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Country profiles of health system responses to the crisis | Serbia 477 Changes to health service planning, purchasing and delivery Prices of medical goods • Producers waived the cost of 10% of total sales in response to a request from SHI (2011–2012). Salaries and motivation of health sector workers • Lower remuneration in contracts for house-keeping and information technology support workers in health care organizations (2010). Payment to providers • Introduction of a capitation formula in primary care (2012). This is the first step in which it is planned to reallocate not more than 2% of salary among teams. It represents a paradigm shift from line internal budgets towards performance based payments. Overhead costs: restructuring the Ministry of Health and purchasing agencies • Reduction of the number of employees at the Serbian Health Insurance Fund by 11% over a period of two years, using social programmes and regular retirement schemes. Provider infrastructure and capital investment • Continued implementing several e-health infrastructure projects including national electronic health records (2012). Priority setting or protocols to change access to treatments, coordination of care and patterns of use • No response reported. Waiting times • No response reported. Health promotion and prevention • New screening programmes on cervical and breast cancer, diabetes and hypertension (2013).

Slovakia Karol Morvay and Tomáš Szalay Economic trends • Slovakia's economy contracted in 2009, and in 2010 and 2011 returned to growth rates below the European mean. Deficit levels relative to GDP increased in 2009, although they were lower as government spending relative to GDP declined in 2010 and 2011. • Unemployment rates were above the European mean throughout the 2008 to 2011 period. • While the size of government expenditure has reduced since 2009, the priority for health spending remained stable from 2009 to 2011, slightly above the European mean. This meant that public per capita health spending slowed in 2009 and declined in 2010 and 2011 by 0.4 and 1.5%, respectively. OOP expenditure per capita also slowed in 2010 and 2011 (Slovakia: Figs 1 and 2). Policy responses Changes to public funding for the health system • SHI revenue growth slowed from 12.5% in 2008 to an average of 3.3% per year between 2009 and 2011. • Government transfers to SHI on behalf of non-contributing people rose from 4% of the average wage in 2005 to 4.9% in 2009 and were gradually reduced to 4.25% in 2013; SHI contributions were extended to dividends (2011). • The government transferred €50 million from the state budget to SHI by temporarily increasing the contribution rate for government employees from 4% to 4.33% (2012); the maximum assessment for SHI contributions was increased three times, to five times the average wage, and SHI contributions were extended to part-time contracts (2012). Changes to health coverage Population (entitlement) • No response reported. The benefits package • No response reported.

Country profiles of <strong>health</strong> system responses to the <strong>crisis</strong> | Serbia<br />

477<br />

Changes to <strong>health</strong> service planning, purchasing <strong>and</strong> delivery<br />

Prices of medical goods<br />

• Producers waived the cost of 10% of total sales in response to a request<br />

from SHI (2011–2012).<br />

Salaries <strong>and</strong> motivation of <strong>health</strong> sector workers<br />

• Lower remuneration in contracts for house-keeping <strong>and</strong> information<br />

technology support workers in <strong>health</strong> care organizations (2010).<br />

Payment to providers<br />

• Introduction of a capitation formula in primary care (2012). This is the first<br />

step in which it is planned to reallocate not more than 2% of salary among<br />

teams. It represents a paradigm shift from line internal budgets towards<br />

performance based payments.<br />

Overhead costs: restructuring the Ministry of Health <strong>and</strong> purchasing agencies<br />

• Reduction of the number of employees at the Serbian Health Insurance Fund<br />

by 11% over a period of two years, using social programmes <strong>and</strong> regular<br />

retirement schemes.<br />

Provider infrastructure <strong>and</strong> capital investment<br />

• Continued implementing several e-<strong>health</strong> infrastructure projects including<br />

national electronic <strong>health</strong> records (2012).<br />

Priority setting or protocols to change access to treatments, coordination<br />

of care <strong>and</strong> patterns of use<br />

• No response reported.<br />

Waiting times<br />

• No response reported.<br />

Health promotion <strong>and</strong> prevention<br />

• New screening programmes on cervical <strong>and</strong> breast cancer, diabetes <strong>and</strong><br />

hypertension (2013).

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