1. National Health Accounts in Serbia
Lund, 6-7 July, 2007
Dr Milena Gajic-Stevanovic

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),
Providers are mostly public and contracted by HIF.
Private sector is not part of public financing

4. Money flow in Serbian health system
Republic. Budget
MoD
Military HC providers
Republican Budget
MoJ
Prison 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 HC
Enterprises
Budget allocation
Contributions
Taxes, tolls
Intergovernmental money transfers
Refunds, compensations
Public current health expenditures
Private current health expenditures
Public health-related expenditures
HIF sub account

5. Establishment of NHA in Serbia
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 internationally comparable indicators, analysis and recommendations based on the information received and processed.
Material and methods: Data are obtained from Public expenditure Reviews, Administrative data, Household Budget Surveys, Provider Surveys, and linked applying the rules of “A System of Health Accounts (SHA)” Version 1.0.

6. 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 January 2005.
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

7. Establishment of NHA in Serbia
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 with projections for 2007,2008
-Six workshops were organized with 200 participants
-Presentation of NHA in Budapest HE Conference
-Adjusted reporting data from providers
-Media popularization and connection with private sector

8. 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)

9. 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

10. Results:Financing structure 2003 Who pays and how much?

11. Financing structure 2004

12. Financing structure 2005

13. Money allocated to providers Who provides goods?
Table 2A. Current health expenditure allocated the health providers (% )
Current costs in Serbia in %  
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 ,06) (0,06) (0,05)
Total current health costs
 100

14. Table sample:National health expenditure by type of finansing agent and type of provider (FAxP)
Providers ↓
Financing structure according to health care providers
HF Central government
HF State/ provincial government
HF Local/ municipal government
HF Social Security funds
HF Private house holds' out of-pocket payment.
HF Rest of the world
HP.1 Hospitals
46,94
6,2
0,76
0,72
87,34
5,97
100
HP.2 Nursing and residential care facilities
0,31
HP.3 Providers of ambulatory health care
19,45
4,37
0,20
0,67
62,00
32,90
HP.4 Retail sale and other providers of medical goods
24,00
0,01
35,30
63,92
0,40
HP.5 Provision and administration of public health programmes
1,18
38,98
1,69
0,85
42,37
3,39
14,41
HP.6 General health administration and insurance
4,93
9,74
80,14
10,14
HP.7 All other industries
3,13
10,00
90,00
HP.9 Rest of the world
0,06
National health expenditure
4,74
0,42
0,49
67,92
25,59

15. finansing agent and by function (FAxF)
Table sample:National health expenditure by type of
finansing agent and by function (FAxF)
Functions
Financing Agents
Total
HF.1 General Government
HF.2 Private Sector
HF Rest of the world
HF.1 Territorial Government
HF Social Security funds
HF.2.1 Private social insurance
HF Other private insurance
HF Private households' out-of-pocket payment
HF Non-profit institutions serving households
HF Private firms and corporations
HF Central government
HF Autonom region
HF Local/ municipal government
HC.1 Services of curative care
45,07  
55,82
54,20  
44,26  
29,58
14,41
 39,68
HC.2 Services of rehabilitative care
0,49  
0,26
0,76  
0,48  
1,08  
0,82
  0,62
HC.3 Services of long term nursing care
0,46
0,31  
HC.4 Ancillary services
20,00
23,99
23,04
19,64
6,10
5,40
16,03
HC.5 Drugs and other med.goods
11,52
13,93
15,80
25,72
62,67
31,97
HC.6 Prevention
12,77
5,99
6,20
3,65
0,58
79,37
6,45
HC.7 Administration
10,15
5,79
60,00
4,93
100
100 

16. Table sample: National health expenditure by type of provider and by function (PxF)
Health providers ↓
Financing structure according to health care providers
HC.1 Services of curative care
HC.2 Services of rehabilitative care
HC.3 Services of long term nursing care
HC.4 Ancillary services
HC.5 Drugs and other med.goods out of hospital distibuted
HC.6 Prevention and occupational health
HC.7 Administration
HP Hospitals
46,94
59,99
0,47
25,08
14,46
100
HP Nursing and residential heal.care fac
0,31
HP Providers of ambulatory health care
19,45
58,09
2,02
21,47
7,65
10,78
HP Retail sale andproviders of medical goods
24,00
HP.5 public health programmes
1,18
HP Gene.health administration and insurance
4,93
HP All other industries
3,13
HP Rest of the world
0,06
63,59
1,64
26,03
8,75
0,83
National health expenditure
39,68
0,62
16,03
31,97
6,45

17. How are health care funds distributed across the different providers?

18. How are health care funds distributed across the different services?

19. 2003

20. 2004

21. Preliminary results for 2005

22. Discussion: The compilation of health accounts was in many ways useful
Discussion: The compilation of health accounts was in many ways useful. For the first time private sector of providers and financers were observed.
Conclusions and recommendations: 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.

23. 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.
Institutionalization of NHA
is an ongoing process in which NHA activities, structures, and values become an integral and sustainable part of Government operations. This complex process can take years and multiple estimates before it is fully integrated into country’s formal structure, but in order to ensure that NHA remains an effective policy tool in the future, institutionalization should be a goal from the initiation of NHA.
Health information centre in PHI- Official health expenditure statistics
Memorandum of understanding between RSO, PHI, CHI, MOH, HIF

24. Thank you for your attention<