As part of the POLICY ANSWERS capacity building programme, the project partner RIINVEST produced several policy briefs and reports.

This POLICY ANSWERS Brief was prepared in 2025/26 by Benet Maloku and published by the Riinvest Institute. The report aims to assess recent developments in the healthcare sector, particularly in relation to financing, the digitalisation of the sector, and the volume and execution of the healthcare budget. It builds on an earlier report “An absemt therapy for health financing” presented by POLICY ANSWERS in March 2024. That report identified several serious challenges in the financing of the health sector, including: the low share of health expenditures in the national budget and GDP; the under-execution and underutilisation of planned budgets by health institutions; the high burden of out-of-pocket spending borne by households; and significant delays in operationalising health insurance and the Health Information System (HIS). The report yielded several key recommendations:

• increasing the health budget from 3.5 % to around 6 % of GDP within a three-year period;
• ensuring effective management and full execution of the budget to improve infrastructure, equipment, and capital investments;
• raising salaries for health personnel; and
• accelerating the timeline for implementing health insurance. 

The preparation of this report, which primarily reviews developments during 2024-2025, is grounded in an analysis of digital sources, including strategic documents, official institutional publications on websites and social media, work reports, audit reports, budget data, and statistics from international organisations. The report also outlines the actions undertaken in line with the recommendations of the previous report, which are presented below.

Executive summary

The development of the health system in the post-war period has faced serious stagnation, resulting in an insufficient level and quality of healthcare protection and services in Kosovo, both in relation to the population’s needs and compared with other Western Balkan (WB) economies. Previous studies have confirmed that inadequate budgetary financing remains a recurring problem, linked to the low execution of capital expenditures, the absence of health insurance and the incomplete operationalisation of the HIS.

In 2024, health expenditures accounted for only 3.14 % of GDP and 9.8 % of budget expenditures, with projections to reach 3.33 % of GDP and 10.3 % of budget expenditures in 2025. This level remains significantly lower than the average health spending of European Union (EU) economies as a share of GDP, which was around 7.4 % in 2023 and also below the average of WB economies, at 5.15 %. According to projections for 2025, health expenditures per capita are expected to reach 231 EUR, whereas in 2024 they amounted to 205 EUR per capita. Overall, in terms of public financing levels, the execution of the 2024 budget, and the planned budget allocations for 2025, the necessary changes have still not been undertaken.

However, during 2024, there was an improvement in budget management. The Ministry of Health executed 83 % of its budget in 2024, although execution of capital investments lagged behind at 56 %. Meanwhile, the Clinical and University Hospital Service of Kosovo (CUHSK) has maintained a high level of budget execution, at around 98 % in recent years. Its 2025 budget has increased by 9.3 % to surpass 190 million EUR. This budget includes clinic renovations and the purchase of new medical equipment. However, many existing devices remain outdated or non-functional. In primary healthcare, the health grant increased by 12.7 % from 2022 to 2023 and by 16 % from 2023 to 2024, while in 2025 it remained unchanged.

From the citizens’ perspective, the financial burden remains high. Out-of-pocket expenditures accounted for around 40 % of total health spending, amounting to approximately 197 million EUR (2021). An important development was the adoption of the new Health Insurance Draft Law in 2024[6]. However, its implementation has remained delayed, as it was sent to the Constitutional Court for review which recently issued a statement regarding the case. The collection of contributions has not yet begun, and the Health Insurance Fund continues to rely entirely on the state budget.

Although the number of departures among healthcare staff has declined in recent years, personnel shortages remain evident in several clinics and family medicine centers, affecting the provision of quality services for citizens. Moreover, the level of salaries continues to be a serious concern and remains significantly below the recently increased base wage levels for healthcare professionals.

The digitalisation of the health sector is another area that remains insufficiently developed. The Basic Health Information System (BHIS) has begun to be rolled out, but at a very slow pace, which still does not enable real-time sharing of health data with other systems. This situation limits service efficiency and hinders the integrated management of the sector, including the implementation of health insurance. Strengthening technological infrastructure, standardisation, completion of diagnostic and treatment protocols, and ensuring sustainable financial support remain serious challenges that urgently require effective action and resolution. The Riinvest Institute recommends:

• The Law on Budget Appropriations should strengthen the position of the health sector, ensuring that the level of government spending reaches the average of WB economies (around 6 % of GDP).
• The condition of technical equipment for patient diagnostics and treatment should be improved through extraordinary investments, with the aim of reducing long waiting lists, replacing outdated devices and lowering out-of-pocket expenses for citizens.
• The planned timelines should be reconsidered to ensure the completion, within no more than two years, of the health insurance system and the HIS, as well as the broader digitalisation of the health sector.
• The salary system should be reviewed and made more competitive to address the turnover of medical and support staff.

For sources, list of references and further information, please refer to the full report available below.