Abstract
Background
Armenian healthcare reforms have been carried out since independence in 1991, but achieved their full scale starting in 1995–1996. Although the healthcare system has already been modified and changed for 10 years, there is a lack of research in this regard.
Objectives
This paper aims to present the organization of the healthcare system in Armenia, its changes and challenges throughout the reform process.
Methods
This paper is mainly based on a review of the relevant professional literature, a review and interpretation of legal acts in the healthcare field, and a review of research and assessment works done by several international and local organizations.
Results
There are still large numbers of elements typical for the Soviet Semashko model in Armenian healthcare structures. Implemented reforms have separated the institutions of the public payer and the providers, but did not manage to change the model of financing to be based on compulsory insurance. The level of financing is similar to the average in Central and Eastern Europe, but is based mainly on out-of-pocket payments contributing to about 80% of all system resources. The informal payments reach even 45% of expenditures. The structure of hospital beds remains ineffective, and there are still no mechanisms of increasing the quality of services. Privatization has been applied, but the role of private providers is still limited.
Conclusions
The reforms have not caused satisfactory improvement in healthcare performance, although the health indicators are better than at the beginning of the transformation period. The stability of the reforming processes in previous years as well as the engagement of international institutions is a chance for positive changes in the near future.
Similar content being viewed by others
References
Carrin G (2002) Social health insurance in developing countries: A continuing challenge. World Health Organization, Geneva
Dixon A, Langenbrunner J, Mossialos E (2004) Facing the challenges of health care financing. In: Figueras J, McKee M, Cain J, Lessof S (eds) Health care systems in transition: learning from experience. European Observatory on Health Care Systems, Copenhagen
Draft RA Law “On Healthcare Services”, not adopted yet
Green A (1992) An introduction to health planning in developing countries. Oxford University Press, Oxford
Hovhannisyan SG, Tragakes E, Lessof S, Aslanian H, Mkrtchyan A (2001) Health care systems in transition. Armenia. European Observatory on Health Care Systems, Copenhagen
ICHD, NSS, NIH, SCAD (2005) Report on the results of the National Survey on the Drug, Alcohol and Smoking Prevalence among the General Population of Armenia. ICHD, NSS, NIH, SCAD, Yerevan
Minister of Health (2003) Order On RA State Owned Primary Healthcare Facilities Medical Personnel Remuneration Setting Procedures, 1 195, 28 Mar (HH Aroghjapahutyan nakharari hramany hh aroghjapahutian hamakargi ambulator-poliklinikakan kazmakerputiunneri koghmic bujandznakazmi vardzatrman hamar sahmanvats miavorneri hashvarkman kargy hastatelu masin, 195)
Ministry of Health of RA (2004, 2005) Public Health of Armenia, Statistical Yearbooks. Ministry of Health of RA, Yerevan
Mossialos E, Dixon A, Figueras J, Kutizn J (2002) Funding health care: options for Europe. World Health Organisation, Open University Press, Buckingham
National Statistic Service of RA (2006) Statistical Yearbook of Armenia–2005. National Statistic Service of RA, Yerevan
National Statistical Service of RA, on-line at www.armstat.am
Project of RA Law “On Public Health Safety”, not adopted yet RA Government (1997) Decree On Creation of State Health Agency, 1 593, 18 Dec (HH Karavarutyan voroshumy hh karavarutyann arynter petakan arokhjapahakan gortsakalutyun stekhtselu masin, n 593, hhpt 1997/29, 25.12.97)
RA Government (2004a) Decree On State Guaranteed Medical Services in 2004, 1 318-N, 4 Mar, with several additions and changes by the following GOA decrees 1 266-N; 17 Feb 2005, 1 291-N, 09 Feb 2006; 1 641-N, 18 May 2006; 1 146-N, 08 Jan 2006; 1 880-N, 19 Jul 2006 (HH Karavarutian voroshumy petutyan kokhmic yerashkhavorvats anvchar bjshkakan ognutyan yev spasarkman masin, n 318-n, hhpt 07.04.04./20(319) hod.465)
RA Government (2004b) Decree On Family Physician Statements and Procedures of Its Performance Reporting, 1 539-N, 08 April (HH Karavarutian voroshumy yntanekan bjshki gortsuneutyan kazmakerpman druytnery yev yntanekan bjshki gortsuneutyan masin teghekatvutyun nerkayacnelu dzevy hastatelu masin, 539-n, hhpt 2004/25 (324), 05.05.04)
RA Government (2006a) Decree 1 amending
RA Government (2006b) Decree on Procedures of PHC Doctor Selection & Registration with Him, 1 420-N, 30 Mar (HH Karavarutian voroshumy aroghjutyan arajnayin pahpanman tsarayutyunner matucogh bjshki yntrutyan yev nra mot bnakchutyan grancman kargy hastatelu masin, n 420-n, hhpt 19.04.06./23(478) hod.462)
RA Law On Drugs and Psychotropic Agents (2002b) adopted 26 Dec (HH Orenqy tmramijocneri yev hogemet niuteri masin, ho-518-n, hhpt 2003/10 (245), 20.02.03)
RA Law On Human Organs and Tissues Transplantations (2002c) adopted 16 Apr (HH Orenqy mardu organner yev (kam) hiusvatsqner pokhpatvastelu masin, ho-324, hhpt 2002/16 (191), 29.05.02)
RA Law On Medical Aid and Medical Services for The Population (1996) adopted 4 March (HH Orenqy bnakchutyan bjshkakan ognutyan yev spasarkman masin, ho-42, hhajt 1996/ 7–8)
RA Law On Medications (1998) adopted 27 Oct (HH Orenqy degheri masin, ho-259, hhpt 1998/31 (64), 22.12.98)
RA Law On Prevention of Disease Caused by HIV (1997) adopted 03 Feb (HH Orenqy mardu imunain anbavararutian virusic arajacats hivandutyan kankhargelman masin hh, ho-103, hhpt 1997/ 3, 28.02.97)
RA Law On Reproductive Health and Reproductive Rights (2002a) adopted 11 Dec (HH Orenqy mardu verartadroghakan iravunqneri masin, ho-474-n, hhpt 2003/ 1 (236), 07.01.03)
RA Law On Sanitary-epidemic safety for the population (1992) adopted 12 Dec (HH Orenqy hh bnakchutyan sanitarahamacharakain anvtangutian apahovman masin, ho-43, hhgkht 1992/23)
State Budgets of RA (2002 to 2006), on-line at www.laws.am
State Simplified Health Budget (2006). Yerevan. Tar-Grigoryan A (2001) Health Financing in Armenia. Yerevan
Ter-Grigoryan A (2001) Health Financing in Armenia. Yerevan
Transparency International (2006) Global Corruption Report. Transparency International, Pluto Press, London
United Nations Development Program (2005) Human Poverty and Pro-Poor Policies in Armenia. United Nations Development Program, Yerevan
World Health Organisation (2005) The World Health Report: 2005: Make Every Mother and Child Count. World Health Organization, Geneva
World Health Organisation (2007) Health for All Database. World Health Organisation Regional Office for Europe, Copenhagen
Acknowledgements
The Department of Health Policy of the Medical University of Silesia uses computer equipment purchased by the Medical Aid for Poland Fund in London.
Conflict of interest statement
The authors disclose any relevant associations that might pose a conflict of interest.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Torosyan, A., Romaniuk, P. & Krajewski-Siuda, K. The Armenian healthcare system: recent changes and challenges. J Public Health 16, 183–190 (2008). https://doi.org/10.1007/s10389-007-0160-y
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10389-007-0160-y