Healthcare access in Bosnia and Herzegovina in the light of European Union accession efforts

Hannes Jarke, Amra Džindo, Lea Jakob

Abstract

European Union (EU) member states are bound to ensure accessible, good quality healthcare for all of their citizens. In 2018, Bosnia and Herzegovina has been named as a candidate for accession to EU membership as part of the “Strategy for the Western Balkans”. This scoping review identifies healthcare access issues in the country, aiming to inform policy-makers of challenges that may be faced in a possible membership application process and beyond. While the country has seemingly improved citizens’ healthcare access—as measured by the Healthcare Access and Quality Index—various specific problems remain unresolved. The main barrier to equal access appears to lie in the division of the healthcare system between the Federation of Bosnia and Herzegovina, the Republika Srpska, and the Brcko District, which also influences medicine availability and pricing. Although not necessarily systematic, studies further report distance from healthcare providers, alleged widespread corruption, discrimination of minorities and vulnerable populations, as well as vaccination gaps as problems in healthcare access for specific groups. While certainly not easy to realise, this scoping review concludes that possible solutions could include efforts to unify the healthcare and pricing system, and the implementation of the World Health Organization’s Essential Medicines List, as well as investigating and tackling corruption and stigma issues.

Keywords

Bosnia and Herzegovina, European Union membership, healthcare access, healthcare access and quality index, inequality.

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References

Strategy for the Western Balkans: EU sets out new flagship initiatives and support for the reform-driven region. Available from: http://europa.eu/rapid/press-release_IP-18-561_en.htm (accessed: October 9, 2018).

Treaty of the Functioning of the European Union. Part Three: Union Policies and Internal Actions – Title VIV: Public Health - Article 168.

Mujkic E. Sistem zdravstva u Bosni I Hercegovini: stanje i pravci moguce reforme. Sveske za javno pravo. 2011;2:46–58. Available from: http://www.pfsa.unsa.ba/pf/wp-content/uploads/2015/01/Sistem-zdravstva-u-Bih.stanje-i-pravci-moguæe-reforme.pdf(accessed: October 12, 2018) [in Bosnian].

The World Bank. Bosnia and Herzegovina. Available from https://data.worldbank.org/country/bosnia-and-herzegovina (accessed: February 5, 2019).

Kondylis F. Conflict displacement and labor market outcomes in post-war Bosnia and Herzegovina. J Dev Econ 2010;93:235–48.

Neerup Handlos L, Fog Olwig K, Bygbjerg IB, Norredam M. Return Migrants’ Experience of Access to Care in Corrupt Healthcare Systems: The Bosnian Example. Int J Environ Res Public Health 2016;13:924.

Federalni Zavod za Statistiku. Konacni rezultati popisa 2013. Available from: http://fzs.ba/index.php/popis-stanovnistva/popis-stanovnistva-2013/konacni-rezultati-popisa-2013/ (accessed: February 12, 2019) [in Bosnian].

The European Union’s CARDS Programme for Bosnia and Herzegovina. Functional Review of the Health Sector in Bosnia and Herzegovina: Final Report. 2016. Available from: http://parco.gov.ba/wp-content/uploads/2016/09/functional-review-of-the-health-sector-in-bh.pdf (accessed: February 12, 2019).

Guzvic V, Catic T, Kostic M. Health Technology Assessment in Central-Eastern and South Europe Countries: Bosnia and Herzegovina. Int J Technol Assess Health Care 2017;33:390–5.

Hodgetts G, Broers T, Godwin M, Bowering E, Hasanovic M. Post-traumatic stress disorder among family physicians in Bosnia and Herzegovina. Fam Pract 2003;20:489–91.

Musa S, Peek-Asa C, Jovanovic N, Selimovic E. Association of adverse childhood experiences and health risk behaviors among young adults visiting a regional primary healthcare center, Federation of Bosnia and Herzegovina. PLoS One 2018;13:e0194439.

Godwin M, Hodgetts G, Bardon E, Seguin R, Packer D, Geddes J. Primary care in Bosnia and Herzegovina - Health care and health status in general practice ambulatory care centres. Can Fam Physician 2001;47:289–97.

Ryken KO, Hogue M, Marsh JL, Schweizer M. Long-term consequences of landmine injury: A survey of civilian survivors in Bosnia-Herzegovina 20 years after the war. Injury 2017;48:2688–92.

Offermanns G, Draganovic S, Alispahic A. Patient Safety in Bosnia and Herzegovina hospitals: First insights and opportunities for improvement. Eur J Public Health 2015;25.

