By Dritan Hila
For personal reasons, I followed the Health Minister’s press conference with particular attention. Since I am currently experiencing the hospital service firsthand—something that certainly does not make me an expert—it nevertheless prompted me to share a few thoughts, merely as observations and not at all as solutions.
First of all, the healthcare system needs, above all else, a budget at least three times larger than what it currently has. A simple comparison shows the scale of the gap: a European country like Italy spends around €2,200 per capita on healthcare, while we spend only €200. This alone highlights the vast distance between our aspirations and reality.
For instance, patients are fully justified in demanding access to the full range of medical preparations. But if a single immunoglobulin costs €180 for 2.5 grams, and a patient may need between two and ten doses a day depending on the therapy, then the logic is simple: you pay when you are healthy so that it is there when you truly need it. Otherwise, doctors are placed in the impossible position of deciding who should be prioritized. I will not even mention IV lines, syringes, gloves, or the rivers of antibiotics that are consumed daily. The only real solution is to increase individual contributions by at least three times and cover the difference from the state budget—perhaps even by reducing infrastructure investments—so that we can preserve something resembling humane medicine.
Hospital environments today are incomparable to the past in terms of cleanliness and catering services. The time I spent in the nephrology ward showed me clearly that order and hygiene there are not accidental. The same can be said for other departments. But this is largely where the authority of department heads ends. Beyond that lie systemic and budgetary problems.
The emergency department is the exception. It resembles more a Ukrainian frontline hospital than a modern medical facility. Improvised beds, often dirty, where you are lucky if someone at least places a sheet on them. Frequently patients remain on the stretchers of the ambulances that brought them in. The staff there are few and constantly under pressure. The length of one’s stay depends entirely on whether there are empty beds in other wards. Emergency rooms everywhere in the world are known as places of immense pressure due to the unpredictable influx of cases, but the Albanian one seems to exceed even that.
Not to mention the ambulances themselves, which probably need their shock absorbers replaced since they feel as if they have horseshoes instead of suspension. A full interior overhaul would not hurt either.
Medical departments also suffer from a shortage of personnel. Nurses barely have time to change IV lines, and by the time the last one is done, it is already time to return to the first. This gap is often filled by relatives of patients who, unfortunately, do not always understand the rules of hospital hygiene or conduct. Most of the time they serve as human buzzers, calling the nurses for every issue, which only increases the staff’s stress.
The era of inaugurating hospitals has passed; now we are entering the phase of replacing equipment. Intensive care units face problems with monitors and beds, none of which seem to have all the functions working properly. The staff there can rightly be called heroes, but when a wave of patients overwhelms the system, there is little anyone can do.
The bed occupancy rate is critically overloaded, exceeding 130%, when the normal level should be around 75–80%. Otherwise, patients end up being “stored” in the emergency department. Of course, there is the option of private hospitals, but their costs are such that you might have to sell your house to afford them. And even there, the service is often provided by trainee students or doctors who, after exhausting themselves in the public sector, continue working in the private one.
Staff salaries are low, especially when you consider that today you can hardly find an unskilled laborer willing to work for less than €800 per month—while medical professionals work daily among infections and bodily waste.
It might not be a bad idea to consider the Italian model, where doctors are allowed to practice privately within public hospital facilities in exchange for paying rent. This could help prevent the trafficking of patients toward private clinics. Another idea would be introducing a small fee—perhaps even 10% of what the state spends per hospital bed—with the revenue directed toward the medical staff.
What seemed new and promising was the project for a geriatric care service. With a rapidly aging population and families often fragmented by migration, such a service is becoming urgent. In the past, children were the health insurance of their parents’ old age. Today, with many of them abroad, the elderly increasingly depend on the state.
Even when they do have children, elderly people who are paralyzed or require rehabilitation often become a heavy burden for families. If their children want to keep their jobs, they are forced to rely either on untrained caregivers or on specialized companies whose services are financially out of reach for the average person. Rehabilitation homes are quickly becoming a necessity of our time. An intermediate solution could be state and municipal subsidies for caregiving assistants.
Another immediate problem among the many challenges of the healthcare system is physiotherapy. The internet is full of miracle healers and self-proclaimed experts, but very few actually possess real knowledge about rehabilitation for injured patients.
Healthcare is the new and most important frontline of this country—more than any other sector. If we do not want people to continue leaving, and if we want those who have left to return, the place to start is medicine.