In 2014, Kosovo’s Assembly passed the Law on Health Insurance, which stipulates universal access for Kosovo’s citizens and residents to quality basic healthcare services. The aim, through the establishment and regulation of a mandatory health insurance system, is to improve health indicators and to help provide financial security from poverty, by relieving Kosovars from the high cost of healthcare.

In the summer it was announced that premiums will begin to be collected on January 1 and the Ministry of Finance has already allocated the anticipated income in the 2017 spending framework. “The fact that implementation is being discussed implies progress regarding the creation of conditions for the implementation of this law,” said Minister of Health, Imet Rrahmani.

However, citizens of Kosovo, and the institutions themselves, still do not know how long after the collection of premiums begin must patients wait to start receiving services, or even which services will be covered. The main processes related to this issue have not yet been finalized and without their finalization, financial reimbursement and the providing of services cannot be offered through one unitary system.

Insurance for all

Up until now people in Kosovo have only had the option of paying for voluntary health insurance, through contracts with private health insurance companies. They have paid set sums for the services they receive through different packages, with prices varying according to individual company offers.

With the Law on Health Insurance, citizens will receive mandatory health insurance from the state. This will generally be contributed to by the individual and employer through salaries, although there are exemptions from contributions for many groups of citizens.

For public sector employees and those working in larger private sector organizations, individuals will be required to contribute 3.5 percent of their gross monthly income toward health insurance, which must be matched by the employer — this also covers family members who are not already contributing premiums directly. In private companies with an annual revenue of under 50,000 euros, employees must pay 2 euros per month, while the employer is exempt from contributing. The collected funds from the payment of these premiums will be allocated to the Fund for Health Insurance, which will be topped up by money from the regular health care budget.

Insured persons will be reimbursed for the cost of some healthcare services, including medicines, that will be set out in a ‘List of basic health care services.’ According to the law, the List should be provided to the Steering Board of the Fund three months before the beginning of each fiscal year, and the List must be approved before the collection of premiums can begin. However with just two months to go until the government’s stated start date for collections, January 1, the list has yet to be submitted to the Steering Board.

The law also requires that at least 75 percent of individuals are issued with a health insurance card verifying their insurance status before premiums can be collected, but this process has not yet begun.

Blerim Syla, head of the Federation of Healthcare Trade Unions of Kosovo, insists that there are a whole range of additional reasons why the law on health insurance is not ready to be implemented, not least the need for an an effective management system to be put in place. “The first and main mechanism for this issue is the formation of the Informative Healthcare System, which will collect all data on patients, medicaments, treatments, and doctor performances,” he told K2.0. “This must be done through software, and must not only be notional.”

While there have been delays with the Information Healthcare System, the software (at a combined cost of 1.7 million) and servers (at a cost of 600,000 euros) have now been purchased while the first phase of hardware distribution (1.6 million in a pilot to cover 30 percent of Kosovo) is being rolled out.

The minister also suggested that staff training is now underway. “Lately a company has finished training healthcare workers in the Prishtina Municipality,” he told K2.0. “The system [is] functioning and this company is overseeing and assisting where needed. This form of distribution will continue into [the University Clinical Center of Kosovo] UCCK, and the Prizren area. This foresees the training of around 5,000 healthcare workers that will be users of the information system. We have begun with the distribution of hardware in 70 percent of other areas.”

No immediate change

However UCCK, the main provider of public healthcare in Kosovo, is also unprepared for some of the challenges posed by the new health insurance system, a point repeatedly stressed by its director Curr Gjocaj. To begin preparations for offering these services, this institution has compiled a list of deficiencies, noting issues that without resolution the implementation of the law cannot begin; according to the director, the cost of funding the equipment and other required investments for the law to be functionalized would be 42 million euros but no additional funding has been allocated.

The Ministry expects to receive an additional 50 to 60 million euros from premiums in the first year. “This will be an added budget for the healthcare system, and with time, after we overcome the aforementioned obstacles, I think the value of this budget will be greater,” explains Rrahmani further, adding that initially premiums will only be collected from employees of state institutions.

However, this budget won’t be translated into services for citizens immediately and improvements in access to healthcare services will take time. “We are planning, we are working in fact, to decide which groups will be the first beneficiaries of the health insurance scheme,” said Rrahmani. “We are deliberating on whether it should be pensioners, or certain groups of patients. This evaluation is being prepared by experts, and initially we will start to offer better healthcare services, or, respectively, medicament reimbursement.”

With premium collection theoretically due to begin in just two months, there are still more questions than answers with regard the new health insurance scheme. K

Featured image: Fikret Ahmeti / K2.0.