Long-Term Health Expenditure Changes in Selected Balkan Countries

Spending on health is a significant policy issue for most countries’ economies of the world. Those expenditures put high pressure on public budgets, measuring government investments in health and well-being of their citizens. This task is even more challenging for most Balkan countries, embraced by the global economic crisis in the last decade and prior history of civil war for most of them. Total health expenditure (THE), as a sum of public and private expenditure (1), expressed as percentage of gross domestic product (GDP), in the most of the selected Balkan countries, for the selected period from 1995 to 2012, showed obvious increase (Table 1) among majority of them. THE share of GDP among observed countries in 2012 was highest in Albania, with almost two and the half times larger share than in 1995. Romania, Serbia, and Bulgaria recorded about 1.5 fold higher share, while Greece, Bosnia, and Herzegovina and Montenegro remained at the same level as in 1995, comparing selected indicator. Exceptions were Croatia and The Former Yugoslav Republic of Macedonia (FYRM), with minor decrease. Possible explanations could be decline in the number of births, an increase in the mortality of younger aged people during the war and negative migration trends. Those could have influenced on stagnation of the growth of THE as percentage of GDP in Croatia (2), while FYRM is a country with more than 25% of the population living in poverty and with an unemployment rate in the country of over 30% (3). On the other hand, growth in health spending as a proportion of GDP contribute to the problem of economic and fiscal sustainability where health system revenue is insufficient to meet growing health obligations (4). This scenario is even more obvious in countries with shrinking economies. Total expenditures on health per capita, in terms of current purchase power parity in international $, in all selected Balkan countries showed significant growth comparing 1995 and 2012 (Table 1). Reason for this, not just local phenomenon, partially would be probably due to a population aging (5), which is in the close relationship with intensive health care spending and one of the cores of a health financing problem in Balkan countries (6). Life expectancy, as one of the widely used measure of health, showed increase in all observed countries, except Montenegro (7). The most obvious increase achieved Bosnia and Herzegovina, with prolonged 8 years of life in 2012 compared to 1995, reaching 76 years. Greece and Slovenia had the highest life expectancy, with 81 and 80 years, respectively (7). In all observed countries, general governmental and private expenditures on health per capita also showed significant and constant growth (Table 1). However, general governmental expenditure still remains a dominant mode of the health financing in most selected Balkan countries. The only exception is Albania, where private expenditure on health in 2012 was slightly higher than governmental. The fact that the ratio of private expenditure growth in 2012 compared to 1995 was almost sevenfold higher in Bulgaria, closely followed by Serbia, Albania, and Romania remains. The greatest share of private expenditure consists of out-of-pocket expenditure, which accounts 56% of THE in Albania, 42% in Bosnia and Herzegovina, and 22% in Serbia and Montenegro (8). It could have severe effect on household economic status of already impoverished population.