Speech of Prime Minister Edi Rama at the meeting “Free drugs for 600 thousand people not covered by insurance”:
Hello everyone!
Today is another milestone to be marked on the extremely difficult path to Health Renaissance. Since we are in Durres, I would make a comparison with three and a half years ago when with regard to this sector, not only to this sector but with regard to all sectors of life, we were on the open sea.
We haven’t reached the port but we have a compass that guides us in the right direction, and thanks to a well-organized work on a comprehensive site of reforms, but also specifically of measures to support every reform, we are in the condition when we can tell people with pride that we have significantly reduced health costs for them, and tell them also with increased awareness and modesty that not only there is still much to do, but we know exactly how we will do it.
From the beginning of this year, 600 thousand Albanians will be receiving for free drugs from the list of reimbursable drugs. They are men and women, boy and girls who are not covered by insurance and are having a tough time, and until yesterday they had to pay, although they are obviously the weakest and most vulnerable part of society in this respect.
Today, everyone has free access to healthcare for every medicine, and if we take into account the stories we just heard, or the stories that can be told us from all over the country by chronically ill people, it is an extraordinary relief that erases once and for all the dilemma due to the lack of financial means: “Should I continue treatment this month, or postpone it to next month because I don’t have the money, etc.” On the other hand, it makes all citizens equal in relation to access to healthcare in terms of medication. When I say medicines, I do not forget that the service at the family doctor is now provided for free. I do not forget that now service fees are symbolic in relation to what they used to be for all those who aren’t covered by insurance. Also, I don’t forget a series of other facilitations that have brought a 25% decrease of the burden of health costs from 2014 to 2015, because in terms of 2016 we will have to wait relevant statistics.
Obviously, a lot more is required, and there is no doubt that people have prejudices in relation to the health sector, and they are very right to tell the truth, since this sector is directly related to people’s lives, to the care of our loved ones, and here every weakness translates into a threat to human health. But one thing is certain. Those who are provided today healthcare services have a more positive attitude towards the way this service is offered today, than those who fortunately do not need to go to hospitals and see the difference, and the attitude of the latter is not only suspicious, but it is also extremely negative in relation to the sector.
I have to remind you that in 2013 this sector was the most meaningful image of an overall collapse. I must also remind you that in the years 2012-2013, the conditions of the health sector in Albania turned into a topic for foreign media. I’ve brought here one of the many examples that I could bring, of one of the major Spanish newspapers which in 2013 would write that mismanagement and corruption ruled public health in Albania, among “miserable hospital conditions, without drugs, with catastrophic hygienic conditions, and where patients have to pay bribes to receive even the most basic services.”
Well, if we claimed that bribe is not part anymore of the daily life of our health service, we would be terribly wrong. But on the other hand, what is worth noticing today is that by reforming the health system, step by step we are pulling corruption and bribes back also in our national health system. When I say we are pulling them back step by step, I don’t claim that we have taken them out of the door of this service. The electronic prescription also, which was designed and successfully applied as a pilot project here in Durres, will become effective during the month of February, and during the following two months, in spring of this year, it will be the only prescription nationwide. Which means that every bitter story we have heard, or many others we have not heard, for nobody has understood them, of a systemic corruption with the fund which would feed a number of channels of misdeeds, ranging from the pharmacies that issued hand-written prescriptions for drugs they didn’t sell, to the state agency that engaged in this corrupt relationship, all this is over because from now on every prescription will be issued electronically, and no pharmacy can produce anymore its hand-written prescriptions. Every medicine that is sold has to match that in the electronic database of prescriptions across Albania.
Also, allow me to go a bit back in time and remind you that the services provided until 2013 were miserable, and many devices in the hospitals were there as result of sporadic purchases, without any vision, any plan, any order in doing things, but they also witnessed the very collapse of the system. The minister showed the figures increased by many times of the number of services provided at the hospital in Durres. The same applies across the country. Obviously, not all hospitals in Albania have had the exemplary transformation of the University Hospital Centre “Mother Teresa”.
Not all hospitals in Albania can be compared to the hospital of Durres which is one of the best hospitals, but there is no doubt that there is no hospital in Albania where the change that comes as a result of this reform, accompanied by specific measures and on the basis of a map of step-by-step actions to build the state foundations in the health sector, has not started to being felt.
Let’s look at surgical instruments. The instruments we inherited were beyond any sterilization standard, and according to research conducted by international consultants, they were a direct threat to the lives of any of the 50 thousand patients who underwent surgery in Albania, only due to the lack of sterilization standards.
Today we have excellent surgical instruments, which are among the results of a public-private partnership, or of what was cursed every day by any sort of demagogues and fools as concessions that enriched some and impoverished some others.
Allow me to stop a little bit at the so-called concessions – as they are genuine public-private partnerships – and explain you that there are 2 methods to enter a partnership with the private sector. One of them is the old method of the previous government, when partnership between the state and private entities was paid by citizens. The other method is our method, according to which citizens are beneficiaries of the partnership between the state and private entities.
Today, check-ups are for free, which means that no citizen has to pay for a series of required tests to prevent a significant number of diseases that develop in our bodies without us being aware of this. In addition, these check-ups have given us for the first time a statistical basis for our health policies. Of course, the state pays. But why does the state pay instead of providing these services itself? Because the state can’t make the initial investment. It’s not how it is being told, that “the state is giving money to privates, who take the money and leave, and citizens are the ones who suffer the consequences”. This is crazy. The contrary is true.
