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Sustainability of healthcare financing in the Western Balkans : an overview of progress and challenges


  • Bredenkamp, Caryn
  • Gragnolati, Michele


This paper explores the major challenges to the sustainability of health sector financing in the countries of the Western Balkans - Albania, Bosnia and Herzegovina, the Former Yugoslav Republic of Macedonia, Montenegro, Serbia and the province of Kosovo. It focuses on how the incentives created by the different elements of the healthcare financing system affect the behavior of healthcare providers and individuals, and the resulting inefficiencies in revenue collection and expenditure containment. The paper analyzes patterns of healthcare expenditure, finding that there is some evidence of cost containment, but that current expenditure levels - while similar to that in EU countries as a share of GDP - are low in per capita terms and the fiscal space to increase expenditures is extremely limited. It also examines the key drivers of current healthcare expenditure and the most significant barriers to revenue generation, identifying some key health reforms that countries in the sub-region could consider in order to enhance the efficiency and sustainability of their health systems. Data are drawn from international databases, country institutions, and household surveys.

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  • Bredenkamp, Caryn & Gragnolati, Michele, 2007. "Sustainability of healthcare financing in the Western Balkans : an overview of progress and challenges," Policy Research Working Paper Series 4374, The World Bank.
  • Handle: RePEc:wbk:wbrwps:4374

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    References listed on IDEAS

    1. Mireille Razafindrakoto & François Roubaud, 2006. "Are international databases on corruption reliable? A comparison of expert opinion surveys and household surveys in sub-Saharan Africa," Working Papers DT/2006/17, DIAL (Développement, Institutions et Mondialisation).
    2. Jakob Svensson, 2005. "Eight Questions about Corruption," Journal of Economic Perspectives, American Economic Association, vol. 19(3), pages 19-42, Summer.
    3. Knack, Stephen, 2006. "Measuring corruption in Eastern Europe and Central Asia : a critique of the cross-country indicators," Policy Research Working Paper Series 3968, The World Bank.
    4. Omar Azfar & Peter Murrell, 2009. "Identifying Reticent Respondents: Assessing the Quality of Survey Data on Corruption and Values," Economic Development and Cultural Change, University of Chicago Press, vol. 57(2), pages 387-411, January.
    5. Charles Oman & Christiane Arndt, 2006. "Governance Indicators for Development," OECD Development Centre Policy Insights 33, OECD Publishing.
    6. Kaufmann, Daniel & Kraay, Aart & Zoido-Lobaton, Pablo, 1999. "Aggregating governance indicators," Policy Research Working Paper Series 2195, The World Bank.
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    Cited by:

    1. World Bank, 2008. "Kosovo : Health Financing Reform Study," World Bank Other Operational Studies 8121, The World Bank.

    More about this item


    Health Monitoring&Evaluation; Health Economics&Finance; Health Systems Development&Reform; Public Sector Expenditure Analysis&Management; Health Law;

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