Primary Health Care Reform in Albania2003- 2006 || U.S. Agency for International Development |
Abstract
Under United States Agency for International Development's (USAID) Primary Health Care Reform project in Albania, Deloitte was part of a team that supported health reform policy and the mobilization of resources to improve primary health care services. The team conducted a number of health care assessments to develop an understanding of Albania’s health care reform challenges. Deloitte’s contribution focused on improving health care funding allocations and developing policies and procedures to streamline business procedures and improve quality of care.
The Challenge
Although free-market reforms have improved the Albanian economy, the country still remains one of the poorest in Europe. Albania’s health care system is mainly financed by public funds, and the Ministry of Health is charged with the funding, administration, and regulation of health care services. Since the early 1990s, the Albanian government has implemented a number of health care reforms to diversify financing and increase decentralization. Despite these reforms primary health care standards remained relatively low. The team was tasked with identifying innovative and sustainable ways to help the health system provide quality health services to the Albanian population given resource constraints.
How We Helped
Deloitte and its collaborators worked with the Albanian government to improve the allocation of health care funding and explore incentives for providing equitable access to primary health care services. Specific project activities included the following:
- Estimation of funds available for single source financing through the Health Insurance Institute (HII) at the regional, district and patient levels
- Analysis of impact of payroll contribution rates on formal employment and compliance with social insurance contributions
- Analysis of targeted responsibility for increased co-pays at the point of service (based on ability to pay and/or ineligibility for HII benefits)
- Analysis of the formula developed for block grants (per capita) to be allocated to the HII from the general budget
- Assessment of capacity of HII to monitor payments for fraud, errors and abuse
- Identification of training needs for regional HIIs and health center financial managers
- Costing of benefit packages being considered for testing by pilot sites, particularly to effect better integration of services including coverage for modern contraception, patient education and prevention, treatment of sexually transmitted diseases and other communicable diseases, and diagnosis and management of chronic diseases
- Development of a revised budget for semi-autonomous health centers beginning in two pilot regions in 2006
- Development of payment methodology and basis for performance to be tested in the two pilot districts
- Drafting of a contract between the HII and the health centers which included clauses stipulating the benefits to be provided, the determination of fixed monthly payments and the performance bonus (based on the number of registered beneficiaries in the HC catchment area, the volume of services provided, quality of staff, and use of protocols for providing care)
- Drafting of a Council of Ministries Decree to initiate the reforms
Solution
The combination of assessments, policy guidance, and implementation of reform initiatives by the Deloitte team helped lay the foundation for long-term improvements in primary health care in Albania, leaving the country better equipped to address broader health care reform challenges.
As used in this document, “Deloitte” means Deloitte Consulting LLP, which provides strategy, operations, technology, and human capital consulting services, Deloitte Financial Advisory Services LLP, which provides financial advisory services, and Deloitte & Touche LLP which provides governance and risk oversight and reporting advisory services. These entities are separate subsidiaries of Deloitte LLP. Please see www.deloitte.com/us/about for a detailed description of the legal structure of Deloitte LLP and its subsidiaries. Certain services may not be available to attest clients under the rules and regulations of public accounting.
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