In-depth | Elections2017

Big election issues: Health

By - 31.05.2017

How to cover the cost of health care.

With 11 days left until voting day, election fever is in full swing. Hyperbole and ambitious promises dominate the discourse, with 24-hour news coverage jumping from interview to interview, and topic to topic.

In this series, K2.0 is taking a step back from all that. Building up to election day on June 11, we’re taking some of the big issues facing Kosovo today, and looking into solutions offered by each of the five Kosovar Albanian political parties represented in the Assembly during the last parliamentary term; their programs, their manifestos, their policies.

The state of the healthcare system in Kosovo has been a perennial concern since the end of the 1999 war. The head of the Federation of Healthcare Trade Unions, Blerim Syla, recently described the public health sector as being on the edge of complete collapse, due to negligence from the government. The private sector is seen as being in better health, but its cost is prohibitive to many Kosovar citizens, and there has been a large increase in public money being spent on Kosovars receiving private treatment abroad.

In April 2014, the Kosovo Assembly passed the Law on Health Insurance, which was written by a working group set up by then Minister of Health, Ferid Agani from the Justice Party, who were a junior coalition governing partner of PDK. The law received cross-party support, with 80 votes in favor and no votes against the motion in the Assembly. The law foresaw the creation of a Health Insurance Fund from which citizens could cover the costs of either private or public healthcare. The Fund was to be financed by payments made from workers’ salaries, with 3.5 percent being paid in by both employee and employer, though a number of groups are exempt.

In order for these payments to start, numerous criteria had to be met, including the creation of an electronic Healthcare Information System detailing patients’ medical histories. Payments made to the fund were expected to start in January 2017, though this deadline was delayed to July 2017 due to requirements not being met. With the onset of these early elections, July 2017 also seems an unrealistic start date, with no clear sign of when Kosovar citizens can expect to start paying into, or receiving benefits from, the Fund.

The Law on Health Insurance is not without its critics, and not just due to its lack of implementation thus far, some voices see it as a reinforcement of the private sector, to the detriment of the public sector. K2.0 looked at each of Kosovo’s five major political parties to discover their views on the law, and how they plan to end its current stasis.

Democratic Party of Kosovo (PDK)

PDK were in power when the Law on Health Insurance passed in April 2014. Their program, “The New Mission 2014-18,” outlined the details present within the law, including the rates of payment that became legislation.

In the next parliamentary term, PDK governed alongside coalition partner LDK, who collectively failed to implement the requirements foreseen in the law in order to functionalize the Fund. On May 29, PDK deputy in the last parliamentary term Besim Beqaj appeared in a televised debate on Klan Kosova, during which he claimed that it is incomprehensible that the Law on Health Insurance had not been implemented. Beqaj blamed coalition partners LDK, whose representatives led the Ministry of Health, for this failure.

K2.0 contacted PDK’s press coordinator Blerand Stavileci and asked for the exact month the health insurance system would be functional under a PDK government but received no response. However, Beqaj was very outspoken on the issue, promising that a government featuring PDK would functionalize the scheme within the first month, adding that the creation of the Healthcare Information System was a priority for the party.

According to LDK’s Minister of Labour and Social Welfare in the last parliamentary term, Arban Abrashi, this data system is currently 30 percent functional, with Abrashi expecting the remaining 70 percent to take the rest of the year to be prepared.

PDK president Kadri Veseli did little to allay fears that the Law on Health Insurance would benefit the private sector more than the public when he made a campaign appearance at a private hospital. K2.0 contacted PDK to enquire whether the health insurance system will be used to empower the private health sector, but received no response.

Democratic League of Kosovo (LDK)

In its 2012 political program called “For a European Kosovo,” LDK has a chapter dedicated to healthcare, which takes up half a page. There, LDK recalls the years of Serbian occupation and takes credit for “keeping alive” the healthcare system for the people of Kosovo.

In the program, LDK says that it is a high priority to develop and improve the health care system. “The reduction of level of illness and mortality, through the improvement in the quality of healthcare services, in line with contemporary standards, is our principal goal,” LDK stipulate.

During its previous governmental term, LDK ran the Ministry of Health, with Imet Rrahmani as its minister. Rrahmani is also running for deputy in the Assembly in this year’s elections.

K2.0 asked Rrahmani as to how LDK will work to functionalize the Healthcare Information System, since this is a precondition in order to initiate the health insurance system. We also asked how they would secure the 50 million euro fund needed to be invested in equipment, before drafting the list of services provided by the University Clinical Center of Kosovo (UCCK), as well as the pricelist for those services. K2.0 received no answer to any of these questions.

However, some declarations regarding health insurance were made by the Minister of Labor and Social Welfare, Arban Abrashi, during a debate on Klan Kosova broadcast on May 28.

Abrashi said that LDK’s priority is the functionalization of the health insurance system and that they plan to do this as soon as possible, and start with the collection of premiums for the Fund during September or October this year at the latest. He admitted that the party are lagging behind in terms of providing these services, but blames the 2010-2014 coalition government made up of PDK and the New Kosovo Alliance (AKR). Abrashi claimed that when LDK took over the ministry they had to “start everything from scratch.”

