Assessment and Application of the Hear Score in Remote Emergency Medicine Outposts in Bosnia and Herzegovina.

Background and Objectives. In emergency departments, chest pain is a common concern, highlighting the critical importance of distinguishing between acute coronary syndrome and other potential causes. Our research aimed to introduce and implement the HEAR score, specifically, in remote emergency outposts in Bosnia and Herzegovina. Materials and Methods. This follow-up study conducted a retrospective analysis of a prospective cohort consisting of patients who were admitted to the remote emergency medicine outposts in Canton Sarajevo and Zenica from 1 November to 31 December 2023. Results. This study comprised 103 (12.9%) patients with low-risk HEAR scores and 338 (83.8%) with high-risk HEAR scores, primarily female (221, 56.9%), with a mean age of 63.5 ± 11.2). Patients with low-risk HEAR scores were significantly younger (50.5 ± 15.6 vs. 65.9 ± 12.1), had fewer smokers (p < 0.05), and exhibited a lower incidence of cardiovascular risk factors compared to those with high-risk HEAR scores. Low-risk HEAR score for prediction of AMI had a sensitivity of 97.1% (95% CI 89.9-99.6%); specificity of 27.3% (95% CI 22.8-32.1%); PPV of 19.82% (95% CI 18.67-21.03%), and NPV of 98.08% (95% CI 92.80-99.51%). Within 30 days of the admission to the emergency department outpost, out of all 441 patients, 100 (22.7%) were diagnosed with MACE, with AMI 69 (15.6%), 3 deaths (0.7%), 6 (1.4%) had a CABG, and 22 (4.9%) underwent PCI. A low-risk HEAR score had a sensitivity of 97.0% (95% CI 91.7-99.4%) and specificity of 27.3% (95% CI 22.8-32.1%); PPV of 25.5% (95% CI 25.59-28.37%); NPV of 97.14% (95% CI 91.68-99.06%) for 30-day MACE. Conclusions. In conclusion, the outcomes of this study align with existing research, underscoring the effectiveness of the HEAR score in risk stratification for patients with chest pain. In practical terms, the implementation of the HEAR score in clinical decision-making processes holds significant promise.

Health policy developments in the Western Balkan Countries 2000-19: towards European Health and Health Care Policies.

BACKGROUND: Albania, Bosnia and Herzegovina, Kosovo, Montenegro, North Macedonia and Serbia have committed to becoming European Union (EU) member states. This, among others, implies that candidate/potential candidate states adopt legally authorized EU policies, including health. The study aims to identify the main country-specific health policy areas critical to the EU accession health policy dimension and present the change in associated selected health indicators from 2000 to 2019. METHODS: The study draws on published reports and analyses of official statistics over time and cross-country. Health care policy adherence to the European Commission's recommended country-specific health actions was classified into five health policy areas: financing, payment, organization, regulation and persuasion. Key health policy areas for Western Balkan countries (WBCs) were identified. Health progress or lack thereof in catching up to the EU15 population health, health expenditure and the number of health professionals are measured. RESULTS: The European Commission prioritized financing and regulation for all WBCs in the five policy areas. Nine of the 18 analyzed selected health indicators showed divergence, and the other nine converged towards the EU15 averages. WBCs continue to face diverse public health challenges in improving life expectancy at birth, death rates caused by circulatory system diseases, malignant neoplasms, traffic accidents, psychoactive substance use, tuberculosis incidence, tobacco smoking prevalence and public-sector health expenditure. CONCLUSIONS: By 2019, there is limited evidence of WBCs catching up to the average EU15 health levels and health care policies. Closer attention towards EU health and health care policies would be favourable.

Health risk assessment of heavy metals in soil, plant, and water samples near "Gacko" power plant, in Bosnia and Herzegovina.

