世界银行-推进医疗融资改革，实现科索沃全民医疗保险（英）-2023.9-48页_1mb

Executive Summary of Health Financing Report for Kosovo

• Context: Kosovo faces significant challenges in health financing, with low public health spending, high out-of-pocket (OOP) payments, and weak strategic purchasing, hindering progress toward universal health coverage (UHC). Despite policy commitments, reforms have been slow, affecting health outcomes and equity.

• Key Issues: Insufficient public funding limits service availability and quality, OOP expenditures exacerbate inequalities, and the absence of strategic purchasing and effective risk pooling stifles efficiency. The informal economy complicates premium collection for social health insurance.

• Recommendations:

  • Implement strategic purchasing to improve provider performance and service efficiency.
  • Establish an effective national risk pool to share costs nationally, consolidating public financing through the Health Insurance Fund.
  • Introduce a targeted poverty exemption mechanism for social programs to ensure fairness and fiscal sustainability.
  • Explore innovative funding sources, such as health taxes on tobacco and alcohol, to increase domestic revenue.
  • Short-term measures: Pilot the Outpatient Drug Benefit Package by the Health Insurance Fund, introduce contract-based payments for external treatments, and expand performance-based capitation in primary health care.

• Conclusions: Incremental reforms are needed to build capacity, with a phased approach starting with simple steps to demonstrate benefits before broader implementation, ensuring sustainability and equity in UHC.