Bjegovic-Mikanovic Vesna, Vasic Milena, Vukovic Dejana, Jankovic Janko, Jovic-Vranes Aleksandra, Santric-Milicevic Milena, Terzic-Supic Zorica, Hernandez-Quevedo Cristina
Centre School of Public Health, University of Belgrade.
Institute of Public Health of Serbia "Dr Milan Jovanovic Batut".
Health Syst Transit. 2019 Oct;21(3):1-211.
This analysis of the Serbian health system reviews recent developments in organization and governance, health financing, health care provision, health reforms and health system performance. The health of the Serbian population has improved over the last decade. Life expectancy at birth increased slightly in recent years, but it remains, for example, around 5 years below the average across European Union countries. Some favourable trends have been observed in health status and morbidity rates, including a decrease in the incidence of tuberculosis, but population ageing means that chronic conditions and long-standing disability are increasing. The state exercises a strong governance role in Serbia's social health insurance system. Recent efforts have increased centralization by transferring ownership of buildings and equipment to the national level. The health insurance system provides coverage for almost the entire population (98%). Even though the system is comprehensive and universal, with free access to publicly provided health services, there are inequities in access to primary care and certain population groups (such as the most socially and economically disadvantaged, the uninsured, and the Roma) often experience problems in accessing care. The uneven distribution of health professionals across the country and shortages in some specialities also exacerbate accessibility problems. High out-of-pocket payments, amounting to over 40% of total expenditure on health, contribute to relatively high levels of self-reported unmet need for medical care. Health care provision is characterized by the role of the "chosen doctor" in primary health care centres, who acts as a gatekeeper in the system. Recent public health efforts have focused on improving access to preventive health services, in particular, for vulnerable groups. Health system reforms since 2012 have focused on improving infrastructure and technology, and on implementing an integrated health information system. However, the country lacks a transparent and comprehensive system for assessing the benefits of health care investments and determining how to pay for them.
对塞尔维亚卫生系统的这一分析审视了组织与治理、卫生筹资、医疗服务提供、卫生改革及卫生系统绩效方面的近期发展情况。过去十年间，塞尔维亚民众的健康状况有所改善。近年来出生时预期寿命略有增加，但仍比例如欧盟国家平均水平低约5岁。在健康状况和发病率方面已观察到一些有利趋势，包括结核病发病率下降，但人口老龄化意味着慢性病和长期残疾情况正在增加。国家在塞尔维亚的社会医疗保险系统中发挥着强有力的治理作用。近期的举措通过将建筑物和设备所有权转移至国家层面增强了中央集权。医疗保险系统覆盖了几乎全部人口（98%）。尽管该系统全面且普及，可免费获得公共提供的卫生服务，但在获得初级保健方面存在不公平现象，某些人群（如社会经济地位最不利者、未参保者及罗姆人）在获得医疗服务时常常遇到问题。卫生专业人员在全国分布不均以及某些专业领域人员短缺也加剧了可及性问题。自付费用高昂，占卫生总支出的40%以上，导致自我报告的医疗需求未得到满足的水平相对较高。医疗服务提供的特点是初级保健中心中“选定医生”的作用，其在系统中充当守门人。近期的公共卫生工作重点是改善预防性卫生服务的可及性，尤其是针对弱势群体。自2012年以来的卫生系统改革重点是改善基础设施和技术，以及实施综合卫生信息系统。然而，该国缺乏一个透明且全面的系统来评估卫生保健投资效益并确定其支付方式。
