Prime Minister Edi Rama’s remarks during presentation of the 2019 draft budget for health sector:

Regarding the state healthcare budget 2019, I believe it is worth focusing on some key points on the healthcare system’s real performance over the next year, making sometimes a reference to the starting point as nobody would ask “how have you been”, but “how are you?” But on the other hand, it also very much true that in order to figure out how far we have to go we should always bear in mind where we started from and asses our capacity for progress we are seeking to further make.

It is a universally known fact that any improvement we make is never enough for the health system. This is also the case in countries with a much more developed healthcare system and this is the case in our country, where the healthcare system is still far from being developed. But, it is also a fact that main criticism and dissatisfaction with the healthcare system is levelled by individuals who have never been hospitalized and have never received health care and perceive this system based on the existing perceptions created also on the basis of the ever-growing needs and the citizens’ demands for more services.

It is true that today, if we are to evaluate the health system in terms of how far we want to go, we all may agree that we are still too far from our targets in every aspect of this system. But it is also true – and this is based on facts and unquestionable data and the experience of the citizens – comparing the system with the starting point it’s like night and day. Today, whenever you walk in a hospital, and I mean not only the university hospital centre, but a whole chain of hospitals, you will notice true hospital premises, while, few years ago only, one could suspect whether he was really in a hospital, or in a train station. This is a significant physical transformation and the structure itself has undergone other changes.

Next year, the ongoing transformation will further deepen considering that the upcoming state budget for the country’s healthcare system is 43% higher than five years ago and this is a considerable and significant increase.

Likewise, if we are two consider the health care and social protection combined, the projected budget is estimated at over 750 million dollars.

It is a considerably high budget considering the country’s capacities and it is a budget that will consolidate the ongoing programmes and will allow us to launch many other projects.

The budget allocated for the drugs reimbursement scheme is currently over $100 million. The next year’s drug reimbursement budget is set to rise to over $104 million, while five years ago this budget was estimated $30 million less. Five years ago, a 10 VAT rate was applied on every medicine. We removed that tax. Likewise, five years ago, more than 600 000 people, due to their inability to pay contribution to the health insurance scheme, were denied any access to the drug reimbursement list. Today, no Albanian citizen is denied access to the reimbursed medicaments. The uninsured people are entitled to drug reimbursement just like everyone else.

There is a number of medical packages for the cardiology services, cardiac surgery, transplantation, haemodialysis, radiotherapy, and so on, that people had to pay for. Today, everything is provided by the state. Whether in public or private hospitals, such services are now funded by the state budget.

We have established a free primary health care service. Everyone had to pay $10 for a routine visit or consultation with the family doctor. Today, the medical check-up is provided to anyone for free and the system is being renewed. Yet we are all aware that our health care centres, most of them, are far from living up to their name. Therefore, we have launched a programme for reconstruction of 300 health care centres in whole territory of the Republic of Albania, 80 of which are set to complete this year, whereas 100 others will be constructed next year. More than half a million Albanian citizens, who will need primary healthcare service, will benefit from this.

The University Hospital Centre’s modernization project is well underway and at the meantime we are implementing a modernization project of all regional hospitals, while the modernization of maternity wards and hospitals across the country remains an inalienable target. During the remaining period of this term in office, we will provide funding to support construction of five maternity hospitals, just like the maternity hospital in Saranda, which is meaningful model of our vision and ambition for the healthcare system we want. The new maternity hospitals will be built in Berat, Korça, Lezha, Mat and Kukes.

Modernization of the hospital centres, maternity hospitals and wards and the significantly increased baby bonus are three components of a policy with the mother and child care and the family on its focus more than ever before. A baby bonus is still in force since when I introduced a symbolic 50 000-lek baby cash gift. That was a symbolic welcome cash gift to every newborn but it has remained unchanged since then. The new cash bonuses will increase to $400 for the first child, double to $800 for the second and treble to $1200 for the third or more children. ince I have been repeatedly asked how the baby bonus will be provided should a woman is to give birth to twins, or triplets? In every case, the twins will be both considered as a second child and not as the first and therefore will receive $800 each in cash gift. The triplets will benefit the baby cash gift as third child, so $1200.

Many of you already know that this transformation process requires a significant change to the budget’s contribution to the salaries for doctors, nurses and whole health personnel. The increase in salaries of health personnel in public hospitals is a necessary step in the government reform efforts to transform the country’s health care system. This has changed in two directions, in terms of the pay rise and income tax cut. Five years ago, nurses received a lower wage and paid a higher income tax rate, whereas today their salary is higher the income tax is reduced. However, the state budget will support a pay rise for the doctors, nurses and other workers in the country’s health sector. As many as 18 416 doctors and health personnel will see their salaries increase by 7 percent in the second quarter of 2019. This pay rise fulfils the objective we set forth four years ago.

