Social Protection in Health Care and Vulnerable Population Groups in Serbia

Social protection refers to a set of policy measures to protect individuals, especially the critically poor, from financial losses due to high-risk events, such as natural disasters, social risks like unemployment, war or unexpected financial shocks, and political risks like discrimination of minorities in conflict zones (1–3). In terms of health, social protection includes protection against health risks, to ensure good quality of care and financial protection that aims to protect people from unexpected health care shocks (4). One way to assure financial protection in the health care sector is to introduce universal social health insurance (5). However, when universal health insurance cannot provide financial sustainability of the health care system, patient charges are necessary. With patient payments social protection can be achieved by the implementation of an exemption mechanism (5). In this paper, we focus on financial protection in health care in Serbia. Serbia is a middle income country with long-term tradition in social protection related to health, inherited from the period of the former Yugoslavia (6–11). The health care system of Yugoslavia was known as a Swedish model in the Balkan (12). However, during the period 1991–2000, Serbia faced a civil war combined with a severe economic crisis (13). The crisis was followed by impoverishment among the citizens and the collapse of the existing health care system. Impoverishment was not the only consequence of the civil war. Like in many other post-conflict and transitional societies, corruption became a modus vivendi in the public sector in Serbia (14). The widespread corruption had a direct effect on health care consumers as well. Different types of informal (under the table) patient payments become common practice in the health care system (15). After a major political change in 2000, the Serbian government introduced health care reforms. The main objective was to improve efficiency, service quality, and equity in health care (16). As part of the health care reforms, in 2002, the Serbian government introduced official co-payments for services covered by the compulsory health insurance to improve the financial situation of the public health care system. The introduction of official co-payments was accompanied with an exemption mechanism (7, 17).