Ministry of Health

Sources of Dissatisfaction in Albanian Health Care System

Zamira Sinoimeri, MD, MSCDeputy Minister of HealthAlbania

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Purpose

To present: Sources of Dissatisfaction in the

Albanian Health System The need to reconfigure the health

care system The strategies needed to face the

problems and overcome the challenges,

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Definition

Sources of Dissatisfaction (SoD) are all those faults in the health system that lead into low utilization of health care services (both curative and preventive); and eventually a deteriorating and vulnerable health status of the population.

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Detailed Review of SoD

System approach: Organization Financing Quality of service Utilization Focus/Resource

distribution Disconnect

People approach: Bypassing Informal

payments Low HI

enrollment Low awareness

about HI

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SoD: System - Organization

Unclear roles and responsibilities of major players: MoH, HII, Public Health/PHC directories in the districts.

Re-organization of district structures into regional ones.

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SoD: System - Financing

Low public funding for health. Health insurance scheme covers only PHC. Low health insurance enrollment. The public health financing is fragmented and

fails to give providers the incentives for efficiency and quality improvements, nor it establish clear lines of accountability.

Provider payment that does not follow performance.

Wide-spread informal payments.

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SoD: System – Quality of Service

Perceived quality of service is low (bypassing in PHC, export of patients in hospital sector)

Few of health personnel have received formal training after their graduation.

More investments are needed to modernize the system

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SoD: System – Utilization

Low utilization of services in both the primary and secondary health care (hospital bed occupancy rate: 50%) .

The amount of PHC services provided in the hospitals are not recorded, this fuels the IP mechanism

Ability to diagnose and treat needs improvement.

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SoD: System – Resources

Services are oriented into the curative services and less into preventive ones.

90% of PHC physicians have no training as Family Doctors

System should have better priorities (epidemiologic shift into chronic illnesses)

Only a part of health personnel have received formal training after their graduation

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SoD: System – PHC- Hospital Sector disconnected

Primary care is isolated from secondary care.

Health insurance covers only PHC. PHC patients bypass their facilities of

coverage to be treated in polyclinics and hospitals (at higher costs).

Weaker PHC means more informal payments to secondary level and inefficient PHC.

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SoD: People - Bypassing

50% of people, especially in rural areas bypass their PHC facility of coverage to go to polyclinics and hospitals in urban districts.

They incur more costs (transportation, examinations, work-day lost, informal payments to personnel)

Increased burden of disease.

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SoD: People – Informal Payment.

Over 93% of people seeking care pay for smth, most of it as informal payments.

IP often cause frustration to patients and delays in seeking care.

Half of health expenditures are of informal nature, often hampering access of patients to health services.

IP, mostly at secondary level, cause increased burden of disease.

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SoD: People – Health Insurance

Population is not fully aware of the benefits of HI scheme and the procedures of getting enrollment.

HI covers PHC and not secondary level.

Penalties in form of user fees for uninsured are often channeled as IP to medical personnel.

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Some reforms introduced

Changes in financing; Reduction of the excess capacity of the

provision network Some decentralization; The introduction of some private initiative Setting up CME & National Center for

Quality and Accreditation

Limited impact - Public perception is still low;

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Strategies needed to face the problems and overcome the challenges (1)

The main challenge is the shift from hospitals to PHC

Health System in Albania needs a reform of its organization, financing to increase efficiency, improve quality of service and have the people in its focus.

The aim of financial reform is to put all public sector funding for health in a single pool.

Re-orient services in line with actual priorities; Provider payments should award performance. Health sector reform calls for a cross-sectorial

approach.

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Strategies needed to face the problems and overcome the challenges (2)

Health care reform requires government workforce planning, and more active policies influencing the education and training

The reform process calls for a strong involvement of all in-country and outside assistance, in a clear timeline and identified milestones.

Full transparency to stakeholders and the public is necessary.

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Thank You!