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Health Care Systems in Transition I Health Care Systems in Transition i Health Care Systems in Transition Written by Besim Nuri Edited by Ellie Tragakes Albania 2002 The European Observatory on Health Care Systems is a partnership between the World Health Organization Regional Office for Europe, the Government of Greece, the Government of Norway, the Government of Spain, the European Investment Bank, the Open Society Institute, the World Bank, the London School of Economics and Political Science, and the London School of Hygiene & Tropical Medicine. Albania ii European Observatory on Health Care Systems Keywords DELIVERY OF HEALTH CARE EVALUATION STUDIES FINANCING, HEALTH HEALTH CARE REFORM HEALTH SYSTEM PLANS – organization and administration ALBANIA © European Observatory on Health Care Systems, 2002 This document may be freely reviewed or abstracted, but not for commercial purposes. For rights of reproduction, in part or in whole, application should be made to the Secretariat of the European Observatory on Health Care Systems, WHO Regional Office for Europe, Scherfigsvej 8, DK-2100 Copenhagen Ø, Denmark. The European Observatory on Health Care Systems welcomes such applications. The designations employed and the presentation of the material in this document do not imply the expression of any opinion whatsoever on the part of the European Observatory on Health Care Systems or its participating organizations concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. The names of countries or areas used in this document are those which were obtained at the time the original language edition of the document was prepared. The views expressed in this document are those of the contributors and do not necessarily represent the decisions or the stated policy of the European Observatory on Health Care Systems or its participating organizations. Suggested citation: Nuri, B. In: Tragakes, E., ed. Heath care systems in transition: Albania. Copenhagen, European Observatory on Health Care Systems, 2002: 4(6). European Observatory on Health Care Systems: WHO Regional Office for Europe Government of Greece Government of Norway Government of Spain European Investment Bank Open Society Institute World Bank London School of Economics and Political Science London School of Hygiene & Tropical Medicine EUR/02/5037245 (ALB) 2002 ISSN 1020-9077 Vol. 4 No. 6 Albania Health Care Systems in Transition iii Contents Foreword ............................................................................................. v Acknowledgements .......................................................................... vii List of abbreviations ......................................................................... ix Introduction and historical background ......................................... 1 Introductory overview .................................................................... 1 Historical background .................................................................. 10 Organizational structure and management .................................. 15 Organizational structure of the health care system ...................... 15 Planning, regulation and management ......................................... 22 Decentralization of the health care system .................................. 25 Health care financing and expenditure ......................................... 27 Main system of financing and coverage ...................................... 27 Health care benefits and rationing ............................................... 30 Complementary sources of financing .......................................... 31 Health care expenditure ............................................................... 34 Health care delivery system ............................................................ 41 Primary health care and public health services ............................ 41 Secondary care ............................................................................. 47 Tertiary care ................................................................................. 54 Social care .................................................................................... 55 Human resources and training ..................................................... 56 Pharmaceuticals and health care technology assessment............. 62 Financial resource allocation .......................................................... 65 Third-party budget setting and resource allocation ..................... 65 Payment of hospitals and institutions........................................... 65 Payment of physicians ................................................................. 67 Health care reforms ......................................................................... 69 Aims and objectives ..................................................................... 69 Content of reform and legislation ................................................ 72 Reform implementation ............................................................... 76 Conclusions ....................................................................................... 81 References ......................................................................................... 83 Bibliography ..................................................................................... 87 Albania iv European Observatory on Health Care Systems Albania Health Care Systems in Transition v Foreword he Health Care Systems in Transition (HiT) profiles are country-based reports that provide an analytical description of a health care system Tand of reform initiatives in progress or under development. The HiTs are a key element of the work of the European Observatory on Health Care Systems. HiTs seek to provide relevant comparative information to support policy- makers and analysts in the development of health care systems in Europe. The HiT profiles are building blocks that can be used: • to learn in detail about different approaches to the organization, financing and delivery of health services; • to describe the process, content and implementation of health care reform programmes; • to highlight challenges and areas that require more in-depth analysis; and • to provide a tool for the dissemination of information on health care systems and the exchange of experiences of reform strategies between policy-makers and analysts in different countries. The HiT profiles are produced by country experts in collaboration with the Observatory’s research directors and staff. In order to facilitate comparisons between countries, the profiles are based on a template, which is revised periodically. The template provides the detailed guidelines and specific questions, definitions and examples needed to compile a HiT. This guidance is intended to be flexible to allow authors to take account of their national context. Compiling the HiT profiles poses a number of methodological problems. In many countries, there is relatively little information available on the health care system and the impact of reforms. Due to the lack of a uniform data source, Albania vi European Observatory on Health Care Systems quantitative data on health services are based on a number of different sources, including the WHO Regional Office for Europe health for all database, Or- ganisation for Economic Cooperation and Development (OECD) Health Data and data from the World Bank. Data collection methods and definitions sometimes vary, but typically are consistent within each separate series. The HiT profiles provide a source of descriptive information on health care systems. They can be used to inform policy-makers about experiences in other countries that may be relevant to their own national situation. They can also be used to inform comparative analysis of health care systems. This series is an ongoing initiative: material is updated at regular intervals. Comments and suggestions for the further development and improvement of the HiT profiles are most welcome and can be sent to [email protected]. HiTs and HiT sum- maries are available on the Observatory’s website at www.observatory.dk. A glossary of terms used in the HiTs can be found at www.euro.who.int/ observatory/Glossary/Toppage. Albania Health Care Systems in Transition vii Acknowledgements he HiT profile on Albania was written by Besim Nuri (University of Montreal). Ellie Tragakes (European Observatory on Health Care TSystems) served as editor, and Josep Figueras as research director. The Observatory would like to thank the following people from Albanian ministries and institutes for their assistance: Silva Bino (Institute of Public Health (IPH)), Margarita Caci (Institute of Statistics (INSTAT)), Nurije Caushi (Ministry of Health), Eli Gjika (Ministry of Health), Saimir Kadiu (Ministry of Health and World Bank), Manuela Murthi (IPH) and Vigan Saliasi (Health Insurance Institute (HII)). The Observatory gratefully acknowledges Antonio Duran (Tecnicas de Salud), Akiko Maeda (World Bank) and Iris Semini (Joint United Nations Programme on HIV/AIDS (UNAIDS)) for reviewing this HiT. We are also grateful to the Albanian Ministry of Health for its support. The current series of Health Care Systems in Transition profiles has been prepared by the research directors and staff of the European Observatory on Health Care Systems. The European Observatory on Health Care Systems is a partnership between the WHO Regional Office for Europe, the Governments of Greece, Norway and Spain,
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