Bosnia and Herzegovina

Bosnia has a transitional economy with limited market reforms. The economy relies heavily on the export of metals, as well as on remittances and foreign aid. A highly decentralized government hampers economic policy coordination and reform. The interethnic warfare in Bosnia and Herzegovina caused production to plummet by 80% from 1992 to 1995 and unemployment to soar.

Bosnia’s private sector is growing, but foreign investment has dropped off sharply since 2007. Government spending, at roughly 50% of GDP, remains high because of redundant government offices at the state, entity and municipal level. Privatization of state enterprises has been slow, particularly in the Federation where political division between ethnically-based political parties makes agreement on economic policy more difficult. A sizeable current account deficit and high unemployment rate remain the two most serious macroeconomic problems.

Disbursement of IMF aid was suspended in 2011 after a parliamentary deadlock left Bosnia without a state-level government. In 2011, the country continued to recover from a recession caused by the global financial crisis. Unemployment and poverty are high. Ethnic and political stalemate slow reform and discourage investment. Bosnia relies heavily on West Europe for trade and credit.

HEALTH CARE SYSTEM IN BOSNIA AND HERCEGOVINA

Health authorities in Bosnia and Herzegovina face growing challenges in inequality in access to health care. With 20% of the population below the poverty line and a further 30% just above it, much of the population remains uncovered by health insurance (17–35% in different parts of the country). A rural-urban gap and health insurance benefits that are not portable across the country further contribute to inequality in access to health care.

Inefficient service delivery.

This results from many factors such as an overextended and fragmented network of service providers, inappropriate mix of primary, secondary and tertiary facilities, a provider payment system without efficiency incentives, composition and quality of services at the primary health care and hospital levels and lack of economies of scale. Reforms of primary health care and the hospital sector need to be properly balanced and synchronized.

Financial sustainability.

The financial sustainability of the health system is uncertain, and the health care system substantially burdens the economy. Public expenditure on health comprises 7.2% of gross domestic product (GDP). Combined with out-of-pocket expenditure estimated to comprise 2.6% of GDP, this results in total health expenditure of about 10% of GDP, higher than the average for central and eastern Europe. The reform agenda evolves around issues related to broadening the collection base for contributions, increasing the pooling of resources and effective mechanisms for allocating resources.

Limited institutional capacity and institutional fragmentation.

This hampers implementation of health care reform. The overall public administration of the health sector duplicates functions that are somewhat outdated or could be rationalized. System-wide decisions are difficult to make because authority among the local, regional or cantonal and central levels is not clearly delineated. Human resources management, consistent planning, policy development and coordination as well as mechanisms for European Union (EU) integration are weak.

Health information system.

The health information system is underdeveloped and does not provide the high-quality information needed for evidence-based policy-making. Health managers are largely deprived of a management information system.

Noncommunicable diseases.

The leading cause of morbidity and mortality is noncommunicable diseases. About 50% of deaths are attributable to cardiovascular diseases and about 20% to cancer. Road crashes and injuries (intentional and unintentional) are rising. The ageing population and unhealthy lifestyles associated with diet and alcohol and drug abuse are main contributors to the epidemiological profile.

Communicable diseases control.

HIV, sexually transmitted infections and tuberculosis (TB) remain high priority despite successes against communicable diseases in the past. Further strengthening of the surveillance system and response needs to be emphasized given the changed global epidemiological situation and the emergence of old as well as new communicable diseases.

Side Effects of Pantoprazole Magnesium

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