This study assesses heavy metal content in soil, water, and plant material from sites located around the lignite mine and the power plant "Gacko", Bosnia and Herzegovina. The samples were collected, prepared, and analyzed for heavy metals content using the flame atomic absorption spectrophotometer. Samples were analyzed for cadmium, lead, copper, zinc, manganese, and iron. To identify the relationship among the metals in samples and their possible sources, Pearson's correlation and principal component analysis were performed. Health risk assessment was applied to establish potential health risks posed to humans caused by contaminants in different environmental compartments. The results of our analyses show that most soil samples contain copper, and one of those samples had a copper concentration of more than 70 µg/g, which is a critical upper value for agricultural use. In the soil samples that were analyzed, cadmium was also detected, and its concentration was greater than 2 µg/g. Lead, on the other hand, had a concentration that was higher than the maximum permissible for unpolluted soils in 40% of the soil samples that were analyzed. Lead and cadmium concentrations in surface waters mostly contribute to a non-carcinogenic risk in the scenario of recreational swimming exposure. The presence of Cd, a highly toxic element in water, may be explained by the leaching of artificial fertilizers used in the study area, whereas Pb's origin may be geological. The results of this study recommend routine heavy metal monitoring in samples of soil, water, and plants from the examined area so that, if metal concentrations continue increasing, remedial action should be advised to prevent accumulation in the food chain.

A pilot biomonitoring study of air pollution in the urban area of Sarajevo, Bosnia and Herzegovina: genotoxicity assessment in buccal cells.

Air pollution, recognized as a human carcinogen, is a significant cause of death in industrial and developing countries, and Bosnia and Herzegovina (B&H) is one of the leading countries for air pollution-caused death rate and has the poorest urban air quality in Europe. Despite a population decrease, urban air pollution in B&H has increased due to traffic pollution and still intensive use of solid fuel for heating and cooking. Human biomonitoring studies, regarding the described air pollution, have not been conducted before, and particularly have not been conducted in the region of Sarajevo. Good health, well-being, and environmental protection are part of the 17 defined Sustainable Development Global Goals. Accordingly, this study aimed to determine baseline levels of DNA damage in a group of Sarajevo citizens and to compare seasonal variations in DNA damage in relation to the reported levels of air pollution. From 33 individuals included in the study, samples were collected in the summer and winter seasons. The buccal micronucleus cytome (BMCyt) assay and comet assay in leucocytes isolated from saliva were performed. Mean values and standard deviations of log-transformed tail intensity (%), tail length (µm), and tail moment results in winter were 1.14 ± 0.23, 2.20 ± 0.14, and 1.03 ± 0.29, respectively, while in the summer season those values were 1.19 ± 0.19, 2.25 ± 0.17, and 1.07 ± 0.25, respectively. No significant differences were found for the comet assay parameters. Nevertheless, BMCyt results showed significant increases in micronuclei (P = .008), binuclear cells (P = .04), karyolysis (P = .0003), condensed chromatin (P = .03), and pyknosis (P = .002) in winter. Although the results of comet and BMCyt assays are not in accordance, this study contributes to the human air pollution biomonitoring in Sarajevo, B&H, and based on the genotoxic effects of air pollution evidenced by the BMCyt biomarker further studies of this kind are necessary.

Health risk assessment of heavy metals in PM2.5 and PM10 in Sarajevo air, Bosnia and Herzegovina.

The concentrations of eight heavy metals (Cd, Cr, Cu, Fe, Mn, Ni, Pb and Zn) associated with PM2.5 and PM10 in Sarajevo air, Bosnia and Herzegovina (BiH) have been studied. A total of 136 PM2.5 and PM10 samples were simultaneously collected from 21 February to 11 November 2020. Metal contents were determined by atomic absorption spectrometry, flame (FAAS) and electrothermal (ETAAS) techniques. The mean concentrations of metals in PM10 are 2.93 ng/m3 (Cd), 7.21 ng/m3 (Cr), 12.02 ng/m3 (Cu), 126 ng/m3 (Fe), 20.74 ng/m3 (Mn), 6.98 ng/m3 (Ni), 8.74 ng/m3 (Pb) and 128 ng/m3 (Zn). In PM2.5 samples the mean concentrations of Cd, Cr, Cu, Fe, Mn, Ni and Zn are 0.39, 4.06, 2.26, 110, 0.63, 1.93 and 5.28 ng/m3, respectively. Pb was not detected in PM2.5 samples. Strong correlation was obtained for metal pairs Mn-Cu in PM10 and moderate for Ni-Fe in PM2.5. The health risk assessment shows that the adult population of Sarajevo is at increased lifetime risk of experiencing cancer because of exposure to Cd concentrations in PM10.

