Kaquri: Debt of the Fund, 30 million, mainly to hospitals in Turkey

While the previous management said that the debt is about 2 million, the current director has confirmed that it is about 30 million euros. Such large obligations of this institution towards private hospitals, mainly those in Turkey, have already caused Kosovar patients to be refused treatment. In these cases, Kaquri has stated that they have no way to help the citizens

The Health Insurance Fund has changed the management board, dismissed the former director after a long investigation by TIME, which proved many abuses in this institution. Four months later, in an interview for KOĖN, the acting director of the Fund, Bujar Kaquri, stated that the problems they have identified are big.

While the previous management said that the debt is around 2 million, Kaquri has confirmed that it is around 30 million euros. Such large obligations of this institution towards private hospitals, mainly those in Turkey, have already caused Kosovar patients to be refused treatment. In these cases, Kaquri has stated that they have no way to help the citizens.

The main problems in this institution, he said, are the problems stemming from the Administrative Instruction that regulates the program for treatment outside public hospital institutions. In this UA there is a list of pathologies that the doctors themselves have determined that they cannot perform in the KKUK, but that they themselves do not respect by ignoring it when they refer patients for treatment outside. Another problem, according to Kaqur, is the price list, which has not been revised. He hopes for the help of the Government to pay off the current debts, while he has given a promise that no more illegal treatments abroad will be approved, as happened in the past. Since July, when the previous management was fired, the number of emergency referrals has dropped by about 50 percent.

TIME: You have been acting as the Health Insurance Fund for several months. How was the situation in this institution?

Curse: From July 20, I assumed the position of acting director. The situation we are in is not good at all. We have a large number of debts, a large number of claims, and the possibilities of realizing the repayment of those claims are small. However, we hope that with the help of the Government of Kosovo we will be able to fulfill these obligations that we have inherited.

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TIME: What were the main problems?

Curse: The debt has been the main one. Another problem has been the issuing of pledges outside the list of pathologies, which is part of the Administrative Instruction dated 03-2017. Upon taking office, I have sent a notice to all clinic directors that no diagnosis that is not on the list at the UA will be approved when it comes to emergency cases. However, despite this fact, the issuance of consular opinions continued, but they were informed that we have no possibility to exceed the list and those requests will not be approved until the list is completed and changed.

KOHA: How is it possible that doctors, even though they have been asked, declare about the diseases that they do not know how to treat, they only declare about some and on the other hand, even for those that they said they know how to treat, they refer them abroad ?

Curse: Perhaps this question is better addressed more to the directors of clinics or consular collegiums, which refer X diagnosis for treatment abroad.

KOHA: Have you informed the doctors that the pathologies that are not on the list of diseases that have been declared that they cannot treat will not be treated, and what response did you receive?

Curse: Yes, we have notified them upon taking office. No, we have not received an answer. It has continued not in the way it was earlier, but the referral has continued even if some of the diagnoses are not part of the list of the Administrative Instruction.

KOHA: But is it unfair for patients who cannot receive help from the state because doctors have declared that they know how to treat diseases that they really do not treat?

Curse: It is perhaps the obligation of the administration, perhaps even of the doctors who treat the citizens that these are the possibilities or these are the criteria that should be considered for support for treatment abroad. It is not an obligation of the citizen and it is impossible, especially in cases where someone has health problems, to be able to even be informed about the procedures for benefiting from financial assistance.

Perhaps it is also a shortcoming that citizens are not informed and do not benefit, because they do not consider the deadlines and the procedures, and lose the opportunity for this help.

TIME: What happens to these patients who can't get help because of predetermined rules?

Curse: I, as the director of the Fund, am obliged to respect the rules in force, in this particular case the Administrative Instruction issued in 2017, which covers the procedures that must be applied to obtain this assistance. Why hasn't that administrative instruction been changed until today, there is room for complaints and dissatisfaction. It is a fact that you must admit that we should have changed it earlier. But as long as it is an act that regulates this field and defines the criteria for benefiting from this aid, then we as institutions have no other way but to implement the rules that are in force. Otherwise, earlier, as you know, there was a release of these criteria and we are in the situation we are in. We have inherited a very large debt..

TIME: When a research was carried out on the institution you lead, the real debt was not known. Do you know how much is the debt to private hospitals today?

Curse: Approximate value - since it is only a matter of pledges, where the approximate value is marked on the proforma, while the real value is when the patient finishes the treatment and brings the financial report. However, the approximate value is around 30 million euros, which value is being regularly reported every month to the Ministry of Finance according to the legislation in force.

KOHA: So the reporting started recently?

Curse: Yes, reporting has started since August. No such report has been made before. A large proportion of debts are not reported at all. Only those obligations which were with decisions have been reported. However, promissory notes are considered as contingent obligations and in the near future, depending on the events that occur, they will turn into real debts. However, the approximate value of the debts that the Fund has within the Program for Treatment Outside Public Institutions is around 30 million euros.

