Modernising the Serbian health system

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we explore the key challenges facing the process of modernising the Serbian health system, including decentralisation, fragmentation, corruption and the lack of a transparent and comprehensive system for health technology assessment.

Health & Medicine

Modernising the Serbian health system
Future improvements
SOURCES: Eurostat; Health Policy Institute; IMS Health; Serbian Association of the Manufacturers
of Innovative Drugs (INOVIA); World Bank; World Health Organisation.
Supported by
Second Serbia Health Project
(approved by World Bank in 2014)
Efficiency improvements:
US$40m
capitation system in primary care & payment mechanisms
based on diagnosis-related groups (DRGs) in hospital care.
The context Healthcare spending is not delivering the expected health outcomes
aims to improve the efficiency and the quality of Serbia’s
public healthcare system, but progress on HTA has been slow. Serbia wants to join the EU by 2020
Healthcare covered under Chapter 28 (consumer and
health protection) in accession negotiations. Serbia has
recently joined the EU’s health programme for 2014-20,
which, among other things, seeks to contribute to
innovative, efficient and sustainable health systems.
Serbia encapsulates many of the health challenges facing less developed Balkan countries.
Itshealthcaresystemisdecentralisedandfragmentedinplaces,andlevelsofout-of-pocket
payments and corruption are high. The country lacks a transparent and comprehensive
system of assessing the value of its healthcare investments and determining how to pay
for them. All of these issues undermine access to healthcare and contribute to relatively
poor health outcomes.
SERBIA
BOSNIA & HERZEGOVINA
SLOVENIA
BULGARIA
CROATIA
REPUBLIC OF MACEDONIA
MONTENEGRO
ALBANIA
ROMANIA
10.4
9.6
9.2
8.4
7.8
6.5
6.4
5.9
5.6
Healthcare spending as % of GDP
The key problems Major concerns about corruption in healthcare, the public health
fund and the process of evaluating new health technologies
Lifeexpectancyanddeathrates
Poor financial situation
of the public health
fund undermines the
sustainability of the
healthcare sector.
Absenceofasustainable,comprehensive
and transparent system
to evaluate and procure new health technology.
No national Health Technology Assessment (HTA)
agency exists, and Serbia is not a member of the
European network for Health Technology
Assessment (EUnetHTA).
Issues with corruption:
out-of-pocketspending
mostly in the form of “informal”
co-payments, estimated to be
36.6% of total
healthcare expenditure.
The consequences Weak patient access to healthcare
Access to medications in Serbia is restricted Patientsarenotgettingthecaretheyneed
Example: justBetween 2010 and 2012 justoneofthe139
new medicines to receive market authorisation was
approved for reimbursement in Serbia,
compared with 44 in Bulgariaand 27 in Croatia.
200-300 patients
are getting prescribed treatment for
hepatitis C out of 2,000 potentially eligible
(excluding new-generation drugs).
Serbian life expectancy
at birth is more than
5yearsshorter
than in EU
(2013 data).
Serbian standardised
death rate from cancer is
50%higher
thaninEU
(2012 data).
Efforts to improve healthcare efficiency, quality and
health technology assessment need to be stepped up

Out-of-pocket (OOP) expenditure on health care has significant implications for poverty in many developing countries. The extent of direct payments for health services are producing severe consequences on both equity and efficiency, making health care services unaffordable for most people, and leading to underfunding of essential inputs. Even relatively modest out-of-pocket health expenditure frequently causes indebtedness and can lead to poverty. This study presents an outlook of the role of out-of-pocket payments for health services, formal and informal, in the Albania, Bangladesh, Eritrea, India and Nepal to generate and utilize evidences in broader understanding of patient payment policies. The main purpose of the study is to: (a) compare the health care systems of the countries based on patient payment policy perspectives (b) to analyze the differences and similarities that exist in regards to the role of out of pocket (formal & informal) in the countries. Based on reviewed literatures in five countries, the finding shows these all countries are low and upper middle income countries except Eritrea, which is a low income country. The health care systems vary from totally centralized (Albania, Eritrea, Bangladesh), Decentralized (India and Nepal). The coverage of Public Sector Social Health Insurance is non -existent in all the given countries except Albania and India. Regarding the private health insurance, the evidences show that there are limited private health insurance coverage in Nepal and Bangladesh and India; however no coverage in Eritrea, and around 53 % in Albania. In average, about 85 % of share of national health economy is contributed by out of pocket payment in each of these countries. In each of the countries, there is an exemption policy to alleviate the inaccessibility of groups in immediate needs of health care. The predominant effects of official fees are underutilization of health care especially among the vulnerable groups, poor quality of health to poor groups, inequity, over-prescription, increasing poverty, and creating fertile ground for informal payments and corruption.

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As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions. Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says. This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots. To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare. Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself. Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places. Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages. Stay informed, stay safe, and get your flu shot today!

