Primary care in Bosnia and Herzegovina - Health care and health status in general practice ambulatory care centres

OBJECTIVE To assess the health care and health status of patients attending primary care clinics in Bosnia and Herzegovina. DESIGN Assisted administration patient survey. SETTING Two ambulatory care clinics (ambulantas) in each of three cities in Bosnia and Herzegovina: Tuzla, Mostar, and Banja Luka. PARTICIPANTS Patients attending the ambulantas during a 1-week period in Ma rch 1999; 885 answered questionnaires. MAIN OUTCOME MEASURES Each patient listed demographic characteristics and a nswered questions on satisfaction with health care and with the physical an d financial accessibility of health care services and medications. A valida ted health status questionnaire (EuroQoL), previously used in parts of the former Yugoslavia, was administered. RESULTS Only 22% of patients were employed; 57% could not pay the nominal f ee to see a physician; 71% walked to the clinic; mean distance from patient s' homes to the clinics was 2.3 km; 63% could not get the medications presc ribed tin 85% of cases because of cost, not availability); 80% to 90% of an swers to satisfaction questions suggested high satisfaction with the care p atients received from their doctors; 67% of the time patients were referred to a specialist by general practitioners; 33% had problems walking; 17% ha d problems with self-care; 36% had problems with usual daily activities; 72 % had at least some pain or discomfort; and 62% described at least some anx iety or depression. The three cities showed significant differences; patien ts in Tuzla generally had lower health status and more problems with health care. CONCLUSION Unemployment and financial considerations reduced health care ac cess in Bosnia and Herzegovina. While only one third of patients had physic al difficulties, two thirds had emotional problems or pain. Satisfaction wi th physicians' care was high.