Despite legal guarantees of free healthcare for children under 18, Albanian parents face steep out-of-pocket expenses due to complex medical protocols, bureaucratic obstacles, and limited access to reimbursable medicines. The state’s promise of accessible treatment for children remains largely unfulfilled, leaving thousands of families burdened with private healthcare costs.
After a long series of examinations at a private clinic for her 10-year-old daughter, Arsilda heads to a pharmacy with a prescription on her phone. She needs an antibiotic and a supplement to fight her daughter's streptococcal infection, which also causes bone pain and skeletal issues.
“She needs constant monitoring,” says the mother of three. Arsilda tells BIRN that the entire process—examinations and medication—cost her about 30,000 lekë (around €300). She had no choice. “It’s too hard for me to go through the public system. I’d have to miss work, and I have two other children to care for,” she explains.
Although Albanian law provides health coverage for children up to 18, many parents find themselves paying privately. Public health services are hard to access due to lengthy protocols and bureaucratic hurdles. This makes timely care difficult, pushing families toward the private sector.
Reimbursement in Theory, Not Practice
Officially, children are entitled to the highest attainable standards of healthcare, funded by the state. They’re exempt from direct payments for services and should benefit from a national list of reimbursable medicines. However, in reality, access to these drugs is nearly nonexistent.
According to data from the Health Insurance Fund (FSDKSH), the government spends about 1 million lekë annually on reimbursable medicines for minors—just 7% of the total drug reimbursement fund. In 2024, only 598 children benefited from reimbursed prescriptions, while thousands more turned to private pharmacies.
Health policy expert and political candidate Gazmend Koduzi criticizes the system for failing families. “The antibiotics on the reimbursement list are inaccessible through prescriptions issued by family doctors,” he notes. “Just 598 reimbursed prescriptions reflect a major deadlock in the protocol.”
The Long Road to a Refund
Defrim Goma, head of Albania’s Pharmacists’ Order, explains that the process of getting reimbursed medication is riddled with delays. Family doctors and pediatricians—the first responders in most cases—are not authorized to prescribe reimbursed medicines. Only specialists can, and even then, only with supporting lab tests like antibiograms.
For many parents, this route is too long and uncertain. “They just want quick results to avoid complications. They often opt for private care, especially when it concerns their children,” says pediatrician Sonila Brati.
She adds that most parents don’t even ask for reimbursed prescriptions. “We issue standard prescriptions, and parents buy the medicine themselves. It’s rare that anyone insists on the reimbursed option.”
A family doctor told BIRN that he had prescribed reimbursable medication only twice in five years—both times to families in extreme poverty—and was later fined. He now avoids the risk entirely. “It’s a long road that prolongs the child’s illness. I’ve even bought medicine for families out of pocket,” he admits.
Overcrowded Hospitals, Understocked Pharmacies
During the winter virus season, the pediatric emergency unit at Tirana’s “Mother Teresa” University Hospital is overwhelmed. Chief of Pediatrics, Dr. Numila Kuneshka, says up to 400 children arrive daily with respiratory and gastrointestinal infections—most of them bypassing local clinics entirely.
“Only 3–4 children come with proper referrals; the rest come directly from home,” she says. Though hospitals treat children urgently regardless of referrals, the lack of a functioning primary care referral system places enormous strain on emergency services.
Pharmacists note that while the list of reimbursable medicines includes helpful antibiotics and syrups, the access rate is extremely low. One pharmacist in Tirana says she processes no more than five such prescriptions per month. Most parents pay full price.
To make matters worse, pharmacies often experience shortages of pediatric medications, especially for respiratory conditions. “Parents are forced to look abroad or buy from unofficial sources,” says Goma. This raises serious concerns about drug safety and quality.
Koduzi, too, is skeptical of the current list of reimbursable drugs, calling it clientelist and poorly regulated. “They treated the 2014 reform like a clothing trade, not a health issue,” he says, calling for reform based on diagnosis, not brand favoritism.
Conclusion
Albania’s promise of free healthcare for children remains largely symbolic. The public system's red tape, unresponsive protocols, and medicine shortages leave families with little choice but to seek private care. Without significant reform to ensure timely, accessible, and safe treatment for children, the right to free healthcare will remain just another line on paper.