Current Market Trends
Procurement and Tenders
Population: 3.5 million
GDP: USD 16.8 billion
Currency: Bosnian Marka (BAM)
Bosnia and Herzegovina (BiH) is a transitional economy with a population of approximately 3.5 million. Per capita GDP in 2017 was $4,880 with total nominal GDP of approximately $16.8 billion. BiH has been a potential candidate country for European Union (EU) accession since 2003. BiH submitted its formal application for EU membership on February 15, 2016. The lack of a single economic space in BiH affects companies trying to do business across the entire country. The country’s political environment and complex government structure creates significant obstacles to economic development. According to the World Bank (WB), BiH is among the least competitive economies in Southeast Europe and is currently ranked 86 out of 190 global economies. Historically, U.S. investment in BiH has been low, primarily due to the challenging business climate, relatively low-income levels, and the lack of opportunities for investment.
BiH offers opportunities to well-prepared and persistent exporters and investors. The country is open to foreign investment and offers a liberal trade regime. It is essential to visit the country early in the market exploration phase in order to develop relevant industry contacts and understand BiH’s multi-layered bureaucratic structure. For a new-to-market company, identifying a local partner is key. The selection should be based on a potential partner’s knowledge of the local market and a thorough check of its reputation. Sales agents, representatives, and distributors all have important roles to play in this market. Regardless of which channel is selected, sales support and after-sales service are critical.
The United States exported $18.1 million worth of medical equipment to BiH in 2017 – or 6% of total U.S. exports to BiH. Most of this medical equipment is subject to a 5-10% tariff, making American products less competitive than duty-free suppliers from Germany, Austria, the Netherlands, and Italy. Hospitals with adequate resources choose to use American technology, which enjoys an excellent reputation in BiH as being high-quality, reliable, and state-of-the-art technology. For example, all of the equipment at the well-funded International Medical Center
in Banja Luka is from American suppliers, including GE Medical and Varian Medical Systems. Other U.S. companies, including Medtronic and Carefusion, are selling diagnostic equipment at hospitals throughout BiH, but the market is price-sensitive and limited budgets make it difficult for hospitals to justify paying 5-10% more for American technology.
The majority of medical equipment suppliers in Bosnia and Herzegovina are EU-based manufacturers (primarily Germany and Italy). However, in recent years, U.S. manufacturers such as GE Medical and Medtronic have made significant headway in supplying U.S. technology in hospitals throughout the country, specifically diagnostic-imaging equipment in the clinical centers in Sarajevo, Tuzla, Banja Luka, and Mostar. The U.S. companies that have opened representative offices in BiH include Abbott, CareFusion, Eli Lilly, Pfizer, Erkona/Waters Corp., Affidea, GE Medical, and Johnson & Johnson.
The majority of medical equipment suppliers in Bosnia and Herzegovina are EU-based manufacturers (primarily Germany and Italy).
The best sales prospects for U.S. medical equipment include cardiovascular diagnostic equipment, non-invasive surgical devices, anesthesia and intensive care equipment, diagnostic imaging (CTs, MRIs), radiation therapy equipment, ultrasound equipment, urology equipment, laboratory and testing equipment and tissue and blood bank related equipment. There are also good prospects for products such as ultra-violet and infrared equipment used in medical, surgical, and dental procedures, as well as apparatuses based on the use of X-rays of alpha, beta, or gamma radiation treatments. Opportunities also exist for U.S. manufacturers of sophisticated diagnostic equipment such as electrocardiographs, endoscopes, scanners, imaging equipment, pacemakers, digitalized X-ray equipment, nuclear medicine instruments, and clinical laboratory equipment. Diagnostic imaging equipment, especially ultrasonic diagnostic equipment and dialysis equipment are in great demand.
Hospitals are the largest healthcare providers in BiH, comprising approximately 35% of total health consumption. The second largest healthcare providers are ambulances, which comprise approximately 28% of total health consumption. The share of retail and other providers of medical goods is also high, and amounts to approximately 27% of total health consumption. Total health expenditures in BiH in 2017 amounted $1.6 billion, out of which 71% was public, and 29% was private care expenditures. Long-term care services, preventive healthcare and health administration are almost exclusively financed out of public expenditures, while medicines and medical devices for outpatients are largely financed out of private expenditures.
The registration process of pharmaceutical products and medical devices includes an Application for sales authorization that can be submitted by a manufacturer with a seat in BiH or a person representing a foreign manufacturer and having a seat in BiH. A producer's representative shall be obliged to have a contract on representation registered with BiH Ministry of Foreign Trade and Economic Relations. The agent shall notify the Agency of Medicines about the contract registered with the competent ministry, and deliver a full information on the manufacturer's liability insurance for possible damage to the user of the medicine on the territory of BiH. Medical devices are categorized according to the duration of the contact of the medical device with the user, the degree of risk in relation to the users, the degree of invasiveness of medical devices, the use of medical devices, application site of medical devices, method of use of medical devices. According to the level of risk, medical devices are grouped into Class I - low risk for users; Class IIa - medium risk for users; Class IIb - high-risk for users and Class III - highest risk for users.
