Can people afford to pay for health care? New evidence on financial protection in the Federation of Bosnia and Herzegovina, Bosnia and Herzegovina

This review is part of a series of country-based studies generating new evidence on affordable access to health care (financial protection) in health systems in Europe. Financial protection is central to universal health coverage and a core dimension of health system performance. The review finds that financial protection in the Federation of Bosnia and Herzegovina, Bosnia and Herzegovina has improved over time, with the share of households with catastrophic health spending falling from a high of 11% in 2007 to 6% in 2021. Catastrophic health spending is heavily concentrated in the two poorest consumption quintiles and among households headed by pensioners and other economically inactive people. Outpatient medicines are the largest driver of catastrophic health spending, particularly for the poorer quintiles. Weaknesses in all three dimensions of coverage policy – population coverage, the benefits package and user charges (co-payments) – lead to gaps in coverage. Efforts to reduce financial hardship should give priority to improving the affordability of outpatient medicines and strengthening protection from out-of-pocket payments for households with low incomes.