7.2 Administration and governance
The BiH Constitution delegates the responsibility for the provision of health-care to the two entities and BD BiH. There is no state level ministry of health, although the BiH Ministry of Civil Affairs is responsible for national coordination and international strategies related to health. BiH has a total of 13 health insurance funds and 13 ministries or departments responsible for the provision of healthcare services, in an arrangement that directly follows the constitutional structure of the country.
The FBIH Constitution describes healthcare as a joint responsibility of the entity and of the cantons, supported by the eleven ministries of health and the eleven health insurance funds: one fund in each canton and at the entity level through the ‘Solidarity Fund’. The latter was designed to equalise access to the most sophisticated healthcare and to pay for priority public health programmes such as immunisation. Service provision varies widely across the cantons in terms of access, quality and cost, with some cantons requiring an annual fee as well as co-payments for a wide range of services. RS has one health ministry and one health insurance fund, while BD BiH has one department that is responsible for health and one health insurance fund.
The healthcare system includes the insurance funds, medical facilities and staff. The structure of health facilities in both entities reflects the model and system of former Yugoslavia comprised of specialist clinical centres, specialist and general hospitals, health centres and smaller outpatient clinics. There is also a network of public health institutes that are responsible for monitoring and surveillance, health protection, disease prevention and health promotion. These institutes are distributed geographically with the central Public Health Institute for the FBiH located in Sarajevo and cantonal public health institutes in the Central Bosnia, Posavina, Sarajevo, Tuzla and Zenica cantons, while the central RS Public Health Institute is located in Banja Luka with five branches distributed throughout the entity. Health issues in RS is centralized and exists at the entity-wide level. Thus, centralized system of health insurance in RS is much more favourable for the insured persons compared with what is provided for the insured persons in the FBiH.
The health issues of BD BiH are regulated by the BD authorities.
According to Article 15 of the Law on Ministries and Other Administrative Bodies, the BiH Ministry of Civil Affairs is responsible for carrying out activities and tasks which are under jurisdiction of BiH and related to defining the basic principles of coordinating activities, harmonizing plans of entity authorities and defining the strategy at the international level in the areas of: health and social welfare, pensions, science and education, labour and employment, culture and sport, surveying, geological and meteorological affairs.
The Department of Health Care of the BiH Ministry of Civil Affairs facilitates, at the state level, supervision and coordination of the health sector, representation of BiH at the international level in the field of health, as well as ensuring better compliance of health care matters with standards of the international community and the fulfilment of international obligations.