FINANCIAL VULNERABILITY AND OBSTACLES TO GOOD HEALTH: AN ANALYSIS OF THE HEALTH CARE SECTOR IN ALBANIA

The health care system in Albania has its roots in the Soviet “Semashko” model, and has suffered from many of the same problems that affect health service delivery other Central and Eastern European countries. The Government’s priority in health was to provide universal access to primary and secondary care. This policy led to the construction of a relatively large number of local and regional hospitals, which were typically overstaffed and relied mostly on outdated equipment. The reforms to the health sector that followed immediately after the fall of the communist regime focused mostly on reorganizing responsibilities over health care centers. During the 1990s some administrative responsibilities and ownership of many primary health care facilities were shifted to the local level. However, human resource policies and financing for hospitals remains centralized. This level of health spending is comparable to other countries in the region, however, only half of this amount is publicly financed. The share of out-of-pocket expenditures remains high in Albania when compared to similar countries. For households in the lowest quintile the share of out of pocket spending on health is as high as 50 per cent of the total monthly per capita expenditure per one episode. Such high levels of out-of pocket spending for health services can create barriers to access to health care. Using the Albanian Living Standard Measurement Survey (ALSMS) this paper will present a simple methodology to estimate Out-of-Pocket (OOP) health spending and furthermore it will describe the composition of such spending.