WB calls for a turnaround in healthcare financing, hospitals to be paid based on results

2026-07-20 08:26:31, Aktualitet CNA

WB calls for a turnaround in healthcare financing, hospitals to be paid based on

The World Bank recommends changing the way health services are financed in Albania, proposing that the Mandatory Health Insurance Fund (FSHIF) move from managing historical budgets to a model where payments are linked to results, quality, and performance of service providers.

According to the report, this reform is considered the main lever for increasing the efficiency of the health system and improving the quality of services.

The report notes that the Fund manages about 67% of public health spending, but functions mainly as a budget administrator. The financing of public hospitals is based on historical budgets by expenditure item, while the use of selective contracting or performance-related payments remains limited. As a result, hospital financing is little linked to activity or results achieved.

The World Bank notes that the current model gives providers few incentives to increase productivity, streamline service delivery, or shift treatments to lower-cost forms. According to the report, the problem is not related to the fragmentation of funds, but to the lack of capacity for strategic procurement of services.

The document recommends that, in parallel with the expansion of the autonomy of public hospitals, the Fund gradually begin implementing results-based purchasing of services at all levels of healthcare.

For primary care, the report proposes the use of capitation-based payments, adjusted according to the age and risk of patients, accompanied by funds dedicated to laboratory and instrumental diagnostics, as well as performance indicators where possible.

For specialized outpatient services, the World Bank recommends that public providers be strategically contracted to guarantee the provision of certain services, while payments be regulated in a manner similar to those applied to PPPs and private providers, but limited by quotas and budget ceilings to avoid unnecessary expansion of services.

At the hospital level, the report proposes selective contracting and financing based on volume or certain criteria, in line with the National Hospital Plan 2023–2030. It also recommends a gradual transition from budgeting by expenditure items to financing by cases or service packages, using different combinations of payment methods.

According to the World Bank, a more flexible system of purchasing services, combined with managerial and financial autonomy for providers, would create more opportunities for institutions to plan personnel and use performance-related incentives.

In its summary of recommendations, the report calls for the Fund's transition from a passive budget administrator to an active purchaser to improve the performance of the Albanian healthcare system. /Monitor