Expansion of the Benefits Package : The Experience of Armenia
The legacy of the Semashko system left Armenia with an oversized and overstaffed health system. Beginning in the 1990s the country focused on re-designing its health system in an attempt to rationalize resources. In order to improve the efficiency,...
| Main Authors: | , , |
|---|---|
| Format: | Working Paper |
| Language: | English |
| Published: |
World Bank, Washington, DC
2018
|
| Subjects: | |
| Online Access: | http://documents.worldbank.org/curated/en/615741516195329170/Expansion-of-the-benefits-package-the-experience-of-Armenia http://hdl.handle.net/10986/29178 |
| Summary: | The legacy of the Semashko system left
Armenia with an oversized and overstaffed health system.
Beginning in the 1990s the country focused on re-designing
its health system in an attempt to rationalize resources. In
order to improve the efficiency, access and quality of
health care service provision, the Government undertook
supply-side reforms. These reforms included: (a)
strengthening Primary Health Care (PHC) provision; (b)
downsizing excess hospital capacity; and, (c) changing
provider payment mechanisms and introducing a
purchaser-provider split.Armenia introduced the Basic
Benefit Package (BBP) in 1999 for the socially vulnerable
population to target the so-called socially important
diseases. The package utilizes public resources to finance,
through provider contracts, PHC and emergency services for
all Armenian citizens, with co-payment exemptions for the
poor and vulnerable. In addition, selected inpatient
services are provided for free for the poor, vulnerable and
other specific categories.Unfortunately, low public health
spending levels and incomplete demand-side health financing
reform have resulted in serious shortcomings in financial
risk protection outcomes. Armenia’s public health financing
is among the lowest in the region. High co-payments for BBP
covered services, lack of in-patient care coverage for the
non-vulnerable population and outpatient pharmaceuticals for
all, have resulted in household out-of-pocket (OOP) spending
being the predominant source of financing for health in the
country. As Armenia is grappling with an aging society and a
health care system struggling to adjust to morbidity and
mortality epidemiological changes, its path to Universal
Health Coverage (UHC) requires increased funding from
prepaid pooled sources in order to sustain and make further
progress on improving population health outcomes and
financial risk protection.This paper examines the Armenian
health system, with a focus on the BBP program. It takes
stock of implemented reforms and analyzes the pending
agenda. The paper is organized as follows. Section two
provides a general overview of Armenia’s health system,
focusing on financing and health service delivery. Section
three describes the BBP program including its institutional
architecture, beneficiary targeting, BBP services and fund
management, and related information dissemination. Section
four discusses the sustainability of the BBP program amidst
economic, epidemiologic, and demographic challenges. The
last section focuses on the pending agenda related to
targeting, integrated care, and coverage of the
non-vulnerable population. |
|---|