Europeanization of health policy in post-communist European societies: Comparison of six Western Balkan countries.

Europeanization is assumed to influence health policy in the Western Balkans, but little is known about the actual impact of this process in these countries which constitute a complex geopolitical region of Europe. In this context, we used time trends to explore the Western Balkans health policies during the Europeanization through a cross-country comparative analysis of six countries. We conducted a health policy analysis by adapting the framework for globalization and population health coined by Huynen et al. in 2005. We analyzed 90 progress reports of Albania, Bosnia and Herzegovina, Croatia, Montenegro, North Macedonia and Serbia from 2005 to 2020. In particular, we considered chapter 28 on "Consumer and health protection" and other chapters that contained the words "health" or "population health". Evidence indicates that Europeanization influences Western Balkans' policies at different levels. Western Balkan countries revise national legislation in accordance with new European Union acquis as addressed in the progress reports and build cooperation with international institutions. They build national health reforms and reorganize relevant institutions to better address regulations in accordance to Europeanization. However, it is necessary to monitor law implementation so that the current legislation is enforced and further positive impact can be measured on population health.

New Insight into the Measurements of Particle-Bound Metals in the Urban and Remote Atmospheres of the Sarajevo Canton and Modeled Impacts of Particulate Air Pollution in Bosnia and Herzegovina.

The Sarajevo Canton Winter Field Campaign 2018 (SAFICA) was a project that took place in winter 2017-2018 with an aim to characterize the chemical composition of aerosol in the Sarajevo Canton, Bosnia and Herzegovina (BiH), which has one of the worst air qualities in Europe. This paper presents the first characterization of the metals in PM10 (particulate matter aerodynamic diameters ≤10 µm) from continuous filter samples collected during an extended two-months winter period at the urban background Sarajevo and remote Ivan Sedlo sites. We report the results of 18 metals detected by inductively coupled plasma mass spectrometry (ICP-MS) and electrothermal atomic absorption spectrometry (ETAAS). The average mass concentrations of metals were higher at the Sarajevo site than at Ivan Sedlo and ranged from 0.050 ng/m3 (Co) to 188 ng/m3 (Fe) and from 0.021 ng/m3 (Co) to 61.8 ng/m3 (Fe), respectively. The BenMAP-CE model was used for estimating the annual BiH health (50% decrease in PM2.5 would save 4760+ lives) and economic benefits (costs of $2.29B) of improving the air quality. Additionally, the integrated energy and health assessment with the ExternE model provided an initial estimate of the additional health cost of BiH's energy system.

Price and income elasticity of cigarette demand in Bosnia and Herzegovina by different socioeconomic groups.

BACKGROUND: Tobacco tax policy in Bosnia and Herzegovina (B&H) assumes a gradual annual increase in specific excise taxes on cigarettes. However, it is insufficient to reduce significantly consumption. This paper examines effects of the increase in cigarette prices and disposable income on cigarette demand in B&H by different income consumer groups. METHODS: Based on the Household Budget Surveys and microdata from 2007, 2011 and 2015, we employed logit model to estimate prevalence and Deaton's model to estimate intensity elasticity of cigarette demand for the sample of 21 424 households (9953 are smoking households) by different income groups. We used obtained elasticities and estimated the impact of tax increase on cigarette consumption and government revenue in three tax increase scenarios. RESULTS: Ten per cent price increase would reduce the consumption of low-income households by 14%, as opposed to 9.9% for middle-income and 7% for high-income households. Low-income households would significantly increase the demand for cigarettes compared with high-income households if income increased. Increase in the specific excise tax by 25% would reduce cigarette consumption and increase government revenue, while the low-income group would experience a reduction in tax burden. CONCLUSIONS: Changes in prices have different impacts on tobacco prevalence and consumption of low-income compared with middle-income and high-income socioeconomic groups. Low-income households are most responsive to changes in prices and income. Thus, the poor in B&H would benefit from an increase in tobacco excise taxes and price.

