Ministry of Health
Sources of Dissatisfaction in
Albanian Health Care System
Zamira Sinoimeri, MD, MSC
Deputy Minister of Health
Albania
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


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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


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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

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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.

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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


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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



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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)
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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!
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