Rights of Patients to Use Health Care from the Perspective of Legislation and the Real Possibility of Financing Them

The patientsʹ rights based on ex-Yugoslavian health insurance were very broad: unlimited number of visits and PPZ service, number of diagnostic services, hospital care in the in and outside the country, spa care and climatic treatment centers care, sick-leaves and unlimited number of many other health services. In that period, a great deal of social problems was handled through health care system. There are many examples for this claim, but the doctors that had worked at that time have practical experience (number of sick-leaves caused by an illness of a family member, old and chronic patientsʹlong stays at hospital etc.) In the period after the war, citizens still had old habits of irrational exploitation of health services, and the legal acts helped them in that. Health Insurance Law and Medical Care Law from 1997 are just modified laws from before the war which kept breadth of patientsʹrights. Under the pressure of certain interest associations and groups (Crohnʹs disease patients, physically disabled persons - by war and other circumstances, chronic and malignant diseases patients, pressures of financing medical care abroad, etc.) patientsʹ rights increased regardless of real financial possibilities. Insisting on bringing basic patientsʹ rights from obligatory insurance over the years succeeded - by the end of 2008 the document went through law procedure and has been acquired. Unfortunately, the document did not create precondition for expense rationalization in medical service, like it was expected, but it was more like the sum of patientsʹwishes, except there were no longer people without insurance. A serious question is raised on financial funds that would follow such a broad patientsʹ rights. Rate of paying from GDP in FBiH takes out 8.82%, which is a good rate of paying compared to the other ex-Yu countries (Croatia 7.5%, Montenegro 6.8%, Slovenia 8.4%, Serbia 8.0%) and EU countries (Sweden 8.9%, Norway 8.7%, Italy 9.0%, Austria 9.9%), and taking in consideration countries from the ex communist block, our rate is higher (Romania 5.7%, Russian Federation 5.3%, Check Republic 6.8%, Bulgaria 6.9%, Albania 6.3%). Unfortunately, statistics brought by simple math does not give us a real insight - all mentioned countries, except Serbia, Albania and Ukraine, have higher GDP than Bosnia and Herzegovina, some of them even seven times higher (Norway), and therefore their annual payment for medical care per capita is several times higher: Check Republic 1940 US$, Italy 2623 US$, Sweden 3119 US$, Slovenia 2065 US$, Croatia 1084 US$. While Bosnia and Herzegovina has substantial GDP rate of paying for health care, on the other hand, annually, it has far smaller financial means per capita (FBiH 431.00 BAM - in 2007, and Sarajevo Canton 619.08 BAM per insured person). Based on 2007 data, a citizen of Sarajevo used medical service in these scopes: 3.7 services in PPZ, 3.29 visits in specialized health care, 1.51 per day, 15.7 diagnostic services, 1.13 physical rehabilitation services, 1.31 dentist services, in women health care 1.31 services, 6.7 medical prescriptions (costing 17.04 BAM which means 114 168 BAM). Sick leave reimbursement, orthopedic aids, health services abroad and any other possible (legally specified expense) should be added to this, the sum of these prices individually obviously goes far more than 619.08 BAM. If we take into consideration that also uninsured persons used medical care on some ground, then, it is clear that sum per capita is even smaller. How to continue without bringing collapse in financing and functioning medical services?We think that two possible ways of effect: the first one is revising the rights from obligatory insurance, primarily basic package; the other way is final initiation of additional/supplementary insurance, but it would be more successful if both of these ways would be implemented.