Author: Denis Tahiri
VH, mother of three children, has been waiting for an orthopedic prosthesis for two years due to a health problem with her right leg.
" Every time I go, they tell me there's none. We're waiting, but I've been waiting for two years and it's not my turn," says the 50-year-old, whose physical problem with her right leg has significantly affected her daily life. " I have pain, I can't move much," she says, adding that the doctors have not considered it an emergency.
Meanwhile, the intervention she needs, if carried out in private, is expensive.
" I can't afford it, the prosthesis alone costs around 1500-2000 euros. Only my husband works, will he support the family, the children in school or my health expenses? The private intervention costs around 5000 euros ," she says, adding that there is no one to help her with the necessary monetary amount.
Meanwhile, similar interventions are also offered by private hospitals, but their prices are salty for the pockets of Albanians.
RC, 26 years old, is one of the citizens, who preferred to do this intervention in private, even though the price was high.
" I had a damaged meniscus and a torn ligament. The operation cost 4500 euros and included the operation, two nights in the hospital, food, check-ups with the doctor, the help of nurses whenever I asked for them, etc.," she says, adding that the choice to have the operation in private was influenced by the trust she had in the doctor, who had followed her since the beginning of her problem, but also the complete package offered by private hospitals. " I chose the doctor I had the most confidence in and the doctor I wanted was in private. When I analyzed the part of the benefits that I pay once and have everything included, I felt safer and calmer," she says.
The service with free orthopedic implants was trumpeted in 2016 as a health achievement in Albania, starting first at the University Trauma Hospital and then it would be offered in regional hospitals as well. But the statistics show the opposite.
" Sinjalizo" addressed a request for information to the University Trauma Hospital, a hospital structure in which the provision of free orthopedic implants was implemented for the first time, asking them to know the number of surgeries performed within the framework of this initiative.
In response to our request, the Trauma Hospital officially stated that: "The number of surgical interventions (operations) over the years is very high and requires a long time to process the requested data since the statistics sector at the SUT has limited personnel and cannot process data from several years in a short time."
For the years 2016-2018, the Trauma Hospital has made this data available to the "Together for Life" association, according to which: " Regarding the number of patients who have benefited from prostheses for the years 2016-2018, it turns out that there are 513 patients. Meanwhile, there are currently 891 patients on the waiting list. If for 3 years the number of patients who have benefited from prostheses has been 513, with a simple division it comes out to 171 patients prostheticized per year. If there are 819 patients on the waiting list, it turns out that the turn is reserved for 4-5 years."
Meanwhile, when asked by "Sinjalizo", the University Trauma Hospital announced that there are 900 people on the waiting list for orthopedic implants. Among other things, the Trauma Hospital says: " The number of people on the waiting list is constantly being reduced. We would like to inform you that patients admitted as emergencies to the SUT have received immediate service. The planned cases are in the process of treating their needs and their number is decreasing, taking into account the gradual increase in funds available to the SUT."
The University Trauma Hospital states that the budget for the orthopedic service has been constantly increasing. " According to the information we have at SUT, the budget for orthopedic materials has been as follows:
- the three years 2016-2017-2018 - two hundred million ALL without VAT;
- years 2019-2020 - two hundred and forty million ALL without VAT;
- years 2021-2022 - three hundred million lek excluding VAT", the Trauma Hospital officially says, adding that at the end of 2022, a framework agreement was signed for the next 24 months with the fund: three hundred and fifty-six million new lek excluding VAT.
"Sinjalizo" also sent a request for feedback to the Ministry of Health regarding the program of free orthopedic prostheses in state hospitals, but until the publication of this article, it has not received a response.
High demand, slow service
Denisa Cenameti, manager of health programs in the "Togather for life" association, says that the need for free orthopedic implants is very great.
" The waiting list according to our sources is around 1000, while according to the data of the Trauma Hospital, around 280 patients benefit from orthopedic prostheses every year. So the need is many times higher", she says, adding that in the context of the decentralization of health Services, the distribution to regional hospitals is a very good decision. However, in the context of the lack of budget for this service, the provision of the service remains difficult for both Tirana and the districts.
"Equipment supply should be planned according to needs and not based on the previous year's budget," insists Cenameti.
European Commission Report: The health system in Albania is under-financed
According to the World Health Organization, in 2018, Albania spent a figure of 275 dollars per capita, this year, where the average of the Balkan countries was 500 dollars per capita, spending a total of 2.8% of the Gross Domestic Product, when the countries neighboring countries, the budget for this sector amounts to 5% of GDP.
Meanwhile, in 2020, the Albanian state for the primary service, municipal, regional, university and emergency hospitals would spend a total of only 113 euros per capita, not even justifying the amount of health insurance of 29.400 lek that an employee with a salary of 50 thousand ALL.
On the other hand, the European Commission in its final report in 2022, entitled "Progress of Economic Reforms of Albania, Montenegro, North Macedonia, Serbia, Turkey, Bosnia and Herzegovina and Kosovo", would emphasize that the health sector in Albania it is underfunded and there is a significant portion of uninsured people.
" There are about 600 thousand uninsured people (about 21% of the entire population). They are mostly informal workers, low-income groups, minorities and people living in rural areas. The Albanian health system suffers from under-financing of primary health care," the report says.
But this underfunding has weighed heavily on the pockets of Albanian citizens. " Albanians pay about 50% of the costs of receiving health Services out of pocket and this is a figure calculated by the World Bank, while the Ministry of Health itself in the strategic document admits that out-of-pocket costs are over 40%," says Denisa Cenameti, health project manager at the "Togather for Life" association, adding that this hits low-income groups harder as they are less able to afford health expenses themselves.
" Free healthcare does not exist as a concept and cannot exist," says Denisa Cenameti, who adds that in the relations of citizens with the healthcare system, the use of this term has caused problems, has led to clashes between citizens and healthcare personnel after they believed in free healthcare. Ms. Cenameti also emphasizes the importance of the fact that healthcare in Albania is underfunded, ranking last in Europe and the region for public spending in relation to Gross Domestic Product. " Even with a very deep difference in relation to the average of EU countries," she concludes.
