title: Health insurance and accessibility to health services among Roma in settlements in Belgrade, Serbia--the journey from data to policy making.
abstract: The Serbian constitution and health-related laws assert that citizens and residents are universally entitled to health care, provided that they hold health insurance. However, until 2010, persons who did not hold a national identification number (ID) were required to present a plethora of documents to be granted one. We assessed the relationship between citizenship, residency and possession of health insurance cards, together with utilization of health services, among Roma residing in disadvantaged settlements in Belgrade. The Roma Health and Nutrition Survey was conducted in 2009 to assess the social determinants of health among Roma. Data were analysed, using logistic regression, to examine health insurance status and utilization of services by citizenship and residency. Eighty-nine per cent of respondents said they were Serbian citizens. Approximately 11% were refugees, 7% internally displaced persons (IDPs) and remainder domicile. Multivariate analysis revealed that non-citizens were more likely to lack health insurance [odds ratio (OR) = 9.2, confidence interval (CI) (3.5, 24.1)], as were refugees and IDPs [OR = 3.1, CI (1.4, 6.9), OR = 4.0, CI (1.4, 11.5), respectively]. Having health insurance was a positive predictor for being seen by a physician [OR = 2.3, CI (1.3, 4.2), OR = 2.3, CI (1.3, 3.9)]. Data from this survey indicated that non-citizen Roma had limited access to health services. These findings led the Serbian Ministry of Health and National Health Insurance Fund to reduce the administrative and legislative hurdles in obtaining health insurance, to ensure the Roma rights to health care. This demonstration of data-driven policies on Roma health could serve as a model for other countries.
authors.affiliation: World Health Organization Regional Office for Europe, Scherfigsvej 8, 2100 Copenhagen, Denmark, World Health Organization Ukraine Country Office, 30, Borychiv Tik Street 04070 - Kiev, Ukraine and Republic of Serbia, Ministry of Health, Nemanjina str.22-26, 11000 Belgrade, Serbia World Health Organization Regional Office for Europe, Scherfigsvej 8, 2100 Copenhagen, Denmark, World Health Organization Ukraine Country Office, 30, Borychiv Tik Street 04070 - Kiev, Ukraine and Republic of Serbia, Ministry of Health, Nemanjina str.22-26, 11000 Belgrade, Serbia.
authors.forename: Dorit Nitzan
authors.initials: DN
authors.lastname: Kaluski
authors.affiliation: World Health Organization Regional Office for Europe, Scherfigsvej 8, 2100 Copenhagen, Denmark, World Health Organization Ukraine Country Office, 30, Borychiv Tik Street 04070 - Kiev, Ukraine and Republic of Serbia, Ministry of Health, Nemanjina str.22-26, 11000 Belgrade, Serbia kristefers@gmail.com.
authors.forename: Kristefer
authors.initials: K
authors.lastname: Stojanovski
authors.affiliation: World Health Organization Regional Office for Europe, Scherfigsvej 8, 2100 Copenhagen, Denmark, World Health Organization Ukraine Country Office, 30, Borychiv Tik Street 04070 - Kiev, Ukraine and Republic of Serbia, Ministry of Health, Nemanjina str.22-26, 11000 Belgrade, Serbia.
authors.forename: Gerry
authors.initials: G
authors.lastname: McWeeney
authors.affiliation: World Health Organization Regional Office for Europe, Scherfigsvej 8, 2100 Copenhagen, Denmark, World Health Organization Ukraine Country Office, 30, Borychiv Tik Street 04070 - Kiev, Ukraine and Republic of Serbia, Ministry of Health, Nemanjina str.22-26, 11000 Belgrade, Serbia.
authors.forename: Elizabet
authors.initials: E
authors.lastname: Paunovic
authors.affiliation: World Health Organization Regional Office for Europe, Scherfigsvej 8, 2100 Copenhagen, Denmark, World Health Organization Ukraine Country Office, 30, Borychiv Tik Street 04070 - Kiev, Ukraine and Republic of Serbia, Ministry of Health, Nemanjina str.22-26, 11000 Belgrade, Serbia.
authors.forename: Piroska
authors.initials: P
authors.lastname: Ostlin
authors.affiliation: World Health Organization Regional Office for Europe, Scherfigsvej 8, 2100 Copenhagen, Denmark, World Health Organization Ukraine Country Office, 30, Borychiv Tik Street 04070 - Kiev, Ukraine and Republic of Serbia, Ministry of Health, Nemanjina str.22-26, 11000 Belgrade, Serbia.
authors.forename: Lucianne
authors.initials: L
authors.lastname: Licari
authors.affiliation: World Health Organization Regional Office for Europe, Scherfigsvej 8, 2100 Copenhagen, Denmark, World Health Organization Ukraine Country Office, 30, Borychiv Tik Street 04070 - Kiev, Ukraine and Republic of Serbia, Ministry of Health, Nemanjina str.22-26, 11000 Belgrade, Serbia.
authors.forename: Zsuzsanna
authors.initials: Z
authors.lastname: Jakab
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006296:Health Services / Q000706:statistics & numerical data*; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006304:Health Status; D006801:Humans; D007348:Insurance, Health / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D012111:Residence Characteristics; D006178:Romani People / Q000706:statistics & numerical data; D055771:Serbia; D012959:Socioeconomic Factors; D055815:Young Adult
keywords: Access to health; Roma; health insurance; health protection; human rights; universal health care