- (i) <u>Accuracy of population estimates: Population estimates, and thus all</u> _per capita_ estimates, are subject to a high degree of inaccuracy owing to mass migration movements associated with sub-regional conflicts, as well as incomplete registration of births and deaths.

- (ii) <u>Political status of Serbia, Montenegro and Kosovo: Separate data for Serbia and</u> Montenegro are not yet available in most international databases since it is only in 2006 that Montenegro gained independence. There is also no information available for Kosovo in these databases due to its current status as an autonomous province. Data for Serbia, Montenegro and Kosovo, then, are predominantly drawn from World Bank documents, such as health sector notes and public expenditure and institutional reviews.

- (iii) <u>Data vintage:</u> For most analyses, this report uses 2004 data, which is the latest year for which validated data are available in most international databases. If earlier or later estimates are used, this is stated.

- (iv) <u>Consistency of estimates across sources:</u> For some indicators, the international databases contain different estimates for the same year. In addition, the EU, EU-15 and EU-12 aggregate estimates that are produced by the WHO HFA-DB 2007 and World Bank WDI 2007 databases sometimes differ since the former uses populationweights in compiling its estimates, while the latter bases its weights on the denominator. In the event of inconsistencies across databases, we favored the estimates in the World Development Indicators 2007 over other databases, and estimates in World Bank publications over estimates in the publications of other institutions.

Because of these limitations, although data are drawn from the sources thought to be most accurate, they should be interpreted only as indicative of broad trends and of major differences across countries rather than as providing precise quantitative measures of those differences.

# **C. ENSURING SUFFICIENT REVENUES**

The relative importance of payroll taxation and general revenues in the financing mix is one of the most common distinctions made between healthcare systems. In pure Bismarckian systems, the dominant sources of financing are employer and employee contributions, levied as a proportion of payroll, and pooled in social health insurance funds. At the other end of the spectrum, pure Beveridge systems are funded from general revenues with universal entitlement to a fairly comprehensive range of services, at least in Western Europe.

The health system of the former Yugoslavia, referred to as the _Stampar_ model, was unique in Eastern Europe because it was funded from compulsory social insurance contributions rather than the state budget<sup>7</sup> . This financing mode persists in the new states and social health insurance is the dominant form of health financing in Macedonia, Serbia, Montenegro, and Bosnia and Herzegovina. The heritage of Albania’s healthcare system is very different. Based on the former Soviet _Semashko_ model, it was historically funded directly from the central government budget, with central health allocations for different health inputs and for each health care institution made according to population-based norms. Health insurance was only introduced in 1995 and does not play as prominent a role in health financing as in other countries of the sub-region.

> 7 The _Stampar_ model, named for Croatian specialist in social medicine Andrija Stampar, emphasized primary health care and community-based medicine, encouraging family practice as a recognized specialization of medicine.

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