Sources of Dissatisfaction in Albanian Health Care System

1
Sources of Dissatisfaction in Albanian Health
Care System

• Zamira Sinoimeri, MD, MSC
• Deputy Minister of Health
• Albania

2
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,

3
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.

4
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

5
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.

6
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.

7
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

8
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.

9
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

10
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.

11
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.

12
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.

13
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.

14
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

15
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.

16
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.

17
Thank You!