First Results of National Health Accounts (NHA) of Serbia 2003, 2004, 2005

Abstract

Background: Serbia has a health system financed by earmarked payroll taxes via the National Health Insurance Fund (NHIF). Providers are mostly public and contracted by NHIF. The viability of the system is challenged by the reduced financial basis of health insurance contributions and transparency of both public and private sector (2 million employed financing 7 million insured). Objective: To increase transparency of financial resources allocation by National health accounts in order to determine and compare Nation's overall health spending patterns. Aim: To provide policy makers with international comparable indicators, analysis and recommendations based on the information received and processed. Material and methods: There are multiple sources of health care data which were linked applying the rules of A System of Health Accounts (SHA) Version 1.0. Data are obtained from Public expenditure Reviews, Administrative data, Household Budget Surveys, and Provider Surveys. Results: The full three-dimensional table HFxHPxHC was compiled for the years 2003 and 2004. First estimates are available for 2005. The results confirm that NHIF is the predominant financing agent for health care. In 2004 about 66% of expenditures are financed by NHIF, 5, 5% by the Government, 0, 85% are financed from abroad. Private spending makes 25, 39% of total spending and particularly high for pharmaceuticals, 62, 27%. The share of GDP devoted to health care was 9, 37%. However, per capita spending for health was relatively low, $224, 29 ppp. Discussion: The compilation of health accounts was in many ways useful. It increased transparency among the financial flows within public sector. Also, for the first time private sector of providers and financers was observed. One major problem in the existing pilot compilations are some inconsistencies in relation to non-financial data. Conclusions and recommendations In order to check inconsistencies it is necessary to control data flows bottom-up. Full access to the relevant information is indispensable. Data reporting might be biased by vested interests of stakeholders. It is therefore necessary to develop safeguards for reliable data delivery and analysis.