Revenues from health contributions for the Albania Health Insurance Institute during 2000-2011

Albania Health Insurance Institute (AHII) is one of the most important institutions of the country’s health system. It was established in 1995, after the Albanian government’s decision to build a health financing system based on contributions and a single payer. Initially, the AHII reimbursement service covered only a number of drugs, but whiles it was designed to provide step by step more and more services. The necessity of undertaking reforms in the health service remained pending for nearly 10 years and very few concrete initiatives were undertaken.

^{Source: Ministry of Finance
Comments and Analysis: Open Data Albania (ODA)}
 
Based on its Statute, AHII provides funding sources from: contributions of the insured, state budget, donations and other revenues. As the revenues from compulsory and voluntary health insurance are too low to cover its functions, the health insurance scheme’s gap is financed from the State Budget.
 
Even though in 2005 the contributions growth rate has been at satisfactory level (round 15%), in 2007 this indicator recorded significant improvements, round 24% higher compared to 2006. This trend continues even in the other years. In 2010, health insurance revenues were 4 times higher than in 2000 and 2 times higher than in 2005. These indicators improved mainly from the informality reduction and growth of wages (salaries). However, despite growing trends, revenues from contributions are still low to enable the self-financing functions of AHII. The main problem has been consistently the low rates of health insurance contribution, because this latter is a political decision, as it brings a huge public impact.
 
The second reason is related to the payment of social security. The rate of social security contribution is several times higher than that of health insurance, while an individual has not the right to choose which one to pay (as it is obligatory). In these circumstances, trying to avoid payment of social security, the individual avoid even the payment of health insurance, which is several times lower than that of social security (Reynolds 2003).
 
The third but not the less reason that influences the low level of revenues from the contributions is related to, the under the table payments and even from people’s trust towards the health system in general. If health costs are similar to those insured and not insured individuals because of the under the table payments, this means that the insurance scheme does not protect participants (beneficiaries) from non-participants in the scheme (Roshi, Tozzi, Qirjako, 2009). If these payments will be collected in an institutional way and be used effectively, this will immediately improve quality service. Poverty, lack of information, the informality of the economy, etc. are some other factors that influence low collections of contributions.

All the information is presented in the table below:

^{Source: Ministry of Finance
Comments and Analysis: Open Data Albania (ODA)}