Privates invest, and the state pays off their investment in instalments over the years, and according to the contracts, within 7-10 years the state becomes the owner of laboratories, owner of surgical instruments, owner of the new dialysis wards, owner of all these investments initially made by privates.
The most important thing is that this is not like the infamous concession of scanners according to which anybody who takes some goods in Albania has to pay a bill, even if the goods are not scanned. So, a collaboration with the private paid by the citizens.
Whereas, from these collaborations with privates in the health sector, but also in all other cases, we have not allowed and do not allow in any case that a public service is improved by applying an additional fee to citizens, but we have made it possible for citizens to be provided public service with completely different conditions and with a totally new quality, the investment for which will be paid by the state over the years. This is not an invention of ours. This is a new path paved years ago by many countries more developed than us.
If we speak about Turkey as one of the countries where the health sector transformation has been spectacular and universally admired, the basis of this transformation in Turkey is public-private partnership.
It’s privates who invest massively and the state pays this investment off in instalments without increasing public debt, because the other way would be that of borrowing money from the banks, and have the investment made by the state. But Albania cannot borrow money, and you know very well why and how. On the other hand, it cannot make immediately investments of such volume.
The largest volume of investment in health in the last 25 years has been made during these years. Of course, it was made not only by increasing the state budget, but also by increasing the amount of private money for public use, for health in this case.
For the first time in the history of these 26 years, this year’s budget for health has been half billion dollars. It has never been this much. But this half billion are both public and private money. The state pays off the private money that enters immediately the system and immediately improves services, in a span of time of 7 or 10 years, according to the contracts.
Also, it is very important to highlight the deep transformation which emergency will undergo soon. The launch of the “National Centre of Medical Emergency”, and a thoroughly organization of the medical transport service across Albania, along with the training of the emergency staff will bring a radical improvement. Just as a radical change has been brought by the 24/7 functioning of the medical emergency service for heart, vascular and cerebral diseases from which some 4000 people per year will benefit something crucial for their lives that used to be previously threatened.
I won’t be long with the list of cardiologic wards in the 11 regional hospitals, with the new policlinics, the new diabetes wards of the regional hospitals, with the units of the neurovascular service, and the launch of a new service system at the “University Hospital Centre Mother Teresa” – which I am proud to say no other hospital has – but I’d like to stop at the necessity to have this historic transformation process in the health sector continue. This process will definitely continue because the reform is very clear and the measures accompanying it are well-defined. Just as, when we came to Durres a year ago, a good part of the people in the room was quite sceptical about the electronic prescription, while today it is a fact welcomed by all family physicians, and a clear indication of how the spending of public money for refunds based on electronic prescriptions is a success story.
Electronic prescription only will be applied across the country by spring. But there are things that take their time, require the experience earned during the transition from the project on paper to the everyday reality, and above all a clear vision of where we want to reach. There is no question that the increase in salaries for doctors, nurses and healthcare staff is a step in this direction. Just as, I say it once again, there is no question that there are still many cases among the white shirts of those who tarnish the white shirts with their behaviour, their corrupt approach, and the trouble they create to the patients. But, let’s be very clear, it’s not people who corrupt the system, it’s the system that corrupts people. We need to reform, if we want to have less corruption, and these reforms must be deep if we want to save people from the clutches of corruption. It’s the system built through the reforms that makes corruption very difficult, if not impossible to be practiced, such as case of electronic prescriptions. It’s a new system that makes corruption impossible among pharmacies and corruptible and corrupt officials because it is not possible anymore to write prescriptions and take the money from the state coffers not to reimburse the sold medicines, but to reimburse the “medicines” that have never been sold, and have been divided between pharmacists and corrupt officials, as it happened in over 20 years. This will not happen anymore! First, it’s the system that makes this impossible. The people are the same, tempted by corruption when through it they can get rich more quickly, or receive a service which they cannot receive otherwise.
Thank you all for being here! Remaining hopeful that as many people will be affected by this change, not by going to the hospital perforce, I don’t wish this to anyone, we are determined to deepen this change. Because we are very aware that what we have done is a lot compared with 3 and a half years ago, but it is not absolutely enough in relation to the ambition we have for a country where healthcare is provided according to needs and not according to the pocket, where health is not a commodity that can be bought provided that you have the money, and where every Albanian, despite their economic and financial situation, will receive with full dignity health services in this country.
Many thanks!
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Since the beginning of this year 600 thousand Albanians will be provided drugs for free from the list of reimbursable medicines. These citizens are people in need who are not covered by health insurance, and until recently they had to pay in cash for every drug prescribed by doctors. Therefore, this is an important step toward the revival of the health sector through universal coverage, and the provision for free of healthcare for all.
A meeting organized by the Ministry of Health was held today in Durres, with the participation of doctors, hospital staff, health workers and patients. The meeting was attended also by the Director General of the Compulsory Healthcare Fund Erion Manohasa, Health Minister Ilir Beqaj, and Prime Minister Edi Rama.
While pointing out that there is still much to do, especially with regard to easing the administrative and bureaucratic burden, Health Minister Beqaj noted that the transformation of the health sector occurred 4 years ago is in the right direction. “150 new patients were provided the dialysis service for the first time in 2016. The costs for this service amount to EUR 1.9 million per year, and it was provided for free. In 2016, we provided for free drugs for the treatment of hepatitis C to 40 patients, and their treatment cost EUR 1.9 million. In 2016, we provided for the first time the service with linear accelerator to 300 patients of oncology. It costs approximately EUR 700 thousand per year, and it was offered for free”, the minister said. All these are part of an ongoing effort to meet the ambition of national healthcare according to needs, not according to the pocket.
