Budget Impact of Publicly Reimbursed Prescription Medicines in the Republic of Srpska

Health Care Services in the Republic of Srpska are provided through the primary, secondary, and tertiary care levels. Primary medical services provision happens throughout the network of 53 primary health care facilities and 1 family medicine polyclinic (1). There are approximately 500 pharmacies (2). Secondary and tertiary health care services are provided in two university hospitals, nine regional hospitals, three health centers, two specialized psychiatric clinics, and two specialized medical rehabilitation facilities (3). Insured citizens use health care services in public health care institutions and private institutions who have signed the contract with the Health Insurance Fund. Health care financing is mostly provided by the Health Insurance Fund, out of the mandatory taxes imposed to the employers and employees alike. Coverage for unemployed population is extended from the employed family member premiums (4). Fund is a legal entity established and owned by the State (5). The Ministry of Health and Social Welfare conducts the supervision of the Fund (6). One of the main functions of the Health Insurance Fund is collection of contributions for health insurance and contracting of health services. Complementary direct payment of contributions is made to the Pension and Disability Insurance Fund (7). The health care system in the Republic of Srpska is centralized with the overall power trusted to the Ministry of Health and Social Welfare, the Institute of Public Health, and the Health Insurance Fund. Employee pool in the health care system of the Republic of Srpska consists of approximately 2,400 clinical physicians, 200 dentists, 100 pharmacists, 6,500 nursing staff, and 4,000 administrative and technical staff (1). Gross National Income per capita increased from 8,770 to 9,820 US$ during 2009–2013 span. Total expenditure on health, as a percentage of gross domestic product, was 9.9% in 2012 (last official release) (8). The Republic of Srpska has around a population of 1,327,000 (9), and health expenditure per capita in 2009 amounted toAC389while in 2013 it reachedAC397 (10). Private and public expenditure on health care has increased in total from 2009 to 2012, and the public share of spending grew from 68.81 to 70.33% (11).