Health Expenditures, State Budget 2020 and the Covid-19 Pandemic

Open Data Albania is looking into the state budget for health in 2020 and the dynamics of changes that the Executive and the Parliament have adopted during the year. The research aims to identify the budgetary behavior in meeting the needs of Health Institutions during the Pandemic. The research focuses solely on changes to the Health Budget. The article does not describe changes related to Social Protection or Business Assistance Packages. Likewise, no prediction related to cost of anti-Covid-19 vaccinations is included in the analysis.

The State Budget for 2020 was adopted by Law No 88/2019. During the year, the Executive and the Lawmakers have changed this Budget four times. Specifically, the Budget was amended on 21 March by Normative Act No. 6, on 15 April by Normative Act No. 15, on 28 July by Normative Act No. 28 and only two weeks before the end of the year by Normative Act No. 34.

Programs that are directly related with Health Care Services include: Primary Health Care Service; Secondary Health Care Service; Public Health Service, and the National Health Emergency Service.

Data: Law no.88 18.12.2019 On the 2020 budget and accompanying tables, Normative Act 2020
Processing and Analysis: Open Data Albania

Data: Law no.88 18.12.2019 On the 2020 budget and accompanying tables, Normative Act 2020
Processing and Analysis: Open Data Albania

The budget foreseen for these four programmes was planned in the Initial Budget of 2020 at a total value of 37 522 712 000 ALL (thirty-seven billion five hundred twenty-two million seven hundred twelve thousand ALL), or 303.82 Million Euro. At the end of the year, after the adoption of the final act on budget changes, these four programs reached 39 625 286 000 ALL (thirty-nine billion six hundred twenty-two million two hundred and eighty-six thousand ALL) or 320.85 Million Euro. The budget for the four Health Programs increased by 2.1 billion ALL or 17 million euros. The change ratio between the initial budget and the Final Budget in the year of the pandemic for these four Health Programs consists of an increase of 5.6%. Meanwhile, the needs for infrastructure and intensive therapy tools, tests, medications, installations and hospital services, human resources during this year were emergency needs and represented a strong public interest.

Data: Law no.88 18.12.2019 On the 2020 budget and accompanying tables, Normative Act 2020
Processing and Analysis: Open Data Albania

Data: Law no.88 18.12.2019 On the 2020 budget and accompanying tables, Normative Act 2020
Processing and Analysis: Open Data Albania

Comparing the changes between initially total planned expenditures and the actual final ones, in terms of value and percentage, we see that total expenditures increased by plus 30.16 billion ALL, where only 2.1 billion went directly to Health Services. Even the share of expenditures planned for the Ministry of Health and Social Protection in the Total Expenditures has not increased. On the contrary, from 19.9%, it dropped to 19.7% of the total expenditures by the December final Normative Act

Data: Law no.88 18.12.2019 On the 2020 budget and accompanying tables, Normative Act 2020
Processing and Analysis: Open Data Albania

Data: Law no.88 18.12.2019 On the 2020 budget and accompanying tables, Normative Act 2020
Processing and Analysis: Open Data Albania

If we look at the programs one after another, it turns out that the Budget for the Primary Health Care Service Programs decreased by 2.7% from the Initial Plan; Public Health Service decreased by 0.68% from the initial plan, while the expenses for the National Health Emergency Service decreased by 2.22% from the initial plan. An increase was marked for the Secondary Health Care Service (Hospitals and the University Center) with 9.11% of the planned budget at the start of the year, when the emergency pandemic situation was not yet confirmed. Specifically, the budget for the Secondary Health Care at the beginning of the year was planned at the value of ALL 25.86 Billion. In December, according to the adopted Normative Act, the budget approved was ALL 28.22 billion.

Looking at the Capital Expenditure Budget for the 4 Budgetary Programmes, we may see to what extent the planned investments were actually implemented during the year. This helps us understand whether the Government has actually invested in 2020 in capacity building and medical equipment to meet the emerging needs.

Capital Expenses show Investments in Capital buildings or assets. This includes also purchases of equipment for medical service inventory. In the case of 2020, capital expenditures (investments) for Health Programs have decreased by  four hundred and fifty-five million and twenty-six thousand lek or minus 15.75% from what was planned. The biggest decrease is marked in the capital expenditures planned to be made by domestic funding.

Data: Law no.88 18.12.2019 On the 2020 budget and accompanying tables, Normative Act 2020
Processing and Analysis: Open Data Albania

If we compare Capital Expenditures for the 4 Health Programs in 2020, we will see that they reached 2 433 946 000 ALL (two billion four hundred thirty-three million nine hundred and forty-six thousand), which marks a decrease from 2019, when Capital Expenditures for Health were 2 962 915 000 ALL (two billion nine hundred sixty-two million nine hundred fifteen thousand).

Data: Law no.88 18.12.2019 On the 2020 budget and accompanying tables, Normative Act 2020
Processing and Analysis: Open Data Albania

Current expenses, on the other hand, are mainly for wages, acquisitions and utilities, which do not contribute to a long-term improvement of the system and services. Therefore, they do not constitute capital assets. The more Capital expenditures (investments) are made for a sector, the more assets and buildings increase, which in the long term leads to improved indicators. In the case of the Pandemic, the most expected capital costs are associated with the need for intensive therapyequipment and utilities, the need for which was associated with difficulties in providing materials due to the high demand in times of a World Emergency.

Data: Law no.88 18.12.2019 On the 2020 budget and accompanying tables, Normative Act 2020
Processing and Analysis: Open Data Albania

All expenses incurred by the Health Budget Institutions during 2020 and onwards are accessible in the Treasury Transactions Section on the Spending Data Albania portal. Information is provided for each payment, including the date, description, paying institution, and beneficiary client. Thus, information about expenses by the University Hospital Center Mother Teresa QSUNT Ministry of Health, Shefqet Ndroqi Hospital Center, University Trauma Hospital and each health institution are published and can be accessed by searching, using search filters for Paying Institution, Category, Date, Client, and invoice description.

Capital Purchases and Investments for the Health Sector related to Covid 19 are listed with passports for each contract in the Transparent Procurement Database. For each procedure there is comprehensive information, including calls, deadlines, fund limit value, successful offers, appeals, and implementation.

Open Data  (Open Data; Open Porcurement; Open Spending) on expenses, payments, tenders, contracting, and other indicators, promote Transparency, Accountability and Good Governance.

Download excel: Health Expenditures, State Budget 2020 and the Covid-19 Pandemic
Comment and Analysis: Open Data Albania
Translated by: Etleva Kondakçi