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Introduction In the period from 2004 to 2020, many reforms were implemented in the health sector of the Republic of Serbia and it's financing. The aim of this work was to provide an insight into foundations on which healthcare was based in the Republic of Serbia in the period from 2004 to 2020 and review the reform changes in the healthcare sector and it's financing. Material and method A retrospective analysis of data from the National Health Account of the Institute of Public Health of Serbia, the regulations of the Republic Health Insurance Fund, reports of the Ministry of Health as well as laws and regulations related to the health sector was performed. Results The results of the analysis showed that the State health sector represented the foundation of the health system in the Republic of Serbia in the observed period. Of the total health financing, it was estimated that about sixty percent were public financing schemes, and about forty percent belonged to private schemes, with a large part of private schemes being out-of-pocket payments. Conclusion The general conclusion of the analysis is that in the observed period, within the framework of the reform changes, Serbia had a good system of exemption from participation, but that out-of-pocket payments for certain health services and corrupt payments represented a barrier to health care.

Introduction There is growing interest in the world for estimating the cost for the treatment of a disease. This value can be used to determine to which extent a particular disease or group of diseases burden society in terms of the global crisis (Segel 2006). In 2000, Organization for Economic Countries Development (OECD) established a System of Health Accounts (SHA), and provided methodological guide for calculating the cost of treating the disease. The aim of this study was to determine the cost of individual health care in the Republic of Serbia according to the major International Classification of Diseases (ICD) for the period 2010-2015. Material and Methods A retrospective and comparative analysis of health statistics from the database of the Institute of Public Health of Serbia (IPHS) and financial information provided by the National Health Insurance Fund (NHIF) in the period 2010–2015 was performed. Financial information and data on hospital services, outpatient, home health care, auxiliary health care services, drug consumption and consumer goods in healthcare were analyzed using SHA methodology. Results showed that during observation period the maximum cost of individual health care in Serbia by main classification ICD was achieved in 2015 and it was 194,128,864,011 RSD (€1,580,853,941; $1,764,807,854) and the minimal cost was achieved in 2010, 151,333,139,835 RSD (€1,434,464,541; $1,908,843,843). Conclusion The cost of individual health care in the Republic of Serbia in the period 2010-2015 increased by thirty percent. The highest amount was allocated to treat people with diseases of the circulatory system.

The European Health Consumer Index (EHCI) is a project that since 2006 has been comparing and ranking health care systems of European countries, from the perspective of patients (consumers) - users of the health care system. Its purpose was to set standards for well functioning and organized health care. The aim of this study was to assess the state of Serbian health care system from the perspective of the European health consumer index and propose recommendations for its improvement and functioning in accordance with European standards. The assessment of the health care system is based on pre-determined forty-eight indicators divided into six groups. According to these indicators, scoring and ranking of countries was done (maximum score for a particular indicator was 3, and the minimum was 1). As per European Health Consumer Index the Republic of Serbia is ranked at 33rd place, with total of 473 points, while Netherlands has been found on the top of the list for years (this year 898 points).

Culture encompasses entire societies, influences everything we feel, see, do and believe and shape the way we approach the world around us. Culture is an inseparable part of human existence and as such an important part of health and health care. The aim of this paper was to present specific forms of culture in health care that have influence on the quality of health care system, as well as to investigate in which capacity is work on culture in the health care system in Serbia represented. National and international literature and documentation was processed using analytical methods - observation and comparative method. Health culture as responsibility of health care users and culture in health care as responsibility of health care employees are key factors in improving the health system in Serbia. The most important step has been made with the strategic plan of the Government of the Republic of Serbia in 2010, however, everyone has to accept and understand the importance of culture in health care and apply its rules into the practise.

Health institutions have the most complex organization and management among all institutions. Unlike traditional management in organizational systems characterized by analytical and interdisciplinary approach, health institution management is characterized by trans-disciplinary approach to solving business problems. Introduction of quality improvement is a challenge for health care managers due to their responsibility to create an environment that will lead to quality improvement and safety of health services. New Health care Act (2005) has created a legal framework for defining quality indicators, and setting up various committees and bodies in order to improve the quality of health care. As the planning, management and quality control are the most important parameters of the health system development, health manager must be a leader with exceptional communication skills and able to apply his knowledge and skills in the management of resources. Top managers, central type and lower level managers must be the driving force of their institutions creating the basis for activities related to quality. They should have a proper education as well. New concept of management emphasizes people and their specialized knowledge. Past practice in Serbia did not show significant improvements in the management process through the knowledge and skills of managers, especially in terms of strategic decision-making in the operation and development of the health system.

