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 March 1999; 885 answered questionnaires.

MAIN OUTCOME MEASURES Each patient listed demographic characteristics and answered questions on satisfaction with health care and with the physical and financial accessibility of health care services and medications. A validated 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 fee to see a physician; 71% walked to the clinic; mean distance from patients' homes to the clinics was 2.3 km; 63% could not get the medications prescribed (in 85% of cases because of cost, not availability); 80% to 90% of answers to satisfaction questions suggested high satisfaction with the care patients received from their doctors; 67% of the time patients were referred to a specialist by general practitioners; 33% had problems walking; 17% had 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 anxiety or depression. The three cities showed significant differences; patients in Tuzla generally had lower health status and more problems with health care.

CONCLUSION Unemployment and financial considerations reduced health care access in Bosnia and Herzegovina. While only one third of patients had physical difficulties, two thirds had emotional problems or pain. Satisfaction with physicians' care was high.