After the end of the 10-year hemodialysis concession contract, the state is expected to take over five functional centers, along with the investments made in them. However, instead of the service continuing to be provided directly by public structures, it is envisaged that the five centers will be transferred to a private operator for four years.
The limit fund made public for this procedure is around 4.6 billion lek.
The decision raises a question that goes beyond the procurement procedure itself: why does the state, after taking over the centers and investments made during the concession, choose to pay a private company again for the administration of the service?
From lack of investment to 10-year concession
In 2015, the Ministry of Health signed a 10-year contract with the concessionaire company DIAVITA to provide hemodialysis in five centers. The contracted price was 11,103 lek per session.
The model chosen at the time was related to the need for investments that the state could not make on its own. The contract guaranteed the concessionaire a certain volume of sessions, so that during its period the investments made could be amortized.
Upon termination of the contract, the investments made in these centers are transferred to the state without additional payment.
Here, the economic conditions on which the 2015 model was built also change. The state is no longer ahead of the initial need to build the five centers from scratch.
However, according to the procedure announced by OSHISH, the service in these centers is expected to be entrusted again to the private sector, this time for a period of four years.
How many sessions can be financed?
One of the key elements to understanding the fund of approximately 4.6 billion lek is the expected number of sessions.
In 2019, 57,809 sessions were conducted in the five centers, which, with a frequency of three sessions per week, corresponds to approximately 371 patients.
In 2025, the number had reached 75,273 sessions, or about 483 patients using the same calculation method.
If the number of sessions in 2025 remained unchanged for four years, around 301 thousand sessions would be held.
Another scenario, which takes into account the continued increase in the number of patients, brings the projected total to around 352 thousand sessions during the period 2027–2030.
The real number may lie between these scenarios. The official forecast, however, must be based on epidemiological data and assessments by the responsible nephrology structures.
How do you get to 4.6 billion lek?
The basic price of a hemodialysis session has been determined over the years by decisions of the Council of Ministers.
Në vitin 2014 ai ishte 11,204 lekë. Në vitin 2017 u përcaktua në 11,530 lekë, ndërsa për ofruesit privatë u njoh një marzh fitimi prej 5%, duke e çuar pagesën në 12,106 lekë për seancë.
Në vitin 2022 u miratua gjithashtu një mekanizëm për rishikimin periodik të çmimeve të paketave shëndetësore.
Nëse, vetëm për qëllime analize, merret një rritje hipotetike prej 3% në vit, çmimi i seancës do të shkonte nga rreth 12,469 lekë në vitin 2027 në rreth 13,625 lekë në vitin 2030.
Kombinimi i këtyre çmimeve me skenarin e rritjes së numrit të seancave prodhon një vlerë totale rreth 4.57 miliardë lekë, shumë pranë fondit limit prej 4.6 miliardësh të bërë publik.
Kjo përllogaritje mund të shpjegojë matematikisht madhësinë e fondit limit, por nuk i jep përgjigje pyetjes kryesore: kontraktimi i një operatori privat për ofrimin e shërbimit a është alternativa më ekonomike për shtetin?
Çfarë do të kushtonte nëse shërbimin do ta ofronte vetë shteti?
Këtu analiza bëhet më e ndërlikuar.
Shteti do të marrë pesë qendra funksionale. Ambientet janë publike dhe investimet e koncesionarit kalojnë në pronësi të tij. Në këto kushte, disa elemente që normalisht rëndojnë mbi koston e një operatori privat mund të mos kenë të njëjtën peshë për sektorin publik.
Çmimi bazë aktual prej 11,530 lekësh duhet që të zbërthehet në elementët që e përbëjnë, materiale dhe barna, personel, mirëmbajtje, energji, amortizim pajisjesh, ambiente dhe shpenzime të tjera.
Pa këtë analizë nuk mund të përcaktohet me siguri sa do t'i kushtonte shtetit një seancë nëse shërbimin do ta administronte vetë.
Nëse, si skenar analitik dhe jo si kosto e provuar, supozohet se amortizimi i investimit dhe kostoja e ambienteve përfaqësojnë të paktën 10% të çmimit bazë, kostoja teorike do të zbriste në rreth 10,377 lekë për seancë.
Sipas këtij skenari, shpenzimi katërvjeçar do të ishte rreth 3.83 miliardë lekë.
Por kjo shifër nuk mund të konsiderohet përfundimtare pa një zbërthim zyrtar të kostos.
218 milionë lekë vetëm marzhi i fitimit
Një tjetër element është marzhi prej 5% që i njihet operatorit privat.
Nëse përllogaritja bëhet mbi skenarin e projektuar të shërbimit, vetëm ky komponent mund të arrijë rreth 218 milionë lekë gjatë katër viteve.
Fitimi i operatorit privat është një element normal i një kontrate tregtare. Çështja është tjetër: a ka analizuar shteti nëse administrimi publik i pesë qendrave do të kushtonte më pak se kontraktimi i një operatori që duhet të mbulojë kostot dhe njëkohësisht të realizojë fitim?
Përgjigjja kërkon një krahasim të dokumentuar mes dy modeleve.
A është ende real çmimi i një seance dialize?
Procedura e re nxjerr në pah edhe një çështje tjetër: çmimi bazë prej 11,530 lekësh është përcaktuar në vitin 2017.
Që prej atëherë kanë ndryshuar një sërë kostosh. Pagat, energjia dhe materiale të ndryshme janë shtrenjtuar. Por në drejtim të kundërt ka lëvizur ndjeshëm edhe kursi i këmbimit.
At the time the price was set, the euro was trading at significantly higher levels against the lek, while today the exchange rate is approximately 95–100 lek per euro. For a service where some of the equipment and materials may be imported, this change may have an impact on the cost structure.
Precisely for this reason, mechanical comparison of prices from different years is not enough. A full update of the real cost of a session is needed.
The AKS case and another question mark
An indicator that deserves more in-depth verification is the financial performance of existing operators.
The AKS company has been providing hemodialysis services in Berat for about a decade. The activity started with about 40 patients, while the number is currently reported to be about 70.
Over 90% of its annual turnover is related to payments from FSDKSH for hemodialysis services, while the declared profit rate is around 25%.
If these data are confirmed by the financial statements and relevant contracts, the difference between the 5% margin recognized in the package price and the operator's real financial result deserves analysis.
A higher profit margin does not in itself prove that the price is inflated, as the financial result is influenced by many factors. But it is an additional reason to seek the answer to a simple question: how much does a hemodialysis session really cost today?
The question that should precede the tender
The debate over the new procedure is not about whether the private sector should or should not provide health services.
The issue is whether, before committing around 4.6 billion lek over four years, a full economic analysis was conducted comparing public administration with outsourcing.
In 2015, the concession was also justified by the need for investments. Ten years later, the state takes delivery of these investments.
For this reason, before the five centers are transferred back to a private operator, at least three elements need to be clarified: What is the real cost of a session today, how much would direct administration cost the state, and based on what analysis was the conclusion reached that providing the service to a private operator is the most favorable alternative?
Without documented answers to these questions, the figure of 4.6 billion lek indicates how much is expected to be spent. But it does not yet indicate whether this is the most economical way to spend public money.
