Yerevan 2010
Introduction
Based on the analysis of the current situation in the health care system and following identification of the main problems that require radical reforms, the Armenian National Congress hereby presents for public review the main concepts of the reforms in the health sector.
Current demographic and health indicators in Armenia raise concern and may pose serious threat in future. Such diseases as cardio-vascular diseases and malignant neoplasm continue to make predominant share in the total mortality and maintain growing trends. The level and quality of health services provided to population is unsatisfactory. State funding of the health sector is insufficient; the existing system is not feasible and quite cost consuming. Health sector is financed exclusively through the state budget and from out-of-pocket payments, while presently most of the world countries are widely using the mandatory health insurance schemes. Level of corruption and spread of shadow turnover raises serious concerns. Society does not recognize the existing social system as a state guaranteed health protection, irrespective of the social status of a person.
The health system should not be viewed as a mere provision of medical services and care, but it also should envisage disease prevention and health promotion. The strong and viable health system is the major prerequisite for the improved health conditions, as it can help save lives of people. To that end, the state should do its best in order to create efficient system, which would ensure further economic growth and higher living standards. It is unacceptable that people due to deteriorated health and/or for the reason of recovering it will find themselves on poverty line.
As a consequence, the existing situation in the health sector requires urgent implementation of the principles used worldwide, such as justice, social solidarity, affordability of services, and equality. To this end, the issue of ensuring rights and liabilities of the state and citizens is of a prior importance.
The draft of "National Health Policy" of the Armenian National Congress is based on the following fundamental principles:
Public Health
1. Create "Public Health Service". Based on the existing State Hygienic and anti- epidemic Inspection a new "Public Health Service" should be established and provided with new functions to address existing issues of the public health, including surveillance and assessment of the population's health status, projection, disclosure, study and elimination of the risk factors influencing health of the people, disease prevention by taking primary and secondary measures.
2. Decentralize functions of "Public Health Service". Number of functions will be transferred to the primary health care (such as protection of individual health, raising awareness, etc.), while hygienic control services should be outsourced to the local self-government bodies. Financing sources of the new Public Health Service should be from the state budget, fees from the paid services (laboratory examinations and tests, etc.), as well as other sources not prohibited by legislation of Armenia.
3. Implement multisectoral programs. Given that within the total mortality up to 70% of cases are caused by cardio-vascular and oncological diseases, multisectoral target programs on primary health care should be implemented on the national level, such as fight against cancer, prevention of cardio-vascular diseases, diabetics, as well as control programs on tobacco, alcohol, drug addiction, and weight. Programs on combating socially hazardous diseases (tuberculosis, virus hepatitis, HIV/AIDS, etc.) should be implemented.
4. Health of young and elderly people. The government should implement target programs aimed at health protection of young and elderly people, with the view to protecting and strengthening people's health during their entire life, including implementation of special social-educational programs for the youth, and undertaking measures aimed at activation, self-protection and social productivity of elderly people. The government should introduce the concept of creating long-term health care centers.
Efficiency of health system and affordability and accessibility of the medical services provided to population
The Government should shift from financing treatment expenses of the patients to financing programs aimed at health protection. Subsequently, the primary health care system will have an opportunity for continuous development in order to fully accomplish the stated goals and objectives (detection and prevention of diseases, immunization, promotion of healthy life style, community health care, etc.).
5. Management of financial resources. In order to raise efficiency of the health care system, the principle of diversity of financial sources should be introduced - state budget, local self-government bodies, co-payment, medical insurance, personal PAYE medical accounts and so on. This process should be facilitated by establishing a system for organization of tenders for state order allocation and for assurance of quality and scope of the services provided. Financing should be directed not to the medical facilities, but to a citizen. Pricing policy for the services provided under the state order should be regulated in order to eliminate the practice of out-of pocket payments by the patients under the state order.
6. Financing of health services through certificates issued by state. This system should be implemented within the framework of annual health program approved in the state budget. Certificates as means of payment for medical services should circulate in stock markets, social insurance sector, and all medical facilities and should be redeemed by the government at the first request. This will lead to an improved quality and affordability of medical services, enhanced management of cash flows and reduced corruption. The certificates should be provided to citizens, and their realization should be done on competitive basis among medical facilities.
