Health Systems in Action: Bosnia and Herzegovina

Key points

• Bosnia and Herzegovina is made up of two entities – the Federation of Bosnia and Herzegovina (itself divided into 10 cantons) and the Republika Srpska – plus the Brčko District of Bosnia and Herzegovina. There are 14 ministries in charge of health and 13 health insurance funds, making reform complex.
• Differences in approach, health policy-making and levels of decentralization all foster inequalities.
• Social health insurance schemes are mandatory across entities/district but coverage is not universal. Substantial parts of the population have very limited access to publicly financed care.
• Public spending on health is relatively high for the South-Eastern Europe Health Network, but sustainability is a concern.
• Out-of-pocket spending is high (31% of all health spending in 2021). This causes financial hardship in 8% of households in the Federation of Bosnia and Herzegovina and 10% in the Republika Srpska.
• The Republika Srpska and the Brčko District of Bosnia and Herzegovina pool resources at the entity/district level, reducing disparities in care. In the Federation of Bosnia and Herzegovina pooling for primary and secondary care is at the canton level.
• Care remains largely hospital-based although hospital bed numbers are low. The rates of physicians and nurses have increased but are still low and there is no strategic plan to address the ageing health workforce or the increasing emigration of health professionals.
• Overall mortality rates have been declining, although the pandemic resulted in substantial excess mortality.
• Cardiovascular disease is the leading cause of death and disability, although premature mortality in adults is mainly due to cancer.
• Smoking, unhealthy diets and hypertension are all major contributors to ill health.
• Reform efforts under way aim to strengthen primary health care, improve prevention for noncommunicable diseases, digitalize health records and introduce e-health.

Source: Health systems in action: Bosnia and Herzegovina|European Observatory on Health Systems and Policies