What are the expectations and experiences of a GMH research programme delivered in Bosnia-Herzegovina, Colombia and Uganda? A prospective longitudinal qualitative study.

OBJECTIVES: Global health research collaborations between partners in high-income countries and low-income and middle-income countries (LMICs) aim to generate new evidence, strengthen research capacity, tackle health inequalities and improve outcomes. Previous evaluations of such programmes have identified areas for improvement but consisted only of retrospective experiences. We conducted the first prospective study to assess the initial expectations as well as the final experiences of participants of a global health research programme. DESIGN, SETTINGS AND PARTICIPANTS: This study adopted a prospective longitudinal qualitative study, 38 participants of a global mental health research programme with partners in Bosnia-Herzegovina, Colombia, Uganda and the (UK). The interviewees included senior investigators, coordinators and researchers. Framework analysis was used to analyse the data. OUTCOME MEASURES: Participants were interviewed about their initial expectations at the inception of the research programme and their final experiences at the end. RESULTS: Many of the original expectations were later reported as met or even exceeded. They included experiences of communication, relationships, developed research expertise, further research opportunities and extending networks. However, other expectations were not met or only partially met, mainly on developing local leadership, strengthening institutional research capacity and opportunities for innovation and for mutual learning. Around equity of partnership and ownership of research the views of participants in the UK tended to be more critical than those of partners in LMICs. CONCLUSIONS: The findings suggest that global health research programmes can achieve several of their aims, and that partners in LMICs feel equity has been established in the partnership despite the imbalance of the funding arrangement. Aims of global health research projects should have a realistic focus and be proportionate to the parameters of the funding arrangement. More resources and longer time scales may be required to address sustainable structural capacity and long-standing local leadership sufficiently.

Factor structure and internal consistency of the Clinical Assessment Interview for Negative Symptoms (CAINS) on a sample of persons with psychotic disorders in Bosnia and Herzegovina.

The assessment of negative symptoms is crucial for development of adequate therapeutic interventions. This is a challenging task due to complex clinical presentation and lack of reliable and valid instruments. This study examined the psychometric characteristics of the Clinical Assessment Interview for Negative Symptoms (CAINS). The sample consisted of 81 persons with schizophrenia or schizoaffective disorder recruited from two health institutions in the Sarajevo Canton: the Clinical Center of the University of Sarajevo and the Psychiatric Hospital of the Sarajevo Canton. The 13 CAINS items grouped into four factors (expression, motivation and satisfaction in the recreational domain, motivation and satisfaction with social relationships, motivation and satisfaction with job and education). The four-factor solution accounted for 87.83% of the variance of manifest items. The reliabilities of extracted factors were as follows: for motivation and satisfaction with social relationships α = 0.897, for motivation and satisfaction with job and education α = 0.961, for Motivation and satisfaction in the recreation domain α = 0.981, and for expression α = 0.938. The highest correlation between factors was found between Motivation and satisfaction with recreation and Motivation and satisfaction with social relationships. On the other hand, the lowest correlation was found between motivation and satisfaction with social relations and motivation and satisfaction with job and education. In conclusion, the study showed that the latent structure of CAINS is adequate, clearly interpretable, and consisted of four factors. The measure can be used for assessment of the negative symptoms in outpatients with psychosis in Bosnia and Herzegovina.

Genotoxic and cytotoxic assessment of two endemic Lamiaceae species from Bosnia and Herzegovina.

