1. National Health Accounts Republic of Serbia Output I Ljubljana 13-15 March, 2007

2. Establishment of NHA in Serbia In Republic of Serbia NHA represents a part of the Government Health sector reform strategy Work on NHA started in 2004. Work was divided on Phase I and Phase II Purpose of Phase I: - to produce a first set of NHA - 3 tables - to determine overall health spending patterns - to provide recommendations to policy makers based on first results Purpose of Phase II: More detailed information on private sector, labour account, cost of illness account All of that was accomplished as well as : OECD Guide for the use of NHA translated -NHA enters the government financial plans in 2006 -Six workshops was organized with 200 participants -Presentation of NHA in Budapest -Adjusted reporting data from providers -Media popularization and connection with private sector

3. Background Statistics Serbia population: 7,5 million, Health System financed by compulsory health insurance based on 12,3% payroll taxes via Health Insurance Fund, Problems of reduced financial basis in Health care system (2 million employed financing 7 million insured), Private sector is not part of public financing

4. Money flow in Serbian health system Republic. BudgetMoD Military HC providers Republican Budget MoJPrison Health providers MoE MoF oJ MoSA MoH Health education HIF MHIF Public HC providers Pension Fund Military personnel General population Regional Budgets Municipal Budgets Private HC providers Enterprise HCEnterprises Budget allocation Contributions Taxes, tolls Intergovernmental money transfers Refunds, compensationsPublic current health expenditures Private current health expendituresPublic health-related expenditures HIF sub account

5. Providers in Public sector Public Health care facilities in network-316 – HIF and CHI data HP.1.1. Hospitals - 48 HP.1.2. Mental hospitals - 4 HP.1.3.Specialized hospitals - 49 HP.2 Long term care - 51 H.P.3.2. Dental institution - 4 H.P.3.4.4.Center for dialysis - 1 H.P.3.4.5.Ambulatory care - Dom zdravlja - 90 H.P.3.5.m.l.-1+H.P.3.6.ger.-1+H.P.3.9.1.amb.-2+HP.3.9.2.blood -3 HP.4 Pharmaceutical Institutions-29 HP.5 Public Health Institutes-22 H.P.7.1.Occupational care-6 H.P..7.9.Other-5

6. Providers in Private sector Private health care facilities 3013 - MOH data + RSO site HP.1.1.Hospitals – 31 HP.3.1 Offices of physicians - 830 HP.3.2. Dental offices – 1119 HP.3.4. Ambulatory care policlinics – 4 HP.3.5. Med. lab. – 128 HP.4 Pharmacies - 901

7. Money allocated to providers Table 2A. Current health expenditure allocated the health providers (% ) Current costs in Serbia in % 2003 2004 2005 Hospitals HP.1 (42,32) (46,94) (44,56) Nursing and residential care HP.2 (0,30) (0,31) (0,2) Ambulatory care HP.3 (18,39) (19,45) (19,82) Retail sale and other providers of medical goods HP.4 (26,01) (24,00) (27,51) Public health institutes HP.5 (2,56) (1,18) (1,86) Health administration and insurance HP.6 (7,08) (4,93) (4,04) Other industries Occupat.health and households HP.7 (3,25) (3,13) (2,05) Rest of the world HP.9 0,06) (0,06) (0,05) Total current health costs 100

8. Categories of healthcare providers 2004 by sources of finance

9. Categories of healthcare functions 2004 by sources of finance

11. Finansiranje usluga 2005

12. 2003

13. 2004

14. Preliminary results for 2005

15. Rashodi za zdravstvo u 2006.

16. Preliminary results for 2005

18. First task- to find data sources Second task- setting up the system of cooperation and coordination of all relevant sides The Ministry of Finance- Tax office,(HF2.5) Budget and Treasury The Ministry of Health (HP.5,HP.6,HC.6,HC.7,HC.R.1) The Ministry of Labor, Employment and Social Affairs (HP.2,HC.3,) Ministry of Justice Ministry of Education (HC.R.2) Ministry of Defense Ministry of International Economic Relations (HF.3.1) Ministry of Science (HC.R.3) Health Insurance Fund- Public expenditure reviews Public Health Institute Republican Statistical Office Chamber of Health Institutes - Public expenditure reviews Drug agency (HP.4, HC.5) Agency for Environment Protection (HC.R.5) Retirement Fund (HC.R.6)

19. Data Sources (continued) Households out of pocket spending for Public sector are calculated from health institutions data and HIF data on co-payment Households purchases of pharmaceuticals are obtained from retail trade data from drug agency Household out of pocket spending for Private sector providers are calculated from Statistical surveys : Complex annual report – is based on annual financial reports and provides data on income end expenditure of health care providers; Survey on private entities – is based on data from Tax Office with data on income of private providers; Household budget survey – provides data on household’s expenditure for physicians, dentists, medical aids, hospitals, Spas

20. Plan for improving NHA The main issue to be addressed in the coming months is the institutionalization of the team and regular work on NHA. Official health expenditure statistics –CHI Health information centre in PHI Memorandum of understanding between RSO, PHI, CHI, MOH, HIF Expectations from workshop - Setting up the system of cooperation and coordination between countries in region in order to enable information flow among them.

21. Thank you for your attention<