Health insurance in Armenia will turn into a monster - Tigran  Jrbashyan

ArmInfo.Let's increase funding for an inefficient healthcare system and do a good deed. according to Tigran Jrbashyan, the Director of Management Advisory at Ameria  Advisory, this is exactly how the Mandatory health insurance system  model proposed by the RA government, represented by the Ministry of  Health, can be described.

<When looking at the figures, one can notice that a very peculiar  situation is developing in the healthcare system - it is one of the  most inefficient. This is due to a number of reasons>, the economist  said in an interview with civil.net.

Thus, when considering the current expenditures on health care  (expenses of the state, society) as a percentage of GDP, it can be  noted that this indicator in Armenia for 2020 amounted to more than  12% of GDP and exceeds the indicators of such countries as Israel  (8%), Italy ( 10%), Finland (10%), and comparable to France (12%) or  Germany (13%). "These figures indicate that healthcare is a very  expensive pleasure for the population of Armenia," Tigran Jrbashyan  said.

At the same time, over the past 20 years, per capita health spending  in Armenia, both public and private, has grown almost 20-fold, from  $26 in 2000 to $524 in 2019. As a result, the cost of medical  services in Armenia is currently much higher than in other countries  of the region. According to this indicator, Armenia surpasses the  indicators of both Georgia ($291) and Azerbaijan ($193). "It would  seem that with such spending on health care, the situation with  health care should have been more favorable," the economist said.

However, according to 2019 data, non-communicable diseases are the  cause of about 93% of deaths in Armenia (with coefficient of 829,  while in 1990 the figure was 528). According to this indicator,  Armenia exceeds not only the world average (73%), but also the  comparable countries (85%).

Armenia also regressed in terms of the healthcare quality and  accessibility index - from 71 in 2016 to 63.2 in 2019. "We have  created such an inefficient healthcare system that back in 2015  Armenia had 4.2 hospital beds per 1,000 inhabitants, which is more  than 1.5-fold the global average of 2.7 beds. This indicator of  Armenia is comparable with a number of Western European countries,  including Greece (4.2), Luxembourg (4.3), Switzerland (4.4), and  exceeds the similar indicator of such countries as Sweden (2.1),  Norway (3.5) and Denmark (2.6).

In terms of the number of doctors per 1,000 inhabitants, Armenia (4.4  doctors per 1,000 inhabitants) outperforms both the world average  (1.7) and the averages of upper-middle-income countries (2.3) and  high-income countries (3.7) . Armenia occupies a leading position in  terms of the number of MRIs per 1,000 inhabitants and outperforms  many advanced countries in Western Europe. It turns out that we spend  more, but are much inferior in quality and are similar to third world  countries, he stressed.

According to the expert, the secret lies in the healthcare financing  model that has been developed for many years. <For the effective  implementation of state funding, it is necessary to have certain  protocols, the so- called standards for the treatment of diseases.  This has been discussed for many years, but the standards have not  been developed>, Jrbashyan noted. As a result, the same disease is  treated differently in different medical institutions, depending on  the degree of closeness to the doctor or clinic management.

All this, according to Jrbashyan, has led to the fact that the system  works autonomously, for itself, for its own sake, and not for the  sake of achieving a result. All the beneficiaries involved in the  process are interconnected, their interests coincide: government  officials - in the role of distributors of funds, hospitals - in the  desire to snatch an additional piece from state funding. As a result,  already at the beginning of the year - in April, May, the state  funding ends, and the patient  has to pay out of his own pocket to  receive medical services. Thus, we have a situation where everyone's  interests coincide, except for the final consumer," the expert noted.

Under these conditions, as the economist noted, the Ministry of  Health proposed a Concept for the implementation of universal health  care, where not a word was said about the existence of the most  serious tasks in the field, the need to improve its efficiency, in  particular, the development of standards and the development of  primary health care.  For this reason, the populist idea of the  authors of the document on social solidarity, under which the  Universal Health Insurance of Armenia will "take away from the rich  and give to the poor", will also prove fruitless, that is, working  citizens will pay insurance premiums for non-working citizens, which  will actually become a new type of tax. In addition, as the expert  notes, for the successful implementation of compulsory medical  insurance, it was possible at the initial stage to determine the  threshold of income received by citizens, their property, above which  they would not be available for state orders. This could unload the  system, and direct the funds more targeted.

<The institute for the redistribution of benefits begins to work  when, as a result of this, the beneficiaries - socially vulnerable  groups, begin to receive these services. But the proposed system will  not ensure this, because without the necessary reforms, the system  will turn into a monster that will conserve all the inefficiency in  the system and even multiply its degree. That is, we add fuel to the  fire that burns taxpayers' funds", Tigran Jrbashyan noted.  As the  economist noted, the problem is not in the very idea of introducing  CHI. Today, the most efficient system is private insurance, which is  interested in controlling the quality of services provided by medical  institutions. But, instead of taking advantage of the successful  experience of the same liability insurance for vehicle drivers  (CMPTL), the authorities decided to take the system into their own  hands - to create a State Fund, where the head of the Ministry of  Health will be at the helm and who will be in charge of all  government orders.  It should be noted that despite the fact that  most independent experts consider the Concept to be unfinished, crude  and not meeting the declared goals and objectives, on February 2 the  document was approved by the RA government.