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

The patients’ 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 patients’ long 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 patients’ rights. Under the pressure of certain interest associations and groups (Crohn’s disease patients, physically disabled persons – by war and other circumstances, chronic and malignant diseases patients, pressures of financing medical care abroad, etc.) patients’ rights increased regardless of real financial possibilities. Insisting on bringing basic patients’ 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 patients’ wishes, except there were no longer people without insurance. A serious question is raised on financial funds that would follow such a broad patients’ 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