“We are now at a time where we can start with the collection of premiums; we have drafted a hospital and extra-hospital list that can be contracted and bought,” he said. According to Abrashi, the Health Fund is planned to reach 100 million euros during the first year of collecting premiums, describing this money as an “injection” for the healthcare sector.

Vetevendosje (VV)

In their 2013 Governing Alternative program, Vetevendosje outline two forms of financing to help create an increase from the 51 euros per citizen being spent on healthcare by the Kosovar state in 2013, to the party’s target of 144.18 euros per citizen. The first was an increase in the state budget being spent on health, though exact figures on how much of the budget should be allocated are absent from program. The second source of finance was the creation of a Health Insurance Fund.

In regards to the insurance system, the program dictates that it should be planned according to the Bismarck model, “where both the employer and employee will pay 3 percent of the gross salary.” Mirsad Shkreta, a member of Vetevendosje’s health committee and a candidate for the Assembly, told K2.0 that this model is “based on the principle of solidarity and is one of the most practiced systems worldwide.”

Though the percentages are slightly higher, this model is largely the one outlined in the Law on Health Insurance. Shkreta told K2.0 that his party intends to make slight amendments to the law if voted into power, something also revealed by mayor of Prishtina and candidate for the Assembly, Shpend Ahmeti, while presenting 40 priorities of a Vetevendosje government on May 25. However, neither Shkreta or Ahmeti have described exactly what these amendments would be.

But Vetevendosje have been very clear on the procedural steps the party would take in forming the Health Insurance Fund, stressing that the Healthcare Information System must be functional before premiums start being paid. “We do not intend, and moreover we object to collecting health insurance premiums without explaining to our citizens which services they are paying the premium for, and what health care services are being provided for by the state,” Shkreta told K2.0.

Shkreta identified several other steps that must be taken before premiums start being paid, including providing citizens with an insurance card and listing the medical services that would be available under the insurance system and their pricing. Ahmeti added that Vetevendosje would provide citizens with their own medical record, that would include their history of illness, frequency of medical checks and detail how medical services are being used.

“The government prepares, and at the end of the process premiums start to be collected,” Shkreta stated.

Alliance for the Future of Kosovo (AAK)

In their 2014 program, AAK pledged to change the health care system in a year if voted into government. The party envisioned a health care system with increased quality and with a sustainable financial system underpinning it. At the heart of this transformation was the correct implementation of the newly adopted Law on Health Insurance, which the party described as able to guarantee basic health care services for all citizens.

In a round table meeting held by the party in 2016 when in opposition, conclusions were drawn that “health insurance comprises one of the key elements of the health care system, and is the key to solving many problems that face the system.” However, in the same meeting, AAK concluded that the current Law for Health Insurance, and the attempts that are being made to implement it, do not guarantee solutions for the problems that the healthcare system faces.

Another recommendation drawn from of this meeting was that the budget for the healthcare sector is 150 million euros and the maximum value that could be provided from the Insurance Fund is between 30-50 million euros. According to AAK, this would still be insufficient, because it would total only 200 million euros, meaning Kosovo would allocate only 100 euros per capita on health care, making it the country that spends the least on healthcare in the region.

However, AAK have yet to give details regarding a potential increase of the health care budget, or what budget would be most suitable. As for the health insurance system, AAK are yet to outline how it should best be implemented, or whether amendments need to be made to the existing law.

Initiative for Kosovo (Nisma)

There is no mention of the health insurance system in Nisma’s political program, published in mid-2016. Instead, the program describes Kosovo’s health care system as ravaged, stating that it “does not fulfil the needs of the citizens.” However, the party do not offer alternatives to solving the problems in this sector, and do not give details about how Kosovo should go about creating a health insurance fund.

K2.0 contacted Nisma’s media office, attempting to discover more about why they do not mention health insurance in their program, their views on the insurance Fund, how premiums could be collected, and other details. We received no answer from their officials.

However, in public discussions, Nisma officials have discussed health insurance, criticizing previous governments for the Law on Health Insurance. Nisma deputy, Shukrije Bytyqi, criticized the law, questioning its tendency to centralize the competences of the Ministry of Health, saying that this would create opportunities for abusing power.

In Nisma’s party conference, held in June 2016, a member of the party’s leadership, Muharrem Kuci, listed health care as one of the party’s highest priorities, calling for a segregation between politics and health care. The creation of “financial stability” was also a part of his strategy for regulating the health care system. Health insurance would contribute to this stability, but according to Kuci, any civil participation in this contribution scheme must not impinge on family budgets.

Up until now, Nisma officials have not given any concrete ideas as to what a health insurance scheme would look like, how health insurance premiums would be collected, or in what time period the Health Insurance Fund could be functionalized.K

Photos: Majlinda Hoxha / K2.0.

For more on where Kosovo’s political parties stand, watch K2.0’s video on ideology, and read previous articles on election issues, including employment, education, the army, and gender equality.