Can people afford to pay for health care? New evidence on financial protection in Serbia

This review is part of a series of country-based studies generating new evidence on financial protection – affordable access to health care – in European health systems. Financial protection is central to universal health coverage and a core dimension of health system performance. Catastrophic health spending is higher in Serbia than in most European Union countries and it has grown in recent years. It is heavily concentrated in the poorest fifth of the population and in households headed by pensioners and other economically inactive people, and largely driven by out-of-pocket payments for outpatient medicines. These findings reflect the health system’s heavy reliance on out-of-pocket payments, gaps in health coverage and the complexity of coverage policy. Efforts to strengthen financial protection should focus on delinking entitlement to National Health Insurance Fund coverage from payment of contributions; improving the coverage of medicines, medical products and dental care for adults; continuing to address waiting times in inpatient care; setting simple and strong protection for households with low incomes and other groups in vulnerable situations; removing percentage co-payments; and strengthening national capacity to engage in strategic purchasing of publicly financed health care.