HEALTH FINANCING SYSTEMS: THE WESTERN BALKANS CASE

Abstract

Objective: Reforms introduced in the 1990s aimed at sustainability amidst high out-of-pocket costs and low public funding. Over the past three decades, the Western Balkans (WB) countries have undergone profound transformations. The aspiration to join the European Union (EU) strongly shapes health financing policies in the Western Balkans, encouraging reforms focused on equity, efficiency, and financial sustainability. The aim of this paper is to analyze and compare health expenditure levels and financing structures across Western Balkan countries.

Materials and Methods: The analysis is based on data from the World Health Organization HFA-DB and the World Bank, supplemented by Health in Action reports for the selected countries. Public health approach has been applied.

Results: In 2023, health expenditure ranged from 7% of GDP in Albania to 9.7% in Montenegro. Despite this growth, per capita spending remains substantially below EU levels (US$4,153), with Albania reporting the lowest (US$590) and Montenegro the highest (US$1,147). A common regional challenge is the high reliance on out-of-pocket (OOP) payments, exceeding 30% in most countries and reaching over 40% in Albania and North Macedonia, well above the EU average (14,8%).

Conclusion: Health financing systems in the Western Balkans show increasing expenditure but continue to face limited financial protection and persistent inequities. High reliance on out-of-pocket payments and unmet healthcare needs continue to expose populations to financial risk, particularly among lower-income groups. Strengthening public financing, improving risk pooling, and enhancing system efficiency are essential to accelerate progress toward universal health coverage in the region.