EVALUATION OF PLANNING AND CONSUMPTION OF MEDICAL RESOURCES IN PRIMARY HEALTH CARE IN SERBIA
Abstract
Introduction/Aim: Efficient planning and consumption of medicines, medical and sanitary supplies, and laboratory reagents within the framework of Serbia's primary health care directly affect therapy availability, service quality, and the rational use of budgetary resources. Although a formal framework for centralized procurement exists, practice reveals significant discrepancies in criteria, procedures, and institutional approaches. The aim of this study was to examine how health care institutions plan their needs, what decision-making criteria they use, and the role of the Republic Health Insurance Fund (RHIF) in the evaluation and implementation of these plans.
Methods: A quantitative study was conducted among 136 primary health care institutions and 26 RHIF branches, using a questionnaire designed in accordance with valid regulations and professional methodological guidelines. Data were analyzed in the Excel environment, using a binary matrix and thematic classification of responses.
Results: Most institutions (84.6%) rely on historical consumption and RHIF guidelines, while only 8.8% use economic criteria. A multicriteria approach is used by just 5.1% of institutions. Internal evaluation is absent in 26.5% of cases, and information systems are mostly used for administrative purposes. A pattern of planning without analytical verification was observed, along with frequent shifting of responsibility to RHIF, which stated in its response that it did not perform evaluations nor apply analytical tools.
Conclusion: Although the planning system formally meets regulatory requirements, it lacks an analytical foundation and functional evaluation. Establishing a standardized model based on clinical, economic, and epidemiological indicators, along with an active evaluative role of RHIF and two-way institutional feedback, represents a key step toward more rational and equitable management of health care resources.
References
Zakon o zdravstvenoj zaštiti Pristupljeno: 19. jul 2025; Available at: https://www.paragraf.rs/propisi/zakon_o_zdravstvenoj_zastiti.html
Zakon o lekovima i medicinskim sredstvima Pristupljeno: 19. jul 2025; Available at: https://www.paragraf.rs/propisi/zakon_o_lekovima_i_medicinskim_sredstvima.html
Uredba o planiranju i vrsti roba i usluga za koje se sprovode centralizovane javne nabavke: 34/2019-9, 64/2019-3, 17/2020-17, 21/2020-45, 51/2022-3, 66/2023-5, 55/2024-3. Pristupljeno: 19. jul 2025; Available at: https://pravno-informacioni-sistem.rs/eli/rep/sgrs/vlada/uredba /2019/64/3
Herzlinger RE. Why Innovation in Health Care Is So Hard. Harvard Business Review Pristupljeno: 19. jul 2025; Available at: https://hbr.org/2006/05/why-innovation-in-health-care-is-sohard
Kruger J, Dunning D. Unskilled and unaware of it: How difficulties in recognizing one’s own incompetence lead to inflated self-assessments. J Pers Soc Psychol 1999;77(6):1121–34. DOI: https://doi.org/10.1037/0022-3514.77.6.1121
DiMaggio PJ, Powell WW. The Iron Cage Revisited: Institutional Isomorphism and Collective Rationality in Organizational Fields. Am Sociol Rev 1983;48(2):147. DOI: https://doi.org/10.2307/2095101
Mintrom M. Herbert A. Simon, Administrative Behavior: A Study of Decision-Making Processes in Administrative Organization. U: Lodge M, Page EC, Balla SJ, urednici. The Oxford Handbook of Classics in Public Policy and Administration. Oxford University Press; 2015. DOI: https://doi.org/10.1093/oxfordhb/9780199646135.013.22
Cohen MD, March JG, Olsen JP. A Garbage Can Model of Organizational Choice. Administrative Science Quarterly 1972;17(1):1. DOI: https://doi.org/10.2307/2392088
Michael Lipsky. Street-Level Bureaucracy: Dilemmas of the Individual in Public Services. New York: Russell Sage Foundation, 1980. Politics & Society 1980;10(1):116–116. DOI: https://doi.org/10.1177/003232928001000113
Stručno-metodološko uputstvo za izradu plana potreba zdravstvenih ustanova primarne zdravstvene zaštite za 2025. godinu. Institut za javno zdravlje Srbije „Dr Milan Jovanović Batut“; 2024. (interni dokument)
Pravilnik o kontroli sprovođenja zaključenih ugovora sa davaocima zdravstvenih usluga (interno prečišćen tekst) („Službeni glasnik RS“, br. 72/2013 i 84/18). Pristupljeno: 19. jul 2025. Available at: https://www.rfzo.rs/download/pravilnici/ugovaranje/ug2025/Pravilnik%20o%20ugovaranju%202025..pdf
Pravilnik o ugovaranju zdravstvene zaštite iz obaveznog zdravstvenog osiguranja sa davaocima zdravstvenih usluga za 2025 godinu („Službeni glasnik RS“, broj 4/25). Pristupljeno: 19. jul 2025. Available at: https://www.rfzo.rs/download/pravilnici/kontrola/Pravilnik%20o%20kontroli%202018%20-%20preciscen%20tekst.pdf
Plsek PE, Greenhalgh T. Complexity science: The challenge of complexity in health care. BMJ 2001;323(7313):625–8. DOI: https://doi.org/10.1136/bmj.323.7313.625
Ammenwerth E, Schnell-Inderst P, Machan C, Siebert U. The Effect of Electronic Prescribing on Medication Errors and Adverse Drug Events: A Systematic Review. J Am Med Inform Assoc 2008;15(5):585–600.DOI: https://doi.org/10.1197/jamia.M2667
Cresswell KM, Mozaffar H, Lee L, Williams R, Sheikh A. Safety risks associated with the lack of integration and interfacing of hospital health information technologies: a qualitative study of hospital electronic prescribing systems in England. BMJ Qual Saf 2017;26(7):530–41. DOI: https://doi.org/10.1136/bmjqs-2015-004925
Myrberg K, Wiger M, Björkman A. Development of a maturity model for demand and capacity management in healthcare. BMC Health Serv Res 2024;24(1). DOI:https://doi.org/10.1186/s12913-024-11456-4
Arunyanart S, Khumpang P. A decision-making framework for evaluating medical equipment suppliers under uncertainty. Sci Rep 2025;15(1). DOI:https://doi.org/10.1038/s41598-025-93389-4
Taşer M, Özban M. Improvement of Drug Stock Management Using ABC-VED Analysis in a University Hospital. Clinical and Experimental Health Sciences 2024;14(3):618–24. DOI:https://doi.org/10.33808/clinexphealthsci.1204223
Kaplan RS, Porter ME. The Big Idea: How to Solve the Cost Crisis in Health Care Harvard Business Review. Pristupljeno: 19. jul 2025; Available at: https://hbr.org/2011/09/how-to-solve-thecost-crisis-in-health-care