Extremely complex health care organizations, by their structure and organization, operate in a constantly changing business environment, and such situation implies and requires complex and demanding health management. Therefore, in order to manage health organizations in a competent manner, health managers must possess various managerial skills and be familiar with problems in health care. Research, identification, analysis, and assessment of health management education and training needs are basic preconditions for the development and implementation of adequate programs to meet those needs. Along with other specific activities, this research helped to determine the nature, profile, and level of top-priority needs for education. The need for knowledge of certain areas in health management, as well as the need for mastering concrete managerial competencies has been recognized as top-priorities requiring additional improvement and upgrading.

In Bosnia and Herzegovina citizens receive health care from both public and private providers. The current situation calls for a clear government policy and strategy to ensure better position and services from both parts. This article examines how health care services are delivered, particularly with respect to relationship between public and private providers. The paper notes that the public sector is plagued by a number of weaknesses in terms of inefficiency of services provision, poorly motivated staff, prevalent dual practice of public employees, poor working conditions and geographical imbalances. Private sector is not developing in ways that address the weaknesses of the public sector. Poorly regulated, it operates as an isolated entity, strongly profit-driven. The increasing burdens on public health care system calls for government to abandon its passive role and take action to direct growth and use potential of private sector. The paper proposes a number of mechanisms that can be used to influence private as well as public sector, since actions directed toward one part of the system will inevitable influence the other.

In practical terms, whenever tissues are transplanted from one person to another it is essential to suppress the immune response of the recipient, no matter how perfect the HLA matching has been. When cellular (i.e. histo) compatibility differences exist, between donor and recipient, it is necessary to modify or suppress the immune response in order to enable the recipient to accept a graft. Immunosuppressive therapy, in general, suppresses all immune responses, including those to bacteria, fungi, viruses and even malignant tumors. Current scientific research and real life experiences show that the immunosuppression process can be more safely induced by utilizing the pharmacological means. Agents used in humans to suppress the immune response are discussed in more detail in the continuation of our paper. Financing of the organ transplantation will most probably be among one of the key questions, which need to be answered, before the patients begin to undergo this complex, tedious and costly procedure. The average actual costs and the associated financial contributions for the transplantation of liver and kidney, as well as other organs, have been reduced in the last decade. The main reason for this cost reduction is particularly the reduction of the time period of the patients’ hospital stay. Other reasons that contribute to this reduction, among others, include, (e.g. the pressure from the taxpayers as well as the increased innovation and availability of the new, highly potent and more effevctive and efficient immunosuppressive agents). The process of the cost estimation, in simplified terms, usually includes the costs involved in the following actions and procedures: (i.e. in the evaluation of the transplantation suitability, proper maintenance of the transplantatory candidacy, the costs related to the procurement of the compatible organs from the living and deceased-cadaveric donors, all hospital and physicians’ costs, post transplant care as well as the funding of the cost of the immunosuppressive medications within the first year after the organ transplantation). Finally, the aspect of the interest group lobbying and their effect on the key policy decision makers must also be mentioned. The population of patients who, due to their medical conditions, have to prepare for, undergo and follow up after the organ transplantation, by utilizing the special and costly immunosuppressive therapy must have the keen interest in improving their medical, legal and financial status.

INTRODUCTION In this study the authors have analyzed the costs associated with the immunosuppressive therapy in patients who underwent organ transplantation in two countries: the United States of America and Bosnia and Herzegovina (i.e. the entity Federation B&H). AIMS OF THE STUDY The goal of this paper is to compare and contrast the costs of the immunosuppressive therapy in two countries against the total costs of the organ transplantation. Further, the costs, dosages and effectiveness of the particular types of immunosuppressant were also analyzed. Problem of the Study: Immunosuppressive medications are essential in preventing kidney transplant rejection. Most available pharmaco-economic information to date is for induction and maintenance therapies, while the data on the financial impacts of the rejection are still limited. Immunosuppressive regiments are expensive in the socio-economic environment of limited resources and constraints. MATERIAL AND METHODS This academic article has utilized the publicly available sources of information from the Federation Entity of B&H, (i.e. Federal Department of Insurance and Reinsurance) in period 2006 to 2010, as well as peer-reviewed academic articles, books, private and government data from the United States of America from 2006 to 2010, including projections for 2011. RESULTS In the U.S. the cost of the immunosuppressive medications for the major types of organ transplantations typically range from US $19,300 to $34,600 per year based on commonly prescribed doses at average wholesale prices. In the Federation entity of B&H in 2009, the average cost per patient in F.B&H in 2010 was 6,009.00 KM (U.S.$4,292.00), which represents an absolute cost decrease of 740 KM or 11.00%, when compared to the higher average cost per patient in 2009, which was 6,749.00 KM (US $4,821.00). DISCUSSION The process of finding the ideal medication regiments to minimize morbidity and mortality, while maximizing quality of life and optimizing the cost is the major challenge to the transplantation community. Pharmaco-economic analysis can provide valuable insight toward achieving of these, rather difficult goals. CONCLUSION A sensitive pharmaco-economic analysis must be undertaken in order to achieve the best results in the world of limited/constrained resources and increasing demands for the expensive and quality of life improving immunosuppressive therapy in organ transplantation.