Law on Mandatory Health Care Insurance in The Republic of Albania No. 10 383, dated 24.2.2011 (latest amendment no. 65/2023, dated 21.7.2023) establishes the framework for mandatory health care insurance in the Republic of Albania. This law has been amended multiple times to adapt to evolving healthcare needs and policies.
Article 1: Purpose
The law establishes and regulates the mandatory healthcare insurance scheme in Albania, aiming to ensure comprehensive healthcare coverage for all citizens.
Article 2: Scope
The law defines the structure, functions, and operations of the Mandatory Health Care Insurance Fund (the Fund), which manages the financing of healthcare services.
Key Components:
- The Mandatory Health Care Insurance Fund is designated as the sole legal public autonomous entity managing compulsory health care insurance in Albania. It operates in alignment with national healthcare policies set by the Ministry of Health.
- The law mandates that economically active individuals, including employees, self-employed persons, and employers, participate in the insurance scheme. Economically inactive individuals, whose contributions are financed by the state budget or other sources defined by law, are also covered.
- A standard package of health services is provided, encompassing primary health care, hospital care, reimbursable medications, and medical consumables. The specifics of this package are determined by the Council of Ministers.
- Insured individuals are required to contribute a portion of the cost of health services received. The amount and method of these direct payments are decided by the Council of Ministers. Certain categories of individuals may be exempted from direct payments based on their ability to pay, with the government providing subsidies to cover these costs.
Strengths:
- The inclusion of both economically active and inactive individuals ensures broad coverage across different population groups.
- A standardized package of health services helps in setting clear expectations and uniformity in service delivery.
- The establishment of an Administrative Council and a General Director provides a clear governance framework for effective management and oversight.
Key Amendments (2013-2023)
- 2014: Expanded coverage categories (e.g., victims of trafficking).
- 2022: Included specific vulnerable groups like unemployed women with multiple children.
- 2023: Additional provisions to support families with low income.
