From Public Health Institutions to Autonomous Health Centers : A First Step Towards the Implementation of the Primary Health Care Finance Reform in Albania

Learning Objectives: To introduce the participants with the principles, implementation tools and challenges of the Primary Health Care reform in Albania. Background: As of end 2006, the Primary Health Care (PHC) system in Albania was managed centrally, with little incentive or capacity for health centers to rationalize resources and focus on productivity and health outcomes. The fragmented flow of funds involved four government institutions in financing separate parts of PHC services (Ministry of Health, Ministry of Finance, Ministry of Local Government and the Health Insurance Institute). This fragmentation did not favor neither cost containment nor transparency and accountability. In addition, the lack of a reliable Health Information System made it impossible to monitor flows of funds, performance and quality of care indicators. PHC Reform: Starting from January 2007, all funding from different sources were pooled in one pocket that of the Health Insurance Institute (HII). The regional Directories of HII initiated the process of contracting Autonomous Health Centers (AHC) instead of individual providers. The AHC is run by a director elected by a regional board among competing candidates. The Director has a large degree of decision making autonomy in respect to financial management, organization and human resource management. A new, computerized Health Information System based on reporting all provider-patients' encounters, made it possible to monitor the activity, the productivity and certain elements of quality of care. Therefore, the contract between HII and AHC stipulates that 15% of the annual budget is conditioned by the accomplishments of certain productivity and quality of care indicators. Summary of Steps: Full legal background and support; AHC budget elaborated; Guidelines produced and enforced; Training of providers and health managers implemented; Organizational structure defined; Nationwide implementation of the reform; and Constant monitoring of the contractual obligations. Results: Improved ability to manage and keep a ceiling in the national budget; Improved ability to contract AHC through a basic package of services (still under development); Increased transparency and accountability of HII and AHC; and Increased access and quality of health care services predominantly steaming from the higher degree of freedom of the health centers to organise the provision of care and the incentive given with linking payment to performance. Impact: The impact of the reform implementation will be a better health status for Albanians as a result of better quality of care and improved access to PHC services