The latest audit of concession contracts (PPP) in the health sector highlights a continuous increase in expenditures and budget commitments, exceeding initial forecasts and putting pressure on public finances.
According to data from the Mandatory Health Insurance Fund (FSDKSH), there are obvious discrepancies between the values foreseen in the standard contract documents, the actual annual financing and the medium-term budget planning for the period 2023–2025.
One of the most problematic contracts is the one for the provision of integrated services in surgical rooms. While the value initially foreseen in the contractual documentation is around 9.6 billion lek excluding VAT, the budget support planned for recent years shows a clear upward trend. For the years 2022–2025 alone, funding from the state budget goes from 1.7 billion lek to 1.79 billion lek per year, exceeding initial expectations.
Significant growth is also observed in the hemodialysis service concession. Although the contract provides for a total budget support of 7.2 billion lek for 10 years, actual expenses have been higher than the projected level every year. For the period 2021–2023, the invoices received have exceeded the contractual limits, leading to the need for additional funds and negatively affecting budgetary discipline.
The audit also raises concerns about the laboratory service PPP, where expenses for 2023 have increased significantly compared to the previous year. According to the auditors, the increase is not related to changes in reference prices, but to the greater use of high-fee analyses. Financing for this concession in 2023 was 6.9% higher than in 2022, while total expenses in the period 2020–2023 have increased from 1.1 billion to 1.7 billion lek.
The report also emphasizes that the review of service packages has only been carried out for some dialysis procedures, while for other packages, prices and content continue to remain unchanged since 2020, despite economic changes and real costs of services.
In its final recommendations, the audit requests that FSDKSH and the Ministry of Health take measures to fully review all service packages, as well as strengthen the monitoring of PPP contracts, with the aim of controlling expenditures and increasing the effectiveness of the use of public funds, which are showing an increasing trend from year to year.
