Ida Ismail
Healthcare in Albania continues to face a lack of funding, but a new report by the organization Together for Life suggests that the problem is not only related to the budget level. The analysis of public funds for 2025 highlights a lack of transparency in reporting expenditures, payments for unperformed Services in the check-up concession, gaps in the drug reimbursement scheme, and public investments without a clear assessment of results.
A system that is losing weight in the state's priorities
One of the most significant findings of the report is related to the weight that health occupies in public finances. In 2025, actual public spending on health, including FDSKSH funds, reached 76.6 billion lekë. In relative terms, this represents only 2.9% of Gross Domestic Product and 9.6% of total public spending.
At first glance, these may seem like technical indicators. But in reality, they show the place that health occupies in the hierarchy of state priorities. And this place is increasingly modest. According to the report, the 2025 level is the lowest recorded in the last nine years.
The situation becomes more problematic when these figures are compared with the objectives that the government itself had set in National Health Strategy 2021–2030The strategy envisaged that by 2025 public spending on health would reach 4% of GDP and 12% of total government spending. Neither of these objectives has been achieved.
Citizens continue to finance the system themselves
The consequences of this underfunding are not only felt in health institutions. They are transferred directly to citizens. According to World Health Organization data cited in the report, out-of-pocket payments by Albanian citizens account for about 48.27% of total health spending. This is the highest level in the Western Balkans and one of the highest in Europe.
In practice, this means that almost half of the cost of the healthcare system is paid directly by patients and their families. Instead of the financial burden being shared through health insurance and public funding, it continues to fall on individuals.
The report argues that this situation creates a continuing risk of catastrophic household spending, especially for low-income groups, pensioners and chronically ill patients. In a country where public funding remains limited, access to quality Services often depends on individual ability to pay.
This becomes even more apparent when Albania is compared to its neighbors. With about $590 in health spending per capita per year, the country ranks last in the Western Balkans. Montenegro and Croatia invest almost twice as much per citizen. The difference is not just statistical. It translates into fewer personnel, less equipment, fewer medicines, and fewer opportunities to build a system competitive with regional standards.
Primary care: the sector everyone mentions, but no one funds
In modern health policy theory, primary care is considered the foundation of the system. It is the first point of contact for citizens with the health service, the main mechanism for disease prevention, and the most effective instrument for reducing the long-term costs of hospital treatment.
However, this very sector turns out to be one of the biggest losers of 2025.
The initial budget of 6.84 billion lek for primary care was reduced during the year to only 4.94 billion lek. This is a cut of approximately 1.9 billion lek or almost 28% of the initial fund.
The paradox highlighted by the report is that this decrease occurs at the same time as the government promotes the expansion of Home Health Care, a service extended to 356 health centers and aiming to cover around 5 patients with mobility difficulties. Despite its social importance, the report does not identify any dedicated funding line for this program.
In practical terms, this means that the system is expanding its obligations without necessarily securing the corresponding financial resources, leading to a clear discrepancy between announced policies and real budgetary support.
Concessions and the question that remains unanswered
Few topics have dominated the public debate on Albanian healthcare as much as concession contracts. Even the Together for Life report dwells extensively on them, not only because of their cost, but also because of the lack of information on their performance.
The most illustrative case is that of the check-up. During the year 2025, 455.849 citizens underwent health checks. However, the contract provides for payment up to a limit of 475 thousand beneficiaries. As a result, the concessionaire is also paid for 19.151 people who did not receive the service. The cost to the budget amounts to about 35.3 million lek.
The problem is not just financial. It is related to the way oversight mechanisms are built. When payment is not directly linked to the real number of beneficiaries, a situation is created where the economic risk is transferred to the state and not to the service provider.
Similar problems also appear in the dialysis and sterilization contracts. The report highlights discrepancies between the number of sessions performed and the reported costs, while for sterilization, performance analysis is almost completely missing. There is ample information on how much the contract was paid, but not what concrete results it produced.
The numbers themselves don't agree with each other.
One of the most concerning aspects of the report relates to the quality of the institutional reporting itself.
The analysis identifies cases where the costs reported by the Ministry of Health differ significantly from the costs resulting from the calculation of the same financial data. For primary care visits, the ministry reports an average cost of only 127 lek per visit. When FDSKSH funds are included, the real cost results in around 1.872 lek.
A similar situation is evident in the drug reimbursement scheme, where the real cost per patient is several times higher than the reported one. These differences are not just methodological issues. They affect the very reliability of public data.
In the end, the report reaches a conclusion that goes beyond any contract, project or budget line. Albania does not just suffer from a lack of funds. It suffers from a lack of an institutional culture that measures results.
The Ministry of Health's monitoring report for 2025 analyzes financial realization in detail, but provides very little information on the real performance of programs. There is no analysis of hospital autonomy. There is no comparison of results between hospitals. There is no assessment of the impact of projects financed with billions of lek. There is no integration of the findings of the Supreme State Audit audits. There is even a lack of gender analysis, despite it being a methodological obligation in public budgeting.
This creates a persistent paradox. The system reports with relative accuracy how much money has been spent, but much less what that money has produced.
In the end, the question that citizens have the right to ask is not just how many billions of lek were allocated to healthcare. The question is whether those billions brought more Services, more access, more quality, and more safety for patients.acqj.al