KOHA: Can you clarify the legal procedures for a patient to benefit from this assistance?

Curse: The legal procedures provide that urgent cases come with two reports and apply to the Fund. After the verification of the documentation, it is transferred to the director of the Fund, who signs the pledge, through which it is guaranteed that the expenses will be covered, respecting the criteria of the Administrative Instruction. The criteria, the allowed amount and all the rules are defined there. After the patient finishes the treatment, he brings the final report - the financial one, together with accompanying documents specifying the services that have been performed and the final amount. These are further processed to the Board for Treatment, which, based on the evidence and documents of the case, approves the amount for which the Fund must execute the payment. This is the procedure for emergency cases.

KOHA: However, our research has proven that there are cases where the amount of 50 euros was set in the invoice, but the final invoice came in the amount of 300 euros. What should be done in these cases?

Curse: It is a matter for the Board for Treatment Abroad, which has the obligation to verify the documentation and approve the amount for payment. After verifying the documents of the case, the Board issues a decision, and that decision is then processed for payment and finally the payment is processed by us, that is, by the Fund.

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KOHA: You said that this institution has huge debts. Do you have lawsuit warnings or patient rejections from any hospitals?

Curse: We have had cases of rejection of the affidavit recently. We have no cases of filing lawsuits for debt recovery. We have a notification from the hospitals that, for example, you owe so much to X hospital, so much to X hospital. It is a procedure, an equalization commission that deals with financial equalizations with private institutions both inside and outside the country and they do the correct verification for the identification of debts. But I hope that with the support of the Government and the help of the Board of Directors, and all the actors involved, we will find a way to fulfill these health obligations both inside and outside the country.

TIME: Are cases of rejection frequent?

Curse: They are not frequent. There are several cases that have come and are complaining. However, the Fund has no contractual relationship with private hospitals. Based on the Administrative Instruction, the patient himself chooses the hospital in which he will be treated, since the category that covers this field is the category of subsidies and we do not have the right to create contractual relations with health institutions.

KOHA: But in the specific case when the patient complained, what did the Fund do?

Curse: The Fund does not have any legal or other options except that in the future it will be able to fulfill its obligations and continue the treatment of patients in those hospitals.

TIME: In the case of the specific patient, what exactly did the Fund do?

Curse: We have no chance.

TIME: So the patient has to find himself?

Curse: It is completely the patient's responsibility, because the Fund has no mechanism. It is, as they told me, disarmed in this regard, because there is no possibility that it will come to the aid of this specific case, since the debts for each hospital are... as I mentioned, the debt is around 30 million euros, and I have to take into account that we have significant debts to each hospital.

KOHA: Mr. Kaquri, you were also part of the Fund earlier. Has it ever been discussed what responsibilities the Fund should have on the patient after receiving the pledge, so does the state take any kind of responsibility for the patients who pay for their treatment?

Curse: In this case, it does not take responsibility. The way would be to take care of the treatment of our patients, considering that we cover part of the expenses for the treatment they receive. But this is a category of subsidies and the Fund is unable to create contractual relations with hospitals. As long as we do not have a contractual relationship, it is impossible for us to set conditions or ask X hospital to comply with the criteria that we define. In the future, it will be possible to change this way of help and offer them a right, more adequate help and not remain only at the mercy of the hospital as to how it should treat the patient. It is known that the amounts that the Fund spends to cover these diseases are high, especially in cases of serious diseases in children, such as leukemia, cancer, the amount that the state gives is large. Despite the amount, the care that the state must offer to citizens is important, especially when they are diagnosed with serious diseases, the state must always be behind them. However, we are in the situation we are in and we must try to do our best to help these patients. What we can guarantee to both the patients and the hospitals where the patients will be treated from now on is that for every pledge or case we approve, we will approve it based on our budget possibilities and we will not create debts outside the budget possibilities, as we inherited it now that it is very high. We hope that we will find a way and cover these obligations.

TIME: Has the Administrative Instruction been changed?

Curse: The list of pathologies is also in the process of being changed. There will be changes in the way they will be processed and in the list of diseases. However, we must be careful in determining the prices for the price lists of services. But on the legislative level, it is the change of the Administrative Instruction. I believe it will be approved soon.

KOHA: From July, when you were in office until November 18, how many patients went abroad for treatment?

Curse: From now on, the order of payments will be respected. The ones we issue as promissory notes and the regular ones will be paid in order.

KOHA: Is there a drop in references in recent months?

Curse: There is a decrease in emergency cases. There is a decrease of 40-50 percent for the same period last year.

KOHA: Why did it happen, because after the investigation (by KOHA) the implementation of the law was imposed or why?

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Curse: Maybe it is that too, but we have no facts about what is the reason for the declines. Based on the data we have, requests for emergency cases have decreased. Perhaps it is also the fact that I, as director, do not approve requests that are not part of the list of pathologies in the Administrative Instruction.

This article is available for rebroadcast by other media, citing TIME as the source.