Introduction. The backbone of Serbian health system forms the public healthcare provider network with 355 institutions and around 112,000 employees, owned and controlled by the Ministry of Health and financed mainly by the Republican Health Insurance Fund. The law recognizes private practice that was not included, till recently, in the public funding scheme. New Health Insurance Law (2005) decreased the number of entitlements in the basic health service package. It abolished the right to dental health care for adults (exceptions are: children, older than 65, pregnant women and emergency cases) as well as the right to compensate travel expenses. The aim of this study was to evaluate the effects of health care system of the Republic of Serbia and indicate parameters that determine the state of health of the population, on the ground of data obtained by the Institute of Public Health of Serbia. Results. In the period 2004-2012, cardiovascular diseases represented the main cause of illness in Serbia (50%). In 2012 digestive system diseases were on the second place. Neoplasm and nervous system diseases were on the third place. From 2007 to 2012 there was slight decline in the birth rate and number of deaths, but the death rate increased from 13.9 to 14.2. Health care system in Serbia is funded through the combination of public finances and private contributions. Primary care is provided in 158 health care centres and health care stations, secondary and tertiary care services are offered in general hospitals, specialized hospitals, clinics, clinico-hospital centers and clinical centres. Conclusion. A significant but not satisfactory progress has been achieved in the field of health status indicators as the most important outcome of the final performance of the health system. The transition of public health care system in Serbia since the communist period to present and slow integration with European Union is unfinished process.

Introduction. Health care, as one of the most important and sensitive fields of human endeavour, has a significant social impact; therefore changes in this area have wide implications on society in general. The latest economic crisis resulted in slow growth of gross domestic product (GDP), high unemployment rates, low living standards, and increased poverty across the globe. This includes decreased capacity of health system, and reduced quality and supply of health services. The aim of the study was to explore possible impact of the current world economic crisis on the public health sector workforce in Serbia. Materials and Methods. The study was conducted as retrospective analyses of the Public Health Institute (PHI) human resource data, the Republic Statistical Office publications and database, the Republic Development Bureau report, as well as the analysis of healthcare expenditures obtained from the Chamber of Health Institutions reports. The comparative analytical method was used for the assessment of socio-economic and human resource indicators over the period of five years, 2006 to 2010. Results. Results showed that the world economic crisis discontinued steady economic growth in Serbia. Between 2006 and 2008, the real GDP growth rate has been fluctuating between 3.6% and 5.4 %, while in 2009 it had negative growth rate of -3.1 % and slight increase in 2010 of 1.0%. In 2006, the GDP per capita was US$ 3,943, and by 2008 it almost doubled reaching US$ 6,498, while in 2009 it fell down to US$ 5,499, and continued decrease in 2010 to US$ 5,006. In 2007, the overall inflation rate was 6.5%, and after fluctuaion between 11.7% in 2008 and 8.4% in 2009 it droped again to 6.5% in 2010. According to the PHI, from 2006 to 2008 there was steady increase of full-time employees in the public health care sector; from 108,975 in 2006 to 114,317 in 2008. In 2009, the number of full-time employees slightly declined to 114,175 and 114,432 in 2010. There was constant increase in total number of employees in the public health care sector, from 125,081 in 2006 to 129,357 in 2008. In 2009, the total number of employees decreased to 128,694 and in 2010 to 122,695. At the same time, the total expenditure of human resources in the health sector as the percentage of total health expenditure declined from 37.7% in 2006 to 34.7% in 2010. The public health sector salaries after steady increase from 59.9% of total health expenditure in 2006 to 61.2% in 2007 and 2008, decreased to 56.2% in 2010. The unemployment rate for medical doctors almost doubled in 2010 as compared to 2006. Conclusion. Preliminary study results showed that the world economic crisis had negative impact not only on GDP growth rate, the inflation and unemployment rate, but on the public health sector workforce, their salaries and unemployment rate in Serbia.

Introduction. Collecting data about the structure and function of private health care sector in Serbia and its inclusion in joint health care system is one of the most important issues for making decisions in health care and getting more accurate picture about the possibilities of health care system in Serbia. The aim of this analysis was to compare health institutions, personnel, visits, number of hospital days and morbidity by ICD-10 classification of diseases in public and private health sector in South Backa, Nisava, Toplica and Belgrade district in 2009. Material and Methods. A retrospective comparative analysis was performed using data about private providers of health services obtained from the Institute of Public Health Novi Sad, the Institute of Public Health Nis and the City Institute of Public Health Belgrade. Data about personnel and morbidity in public health sector in Serbia for 2009 was obtained from the Center for Information Technology of the Institute for Public Health of Serbia. Data about public health facilities in South Backa, Nisava, Toplica and Belgrade district in 2009 was obtained from Serbian Chamber of medical institutions. Results. The results showed that health care was provided in Belgrade district in 2009 by total of 1,051 employees in private sector and 31,404 in public sector. We found that public sector had a far wider range of health facilities than private sector, which was mainly due to the number of clinics. In South Backa district private sector had 323 practices, the district of Belgrade 655 and Nisava and Toplica district 173. Seventeen times more visits to households (4,650,423 vs. 267,356) and 111 times greater number of hospital days was provided in public health sector as compared to private health sector (781,083 vs. 7,023) in South Backa district. Conclusion. The conclusion of this analysis was that public health sector has remained the foundation of health care system in Serbia. Private health sector is expanding, but its structure and scope of services is still undervalued as compared to public sector.

