3 minutes agoAudience: Patients were not treated equally and effectively by the Fund for Health Insurance
Periskopi(3 years ago)
(3 years ago)The National Audition Office (ZKA) published the performance auditing report “efficiency of the Patients' Treatment Programme outside health institutions” for the period 2019-2022. The conclusion of this audit is that the Health Insurance Fund (FSSH) along with the Executive Board were not effective in the process of managing patients' subvention for treatment outside the institutions [...]
The results of the audit show that patients have not been treated equally from the application process to the application approval.
“The FSSH used various practices in the assessment and treatment of subjects from applying different criteria for the same cases to the amount approved for treatment. The approval of subjects and payments has been submitted by delays, financial obligations were not managed and properly reported, and the Fund had not made all financial comparisons with health institutions in which services were prepaid, said the ZKA report.
In addition to the report, the Executive Board had approved materials in the absence of two pro-fatures and was not consistent in the amounts it had earmarked for coverage of the treatment by disrespecting the Administrative Guide criteria and that with approval of the Board, the Fund paid 756,142 euros for cases which were not envisioned in the Administrative Guide. However, according to the audience, some cases were denied by the very reason that diagnosiss are not part of the Guide.
However the programme is destined to finance the treatment of patients with diagnosis, whose diseases are not addressed in Kosovo's Public Health Institutions, Consiliar Commissions in the specific departments had referred to requests for services offered within these institutions with reasons for lack of material, technical conditions and human resources. For these cases the amount referred to and approved by the tested samples was 844,779 euros”.
The audience found that the fund did not manage and properly reported obligations, and that there were delays in approval and payment, even bills that have not been paid since 2018.
In addition to the report, the fund reportedly does not have an exact mirror of real costs and possible cheap means, draws are made only with hospitals in Kosovo and some in the region, but not with other hospitals. Of the 12m euros approved for regular cases, the commission had managed to equalise only 2.1m or 16,4%, as well as to identify over 408 thousand euros of cheap means.
According to the ZKA, the shortcomings identified in the process of managing patients' subvention for treatment outside public health institutions were the result of changes in the management practices of this programme, without rationalising the need for change, not functioning properly of internal controls, continued organisational changes, and not clarifying the legal framework.
In terms of this audit, General Auditor Vlora Spanca stated that the unfair treatment of patients, unreasonable changes in the criteria and amounts approved for treatment, delays in approval and payment, as well as the inadequate management of financial obligations, risks the programme not reaching the goals it is set for.
To ensure that the Program for Treatment of Patients Out of Health Institutions is managed more effectively and achieved objectives, the ZKA provided 13 recommendations.
Full report:
