Delivering Health Services Efficiently for Serbian’s : Synthesis Report

This review aims to provide evidence-based policy options to improve the performance of the Serbian health care system. The current rise of noncommunicable diseases (NCDs) and rapid aging in Serbia will put significant budgetary pressures on the health care system and, in the absence of structural reforms, will lead to increasing costs. According to the latest estimates, about 17 percent of the population in Serbia is over 65 years old, compared with 11 percent two decades ago. This proportion is expected to reach 25 percent in 2050. Meeting these rising demands in a limited fiscal space and a relatively costly public delivery system requires the government to enhance efficiency in public spending and service provision while ensuring access to quality health care. Overall, achievements in the health sector have been mixed. Serbia has achieved significant health gains in terms of life expectancy and basic health indicators, but these are still far below the European Union (EU) average, and marked differences are apparent across the country’s districts and population groups, such as the Roma. This health care system review also carried out a productivity analysis of health care providers in the public sector. The findings show that both outpatient and inpatient health facilities vary greatly in terms of productivity and that room exists for efficiency gains. There were 139 public primary health care (PHC) facilities included in the analysis. The gaps in cost per visit and visits per staff between the least productive and the most productive groups of facilities were wide, indicating an opportunity for optimization and cost savings. There is also large variation in productivity within and across types of hospitals. More productive hospitals also have better quality indicators and other outcomes. On average, the most productive hospitals had a higher occupancy rate, less staff per bed, and a shorter length of stay. The productive group also had lower acute myocardial infarction and stroke readmission rates and lower C-section rates.