Among the most significant violations are unjustified transfers from the state budget and unrealistic beneficiaries of medical services.
Execution of health insurance funds in 2024 exceeded the planned revenues. Insurance medicine did not experience a shortage of funds, thanks to the growth of revenues from insurance and individual premiums, as well as additional allocations for complex medical services, such as dialysis or special surgical interventions. The budget of insurance medicine last year approached 16 billion lei. Most of the funds (52%) went to hospitals.
However, the auditors did not find sufficient economic justification for many financial flows into and out of the system. For example, transfers from the state budget for health insurance of more than 1.5 million unemployed people – children, pensioners, people with disabilities and other protected categories – were made with deviations from the provisions of the legislation.
The amount of transfers – 6.85 billion lei – is not based on the real number of beneficiaries and financial indicators. And this practice has been undermining their predictability for years, as it is not justified, the Court of Accounts said. Besides, the necessary expenses for medical services come from imputations.
The audit revealed significant differences between the actual population and the number of citizens used for contracting primary health care (PHC) services. At the end of 2024, the PHC registers included more than 3.34 million people, while official statistics showed that Moldova had only 2.42 million citizens. And the level of funding for institutions providing these services is based on a “per capita” tariff.
The PHC information system utilization rate in 2024 reached 62% (compared to 30% in 2023), but numerous technical and organizational difficulties are still present. A significant proportion of health care providers still do not fully utilize the system, control over the exact number of services, and thus insurance medicine expenditures, becomes approximate. Transparency and decision-making ability of the central authorities and CNAM in the allocation process are reduced, the auditors’ report says.
“The system does not allow for the automatic generation of statistical reports, which reduces the transparency and the ability of central authorities and CNAM to make decisions in the process of allocating funds, planning needs and shaping insurance medicine policy,” the Audit Chamber auditors conclude from the audit.
