Presentation on theme: "Ministry of Health Sources of Dissatisfaction in Albanian Health Care System Zamira Sinoimeri, MD, MSC Deputy Minister of Health Albania."— Presentation transcript:
Ministry of Health 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.