I clearly know that when it comes to the pay rise and the healthcare service as a whole, all those who fortunately have never visited a hospital they immediately start criticizing. They immediately launch mud throwing against doctors and nurses. By knowing the system internally in my capacity as Prime Minister, I belong to the group of people who believe that are certain individuals who are disgrace to the doctor’s and nurse’s white coat, but the majority of physicians and nurses in Albania are true heroes. This is what I believe considering what they have gone through and their working conditions, because we talk about hospitals today, but everyone seems to forget that five years ago only hospitals across the country lacked the basic equipment, including sheets and aspirins, and daily TV reports showed people protesting while holding prescriptions in their hands. Of course, it was not the doctors and nurses, neither the health personnel the ones who created those conditions. Those conditions were the outcome of the years of misrule by a corrupt government and the doctors have saved lives even under those conditions.

Saving lives is not news. A lost life is news. When physicians save lives and they receive the gratitude and blessings from tens of thousands families are not news. The curses uttered by a family in case of an accident or death to the carelessness of the doctors is news. The last two make the perception worse.

Nobody reckons the first two. As for me and for us who know how things work today, I repeat, doctors and nurses in their overwhelming majority are heroes and deserve respect. If I’m not mistaken, there is a concern that is not only our country’s concern, it is a concern for many other countries. The fact that a number of doctors leave their countries and go abroad is a matter for concern in Italy, let alone in Croatia, Serbia, Montenegro, or Macedonia. But again, in this case too, what is said and what is imagined compared to what actually happens is like night and day. As many as 120 general practitioners and specialized physicians have applied for the relevant license during the period between January through September.

This is the total number. Meanwhile, 153 doctors have been hired in the country’s health system during the period in review. Some 12 specialized physicians have opted to come back home and serve in our health system. A total of 57 foreign doctors have come to live and work in our country. To have a clear idea on figures, a total of 4650 doctors and 13.765 nurses work in our health system. It is true that a number of young female nurses are seeking to leave the country and go abroad, but on the other hand there is a total of 4000 nurses awaiting to be hired in our health system, whereas the number of those seeking to go abroad is estimated several hundreds, meaning that the healthcare system is facing doctor shortage problem not because doctors choose to leave, but because the postgraduate training programme was closed for four years from 2009 to 2013. Nobody still knows why it happened, but the postgraduate specialization was closed. We reopened the programme and the first 300 specialized physicians will be licensed in January, which means that the healthcare system will not suffer doctor shortages, but a number of these doctors won’t be able to work in this system.

Everyone laughed during the last election campaign when we pledged that every specialized physician who would agree to work outside Tirana would receive a bonus that, with the monthly pay combined, is equal to a doctor’s salary in Germany. This is a fact and many specialized doctors are opting to work in the regional hospitals across the country. It is crucially important to mobilize such specialized doctors who will share their experience and motivation with colleagues in the regional hospitals.

If the regional hospitals face problems today, one should not forget that five years ago only we had no regional hospitals that would really live up to their name due to total abandonment, due to lack of equipment and financial support.

Regional hospitals face problems that need to be solved in the future, yet they are genuine regional hospitals. This is an undeniable change.

The social protection programme has been an abusive and scandalous programme for years. It was a programme of political clientelism and corruption.

A political upheaval followed the decision to cut off some 20 000 beneficiaries from the social assistance system. This is true, but they were not 20 000 people who were starving, but some 20 000 or more households that should have never received social assistance, because their living conditions were not such that other taxpayers had to support them with social assistance. This number included families with two houses, three cars and stuff like that.

Meanwhile, what was never said was that 20,000 beneficiaries that did not deserve it were removed from the social assistance scheme, but 10,000 others who had never received social assistance and lived in extreme poverty were included in the scheme. Because the assessment scheme works and the assessment scheme does not target poverty as a general concept, but extreme poverty. Meanwhile, some 2475 households that were removed from the social assistance scheme or that remained in the scheme receive no longer social assistance, because their family members have been employed. There are many others who refuse to take up a job. This is a problem we are encountering and this is the truth.

This is the bitter truth. Many politicians prefer to shun the bitter truth and instead offer the “sweet honey” of lies and fairy tales as a way to collect votes.

The bitter truth is that many prefer to receive an amount of 50 000 lek instead of taking a job, or they are ready to take up black market jobs and continue benefiting the social assistance. This is a concern repeatedly voiced by private companies, which offer vacancies and job positions that require no special skills. The National Employment Services make available the names of people currently benefiting social assistance, but they refuse to take up jobs.

Next year, we will change this policy. Every country around the world, including Albania, provide unemployment benefit. When a job is on offer, a jobless individual has the right to refuse it once. Should a job offer is turned down twice, then the social or unemployment assistance is cut off, because the others owe them nothing to pay taxes in order to support those who refuse to take up a job although physically fit.

This will no longer happen. If you refuse a job offer, then you will be removed from the social assistance scheme until the end of year. This is what happens in other countries and this is going to happen here too. It is impossible and there is no reason that people who respect law and earn their living by working and pay taxes to continue support other people who refuse to work. This should not happen and will not happen. Whoever is offered a job, he or she should take up that job. If they don’t want to work, they are free to do so, but the state is not obliged to support such parasites by granting them social assistance.

I am confident that we are on the right direction. I am aware that a lot remain to improve and I am confident that the pay rise, the continuation of the bonus policy for every doctor who agrees to work in hospitals outside Tirana, as well as inclusion of the postgraduate specialized doctors will bring about a very positive situation by the end of next year.

Thank you very much for taking the trouble to attend this meeting, courage and respect to everyone.

Thank you!