Access to affordable high quality health care is essential to the human development goals of living a long and healthy life, personal wellbeing, active engagement in society and participation in the labor force.  Although BiH law guarantees health care to any person without adequate resources access to health care in case of sickness, the most recent available estimates suggest that about 20% (FBiH 86%/RS 78%) of the poor and vulnerable population is without insurance coverage and lacks effective access to needed care.  

BiH also has the highest level of health care expenditure in the region, as well as the highest levels of health insurance contributions and a high proportion of private and out-of-pocket payments.

In response to chronic problems with the existing health care and health insurance financing systems, -- including exclusion or inadequate coverage of the socially vulnerable – as part of a World Bank BIH Health Sector Reform project both Entities pledged reforms in the health sector financing system to be in place by the end of 2022. 

Included among the proposed reforms is a pledge to shift the financing of health insurance from the current arrangement of multiple health insurance funds to a the budget authority of each Entity, and to reduce the level of beneficiaries’ monthly contributions which could resolve the problem of non-sustainable PES and CSW funded contributions described in the report.

Although the process of shifting health insurance to the Entity budgets and lowering payroll contribution rates was initiated in January 2020, BiH’s highly fragmented system of health provision and poorly coordinated, unequally distributed care left it inadequately prepared for a pandemic.  Medical supplies, technical aid and funding to support BiH’s COVID-19 response has been provided by the EU, IMF, World Bank, and numerous bi-lateral donors, in addition previously planned support.  It remains to be seen whether universal basic coverage beyond COVID-related treatment will be introduced throughout BiH, either as part of the crisis response or in the course of larger reforms. Such an expansion of coverage would require a broad reform of the health sector, including additional skilled staff, and new or reconfigured facilities to meet the needs of an influx of the previously uninsured.