Clinopodium alpinum subsp. orontium (K.Malý) Govaerts and Thymus bracteosus Vis. ex Benth. are endemic Lamiaceae species in Bosnia and Herzegovina with rather limited data about their cytotoxic and genotoxic effects. This study aimed to analyse phenolic compounds composition of C. alpinum subsp. orontium and T. bracteosus aqueous and dimethyl sulphoxide (DMSO) extracts and their cytotoxic and genotoxic potential in human peripheral blood lymphocyte cultures. Among 33 analytes, 17 were identified and quantified in the examined extracts with the rosmarinic and chlorogenic acids as main constituents. Genotoxic effects of extracts from both species are proven at the highest applied dose. T. bracteosus extracts and DMSO as a solvent exhibited stronger genotoxic potential that should be further investigated in tumour cell lines. Nevertheless, non-endemic species with similar phenolic composition and bioactivity should be the first choice for medicinal purposes.

Financial sustainability strategies of public primary health care centres in the Republic of Srpska, Bosnia and Herzegovina.

BACKGROUND: The literature on the functioning of public health facilities in health systems with significant arrears is limited. The growing liabilities of health facilities and the accumulating arrears have been a challenge in the Republic of Srpska. Most public primary healthcare (PHC) centres generated a gross loss in 2018. METHOD: Guided by the 'positive deviance' approach, we used an exploratory case study design to identify strategies used by managers to achieve financial sustainability in eight top-performing PHC centres. Qualitative data were collected through face-to-face in-depth semistructured interviews with key informants from the PHC centres that reported positive financial results in 2018. RESULTS: Seven organisational goals, comprising 34 financial sustainability strategies, were recognised during the data analysis and were used to build an organisational-level model for a PHC centre. CONCLUSION: Managers concurrently used multiple strategies to ensure financial sustainability. Each centre tailored its range of strategies to the organisational context, local context, and wider environment of the health system. The strategies were conceived and implemented by managers operating at different organisational levels under the leadership of top-level managers. Managers of indebted health facilities can learn from the positively deviant peers who manage facilities that achieved satisfactory financial performance.

TECHNOLOGICAL, ECOLOGICAL AND ENERGY ASPECTS OF THE DEVELOPMENT OF BOSNIA AND HERZEGOVINA

Bosnia and Herzegovina has generally opted to join the European Union. Preliminary decisions have already been taken, but BiH needs to meet some of the standards/criteria contained in the 14 recom-mendations made by the European Commission before formal negotiations with the EU begin. One of the important assumptions of a successful path to the EU is that BiH accelerates economic development and modernizes the economic structure as a whole. In this regard, it is especially important that BiH advances technological development, improves its environmental policy and accelerates the energy transition. The text analysed the current development level of these areas and suggested some measures that should improve the current unsatisfactory situation in them. Particular attention was paid to measures to increase innovation capacity, the need for more vigorous inter-ventions in solving environmental problems and the energy transition as a precondition for entry into Industry 4.0, the introduction of the green economy and the acceptance of decarbonisation as long-term policies. It was stressed that these are the ultimate targets by 2050, in agreement with the long-term development orientation of the European Union.

Human health risk assessment of lead, cadmium, and mercury co-exposure from agricultural soils in the Tuzla Canton (Bosnia and Herzegovina).

The aim of this study was to assess the risk of human exposure to lead (Pb), cadmium (Cd), and mercury (Hg) through agricultural soil by considering both uncertainty and variability in key exposure parameters. For this reason we collected soil samples from 29 locations in the Tuzla Canton (Bosnia and Herzegovina) and measured their metal levels with inductively coupled plasma atomic emission or absorption spectrometry (ICP-AES and ICP-AAS, respectively). The levels of Pb ranged from 13.33 to 1692.33 mg/kg, of Cd from 0.05 to 3.67 mg/kg, and of Hg from 0.02 to 2.73 mg/kg. To estimate cancer and non-cancer risks we used deterministic and semi-probabilistic methods. Lead was found to involve higher health risk than the other two heavy metals. Its hazard index (HI) decreased between population groups (children>women>men) and exposure routes (ingestion>skin contact>inhalation). Our Monte Carlo simulations indicated that Pb HIs for both adult populations had a 0.6 % probability to exceed the threshold value of 1, while in children this probability was 14.2 %. Cd and Hg showed no probability to exceed the threshold in any scenario. Our simulation results raise concern about possible adverse health effects of heavy metals from soil, especially in children. It is very important to continue monitoring environmental pollution and assess human health risk, not only with respect to soil, but also with other important environmental compartments, such as air and water.

