Citation: Tomini SM, Groot W, Pavlova M and Tomini F (2015) Paying out-of-pocket and informally for health care in Albania: the impoverishing effect on households. Keywords: out-of-pocket expenditure, informal patient payments, poverty, Albania, catastrophic health expenditure The health care system in Albania, as in all other ex-communist countries of Central and Eastern Europe (CEE), is rooted in the Soviet " Semashko " model. The legacies of the Semashko system still remain visible especially in the state ownership of public healthcare institutions, public provision of the services, as well as the funding from the general tax base (especially for secondary and tertiary care) (1). WHO data show that in 2013, the total health care expenditure for the country amounted to 5.9% of its GDP (2). This is relatively high compared to other former communist CEE or Former Soviet Union (FSU) countries, but still much lower than the average 8.5% for the EU15 countries (2). However, only about 48.4% of the total health care spending in Albania comes from the general state budget (2), and the share of private expenditures and out-of-pocket expenditures is relatively high (3). The utilization of health insurance in Albania remains low (4). In addition to this, almost 19% of all patients visiting outpatient services and almost 44% of patients visiting inpatient services in 2008 pay informally as well (5). But, are out-of-pocket and informal payments in Albania catastrophic to households' budgets? If yes, what are their effects on poverty? And more importantly, what are the main policy implications for a fast-developing country like Albania? The Health System in Albania The Albanian health sector during the communist period was underfinanced, and the investments in health technology were very low. The extensive web of primary health care (PHC) posts and centers and the large number of local and regional hospitals had out-dated equipment and were overstaffed (6). After the change of regime, the main reforms were focused in PHC and have sought to transfer the financing of the sector to the Health Insurance Institute (HII), which was established in 1994. The HII covers the costs of PHC visits, reimburses (part) of the drugs' prices for drugs in the reimbursement list, as well as covers some costs of secondary and tertiary care. Ministry of Health (MoH) remains the owner and administrator of all public hospitals (4). During the past years, interventions in the hospital sector were mainly targeted to infrastructure and technology improvements and little has been done in terms of reforming the financing of providers. Although the funding of PHC is through the HII, the sector is still dependent on subsidies from the general state budget. In 2013, about 74.1% of total public expenditure on health came from social health insurance funds while the rest came from general taxes [WHO (2)]. The health insurance contribution consists of a flat rate of 3.4% of gross salaries. However, numbers of contributors are still low due to the (still large) informal sector of the economy.
Tomini, S. M., Groot, W., Pavlova, M., & Tomini, F. (2015). Paying Out-of-Pocket and Informally for Health Care in Albania: The Impoverishing Effect on Households. Frontiers in Public Health, 3. https://doi.org/10.3389/fpubh.2015.00207