The Healthcare System of Bosnia and Herzegovina: Organisation, Access for a Foreigner and Emergencies

Bosnia and Herzegovina comprises two entities, the Federation of Bosnia and Herzegovina (ten cantons) and the Republika Srpska, as well as the Brčko District. The European Observatory on Health Systems and Policies, in its review, counts 14 ministries in charge of health and 13 health insurance funds. Pooling of resources is done at the level of the entity, or of the district in the Republika Srpska and Brčko, and at canton level in the Federation for primary and secondary care. The same document notes that social insurance is compulsory but that coverage is not universal: part of the population has limited access to publicly funded care.

In the Federation, the Health Insurance and Reinsurance Institute coordinates the financing of certain services through a solidarity fund; referral to these benefits goes through the family doctor and a commission of the Institute gives its approval. In the Republika Srpska, a single health insurance fund runs the entity and offers sections dedicated to insured people, contributions, foreign insured people and care outside the entity. In Brčko, there is a fund of its own. This organisation explains why practical rules differ between Sarajevo, Banja Luka and Brčko.

CLEISS describes a scheme that covers employees and the self-employed, apprentices, farmers, retirees, registered unemployed people, minors under 18, full-time students under 26 who are not dependants, war veterans and disabled people. Dependants are the spouse or partner, children in full-time education, ascendants and other dependent relatives without resources in the Federation and the Republika Srpska; in Brčko, only the spouse and children in education are cited. No affiliation period is required to open entitlement to benefits in kind and in cash.

For a French national, the most frequent route is affiliation through the employer: the insurance obligation applies to the employee and the self-employed person of the place of employment, with a sickness-maternity contribution of 12.50% of gross pay borne by the employee and 2% by the employer in the Federation, and 10.20% borne by the employee in the Republika Srpska (CLEISS). The pages consulted of the Bosnian administrations detail no voluntary contribution for a non-working resident: this possibility should be checked with the entity’s fund, whose free service answers on 0800 20 226 for the Federation Institute (working days from 1 p.m. to 3 p.m.) and on 0800 5 08 08 for the Republika Srpska fund. The Service for Foreigners also asks for proof of health insurance for any temporary or permanent stay.

As the European Health Insurance Card is not accepted in a country outside the European Union, a French national’s cover comes through local affiliation, through continuation of the French scheme in the case of secondment, or through international insurance. The detail of reimbursements by situation is in the page on healthcare reimbursement in Bosnia and Herzegovina.

The insured person registers with a general practitioner of their choice for a minimum of one year (CLEISS). Consulting a specialist is done on that doctor’s recommendation, with two exceptions: the paediatrician for children under six and the gynaecologist for women over 15. The insured person’s contribution represents about 10 to 20% of the price of a consultation (10 to 25% in the Republika Srpska); in hospital, it reaches about 15% of medical costs and 20% of hotel costs. Several categories are exempt, notably children under 15, pregnant women and people with chronic diseases.

According to CLEISS, the insurance covers prevention, consultations, hospitalisation, medicines, dental care and palliative care. Pregnancy and delivery costs are covered at 100%. Sickness daily allowances are paid by the employer for the first 42 days in the Federation and in Brčko (30 days in the Republika Srpska), then by the fund for up to twelve months, at 80% of the net salary in the Federation and in Brčko and between 70 and 90% in the Republika Srpska. A federal solidarity fund finances specific services on the opinion of a commission.

The University Clinical Centre of Sarajevo (KCUS), a public institution, presents itself as the most complex healthcare facility in the country and provides secondary and tertiary care, with an emergency medicine clinic. Its activity report records hundreds of thousands of outpatient consultations, tens of thousands of hospitalised patients and operations, and millions of biochemical tests; the switchboard is +387 33 297 000. In the Republika Srpska, the university clinical centre of Banja Luka plays a comparable role for the entity.

The emergency numbers published by the City of Sarajevo are: 121 (civil protection operations centres), 122 (police), 123 (fire brigade) and 124 (medical emergencies); for the road, roadside assistance answers on 1282, 1285 and 1288. The European number 112 is the subject of a project supported by the European Union; its local availability should be checked before departure. In a proven emergency (accident, assault, death), the consular section of the French embassy can be reached on +387 33 911 340 during the day and +387 61 144 613 outside office hours.

Medicines appear on an official list and are reimbursed at 50, 70, 90 or 100% depending on their category (CLEISS). France Diplomatie recommends taking the medicines needed in their original packaging, with a prescription written using the international nonproprietary name, and checking their authorisation locally; purchases from street vendors are to be avoided. For chronic treatment, a prior visit to the doctor and contact with the local fund make continuity of care easier.

The Federation Institute publishes the Medicines Agency’s notices on supply shortages, temporary or permanent, useful information for chronic treatments. Insured people remain exposed to a significant out-of-pocket cost: direct payments represent about a third of health expenditure (WHO Europe), which justifies checking supplementary cover; see the guide to healthcare systems.

France Diplomatie recommends consulting your doctor or an international vaccination centre well before departure and updating the usual vaccines: diphtheria, tetanus, polio, whooping cough and measles. Vaccinations against hepatitis A, typhoid and tick-borne encephalitis should be considered, particularly outside towns; rabies concerns young children and rural stays, and hepatitis B frequent or prolonged stays.

Among the risks identified: tick-borne encephalitis, transmitted by ticks mainly in spring and summer and through raw dairy products, with no specific treatment; rabies, which requires an immediate consultation after any suspect contact with an animal; typhoid, linked to contaminated water and food; and air pollution from December to February in Sarajevo, Tuzla and Zenica, largely due to coal heating. Children, pregnant women, elderly people and people with respiratory or heart conditions stay indoors when possible. Washing hands, drinking bottled or treated water and cooking food thoroughly complete these measures.

According to the embassy, the French State does not pay healthcare costs abroad, including in the event of hospitalisation or medical repatriation. France Diplomatie describes an assistance contract or insurance covering all medical costs, surgery, hospitalisation and repatriation as essential. For long stays, the page on expat health insurance compares the solutions, and the page on long-stay travel insurance presents the case of short stays. Expavy helps to set them against local entitlements.