2023-10-02-世界银行-塞族共和国和波斯尼亚和黑塞哥维那联邦私营部门参与非传染性疾病控制_目前的范围和政策选择（英）-2023-93页_93页_3mb

Summary of Private Sector Engagement for Noncommunicable Disease Control in Republika Srpska and the Federation of Bosnia and Herzegovina

Core Content

This report evaluates the current role and potential for private sector engagement in the prevention and control of noncommunicable diseases (NCDs) in Republika Srpska and the Federation of Bosnia and Herzegovina (BiH). It outlines the policy, financing, and service delivery arrangements and proposes recommendations for improving the integration of private health care providers into NCD control strategies.

Main Risk Factors and NCD Burden

• NCDs are the leading causes of death and disability in BiH.
• The top four risk factors are tobacco consumption, high fasting plasma glucose, high blood pressure, and high body-mass index.
• Environmental risks, such as air pollution, are also among the top ten risk factors.
• NCDs have increased in prevalence due to aging and social and behavioral risk factors.
• The high NCD burden has made the population more vulnerable to the impact of the COVID-19 pandemic.

Country Context

• BiH is an upper middle-income country with a GDP per capita of $6,080 in 2020.
• The country has experienced unfavorable demographic trends, including aging, population decline, and low fertility rates.
• Life expectancy has improved over the past few decades, but the burden of NCDs remains high.
• Net migration in 2017 was -107,926, with mostly working-age adults leaving the country.

Governance Arrangements

Key Findings

• In Republika Srpska, the legal framework for health care has been recently revised, creating an opportunity for improved governance.
• The Action Plan for the Prevention and Control of NCDs in Republika Srpska (2019–2026) outlines strategic directions but does not clearly define the role of private providers.
• Private health care providers are insufficiently aware of the action plan.
• Institutional capacities for engaging, contracting, and monitoring private providers need strengthening.
• Registries of private health facilities are often outdated or not publicly available.
• Regulatory frameworks for private sector involvement in NCD prevention and control are not sufficiently developed.

Recommendations

• Republika Srpska:

  • Revise existing regulations to clearly define the role of private providers in NCD prevention and control.
  • Strengthen institutional capacities for engaging with, contracting, and monitoring private providers.
  • Ensure updated public registry and detailed information on the number and structure of private health facilities and their services.

• Federation of BiH:

  • Ensure consistent monitoring of the application of legislation across cantons related to the establishment of private health institutions.
  • Strengthen institutional capacities for contract preparation, monitoring, and reporting with engagement of private sector providers.
  • Integrate health information systems at the cantonal level to enable centralized access to electronic medical records.
  • Enable the active participation of medical chambers and professional associations in strengthening the health system and NCD prevention and control activities.

Financing Arrangements

Key Findings

• In Republika Srpska, the Health Insurance Fund allocates funds for a limited number of prevention services by public providers and contracts a significant number of private health care providers for primary and hospital care.
• Payment mechanisms selectively incentivize NCD prevention and control in Republika Srpska.
• The maximum price for private health services without a health insurance contract is set by the relevant health chamber.
• In the Federation of BiH, most revenue is pooled at the cantonal level, limiting cross-subsidization opportunities.
• Only 10% of revenues is allocated to the Solidarity Fund, which finances certain preventive programs but not NCD-related ones.
• There are differences in contracting regulations and practices across cantons.
• Incentives for NCD services are limited in most cantons.
• Price-setting criteria and transparency in the process need improvement.

Recommendations

• Republika Srpska:

  • Allocate specific funds for financing of NCD prevention and control services in the Health Insurance Fund's budget for all primary health care (PHC) providers.
  • Define and adopt payment methods that incentivize the provision of NCD-related services, including results-based payments.
  • Engage with private and public providers in refining nomenclature of services, setting capitation rates, and service prices.

• Federation of BiH:

  • Introduce incentive payments for better NCD prevention and control.
  • Develop operational and financial plans aligned with the Action Plan for NCD control.
  • Engage with private providers in refining contracting practices, payment for performance systems, capitation rates, and service prices.

Service Delivery Arrangements

Key Findings

• A variety of private health care providers deliver NCD prevention and control services, including private specialist practices, specialist centers, private health facilities, and public-private partnerships.
• These providers are mostly small and medium-sized due to the high cost of establishing larger facilities.
• There is limited coordination between private and public providers, with unclear referral paths.
• Clinical guidelines for NCD case management are outdated, and care pathways are lacking to inform coordination of care across service levels.
• Limited data from electronic health records hampers monitoring and evaluation of NCD prevention and control activities.

Recommendations

• Republika Srpska:

  • Engage private providers in the development of the comprehensive NCD prevention program, revision of referral systems, and definition of a health facility network.
  • Engage private providers in the development of care pathways and revision of clinical guidelines for NCDs.

• Federation of BiH:

  • Engage private providers in the development of the comprehensive NCD prevention and control program and responsibilities for its implementation based on the Action Plan.
  • Stimulate the use of electronic health records in both public and private facilities providing NCD-related services.
  • Stimulate the use of updated clinical guidelines in public and private facilities providing NCD-related services.

Conclusion

Private sector engagement is essential for improving NCD prevention and control in BiH. Strengthening governance, financing, and service delivery arrangements can enhance the role of private health care providers in addressing NCDs. This report provides actionable recommendations for both entities to foster effective public-private partnerships and improve health outcomes through better coordination and integration of private services into the broader health system.