More information on the registration process can be obtained at the Agency for Medicinal Products and Medical Devices at http://www.almbih.gov.ba/en/
Finding a good agent and/or distributor is the most effective means of market entry in BiH. The most common U.S. business presence found in BiH is the representative office. A representative office is not considered a legal entity and its activities are limited to market research, contract or investment preparations, technical cooperation, and similar business facilitation activities. It is essential to visit the country early in the market exploration phase in order to develop relevant industry contacts and understand BiH’s multi-layered bureaucratic structure.
Constitutionally, healthcare is deemed an entity, rather than a state-level, competency. There are two basic compulsory health insurance schemes: one in the Federation of Bosnia and Herzegovina (the Federation), and one in the Republika Srpska (RS). Compulsory contributions are paid for all residents who receive any kind of regular income. These contributions are paid to entity or cantonal funds, which are then responsible for ensuring the provision of healthcare services to those insured within their area of responsibility. The majority of BiH residents are covered by a compulsory health insurance scheme, but the complexity of the arrangement has hindered the effective functioning of the healthcare system in BiH.
BiH, as part of its efforts to accede to the WTO, has made major trade policy reforms to bring practices in full conformity with WTO requirements and eventual membership in the EU. Reforms include the elimination of import quotas, reduction of import licensing and prohibitions, streamlining of customs procedures, and the reduction of tariff and non-tariff barriers. The BiH Customs Tariff Law generally provides that foreign trade is liberal and without limitations. Once registered for performing business activities, a legal entity/entrepreneur may perform foreign, as well as domestic, operations. U.S. made medical equipment is subject to a 5-10% tariff, making American products less competitive than duty-free suppliers from the EU countries.
Foreign investors have criticized government and public procurement tenders for a lack of openness and transparency. Procurement award decisions are often opaque: Transparency International’s 2017 Corruption Perception Index ranked Bosnia and Herzegovina at number 91 out of 180 countries. The BiH Public Procurement Agency and Procurement Review Body provides information pertaining to public procurement legislation, including procurement notices (https://www.javnenabavke.gov.ba/index.php?id=01&jezik=en)
There are no specific local trade events for the health sector.
American Chamber of Commerce (AmCham): www.amcham.ba
Foreign Investors Council (FIC): www.fic.ba
There are also a number of local Chambers of Commerce on the state, entity, and canton administrative levels. The Chambers of Commerce represent member companies’ interests with government related to adopting and amending economic laws, regulations, and programs.
1. Are there visa requirements for U.S. citizens to travel to Bosnia and Herzegovina?
U.S. citizens possessing a valid passport do not need a visa to enter BiH for stays of up to three months while visiting for business or tourism. Foreigners must register with the local police at the nearest police station within 48 hours of arrival when staying at a private residence.
2. Does Bosnia and Herzegovina have a bilateral investment treaty with the U.S.?
BiH does not have a bilateral investment treaty with the United States.
3. Does Bosnia and Herzegovina effectively protect intellectual property rights?
The BiH Government is strengthening its intellectual property rights laws in preparation for eventual membership in the European Union and the World Trade Organization.
Cardiovascular diagnostic equipment, non-invasive surgical devices, anesthesia and intensive care equipment, diagnostic imaging (CTs, MRIs), radiation therapy equipment, ultrasound equipment, urology equipment, laboratory and testing equipment and tissue and blood bank related equipment. Ultra-violet/infra-red equipment used in medical, surgical, dental, as well as apparatuses based on the use of X-rays of alpha, beta or gamma radiation treatments. Electrocardiographs, endoscopes, scanners, imaging equipment, pacemakers, digitalized x-ray equipment, nuclear medicine instruments, and clinical laboratory equipment. Diagnostic imaging equipment, especially ultrasonic diagnostic equipment, and dialysis equipment are in great demand.
Per capita healthcare spending (including investment)
890 (int’l dollar, 2017)
... as percent of GDP
Hospitals, Procedures, Healthcare Professionals UN:
Number of hospitals
Number of hospital beds
... available beds per 10,000 population
Number of surgical procedures per 100,000
1.89 physicians per 1,000 population (2013)
~3,500,000 (July 2018)
Life expectancy men/women
Total Population: 76.9 years
Men: 74.4 years Women: 79.4 years (2017 est.)
9 deaths/1,000 live births (2017)
Percent of population older than 65
10.4 deaths/1,000 population (2017)
U.S. Commercial Service Contact Information
Name: Anders Lynch
Position: Economic and Commercial Officer
Phone: +387 33 704 515
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