Kosovo is the only country in the Western Balkans whose citizens do not have access to public health insurance. At present, only individuals who can afford private insurance have any health coverage. Others must rely on the public health system, which is widely criticized for its poor quality, or spend large sums to receive care either in the private sector or abroad.

Critics have constantly accused successive governments of neglecting the health sector. The University Clinical Center of Kosovo still follows an administrative guideline approved in 2007, when Kosovo was under UNMIK administration, which sets the prices for health services. Prices vary depending on the type of service, ranging from as low as 1 euro and reaching up to 350 euros for certain invasive surgeries, such as heart catheterization, coronary angiography and other treatments.

In addition to paying for services, patients often encounter a lack of appropriate equipment, as most infrastructure has not received investment for years. Basic supplies, like syringes and materials for CT scans, are often missing and patients must cover the costs themselves. They also pay for their own medications.

Long waiting times for services like CT scans or MRIs push citizens to opt for private health care over public options. In more complex cases, they seek treatment abroad. Over the last decade, the health sector has also struggled with a shortage of staff, as highly qualified employees have migrated to European countries in search of better wages and working conditions.

Ensuring all citizens have health insurance is seen as a way to make medical services accessible to everyone while also improving the quality of care in public health institutions.

Health insurance has been a recurring promise in electoral campaigns and government programs, including that of Vetëvendosje, the ruling party since 2021 that is seeking a second term in the upcoming elections in February 2025. The health insurance bill has been on the government’s legislative agenda since 2022 but was not approved until August 29, 2024.

The government’s approval of the bill is just one step toward implementing health insurance, as its history shows. Kosovo already has a law on health insurance. In April 2014, the Assembly of Kosovo approved the Law on Health Insurance, and the Ministry of Health, under the Democratic Party of Kosovo, planned to start collecting contributions in January 2017 to begin establishing the Health Insurance Fund.

At that time, the government of Kosovo allocated 17 million euros for implementing the law, but later redirected these funds to pay war veterans’ pensions. Budgetary constraints were one of the reasons health insurance was sidelined over the years, and the 2014 law was never implemented. From 2017 to 2024, despite four changes in government and repeated promises, no concrete steps were taken to implement health insurance.

Despite the clear advantages of a comprehensive health insurance system, critics have raised concerns about the program’s sustainability over the years. They have pointed out the lack of readiness among state institutions to manage the program, the poor state of public health institutions and the possibility that implementing the health insurance program might push citizens to seek care at private health clinics.

With the bill still far from becoming a fully operational program, K2.0 reviewed the version passed by the government and broke down its key implications.

Who is required to have health insurance?

The program will ensure that health services are comprehensively extended to the entire population, providing equal access to health services even for the poorest citizens. The only difference lies in who pays: the employee and employer, or the state.

According to the draft law, there will be two types of health insurance: active and inactive. Active insurance will be required for employees over 18, the self-employed, individuals receiving pension payments accumulated during their work and all other residents who are at least 18 years old and do not benefit from other schemes.

Inactive insurance will cover dependent family members, such as children under 18. It will also apply to unemployed individuals, those receiving a basic pension, those aged 18 to 28 who are studying or undergoing training and individuals participating in state-funded social schemes.

Who will pay for health insurance?

The gross salary of employed citizens over 18 years old who do not belong to any social schemes will be taxed at 7%. Of this, 3.5% will be paid by the employer and 3.5% by the employee.

For example, if your monthly gross salary is 500 euros, 35 euros will be deducted from your salary, with 17.5 euros paid by the employer and 17.5 euros paid by the employee. This means that, on an annual basis, a citizen with a gross salary of 500 euros will contribute 210 euros to health insurance.

If both parents work and the children are under 18 or are studying until age 28, the children will be co-insured through the insurance of the parent with the highest gross salary.

The government will cover the contributions for categories that cannot make this payment themselves, as detailed in the following table.

Health insurance: What, why and when?

K2.0 breaks down the key implications of the draft law.

Categories of citizens supported by the state budget

Gentiana Paçarizi

Health insurance: What, why and when?

K2.0 breaks down the key implications of the draft law.

Categories of citizens supported by the state budget

Gentiana Paçarizi