Serbia (2019) HiT

New Health Systems in Transition (HiT) review for Serbia: a universal health insurance system with strong state governance

Serbia has a comprehensive universal health system with free access to health care services at the primary level. However, some vulnerable groups face financial barriers for medical care and the current system of financing encourages inefficiency in the use of resources. Despite progress in the last decade, reforms to improve the performance and transparency of the health system are still pending.

Population health is generally improving

Life expectancy in Serbia has continued to increase since 2000, reaching 76.1 years in 2017, but it is still below the average of European Union countries. Positive trends can be seen in falling incidence rates for tuberculosis, HIV as well as infant and maternal mortality. However, cancer rates have increased and health inequalities persist.

Public spending on health care has decreased

Total health spending reached 8.8% of GDP in 2017. However, private spending, mainly related to out-of-pocket payments, has increased over time, reaching 42.4% of total health expenditure in 2017. Compulsory health insurance contributions represent the largest share of total revenue for health from public sources (94%).

An extensive network of state-owned providers delivers the majority of care

Health care is organized at three levels: primary, secondary and tertiary, which are interconnected. Primary care is provided by a “chosen doctor”, with patients assigned to the primary care centre in the area they live. Secondary care includes outpatient or inpatient care in hospitals. Long-term and palliative care are mainly provided by family members and private organizations.

Health system reform has been imbedded in wider public sector reforms

Democratic changes in 2000 and the adoption of the “Health Policy of Serbia” in 2002 initiated significant progress in health policy in the country. Reforms have been supported by funding from donor agencies and loans from development banks. However, implementation of some reforms is still pending, such as a national plan for human resources.