Overview
The healthcare system in Bosnia & Herzegovina (B&H) is divided just like the country is divided politically. There are three laws on healthcare and three laws on health insurance. The Federation of B&H contains the Federal Ministry of Health, Health Insurance and Reinsurance Institute, and 10 Cantonal Ministries of Health. The Republic of Srpska contains the Ministry of Health, Social Protection, and Health Insurance Fund. The Brcko district contains the Department for Health and other services in the government, and the Health insurance Fund. A certain amount of money is deducted from every paycheck of employed people to contribute to the health insurance funds. Students, pensioners (retired people), and unemployed people are freed of any payments and are also covered by the Fund.

The obvious fragmentation of the system on the one hand, and the diversity of laws and bylaws in parts of the country on the other hand, significantly contribute to the different treatment of patients, that is, a situation in which residents in one part of B&H can access more health services and more that are covered by health insurance, and services of better quality than residents in the other part. This is partly why it is so necessary to carry out comprehensive reforms in order to eliminate these differences and elevate quality of care for all residents.*

What happens if you need to see a doctor?
Everyone in Bosnia & Herzegovina has a doctor assigned to them. There are dispensaries and health centers if you need a check up from your doctor and he or she then decides if you need a specialist or to have tests done. General and specialist visits are covered by the Health Insurance Fund. Tests and procedures can be partially or completely free, or full charge, depending on the area of medicine. If you need urgent care you can call or go to the ambulance. The biggest problem is a lack of medical professionals, leading to long wait times. If, on the other hand, you don’t have insurance because of unemployment or other gaps in coverage due to administrative requirements, you will have to pay for every service. Medical staff are lacking at main hospitals and patients can wait many months for services. Corruption in the healthcare system is a big problem. Research has shown that many doctors will not perform a procedure or check-up if you don’t slip them a few hundred dollars under the table.

Who decides what doctors can prescribe?
When it comes to specific diseases, primary care doctors can only prescribe a drug if a specialist decides you need it. If you have a cold, your primary care doctor can prescribe you antibiotics and similar things. There is a Law on Medicines and Medical Means that covers the entire country. The registration and approval of medicines is done by the Agency for medicines and medical means of Bosnia and Herzegovina. The Health Funds have an A and B list. The A list includes every medication and medical device that is covered by the health insurance and the B list covers the others. This is quite unregulated, as a lot of pharmaceutical companies and doctors have personal interests and misuse their positions for financial benefits.

Practically, what is it like to live with type 1 diabetes in Bosnia & Herzegovina?
The best part of our healthcare system is that insulin is 100% free of charge and so are medications for type 2 diabetes. Unfortunately, test strips are either partially covered (a small amount, around one test strip per day for people over 18) or not covered at all. Generally, rights are better for children under the age of 18 who are eligible to get a pump and financial aid from the country. Only in the canton of Sarajevo are the pump supplies covered for a lifetime, and that is only if you received the pump before the age of 18. Continuous Glucose Monitors (CGMs) aren’t registered and as a small country we don’t have enough patients or money to be a potential market. Doctors are undereducated, patients don’t get any education at all, or if they do it’s very poor and according to outdated standards. Considering our country’s government is very dysfunctional, diabetes care is the same, and is probably the poorest in the Balkan region.

What about getting admitted to hospital?
Getting admitted to the hospital is covered by insurance if you are insured. If it is something urgent, the ambulance will pick you up and bring you to the urgent care. The problem is that hospitals are understaffed and undersupplied, so patients from smaller cities and villages have to travel two to eight hours to reach the hospital where their diabetes can be treated.

How does diabetes care vary across Bosnia & Herzegovina?
As mentioned above there are a lot of laws and differences depending on which part of the country you live. Some parts have much better access to care than others. You get the best care in Bosnia & Herzegovina in bigger cities. The best situation is in the main city and its canton. The care varies a lot and many patients aren’t informed of their rights or educated about what diabetes actually is and how to live with it. Changes will happen very slowly, as the country has a lot of political issues to be resolved first.

*This information has been extracted from a report written by Ervin Mujkic and published by the Foundation Law Center.

A special thanks to Lejla Druskic, T1International Global Advocate, for providing this information.