Open Data Albania is looking into the value and beneficiary categories of reimbursable for the 2016 – 2020 period. The list of reimbursable medicines and medical devices is one of the important packages funded by the Compulsory Health Insurance Fund. Reimbursement of medicines is realized on the basis of contracts that the Fund has established with pharmacies, using as reference the List of Reimbursable Medicines and the amount of coverage as per the categories determined by Decision of the Council of Ministers. It is a very important component of the Health Insurance scheme. It serves as a regulator between the needs of the citizens and the real feasibility for covering the medicine expenses.
For 2020, the Fund has contracted about 852 Pharmacies and 58 Pharmaceutical Agencies, 13 Pharmaceutical Distributors and 36 Pharmaceutical Importers. The list of Reimbursable Medicines has been approved by DCM no. 489, dated 30.07.2021.
The actual value of medicine reimbursement for 2020 is about 10.7 billion Lek, ie with an actual execution of 35.1 million Lek more than the initial plan. Compared to 2019, the value of medicine reimbursement has increased by 2%, or 243 million ALL, as a result of the expansion of the reimbursement scheme to include a larger number of patients.
Source: Compulsory Health Insurance Fund, Annual Rreport 2020
Comments and Analyses: Open Data Albania
Referring to the beneficiary categories of the population, the highest reimbursement values are reserved for ‘Retired indefinitely’, ‘Full invalidity’ and ‘Chronic Illness’, respectively 46.41%, 27.47% and 18.47% of the total reimbursement value for 2020. More specifically, for the category ‘Retired indefinitely” the value of reimbursement has been about 4.97 billion Lek or 2.6% more than in 2019. For the category ‘Chronic Illness’, the value of reimbursement for 2020 was 2.94 billion Lek. Expenditures for this category of population have increased by 12.9% compared to 2019.
Meanwhile, for the category of ‘Full invalidity’, the value of the reimbursement was 1.98 billion Lek or 18.4% of the total reimbursement. However, it is to be noted that reimbursement expenditure for this category are in decline since 2017, and in 2020only about 111.2 million ALL were spent or 5.3% less compared to 2019.
The categories affected the most by the decline in reimbursement, compared to the previous year, were ‘War invalids’ with 195 thousand Lek less the “Mentally or physically disabled’ category with 108 million Lek less and the ‘Student’ category with 1.6 million Lek less than 2019.
Whereas, the share the category of persons diagnosed with Covid-19 occupy in the reimbursement scheme is estimated at 0.06% of the total reimbursement expenditure, or 6.37 million Lek.
Source: Compulsory Health Insurance Fund, Annual Rreport 2020
Comments and Analyses: Open Data Albania
If we refer to the performance of reimbursement expenditure during the last 5 years, divided into hospital medicines and medicines traded in the open pharmaceutical network, we notice that the later compose the largest share of total medicines.
In particular for 2020, the share in percentage of hospital medicines to the total is 31.1% or in the amount of ALL 3.33 billion, while the percentage of medicines traded in the open pharmaceutical network is 68.9% or ALL 7.37 billion. Also compared to 2019, the reimbursement expenditure for medicines traded in the open pharmaceutical network during 2020 have increased by 324 million ALL or by 5% . Meanwhile, reimbursement expenditure for the group of hospital medicines have decreased by 100 million ALL compared to 2019.
Source: Compulsory Health Insurance Fund, Annual Rreport 2020
Comments and Analyses: Open Data Albania
Source: Compulsory Health Insurance Fund, Annual Rreport 2020
Comments and Analyses: Open Data Albania
Regarding the reimbursement expenditure for prescription issued over the years, we notice that the reimbursement report per prescription in 2020 marks the value of 2 730 Lek/prescription. This indicator has been declining over the years, as demonstrated in the chart below.
Source: Compulsory Health Insurance Fund, Annual Rreport 2020
Comments and Analyses: Open Data Albania
In relation to the diagnosis, the highest reimbursement expenditure were reserved to diagnoses such as: Arterial Hypertension, Heart Failure and Heart Rate Disorders. Specifically, Hypertension accounts for 14.1% of the total Reimbursement Fund, Heart Failure for 3.2% and Heart Rate Disorders account for 4.2%. Again, in2020, the reimbursement of medicines for these cases has increased compared to 2019.
Source: Compulsory Health Insurance Fund, Annual Rreport 2020
Comments and Analyses: Open Data Albania
Specifically, the reimbursement for the diagnosis of HTA Hypertension marks the value of 1.49 billion Lek or an additional 51 million compared to 2019. Meanwhile, the reimbursement for heart failure in 2020 increased by 46 million and the reimbursement for heart disorders has marked an increase of 48 million or by 10% compared to 2019.
During 2020, the Fund reimbursed only 6.37 (about sixty thousand dollars) million Lek for Prescriptions pertaining to patients with Sars Covid 19.
The data examined in this article were extracted from the Annual Reports of the Compulsory Health Insurance Fund, the 2016-2020 period. Other data concerning Expenditure and Contracting in the Healthcare Sector can be accessed on the Transparent Procurement Page. Other documents, contracts, plans and budgeting related to Contracting in the sector, derived from the Covid-19 Pandemic, are also listed there. At the same time, Open Data Albania Follow the Money page contains a category of articles that inform about different topics of the sector.
Download excel: Reimbursement of medicines by value and by beneficiary categorization, 2016-2020Comments and Analysis: Open Data Albania
Translated by: Rezarta Caushaj