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263778731218 Abortion Clinic /Pills In Harare ,ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group of receptionists, nurses, and physicians have worked together as a teamof receptionists, nurses, and physicians have worked together as a team wwww.lisywomensclinic.co.za/

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Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva. Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade. Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal. Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural. Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis. É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais. O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada. Recomendamos muito. Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos. Esta publicação só está disponível em inglês até o momento. Prof. Marcus Renato de Carvalho www.agostodourado.com

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Physiology of Special Chemical Sensation of Taste

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Title: Sense of Taste Presenter: Dr. Faiza, Assistant Professor of Physiology Qualifications: MBBS (Best Graduate, AIMC Lahore) FCPS Physiology ICMT, CHPE, DHPE (STMU) MPH (GC University, Faisalabad) MBA (Virtual University of Pakistan) Learning Objectives: Describe the structure and function of taste buds. Describe the relationship between the taste threshold and taste index of common substances. Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation. Recognize different abnormalities of taste perception and their causes. Key Topics: Significance of Taste Sensation: Differentiation between pleasant and harmful food Influence on behavior Selection of food based on metabolic needs Receptors of Taste: Taste buds on the tongue Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper) Primary and Secondary Taste Sensations: Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami Chemical basis and signal transduction mechanisms for each taste Taste Threshold and Index: Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine) Taste index relationship: Inversely proportional to taste threshold Taste Blindness: Inability to taste certain substances, particularly thiourea compounds Example: Phenylthiocarbamide Structure and Function of Taste Buds: Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers Location of Taste Buds: Found in papillae of the tongue (Fungiform, Circumvallate, Foliate) Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus Mechanism of Taste Stimulation: Interaction of taste substances with receptors on microvilli Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes Taste Sensitivity and Adaptation: Decrease in sensitivity with age Rapid adaptation of taste sensation Role of Saliva in Taste: Dissolution of tastants to reach receptors Washing away the stimulus Taste Preferences and Aversions: Mechanisms behind taste preference and aversion Influence of receptors and neural pathways Impact of Sensory Nerve Damage: Degeneration of taste buds if the sensory nerve fiber is cut Abnormalities of Taste Detection: Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia) Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels Neurotransmitters and Taste Threshold: Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity Supertasters: 25% of the population with heightened sensitivity to taste, especially bitterness Increased number of fungiform papillae

New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...

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i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource. This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and Associate Division Director for Ambulatory Operations The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma. STATEMENT OF NEED Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL. Target Audience Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL). Learning Objectives 1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL 2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults 3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection

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Modernising the Serbian health system

1. Modernising the Serbian health system Future improvements SOURCES: Eurostat; Health Policy Institute; IMS Health; Serbian Association of the Manufacturers of Innovative Drugs (INOVIA); World Bank; World Health Organisation. Supported by Second Serbia Health Project (approved by World Bank in 2014) Efficiency improvements: US$40m capitation system in primary care & payment mechanisms based on diagnosis-related groups (DRGs) in hospital care. The context Healthcare spending is not delivering the expected health outcomes aims to improve the efficiency and the quality of Serbia’s public healthcare system, but progress on HTA has been slow. Serbia wants to join the EU by 2020 Healthcare covered under Chapter 28 (consumer and health protection) in accession negotiations. Serbia has recently joined the EU’s health programme for 2014-20, which, among other things, seeks to contribute to innovative, efficient and sustainable health systems. Serbia encapsulates many of the health challenges facing less developed Balkan countries. Itshealthcaresystemisdecentralisedandfragmentedinplaces,andlevelsofout-of-pocket payments and corruption are high. The country lacks a transparent and comprehensive system of assessing the value of its healthcare investments and determining how to pay for them. All of these issues undermine access to healthcare and contribute to relatively poor health outcomes. SERBIA BOSNIA & HERZEGOVINA SLOVENIA BULGARIA CROATIA REPUBLIC OF MACEDONIA MONTENEGRO ALBANIA ROMANIA 10.4 9.6 9.2 8.4 7.8 6.5 6.4 5.9 5.6 Healthcare spending as % of GDP The key problems Major concerns about corruption in healthcare, the public health fund and the process of evaluating new health technologies Lifeexpectancyanddeathrates Poor financial situation of the public health fund undermines the sustainability of the healthcare sector. Absenceofasustainable,comprehensive and transparent system to evaluate and procure new health technology. No national Health Technology Assessment (HTA) agency exists, and Serbia is not a member of the European network for Health Technology Assessment (EUnetHTA). Issues with corruption: out-of-pocketspending mostly in the form of “informal” co-payments, estimated to be 36.6% of total healthcare expenditure. The consequences Weak patient access to healthcare Access to medications in Serbia is restricted Patientsarenotgettingthecaretheyneed Example: justBetween 2010 and 2012 justoneofthe139 new medicines to receive market authorisation was approved for reimbursement in Serbia, compared with 44 in Bulgariaand 27 in Croatia. 200-300 patients are getting prescribed treatment for hepatitis C out of 2,000 potentially eligible (excluding new-generation drugs). Serbian life expectancy at birth is more than 5yearsshorter than in EU (2013 data). Serbian standardised death rate from cancer is 50%higher thaninEU (2012 data). Efforts to improve healthcare efficiency, quality and health technology assessment need to be stepped up

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