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Healthcare Resource Guide: Bosnia and Herzegovina

Bosnia and Herzegovina Statistics

Summary

Market Entry

Current Market Trends

Main Competitors

Current Demand

Registration Process

Reimbursement

Barriers

Procurement and Tenders

Trade Events

Local Associations

Government Links

FAQs

Best Prospects

Statistics Snapshot

CS Contacts

Capital: Sarajevo

Population: 3.8 million

GDP*: USD 16.56 billion

Currency: Bosnian Marka (BAM)

Language: Bosnian/Serbian/Croatian

Summary

Bosnia and Herzegovina (BiH) is a transitional economy with a population of approximately 3.8 million. Per capita GDP in 2016 was $4,708.72 with total nominal GDP of approximately $16.56 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 81 out of 190 global economies. Historically, U.S. investment in BiH has been low, primarily due to the challenging business climate and the lack of opportunities for investment.

Market Entry

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.

Current Market Trends

The United States exported $17.6 million worth of medical equipment to BiH in 2015 – or seven percent of total U.S. exports to BiH. Most of this medical equipment is subject to a five to ten percent 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 five to ten percent 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, Affidea, GE Medical, and Johnson & Johnson.

Main Competitors

The majority of medical equipment suppliers in Bosnia and Herzegovina are EU-based manufacturers (primarily Germany and Italy).

Current Demand

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, pace makers, 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.

Registration Process

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 to be 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.

Reimbursement

Constitutionally, health care is deemed to be 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 should be paid for all residents who receive any kind of regular income. These contributions are to be paid to entity or cantonal funds, which are then responsible for ensuring the provision of health care 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 health care system in BiH. 

Barriers

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. US made medical equipment is subject to a five to ten percent tariff, making American products less competitive than duty-free suppliers from the EU countries.

Procurement and Tenders

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 2016 Corruption Perception Index ranked Bosnia and Herzegovina at number 83 out of 176 countries. The BiH Public Procurement Agency and Procurement Review Body provides information pertaining to public procurement legislation, including procurement notices (http://www.javnenabavke.ba).

Trade Events

There are no specific local trade events for the health sector.

Local Associations

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.

Government Links:

Healthcare Procurement:

Ministry of Health of the Federation of Bosnia and Herzegovina

www.fmoh.gov.ba

Ministry of Health and Social Welfare of the Republika Srpska

http://www.vladars.net/eng/vlada/ministries/MHSW/Pages/default.asp

BiH Agency for Medicines and Medical Devices

http://www.almbih.gov.ba

FAQs

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.

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.

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.


Best Prospects

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, pace makers, 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.

Statistics Snapshot

Market Size

Per capita healthcare spending 957 (int’l dollar, 2014)

(including investment)

 

... as percent of GDP

9.6% (2014)

Hospitals, Procedures, Healthcare Professionals UN:

Number of hospitals

20

…Public

20

…Private

0

Number of hospital beds

 

... available beds per 10,000 population

34 (2009)

Number of surgical procedures per 100,000

4,611 (2012)

Physicians

1.89 physicians per 1,000 population (2013)

Demographics

Population

3,861,912 (July 2016 est.)

Life expectancy men/women

Total Population: 76.7 years

Men: 73.7 years

Women: 80 years

(2016 est.)

Infant mortality

5.6 deaths/1,000 live births

Percent of population older than 65

20.52 (2012)

Annual deaths

9.9 deaths/1,000 population (2016 estimate)

U.S. Commercial Service Contact Information

Name: Janet Kennedy

Position: Economic and Commercial Officer

Email: KennedyJM2@state.gov

Phone: +387 33 704 515


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