Once the capacity of the Tirana University Hospital Center is completed, patients who are on the waiting lists for health packs of cardiology and cardiac surgery are sent in private hospitals. From 350 interventions completed so far, more than half are conducted in private, where patients are forced to pay for the service and the days of stay in hospital.
By Avushe Zhuka
They start to undergo heart operations in a public hospital, but lack of capacity brings most of the patients to end up in private hospitals. Providing health packages for cardiology and invasive cardiology in the private hospital service has also reduced the numbers in the waiting lists, but in the end the bill still remains to the patient. These packages that are funded 100 percent from the Compulsory Insurance Healthcare Fund (FSDKSH) do not include the cost of a patient’s hospitalization.
In cardiology and cardio surgery service packs are included the cost of intervention (surgery) and two days of stay under intensive therapy. For the following days of recovery the patient must pay the cost of the residence and service himself which to a private hospital is substantial. Whereas patients hospitalized to the public hospitals that have undergone the package interventions do not pay special costs for the days of stay. Representatives of the University Hospital Center “Mother Teresa” (QSUT) tell that according to this fact patients prefer to perform interventions in state hospital.
The relative of a patient that has undergone a surgery recently confesses that packages are not fully provided for cardiology patients. The patient that in this case was a pensioner, after making the coronarography in the public hospital was informed that he had two blocked coronary artery. Since it was a situation that required quick intervention the patient was taken to a private hospital. The case was taken over as it was agreed earlier that the placement of a stent will be financed by the Fund, while the other will be paid by the patient. But the relative of the patient indicates that the family was forced to pay the cost of this intervention and the days of hospitalization as well. He says that the cost which the family paid for the service and intervention in the private hospital exceeded the amount of one thousand Euros.
The data that the Mandatory Insurance Healthcare Fund set available for the “Association of Journalists for Justice” show an equal share of cases that receive service packages for invasive cardiology and cardiac surgery in private hospitals of our country. By decision of the Council of Ministers health packs are firstly implemented in public hospitals and when the state capacities are completed they are transferred to the private hospitals. Cases are sent with an equal distribution in non-public hospitals contracted by the Fund. According to data from the Fund, from 1 December 2014 until now there were carried out 350 interventions in invasive cardiology and cardiac surgery with 100 percent financing. Of these interventions, 103 were authorized at the University Hospital Center and after the maximum capacity was used, 247 cases were sent to five private hospitals contracted by the Fund. There have also been performed 60 cardio surgeries in private hospitals. While in the public sector i.e. in QSUT are conducted 180 interventions for cardio surgery.
The Fund explains that the authorization for patients that will undergo interventions to private hospitals is made on the basis of the waiting list. At first the cases are sent to the University Hospital Center and in the moment that the capacity of the public hospital is filled the sequent names that are on the waiting list are sent to private hospitals. The waiting list for coronarography in a year is about 1,800 cases, whereas for interventions of cardio surgery is approximately 2000 patients. These are the data that the Fund has on regard to the requirements of patients, while according to the chief of Cardiology at the University Hospital Center, Artan Goda, nationwide requirements for performing coronarography in 2014 were about 6 thousand procedures. It consists of coronarography performed in public and private hospitals. In 2013 there were conducted 4,800 procedures of this kind.
According to Goda, the current needs of our country for coronarography is thought to be about 3500-4000 per 1 million citizens or in other words around 12 thousand coronarographies a year. For 2015 there are scheduled to be performed approximately one thousand procedures of packages in private hospitals from Fund budget. This fact was made known by Health Minister Ilir Beqja, who declared that for the current year there are expected to be carried out 2 thousand procedures more than in 2013. But at a time when more than five months from the application of health services packages have passed, the interventions are low.
Before the implementation of the agreement for service packs with 5 private hospitals, Minister Beqja raised concerns that public hospitals do not meet even 60 percent of patient’s demands. In Cardio Surgery Service 1150 interventions are made while the demands are several times higher. According to the chief of this sector, Artan Goda, earlier in the public hospital was operated only for emergencies. This is because the service requires pavilions supplied with apparatuses, medication and funding as well. Although according to representatives of the University Hospital Center, the application of the agreement with private hospitals for cardiology packages has improved the situation, it still does not provide final solutions. “The agreement with private hospitals has given its results; there is no waiting list as before where the patient had to wait in queues for 5 or 6 months to perform a coronarography. This waiting time forced the patient to choose another alternative by getting the proper service from a private hospital, while those who did not have the economical means had to wait their turn by risking their lives”, say representatives of the University Hospital Center.
Unlike before, nowadays, according to representatives of the University Hospital Center, patients remain on the waiting list a month or two and receive service within a shorter time. On the other hand, application of packages for cardiology into private hospitals has increased the number of patients who receive service faster, but still needs of population are not fulfilled. Patients who do not manage to receive this service are directed to private hospitals in the country or abroad by financing themselves the intervention.
Ministry of Health and Insurance Health Care Fund have signed an agreement to offer health packages for cardiology and cardiac surgery with five private hospitals. Viewing the list of doctors ranked in the staff of private hospitals with which the agreement for packages is signed shows that many of them are the same people who work at the University Hospital Center. Important doctors of the pavilion of cardiac surgery or cardiology are employed in private hospitals. “Doctors play a major role in how the packages are implemented for invasive cardiology or cardiac surgery at the hospital or even in the orientation they make to the patient in choosing the institution where they will receive health services”, say representatives of the University Hospital Center, who cast doubts also about the accuracy of the process. “There were cases when the patient’s coronarography has resulted to be white and thereafter the doctor has suggested him in which hospital to go”, reported the same sources from the hospital.
Citizens remain uninformed about the possibility that offers the Insurance Health Care Fund regarding health packs. Just a few days ago she accompanied her mother to undergo a coronarography in one of the private hospitals. “The doctor here in the town where I live told me that she should undergo a coronarography quickly, but she did not inform me of the fact that this service is offered for free to a private hospital. Thinking that the situation of the waiting list would continue to be like a year ago we approached the private hospital”, says M.P. She says that her mother is a pensioner and she is unable to pay this service in privates, hence she insists that doctors should inform citizens about this agreement and the opportunity that is offered to them.
Health packs have started to be applied in December 2014 in public hospitals and in private ones. The decision of the Council of Ministers foresees that the price of health service packages financed by the Fund will be in the same extent either in the public health institutions or in private ones. Insured persons who benefit from these packages are excluded from co-financing. Packages for cardiology approved by the government with protocols and costs are: coronary angioplasty, coronary angiography, definitive pacemaker, bypass aorta-coronary, valve and congenital interventions. By decision of the Council of Ministers, the cost of coronary angiography is assigned to 51,256 Lek, of coronary angioplasty 164,369 Lek, and the definitive pacemaker costs 194 072 Lek. The cost for a bypass aorta coronary is 360,239 Lek, valve intervention is 524,129 Lek and a congenital intervention is 242,900 Lek.
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