The public health systems in Serbia and Bosnia-Herzegovina both follow the Bismarck model of healthcare in which citizens are covered with state funded insurance. In Serbia, there is one Health Insurance Fund that uses compulsory contributions from employers, employees and the state to cover insurance for the population. In Bosnia-Herzegovina, funding for health coverage is obtained by taking 12.5% of everyone’s salary. This socialized medicine ensures that citizens have free access to basic healthcare.This is a contrast to the American model of healthcare which integrates the private sector and generates a lot of revenue. The motivations for working in the health sector become drastically different across cultures due to the model. I have realized through learning about these systems that cost of care and quality of care are not correlated. Although I believe the Bismarck model is the most ideal model of healthcare, it is a system that is not optimally supported in a post-war context.
One of the major issues that the public health system is facing is “brain drain”. During and after the war, a lot of students left the region to seek better job opportunities in Western Europe. Consequently, there is a lack of manpower in the current healthcare system. The unemployment rate in Bosnia-Herzegovina is nearly 50% and wages for medical professional jobs rarely exceed $500/month. The current financial structure of the public health system does not support a growing medical workforce. Our group visited the primary healthcare centre in Belgrade, Serbia which supported multiple areas of care including urgent care, in-patient care, preventative care, etc. The facilities were originally built to support a federal forestry department but was restructured to accommodate a hospital. One medical staff professional explained to us that there are employees that are committed to working double shifts multiple times a week in order to keep the hospital functioning. The lack of healthcare professionals forces the current employees to be knowledgeable in multiple fields of healthcare which creates a more versatile, dedicated personnel.
Our visits to primary care facilities in both countries demonstrated a divine work ethic from medical staff. In Bosnia-Herzegovina, the system is much different because there are thirteen different entities that create legislation for public health throughout the region. Therefore each canton and district has different regulations and models of functioning. The de-centralized public health system creates problems with collaboration and cooperation throughout the region. Also, each canton or district has its own sources of funding which creates a variety of disparities throughout the country. Socialized medicine is not optimal in BiH because the entire public health system does not follow the same standards and the monetary allocations are not sufficient to keep a well-resourced environment.
What system of health care can best support a post-war society going through social and economic transition?