Bosnia spends 9% of GDP on healthcare meaning a total sector of around €1.5bn with a 70:30 split between the government and out-of-pocket expenditure, says the World Bank.
The country’s public healthcare system is highly decentralised among its three constituent regions - Federation of BiH, Republika Srpska and Brčko District - which is said to make it very complex, especially for a country of only three million people. BiH is further divided into 10 cantons. Having said that, all use mandatory insurance-based systems to fund healthcare for citizens.
The private healthcare sector is small, even relatively, as many Bosnians go to neighbouring countries like Croatia and Serbia for private treatment. There is also a shortage of doctors, who typically emigrate to West Europe after graduating in order to seek better pay and working conditions.
|(Pre-COVID estimates in brackets)||2016||2017||2018||2019||2020 f/c||2021 f/c||2022 f/c||2023 f/c|
|For-profit sector (€m)||11.2||12.4||13.6||15||12 (16.5)||15 (18.1)||16.5 (20)||18.2 (22)|
|For-profit growth %||10%||10%||10%||10%||-20% (10%)||25% (10%)||10% (10%)||10% (10%)|
The Bosnian private healthcare market is made up of several hundred outpatient clinics, only a few of which we consider hospitals. Many Bosnians go to neighbouring Serbia or Croatia, which have better hospitals, for treatment.
Players and market size
The largest appears to be Medical Institute Bayer, which mainly provides government-funded inpatient cardiac treatments and some outpatient services funded by out-of-pocket expenditure. Previously, the facility was the American Heart Hospital, founded by Dr Emir Kabil and backed with a loan by the IFC, but there were legal tussles amongst the investors and it seems to have changed name and ownership in 2020. The Heart Center in Sarajevo has a similar business model while Dr Kostic Specialist Surgical Hospital in Banja Luka looks to be more general.
Other existing clinics are too small to consider so we consider these three, who have a combined €13.5m in 2019 sales (local business registry), as the existing market which we round up to €15m. The three grew sales by a combined 12.5% in 2019.
In May 2021, construction began on the first private general hospital in Sarajevo, the capital. It is being developed by a consortium comprising Eurofarm, one of the largest private polyclinic operators and ASA Prevent, a Bosnian conglomerate. Big medtech supplier Siemens is being called a ‘partner’ in the project. Total investment will reportedly reach €60m. It is not clear when it will open but, if successful, it will at least double the size of the market.
Bosnia has been hit hard by the virus and the three private hospitals’ revenues fell by a combined 20% in 2020, after growing 10-15% in 2019. We have a bounce back of 25% in 2021.