastrophic and impov- erishing health spending in Mexico. Lancet, 368, 1828-1841.

immunodeficiency virus/acquired immunodeficiency syndrome. American Journal of Tropical Medicine and Hygiene, 71(Suppl. 2), 147-155.

Xu K., Saksena P., Jowett M., Indikadahena C., Kutzin J., & Evans D., (2010). Exploring the thresholds of health expenditure for protection against financial risk.World Health report, Background Pa- per, 19.

Xu K., Evans D., Kawabata K., Zeramdini R., Klavus J. & Muray CHL., (2003). Household catastrophic health expenditure: A multicountry anal- ysis. Lancet, 362, 111- 117.

Xu K., Evans DB., CarrinG.,

Aguilar-Rivera,AM ., Musgrove P. & Evans T., (2007). Protecting households from catastrophic health spending, Health Affairs, 26 , 972-983.

Van Doorslaer E, O'Donnell O, Rannan-Eliya RP, et al. (2006).Effect of payments for healthcare on pov- erty estimates in 11 countries in Asia: an analysis of household survey data. Lancet, 368, 1357-1364.

Van Doorslaer E., O'Donnell O.,

Rannan-Eliya R., Somanathan A., Adhikar SR., Akkazieva B., Harbianto D., Garg C., Hanvoravongchai P., Herrin A., Huq M.,

Ibragimova S., Karan A., Lee TJ., Leung G., Lu JFR., Ng CW., Pande B.,Racelis R., Tao S., Tin K., Trisnantoro L., Vasavid C., Yang BM., Zhao Y., ( 2007). Catastrophic pay- ments for healthcare in Asia. Health Eco-

nomics, 16(11), 1159-1184.

Wagstaff A., (2008). Measuring Financial Protec- tion in Health. Policy Research Working Paper Series 4554. The World Bank.

World Bank 2008. World development indicators 2008. Washington, DC: International Bank for Re- construction and Development / The World Bank.

World Bank. Project paper on a proposed additional financing loan to the Republic of Serbia for the health project. Washington (DC): World Bank.



Article Tools
Email this article (Login required)
About The Authors

J. Arsenijevic

M. Pavlova

Font Size