By Ilda.Hoxha

Albanians infected with COVID-19 have had to carry the “burden” of medications and medical services expenses on their own. This is verifiable by the official data that Faktoje was provided by the Funds of Insurances, while fact-checking a statement of the democratic MP Albana Vokshi.  From our fact-checking it turns out that during November 2020 – September 2021, out of 170,131 declared patients infected by the virus only 7536 patients have been reimbursed and that the average reimbursement amount is 4.000 ALL per person.

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“Out of 164 thousand citizens infected by COVID-19 (during the period 2020 – April 2021), only 7,183 were refunded, thus only 4% of the people infected. Every person infected spent about 1 thousand dollars on treatment, whereas the government only reimbursed 40 dollars per person requiring medical attention, which is only 4% of the individual expenses” – stated democratic MP Albana Vokshi through a Facebook post.

Albana Vokshi’s post on Facebook 

Based on this statement, Faktoje decided to fact-check the figures by addressing the Compulsory Medical Insurance Fund (FSDKSH) with a request for information.

Request for information sent to FSDKSH

FSDKSH announces that since the announcement of the order by the Ministry of Health for the reimbursement of COVID-19 patients, from November 2020 to April 2021, 7108 patients diagnosed with mild and moderate COVID-19 have been refunded. In the update published by the Ministry of Health on April 30 of this year it turned out that until then the number of patients confirmed positive with COVID was 131,085 persons.

With Decision of the Council of Ministers No. 908, dated 18.11.2020 “On the approval of the pharmaceutical
package for outpatient treatments of persons diagnosed with COVID-19” which will be financed by the Compulsory Medical Insurance Fund, it has been decided that people who tested positive with Sars Cov-2 can benefit outpatient treatment free of charge in their homes according to the guidelines approved by the Ministry of Health and Social Protection.

Thus, we emphasize that based on the abovementioned decision and according to the outpatient home treatment by family practice physicians, the treatment for mild and moderate types of the illness will be reimbursed at 100% per person diagnosed with COVID-19.

From November 2020 to April 30, 2021, 7108 patients diagnosed with mild and moderate COVID-19 have received treatment – as stated in the official response of the Insurance Fund.

We also learned from FSDKSH that from May 1 to September 30, 2021, 428 patients have had their medical prescriptions reimbursed.  In total, the reimbursed amount for all patients, thus 7536 patients is about 31 million ALL.

According to these data we state that the average reimbursement amount per individual is about 4 000 ALL. We came to with this figure by dividing the reimbursed amount by FSDKSH  with the number of reimbursed patients (31 000 000 ALL: 7536 patients= 4113, 5 ALL).

Meanwhile, according to the calculations it turns out that from November 19 2020 to September 2021 only 5.4% of patients have been reimbursed.

Here is how the reimbursement was carried out: 

“In compliance with the guidelines approved by the Ministry of Health and Social Protection for outpatient treatment in the residence, it is the family’s physician who determines the medication scheme since the moment the patient tests positive for Sars-Cov-2, depending on their condition and existing conditions.

In the description of the reimbursement recipe, the family physician determines the diagnosis ‘Mild or moderated type of COVID-19 according to the guidelines on outpatient treatment in the residence of COVID-19 patients’ and describes the medication for reimbursement” – states the Insurance Fund for Faktoje.

Official data indicate a low number of reimbursed patients, even though the number of infected people reported by the Ministry of Health until September 30 was 170,131 persons.

Faktoje asked the expert Ilir Alimhemeti why reimbursement rates are at these low levels in Albania.

“I think that the two main reasons are bureaucratic struggles to get reimbursement and the low amount for the average reimbursement (the average reimbursement payment for patient is 33 euro).

Considering the very low figure, most people don’t even try to undertake the bureaucratic steps, since as the people say “it’s not worth ti”- emphasized the expert Ilir Alimehmeit.

The fund allocated for the reimbursement of COVID patients

On November 18, 2020the fund of 1.2 billion ALL was awarded for the reimbursement of the medications required to treat COVID-19.

According to the decisionapproved on the government meeting on ‘COVID-19 diagnosis, the state will reimburse 100% of the expenses from the 1.2 billion ALL fund at the disposal of the patients.

On November 19 the Minister of Health, Ogerta Manstirliu stated that the government had taken on the decision to reimburse all COVID-19 patients receiving outpatient treatment at home.

According to the minister, all citizens would benefit from it, whether they were insured or not and adding that the reimbursement value of the medication package for both medication scheme is 125 dollars.

If calculated it turns out that only 31 million ALL of the approved reimbursement fund have been spent or about 2.7%. The residual sum is: 1.169,000,000

Faktoje contacted former Health minister, Petrit Vasili to ask what happens to the remaining money in cases when reimbursement is at low rates.

Vasili explained that the money is reallocated for other works, adding that Albanians have had to carry the burden of treatment expenses against COVID-19 themselves.

From the verification we carried out and the gathered information, we decided to categorize the statement of MP Vokshi on the low number of people who have been reimbursed for COVID-19 treatment as TRUE.

See also: Medical prescription reimbursement fro COVID-19, much ado about nothing