Yugoslavia's Autonomous Health Institutions

Abstract

Health care in Yugoslavia is provided through a partnership of federal, republic, and local health authorities in collaboration with health insurance funds, sociopolitical and work associations, as well as other associations which represent either the providers or users of health services, or those who shape the development of health policy. The concept of cooperation culminates in a high degree of autonomy for individual health institutions, with self-management characterizing the general pattern of Yugoslav health care delivery. Self-management entails legal, administrative, and fiscal autonomy of the institution, both in its relations with other agencies and within the institution itself, with high levels of self-management within individual departments and sections. Given this diminished role of classical hierarchical organization, the health institution operates with a minimum of legal restraints in responding to the special social interests concerned with health matters. To deal with the institution's external role on the one hand, and its internal cohesion on the other, two organs have been created to serve these respective functions: the council and the management board. Self-management requires planning for several distinct levels: the individual health institution, the local community, and the entire republic. Health services development planning requires cooperation of all pertinent organizations in achieving a “social agreement” on the objectives and priorities of the health services, the resources required, and the specific plans for construction and renovation of health facilities. The principles of the “social agreement” encourage the interest as well as the broad support of citizens and their representatives in the development, implementation, and financing of health protection plans.