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Abstract
Introduction: South-eastern European socioeconomic transition followed by extensive health systems reforms has completely changed the pharmaceuticals market landscape in the region. Serbia, as the largest Western Balkans market, may serve as an example of such changes. Methods: Descriptive trend analysis of national-level dispensing of medicines in Serbia 2004–2012 was performed. Results: Total public health expenditure in Serbia increased sharply in less than a decade (€1,175,158,679 to €1,847,971,776); public spending on pharmaceuticals doubled (€339,279,304 to €742,013,976). Market growth was primarily driven by statins, novel platelet aggregation inhibitors, monoclonal antibodies and combined preparations indicated in asthma and chronic obstructive pulmonary disease. Conclusion: The pharmaceutical market of Serbia has undergone thorough and complete transformation from within. Serious crisis of medicine supply sustainability is currently shaking Balkan health systems due to increasing public debt worsened by global recession. More responsible reimbursement policy rooted in cost–effectiveness principle is needed in years to come.
Financial & competing interests disclosure
The authors were supported by the Ministry of Education, Science and Technological Development of the Republic of Serbia grant No. 175014. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.
No writing assistance was utilized in the production of this manuscript.
Key issues
Emerging Eastern European pharmaceutical markets have experienced sudden and profound transformation in terms of value-based consumption and expenditure during socioeconomic transition.
During 2004–2012, national health system of Serbia has evidenced bold increase both in national expenditure on health and its core outcomes, such as longevity.
At the example of Serbia, we witnessed patterns of change with increasing domination of novel cardiovascular, anti-diabetic agents, combined adrenergic and corticosteroid preparations and targeted immunotherapies.
Due to global recession and national coping strategies applied, serious difficulties in provision of sustainable financing and increasingly frequent shortages of pharmaceuticals are now happening across the Balkans region.
Growing public debt toward global pharmaceutical industry impose necessity of more responsible market access and reimbursement policies by the regional governments.
Policies currently in place actually limit accessibility to the expensive novel therapies to narrow indication fields.
Insufficient funding of primary and preventive care in favor of massive hospital sector actually creates boomerang effect. Patients who were denied early screening diagnostics and good access to outpatient services are later being admitted to hospitals in the advanced stage of their diseases.
These clinically evolved conditions demand far more expensive care and generate both financial losses to the budget, as well as worse survival, and life quality prognosis for the patients.
An alarm bell for the official health policy of Serbia should be increased mortality from leading prosperity diseases, such as cancer, chronic obstructive pulmonary disease, diabetes, unlikely to experience plateau level soon unless decisive and profound policy shifts take place.