Resource allocation strategies in Southeastern European health policy

Abstract

The past 23 years of post-socialist restructuring of health system funding and management patterns has brought many changes to small Balkan markets, putting them under increasing pressure to keep pace with advancing globalization. Socioeconomic inequalities in healthcare access are still growing across the region. This uneven development is marked by the substantial difficulties encountered by local governments in delivering medical services to broad sectors of the population. This paper presents the results of a systematic review of the following evidence: published reports on health system reforms in the region commissioned by WHO, IMF, World Bank, OECD, European Commission; all available published evidence on health economics, funding, reimbursement in world/local languages since 1989 indexed at Medline, Excerpta Medica and Google Scholar; in depth analysis of official website data on medical care financing related legislation among key public institutions such as national Ministries of health, Health Insurance Funds, Professional Associations were applicable, in local languages; correspondence with key opinion leaders in the field in their respective communities. Contributors were asked to answer a particular set of questions related to the issue, thus enlightening fresh legislative developments and hidden patterns of policy maker's behavior. Cost awareness is slowly expanding in regional management, academic and industrial establishment. The study provides an exact and comprehensive description of its current extent and legislative framework. Western Balkans policy makers would profit substantially from health-economics-based decision-making to cope with increasing difficulties in funding and delivering medical care in emerging markets with a rapidly growing demand for health services.

Do Health Reforms Impact Cost Consciousness of Health Care Professionals? Results from a Nation-Wide Survey in the Balkans

“…An objective observer might conclude that Health Technology Assessment and cost-effectiveness based decision-making still have to take root in the wider Balkans region (8). Therefore, a lower degree of economic awareness maturity among healthcare professionals and policy makers contributes to the poor effects of the recent policy shift.…”

“…Arising from regional difficulties in healthcare funding and growing instabilities of the health sector, we employed a three-way health policy approach to cut costs and improve the efficiency of service provision in Serbia (8). The National Health Insurance Fund (RFZO) is a core financing institution for the provision of all public and most private medical services in the country.…”

Cost differentials of dental outpatient care across clinical dentistry branches

“…Decrease of public expenditure on dentistry services that happened across six years time span was almost 19%. We should be aware that this change happened during period when total healthcare spending in the country remained stable or exhibited slow growth pattern [8,16]. Opposed trend of public spending on health care services is certainly not following oral diseases incidences which are not optimistic particularly with regards to huge prevalence pool of common tooth decay, paradontosis, and associated conditions [27].…”

“…We have selected the emerging market of Serbia on grounds of being largest Western Balkans market presenting wider regional setting [8]. Its health care sector shares common legacy with most of the region and faces similar challenges in terms of health care provision and financing [16]. Therefore costs and resource use patterns of dental care in Serbia will likely be similar to the ones in neighbour markets as well [17].…”

Is the payment according to the diagnosis comparable with the real cost of treatments?

“…Financing of the health-care system means raising funds on one hand, and paying the executive performers on the other. 1 e payment models have changed in the course of time; one of the most important objectives is the equity of payment for the executive performers (equal payment for equal services. 2 In the year 2004 Slovenia has introduced the payment of the acute hospital treatment according to the Diagnosis Related Groups -DRG.…”