Expert Panel on effective ways of investing in Health. Report on Access to Health Services in the European Union. Available from: http://doi.org/10.2875/10002(accessed: February 12, 2019).

Pham MT, Rajic A, Greig JD, Sargeant JM, Papadopoulos A, McEwen SA. A scoping review of scoping reviews: Advancing the approach and enhancing the consistency. Res Synth Methods 2014;5:371–85.

Peterson J, Pearce PF, Ferguson LA, Langford CA. Understanding scoping reviews: Definition, purpose, and process. J Am Acad Nurse Pract 2017;29;12–6.

Arksey H, O’Malley L. Scoping studies: towards a methodological framework. IntJ Soc Res Methodol 2005;8:19-32.

Barber R, Fullman N, Sorensen R, Bollyky T, McKee M, Nolte E, et al. Healthcare Access and Quality Index based on mortality from causes amenable to personal health care in 195 countries and territories, 1990–2015: a novel analysis from the Global Burden of Disease Study 2015. Lancet 2017;390:231–66.

Federal Ministry of Health. Strateski plan razvoja zdravstva u Federaciji Bosne i Hercegovine u periodu od 2008. do 2018. godine. Sarajevo, Federation of Bosnia and Herzegovina: Federal Ministry of Health; 2008 [in Bosnian].

Mandic Dokic T. Pristup zdravstvenim uslugama i parvo na zdravlje zena u Bosni i Hercegovini. Sarajevo: Zalagacke platforme zena u BiH; 2016. Available from: http://www.fondacijacure.org/files/zalagackeplatforme/Pristup%20zdravstvenim%20uslugama%20i%20pravo%20na%20zdravlje%20%C5%BEena%20u%20Bosni%20i%20Hercegovini.pdf (accessed: February 12, 2019) [in Bosnian].

Catic T. Differences in Reimbursement Prices and Inequalities to Access Most Commonly Prescribed Medicines in Bosnia and Herzegovina. Value Health 2015;18:A527.

Mahmic-Kaknjo M, Marusic A. Analysis of evidence supporting the Federation of Bosnia and Herzegovina reimbursement medicines lists: role of the WHO Essential Medicines List, Cochrane systematic reviews and technology assessment reports. Eur J Clin Pharmacol 2015;71:825–33.

Kurtovic-Kozaric A, Vranic S, Kurtovic S, Hasic A, Kozaric M, Granov N, et al. Lack of Access to Targeted Cancer Treatment Modalities in the Developing World in the Era of Precision Medicine: Real-Life Lessons from Bosnia. J Glob Oncol 2018;4:1–5.

Ministry of Human and Refugee Rights of Federation of Bosnia and Herzegovina. Action Plan of Bosnia And Herzegovina for Addressing Roma Issues in the Fields of Employment, Housing and Health Care 2017–2020. Available from: http://www.mhrr.gov.ba/PDF/LjudskaPrava/4%20%20Akcioni%20plan%20BiH%20za%20rjesavanje%20problema%20Roma%202017-2020_ENG.pdf (accessed: February 12, 2019).

Arora V, Kühlbrandt C, McKee M. An examination of unmet health needs as perceived by Roma in Central and Eastern Europe. Eur J Public Health 2016;26:737–42.

Duval L, Wolff F, McKee M, Roberts B. The Roma vaccination gap: Evidence from twelve countries in Central and South-East Europe. Vaccine 2016;34:5524–30.

Krupic F, Krupic R, Jasarevic M, Sadic S, Fatahi N. Being Immigrant in their Own Country: Experiences of Bosnians Immigrants in Contact with Health Care System in Bosnia and Herzegovina. Mater Sociomed 2015;27:4–9.

Stojisavljevic S, Djikanovic B, Matejic B. ‘The Devil has entered you’: A qualitative study of Men Who Have Sex with Men (MSM) and the stigma and discrimination they experience from healthcare professionals and the general community in Bosnia and Herzegovina. PLoS One 2017;12:e0179101.

Agency for Medicinal Products and Medical Devices. Official Gazette 3/17. 2017 March.

Parliament Directive 2011/24/EU of 9 March 2011 on the application of patients’ rights in cross-border healthcare.

Naser N, Tandir S, Begic E. Telemedicine in Cardiology - Perspectives in Bosnia and Herzegovina. Acta Inform Med 2017;25:263.


DOI: 10.4119/UNIBI/SEEJPH-2019-210

Copyright (c) 2019 Hannes Jarke, Amra Džindo, Lea Jakob

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