Comparison of Seniors in the Community: Risk Evaluation for Eating and Nutrition, version II and Mini Nutritional Assessment - Short Form in detecting nutritional risk among community-dwelling seniors in Bosnia and Herzegovina.

OBJECTIVE: The aim of the current study is to compare Seniors in the Community: Risk Evaluation for Eating and Nutrition, version II (SCREEN II) and Mini Nutritional Assessment - Short Form (MNA-SF), where each is used to identify nutritional risk prevalence among community-dwelling people aged 65 years and above in Bosnia and Herzegovina. DESIGN: A cross-sectional study. Nutritional risk assessed using the nutritionist's risk rating, anthropometric measurements, functional indicators, cognitive parameters, SCREEN II and MNA-SF. SETTING: The municipalities of Foca, East Sarajevo and Bijeljina, Bosnia and Herzegovina. PARTICIPANTS: Eight hundred twenty-one community-dwelling individuals aged ≥65 years. RESULTS: The prevalence of high nutritional risk per nutritionist's risk rating, SCREEN II and MNA-SF was 26, 60, and 7 %, respectively. With the nutritionist's rating score ≥5 as the criterion, the MNA-SF cut-off point of ≤11 (indicating any possible risk) had poor sensitivity (55·7 %), specificity (46·6 %) and AUC (0·563; P = 0·024). When the criterion of >7 was applied, good sensitivity (95·3 %) and specificity (88·9 %) were obtained for the MNA-SF cut-off score of ≤7. AUC for this comparison was 0·742 (considered fair). Cut-off points of <54 (AUC = 0·816) and <50 (AUC = 0·881) for SCREEN II (indicating moderate to high risk) corresponded with good sensitivity (82·2 %; 80·9 %) and fair specificity (72·1 %; 75·0 %). CONCLUSION: MNA-SF may have a limited role in nutritional risk screening among community-dwelling seniors in Bosnia and Herzegovina. SCREEN II has promising results in regard to validity, but further studies are warranted.

The role of the state in financing and regulating primary care in Europe: a taxonomy.

Traditional health systems typologies were based on health system financing type, such as the well-known OECD typology. However, the number of dimensions captured in classifications increased to reflect health systems complexity. This study aims to develop a taxonomy of primary care (PC) systems based on the actors involved (state, societal and private) and mechanisms used in governance, financing and regulation, which conceptually represents the degree of decentralisation of functions. We use nonlinear canonical correlations analysis and agglomerative hierarchical clustering on data obtained from the European Observatory on Health Systems and Policy and informants from 24 WHO European Region countries. We obtain four clusters: 1) Bosnia Herzegovina, Czech Republic, Germany, Slovakia and Switzerland: corporatist and/or fragmented PC system, with state involvement in PC supply regulation, without gatekeeping; 2) Greece, Ireland, Israel, Malta, Sweden, and Ukraine: public and (re)centralised PC financing and regulation with private involvement, without gatekeeping; 3) Finland, Norway, Spain and United Kingdom: public financing and devolved regulation and organisation of PC, with gatekeeping; and 4) Bulgaria, Croatia, France, North Macedonia, Poland, Romania, Serbia, Slovenia and Turkey: public and deconcentrated with professional involvement in supply regulation, and gatekeeping. This taxonomy can serve as a framework for performance comparisons and a means to analyse the effect that different actors and levels of devolution or fragmentation of PC delivery may have in health outcomes.

