Albania needs to expand population coverage to move towards universal health coverage

New WHO analysis finds that out-of-pocket payments for health are a major source of financial hardship for people in Albania. Around 8% of households are pushed into poverty or further impoverished after paying out of pocket and 12% experience catastrophic health spending. The financial hardship caused by out-of-pocket payments is heavily concentrated among poorer parts of the population and is increasingly driven by household spending on outpatient medicines.

A large gap in population coverage and heavy co-payments undermine financial protection

Entitlement to most publicly financed health care in Albania is linked to payment of contributions to the mandatory health insurance fund. This makes it difficult to cover the whole population in the context of a large informal sector. As a result, about a third of the population is uninsured and must pay for almost all health services out of pocket. This is just one reason why financial protection is weak and levels of unmet need for health and dental care are high. The Government of Albania has taken steps to improve access to primary care for uninsured people, offering them free annual check-ups in 2015 and free visits to general practitioners in 2017. These measures are welcome, but do not address other important gaps in coverage.

Uninsured people pay the full cost of diagnostic tests, medicines and non-emergency specialist care, while those who are insured pay co-payments of up to 50% of the reference price for outpatient-prescribed medicines. Although pensioners and disabled people are exempt from these co-payments, there are no exemptions specifically targeting low-income people or most people with chronic conditions; nor is there an annual cap on co-payments. During the period under analysis, out-of-pocket payments for outpatient medicines grew from 53% to 76% of all household spending on health.

Everyone in Albania should have access to needed health services, regardless of health insurance status

Poor households in Albania are at high risk of being uninsured, facing financial barriers to access and experiencing catastrophic health spending. Because of this, steps to reduce unmet need and financial hardship must prioritize people in poverty. Three protective measures are key. First, de-linking entitlement to health insurance from payment of contributions, so that the mandatory health insurance fund automatically covers everyone. Collecting contributions is a tax not health policy responsibility. Second, exempting low-income people and people with chronic conditions from co-payments, including co-payments for outpatient medicines. And third, increasing public investment in the health system, so that the priority Albania gives to health when allocating government spending is no longer among the lowest in Europe.

WHO supports countries to move towards universal health coverage – leaving no one behind

Financial protection is at the heart of universal health coverage, which means that everyone can use the quality health services they need without financial hardship. Linked to WHO’s General Programme of Work, the European Programme of Work places universal health coverage at the core of the WHO Regional Office for Europe’s work. Through the WHO Barcelona Office for Health Systems Strengthening, the Regional Office undertakes context-specific monitoring of financial protection in over 30 countries, including Albania.

The Barcelona Office also provides tailored technical assistance to countries to reduce unmet need and financial hardship by identifying and addressing gaps in coverage.

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