Hospital Autonomy, a strike against quality medical care in public hospitals

It has been a long time since a Draft Law was prepared which delegates financial and managerial autonomy to public hospitals, autonomy which public hospitals currently have, despite the fact that political influence in the appointment of hospital managers has weakened the public hospital function. Why "Hospital Autonomy" for Public Hospitals is a risk for the transition of these hospitals to private crypto-hospitals? There are several causes and factors that severely impair patient care in these hospitals. The arguments are many and strong. It is known that during these 32 years, the medical service in these hospitals to patients has not improved despite the huge expenses to reconstruct the public hospitals.

The first cause is excessive spending on medical services. More and more patients pay for services in public hospitals. and their expenses and care when they are hospitalized go to:

- performing tests paid by the patient due to the lack of performing tests inside the hospital, which is a hospital obligation,

- making examinations paid by the patient due to intentional delays

-consultations of doctors paid by the patient due to either the incapacity of the doctor in charge or due to benefits

-receiving medications with payment from the patient due to deliberate medication shortages

-giving money in hand (kickback) to the doctor and nurse from the patient for medical services that the patient has paid the health tax to the state for years.

-Admissions to a public hospital with payment by the patient due to intentional delays

- lack of control and medical care during the hospitalization of the patient in a public hospital, if the patient does not pay for daily injections, the setting of infusions and other medical and nursing care during the period of hospitalization

-lack of medical ethics in public hospitals. All these have turned the public Regional Hospitals and the University Hospitals of Tirana practically into ``private type hospitals'' but the money goes into the pockets of the personnel who do not pay any tax for them, and nothing goes to improve the situation; that is, illegal and shameful profits and openly in violation of the law. The second reason is the intentional non-activation, possibly due to the disability of the Health Card, which must be realized by the Insurance and Health Care Fund. Why does this happen? It is known that the monthly payment of Health Insurance when starting any job in a public or private institution, - the person pays the health insurance to the Health Insurance Fund. Health Funds are thought to be used in the form of the Principle of Solidarity, in contrast to the Semashko Model of health care ``free from the cradle to the grave'', which was served during the dictatorship. By definition, the modern understanding of Solidarity in health insurance refers to equal treatment for all social groups (elderly, low-income, immigrants, disabled, etc.) anchored in a contribution-based system, which requires that all working citizens must join the same financing fund that contributes to health. In Albania, the national health insurance model incorporates aspects of two models such as Bismarck and Beveridge. As in the Beveridge model, the government acts as a single payer for medical procedures, and as in the Bismarck model, health care providers are private and this is the basis on which the MOH is based. Practically in Albania, the Solidarity Model in Health Insurance has become a model that practically does not serve the population that pays the insurance for years because: first, the payments are taken by the state and when the time comes that the payer gets sick and is admitted to a public hospital, he is not served with quality even pays doctors and nurses extra and underhand for medical services which are actually paid. According to the statistics in Albania, the people pay 3.4% of the salary for Health Insurance every month, but it is calculated that the expenses of the patients in the form of bribery for both outpatient treatment and hospitalization in public hospitals exceed 20,000 new lek per year/per patient: these multiplied by ~279,000 patients who are hospitalized in public hospitals per year, a figure of 5,580,00,000 ALL or 45,365,853 Euro per year is the minimum, which can go up to an additional 80 million euros per year under the hand and informally, that Albanian patients pay for hospitalization in public hospitals in the form of bribery, treatment and admission, to doctors and nurses of public hospitals per year, ruining the income of Albanians, which according to INSTAT are about $5,500 per year. So it is important that the state should increase the % of health insurance, but first of all you should activate the HEALTH CARD for those who pay this health insurance in order to avoid excessive spending by patients and prevent bribery. The third cause of the most serious defects is the lack of Hospital Management and the lack of Quality Medical and Disciplinary Control in Hospitals. So, in Regional and University Hospitals you should: Salaries are increased 100%, but control over the work of doctors and nurses must be increased. Public hospitals must be run by Boards and not by political directors. The employment of Doctors and nurses at least in University Hospitals should be qualitative - the best ones with competition, and annual exams within the hospital. Strict control over Check-up and Analysis PPPs, and if they are not profitable let them be cancelled. Activation of the Physician and Nurse Order for disciplinary, ethical and licensing violations. Gradual and full coverage of Public Hospital Services by Health Insurance. Prohibition of double employment of specialist doctors of public hospitals in private hospitals. The fourth reason is M.SH. The Ministry should propose: - the increase of the GDP for Health and not invent autonomies to the detriment of the people, - there should be professional advisers and meritocrats and not militants, - you should hire professional ministry specialists to lead this ministry and not militants with ministers who already appear in the picture. In conclusion: Can this Bill for the Autonomy of Hospitals serve in relation to the problems that I posed above in terms of improving medical care for the patient? I think - NOT AT ALL. Why? Because the Draft Law on Hospital Autonomy, which gradually delegates financial and administrative decision-making rights from government structures to hospitals, would practically transform public hospitals into private hospitals, would cause corruption galloping even greater than now, it would increase the burden of underpayment (from trouble) of patients to doctors, and increase emigration,