Sources of Dissatisfaction in Albanian Health Care System.ppt

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					            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,

                                       2
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.



                                        3
Detailed Review of SoD
     System approach:           People approach:
        Organization               Bypassing

        Financing                  Informal

        Quality of service          payments
        Utilization                Low HI

        Focus/Resource
                                     enrollment
         distribution               Low awareness

        Disconnect
                                     about HI




                                                     4
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.




                                            5
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.



                                                      6
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


                                           7
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.


                                                 8
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


                                                   9
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.


                                                10
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.

                                      11
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.


                                                 12
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.


                                       13
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;


                                                           14
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.



                                                          15
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.

                                            16
Thank You!




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