The Connection between Socioeconomic Inequalities and the Appearance of the Toothlessness in Mostar.

BACKGROUND: To determine the existence of the toothlessness within the patients in the area of Mostar. The aim is to determine the topography of toothlessness within the population of Mostar, according to Kennedy classification. The aim is to connect measures of socioeconomic status with the appearance of the toothlessness. To develop a model that includes a form of toothlessness and the socioeconomic status of the patients in Mostar. SUBJECTS AND METHODS: The study was conducted at the Health Center in Mostar and the Regional Medical Center in Mostar. The research was cross-sectional study. It included 800 patients who regularlyoccurred to the dental ambulance because of the toothlessness and because of the prosthodontics treatment. The measurement was conducted by the dentist based on the anonymous research cardboard at the first examination of the patient. The dentist will determine the topography of the toothlessness according to Kennedy classification and the etiology of the toothlessness. RESULTS: In the total sample of respondents, the toothlessness was significantly higher represented (P<0.001). The manifestation of thetoothlessness was significantly higher among temporary employees and the retirees (P<0.001). In the total sample, toothlessness affected the sociological status of a higher percentage of the respondents (P<0.001). CONCLUSION: In our study, in a total sample of respondents, toothlessness was significantly higher represented (90% of respondents). The influence on the sociological status of the patient is most visible in the groups with the lower material status.

Gross Domestic Product and Health Expenditure Growth in Balkan and East European Countries-Three-Decade Horizon.

Background: Dynamics of health care has changed over time along with development of the countries themselves. The aim of the study is to compare macroeconomic and health expenditure indicators of interest, such as total health expenditure (THE) as percentage of global domestic product, global domestic product per capita in US$, and private households' out-of-pocket payments of Balkan and Eastern European countries on health, as well as to assess their progress over the observed period. Methods: This research report represents a descriptive data analysis of indicators extracted from the European Health for All database. The data were analyzed using a linear trend and regression analysis to estimate the timeline changes. Results: Greece and Slovenia have the largest median values of global domestic product per capita throughout the whole period, and the largest increment trend was in Lithuania. Median value in out-of-pocket payment of THE was the highest in Albania and Ukraine, while the largest decrease in trend was noticed in Albania and Bosnia and Herzegovina. Bosnia and Herzegovina and Greece had the largest median value of THE as percentage of Gross Domestic Product (GDP) in the observed period, while regression trend analysis showed that Serbia had the largest increase. Most of the countries showed a significant correlation between observed indicators. Conclusion: Trends in the economy must be constantly monitored due to the fact that the population is aging and non-communicable diseases are multiplying, which requires innovations in medical treatment and pharmaceutical development.

Price elasticity of demand for cigarettes in Bosnia and Herzegovina: microdata analysis.

BACKGROUND: Bosnia and Herzegovina (B&H) is among the top 10 countries in the world in terms of number of smokers. The cigarette prices in B&H are under a direct impact of state excise tax policy. The specific excise on cigarettes was introduced in B&H in 2009. Since then it has been increasing every year thus being the main driver of cigarette prices growth. METHODS: In this paper we estimate price elasticity of demand for cigarettes following Deaton demand model and apply it on microdata obtained from the Household Budget Surveys in B&H conducted in 2011 and 2015. Deaton model uses within-cluster information to estimate total expenditure elasticities and then uses between-cluster information to estimate price elasticities. For B&H, the cluster is defined as a municipality × in the year t. Our sample contains 14 252 households, divided into 267 clusters. RESULTS: Our results show that the price elasticity is statistically significant and amounts to -1.366. This means that if cigarette prices in B&H are increased by 10%, the demand for cigarettes would decrease by 13.66%. CONCLUSIONS: We found a negative price elasticity of demand for cigarettes of -1.366. These results of the econometric estimate of elasticity of demand are more elastic compared with the results of similar surveys carried out on the sample of low and middle-income countries. It demonstrates that the demand for cigarettes responds strongly to the price increase.