Health, it is not simply the fault of the system, it is the clear will to abuse

2024-06-29 08:50:00, Aktualitet CNA

Health, it is not simply the fault of the system, it is the clear will to abuse

Illustrative photo

Where there is limited supply and high demand, economic theory says that the market develops speculation. But in underdeveloped markets and with weak regulatory institutions, the probability that abusive mechanisms will be created to the detriment of consumers and businesses is very high.

Albania has many such cases, from monopolies favored by the government, which compete with other businesses and enable the maintenance of high prices or services for consumers, to concessions that often do not offer the product for which they are paid with consumer taxes.

The biggest evil is when this offer is limited by state institutions that spend taxpayers' money to provide one of the most basic services of a citizen's life, that of health care.

The latest investigation by the Prosecutor's Office of Tirana in the Oncology Hospital revealed only the tip of the iceberg of a system that has enabled the provision of a truncated service, both in quantity and quality, creating opportunities for abusers to channel state services for private benefits.

The problem starts with the underfunding of the health sector for years. The state budget spends about 2.9% of what the economy produces in a year (Gross Domestic Product) on health, according to data from the World Bank.

This level is half of the world average of 6.5% of GDP and much lower than that of the developed countries of Europe, which reaches up to 10%.

For comparison in the region, Bosnia, Montenegro and Serbia spend from the budget on the health of their citizens over 6% of the GDP and North Macedonia, almost 5%. Even the number of doctors (18 per 10,000 inhabitants) is again the lowest in Europe.

Low government funding, combined with understaffing, is associated with poor services, forcing citizens to spend their own money on a service that they should theoretically get for free, as they pay taxes once.

Albania is the country that has the largest out-of-pocket payments for health in Europe, with about 60% of the total, from 17% which is the global average for this indicator, according to World Bank data.

In the global ranking, Albania ranks 15th, with countries like Afghanistan, Guatemala, Bangladesh, etc. The increase in the share that citizens spend on their own by almost 20 percentage points in two decades is a clear indicator of the deterioration of the quality of the health service

Even those fundings that have been increased in recent years have gone to cover payments for 4 concessions of the health system, which have little or no effect on the quality of the service, while some of them are already under investigation by SPAK.

From 2017-2023, according to data from the Ministry of Finance, nearly 26 billion ALL were spent on sterilization, dialysis, check-up, laboratories, enough for the construction of 3-4 new modern hospitals.

The transfer of funds to concessions, which are proving to be problematic, with high costs for what they actually offer, has been done at the expense of drug reimbursement.

Official data show that in 2019, the reimbursement fund accounted for 24% of the total expenses of the Mandatory Health Insurance Fund, while in 2024, this figure is estimated at only 20.6%.

The High State Control observed last year that the needs for medicines in the Health Care Center were 3-4 times higher than the budget approved for this purpose. In the case of medicines, lack of funding as needed translates into fewer lives or high out-of-pocket costs for patients to be treated outside the public system.

In contrast, year after year, the share of expenses for health concessions increased, reaching 23.7% of the funds collected from health insurance contributions from employees.

It is clear that the fault is not only of the individual, but much wider, of an entire state mechanism that has failed to offer citizens what it has promised them and for which they are taxed, forcing citizens with income lowest in Europe to look for alternative ways to "buy" life.

So it is fairer to say that the system was set up wrongly and in an abusive manner. But have we said the complete conclusion? No. Apart from the system, it is already clear that the will of the government has been such that it has supported and persistently keeps this phenomenon afloat.

The reason is clear. It can be found in the cases that are under investigation by the justice bodies and the Assembly, or in other cases that do not dare to be investigated, but are already a public secret./ Monitor magazine