Introduction. As the part of research on costs in the health care system, there is a growing interest in the world for the estimating costs for the treatment of disease. This value represents the burden that a particular disease or group of diseases puts on the society. Until the year 2000, when the Organization for Economic Countries Development (OECD) established a System of Health Accounts (SHA), there was not even approximate methodological guide for calculating the cost of the disease. The aim of this study was to determine the costs of health care in the Republic of Serbia according to the major International Classification of Diseases (ICD-10) and to provide a comparative cost analysis for the treatment of diseases in the period from 2004 to 2009. Material and Methods. A retrospective and comparative analysis of health statistics from the database of the Institute of Public Health of Serbia and financial information provided by the Health Insurance Fund in the period 2004-2009 was performed. Financial information and data on hospital services, outpatient, home health care, ancillary health care services, drug consumption and consumer goods in healthcare were analyzed using SHA methodology. Results. Results showed that during the observation period, the maximum cost of health care in Serbia by main classification of ICD-10 was achieved in 2009 and it was RSD 144,150,456,906.00 (€ 1,503,321,134; $ 2,160,253,219) and the minimal cost was achieved in 2004 - the amount being RSD 49,546,211,470.00 (€ 628,086,723; $ 855,203,134). Results showed that in 2004 the highest costs were allocated to circulatory diseases (18.98%), followed by neoplasm (11.12%), and lowest for congenital anomalies (0.64%). In 2009, the highest costs were allocated to circulatory diseases (18.87%), infectious and parasitic diseases (11.20%), diseases of digestive system (9.26%) nervous system diseases (9.20%), and neoplasm (8.88%), whereas the minimal funds were allocated for congenital anomalies (0.33%). Conclusion. Comparative analysis showed that the value of overall spending in healthcare increased three times in 2009 as compared to 2004.

Introduction. Primary health care in the Republic of Serbia is predominantly funded by the Republic Health Insurance Fund (RHIF). From the total income of health centers and institutes at the primary level, with no pharmacy and pharmacies (Kosovo excluded), 84% in 2008 was paid by RHIF. Frequency of participation ranged from 63-95% and it was stable in all observed years. The aim of this study was to determine the expenditures for primary health care for each insured person in statistically defined districts in the Republic of Serbia, with an emphasis on prevention participation. Material and Methods. Retrospective and comparative analysis of health statistics from the database of the Institute of Public Health of Serbia (IPHS) and financial data from the RHIF for the period 2006-2008 was done. Results. Observed by the districts in 2008, in Vojvodina, the lowest expenditure for primary health care had North Backa District (5,207 RSD) and greatest was in West Backa District (6,632 RSD) per capita. In the central Serbia territorial difference was much greater, ranging from 3,574 RSD in the District Morava to 6,701 RSD per capita in the District Toplica and Nisava. Expenditures for direct health care of RHIF per capita in the reporting period continuously have grown. Conclusion. The results showed that the largest cost for primary care for the insured person in the districts of Serbia was registered in the Nisava and Toplica (6,701 RSD) and lowest in the district of Morava (3,574 RSD) per capita.

Introduction: The importance of studying management in one of the most sensitive and complex areas of human endeavor that is healthcare is of great significance for providing high quality and efficient easily-accessible healthcare in the future. Studying the challenges that need to be overcome towards achieving this goal is of great importance not only from the viewpoint of scientific management theory but primarily to help bring about strategically important decisions that are crucial for the continued evolution and reformation of the healthcare system, in which the employees have a new, much more complex role. The objective: was to more thoroughly study, describe and understand the role the employees have in the transformation of health care management. Material and method: During this research the material used was foreign and local literature, processed using the Analytical method as well as the Observation and Comparative methods. Conclusion: In the transformation of the health care management a very important role is played by the health care employees. Without the transformation of the current practice and significant changes in both the structure and work ethic of all the employees in health care services (nurses and people in management alike) there will be no improvement in the health care system overall.

Introduction: Global markets and competition, fast changes, the explosion of information technology, integration processes in international relations are some of the initial factors for changes in health care organizations and their management. Management represents an evolving new generic function of all organizations of social significance across the world. Managers in the health sector have exceptionally complex roles that require new skills and methods. The objective of this study is to analyze in grater detail, explain and describe the role and necessary skills of a health care manager in the strategic transformation of health care management. The modern health care manager can get the best results by strengthening human resources and meeting employees' personal needs in accordance with the global and specific goals of the health care institution. The manager is at the same time a mentor and a facilitator, putting to best use the forementioned transformation strategies whilst expending the resources carefully, strengthening the collective efforts, involving employees in the decision-making process and motivating teamwork and collective problem-solving.