Dental Services Funding and Affordability in Serbia – Decade-Long Perspective

Frontiers in Public Health

Tatjana Kanjevac¹ 

关键词: dentistry;    health economics;    costs;    dental care;    financing;    affordability;    reimbursement;    Serbia;   

DOI  :  10.3389/fpubh.2015.00145

学科分类：卫生学

来源: Frontiers

【 摘 要 】

Since 2004, National Agency for Medicines and Medical Devices of Serbia (ALIMS) issue commercially available periodic reports on precise structure of prescription dispensing and value of sales of all pharmaceuticals within the publicly funded health care facilities, pharmacies, and wholesalers. Recent research of trends over past decade has shown bold growth in local market size (23) dominated by biologicals (24) and oncology-related treatment options (25). These same sources offer us best attainable insight into the structure of Serbian market of dental medicines classified within broadly recognized Anatomical–Technological–Chemical classification system (ATC). Data presented in Figure ​Figure11 point out the falling prescription and dispensing of “Caries prophylactic agents” (A01AA code) whose value-based turnover decreased from € 66,704 in 2004 to € 21,397 in 2013 (actual peak value in the observed period was € 238,397 back in 2010). At the same time, sales of “Other agents for local oral treatment” (A01AD code) grew eightfold from € 302,608 in 2004 to € 2,413,302 in 2013 (actual peak value in the observed period was € 3,079,162 back in 2011). Slightly slower increase but the one dominating the market was the one of “Anti-infectives and antiseptics for local oral treatment” (A01AB code) rising from € 917,894 in 2004 to € 2,736,887 in 2013 (actual peak value in the observed period was € 3,833,995 back in 2008). Combined market size of all these three major groups of drugs used in various branches of dental medicine grew from € 1,287,207 in 2004 to € 5,171,585 in 2013. It is important to emphasize that entire national consumption of stomatological preparations actually contracted due to global economic recession and value of spending was exceeding € 6,000,000 back in 2010. The strong impact of economic crisis on Balkan pharmaceutical markets was noticed across the region with surprisingly better performance of transitional economies compared to OECD ones (26). Size of targeted public spending for oral health inclusive of capital investment, staff salaries, utilities, consumables, and other costs by far exceeds drug acquisition costs. According to the first officially available data, Republican Health Insurance Fund of Serbia (RFZO) has devoted € 51,131,383 in 2007 while over 21% less only 7 years after in 2013 (€ 40,351,340). Referring to the entire public health spending in the country funded by RFZO that this effectively meant percentage point decrease of governmental resources assigned for oral health programs from 2.82% in 2007 to 2.12% in 2013. These facts make de-investment into the clinical dentistry a rare exception compared to the many areas or clinical medicine regardless of crisis induced budget constraint (27). Such reimbursement policy imposed by local authorities effectively shifted financial burden of primary dentistry care to the ordinary citizens. Government legislature confirms that mandatory health insurance premiums were not inclusive of adult dentistry care unless in case of emergencies (28). Unlike among high-income EU economies, such policy in Serbia led to strong fall of demand for dental services motivated by simple lack of affordability rather than clinical need (29). Bureaucratic obstacles to the provision of dentist services contributed to the aforementioned phenomenon as well. Poor access to these medical services ultimately exposed well-known boomerang effect. Patients who were denied right to treatment in the early stages of their illness much later must be treated for severe form of neglected illness, which is much more expensive to treat. Outcomes of such delayed care are much less favorable and predictable and these interventions lose their cost-effectiveness when applied in clinically advanced cases (30).

【 授权许可】

CC BY