Bosnia and Herzegovina

Bosnia and Herzegovina consists of two entities: the Federation of Bosnia and Herzegovina and the Republika Srpska - and the Brčko District of Bosnia and Herzegovina. The Federation of Bosnia and Herzegovina is further divided into 10 cantons, each of which is governed by its own cantonal government. This structure results in a complex health system with 13 health insurance funds and 14 ministries responsible for health. Health policy decisions are centralized in the Republika Srpska, but decentralized to the cantonal level in the Federation, making reform and consensus building challenging.

Primary health care (PHC) is provided by municipal health centers in both entities. Secondary care is delivered by outpatient specialists in PHC centers and hospitals, while tertiary care is delivered in university clinical centers. Health reforms in the 2000s focused on strengthening PHC through family medicine and rationalizing secondary and tertiary care, resulting in an increase in the number of family medicine specialists and a rebuilt PHC system.

Public funding for health care comes mainly from mandatory health insurance contributions, which are collected and pooled at the entity (Republika Srpska), district (Brčko District), or canton (Federation of Bosnia and Herzegovina) level. However, high out-of-pocket expenditure remains a concern, especially for poor households, and is largely driven by the cost of outpatient medicines.