Direct financing of medical facilities from the state budget should be ceased, except for medical facilities engaged in treatment of infectious diseases and tuberculosis.
7. Introduction of compulsory health insurance. Introduction of compulsory health insurance will be based on the principle of social solidarity, where "the healthy pays for the sick, the rich for the poor, the young for the old and the employed for the unemployed". Funds for compulsory health insurance will be generated from joint contributions of employers and employees. This system would make possible to legalize and regulate gradually population's direct and "shadow" payments for medical services, through raising effectiveness of their utilization, eliminating psychological obstacles for addressing a doctor in case of illness, and allowing to collect additional money in order to enhance health care of population. Furthermore, payments for the provided medical care and services will become more predictable, personalized and targeted. Introduction of compulsory health insurance should be carried out step-by-step, gradually embracing various layers of population and social groups. Annual program of compulsory health insurance (social groups and types of diseases) should be approved along with the state budget.
8. Sharp increase of financial resources for health. The share of health financing within the GDP should total at least 3% (instead of current 1.6%). Given all the inflows from different sources, total share of health financing within GDP should total at least 6%.
Quality management of medical care and services
Medical services are "special type of goods", the quality and scope of which cannot be easily assessed by an average consumer, since it requires special knowledge. The state should implement steps for designing and introducing a new system for quality management of medical services, viewing it as a core policy measure.
9. Status change of the "State Health Agency". In order to match demand and supply of medical services, within the framework of the existing financing scheme, the former status of the State Health Agency as a subsidiary of the Ministry of Health should be revised (currently it acts as a buyer of the health services and performs their quality control). It should turn into an autonomous structure and further to introduction of mandatory health insurance scheme, transform into a state fund of health insurance.
10. Introduction of integrated guidelines, standards and protocols for provision of medical services. In order to improve quality and control of medical services, the country should develop and implement comprehensive and integrated guidelines and protocols based on scientific evidence and best practices on disease treatment, medical-economic standards, which will enable to reduce up to 30 percent unjustified costs for medical services.
11. Integrity of supply and demand for medical services. In order to avoid the trends of excessive spending on services provided by medical facilities and physicians (such as unnecessary costly consultations, excessive laboratory examinations, etc.) the system for verification of provided medical care and services should be introduced. The state should check consistency between demand and supply for medical services and care in all medical facilities. Furthermore, quality or treatment of patients should be strongly controlled by the state (irrespective of the corporative form of the institution).
12. Decentralization of medical services quality control function. The responsibility for quality control over the medical services and care, which receive non-budget financing (from such sources as voluntary insurance, personal PAYE accounts of medical staff) should be given to the relevant entities, which carry out financing.
13. Encourage public control. In order to ensure the integrity of the rights and liabilities of medical services and care providers and consumers, the state should encourage formation and development of health professional associations (unions) and organizations engaged in issues related to the rights' protection of patients.
14. Revision of the current licensing system. The state should introduce the system of individual licensing or equivalent approval system for the health professionals, as well as for the medical facilities. Procedures for licensing or equivalent approval system of the medical facilities should be revised and become more transparent, with the view to minimize corruption risks.
Drug policy and food safety issues
The state should focus on providing population with effective, safe, high quality and affordable and available medicines as well as guarantee food safety issues.
15. Increase of the state financing on drug provision. The state should design and introduce a target program for ensuring affordability and access of population to medication, in the amount of at least 10 percent of the state budget financing instead of the current 6.5 percent provided to the health sector.
16. Upgrading drug treatment. The existing 2 years periodicity for revising "the main drugs' list" should be reduced to 1 year. The revised list of drugs should include all new medicines that are recognized in medical practice as effective and affordable, which are crucial for the comprehensive and continuous treatment of the diseases within the framework of the state target programs.
17. Encourage social orientation of the drug safety policy. The state should revise the procedure "On Free or Concessional Provision of Drugs", transforming it into a scheme which is socially more fair, free of corruption risks and flexible, so that patients eligible for the free medication could receive them in full scope and not be induced to pay from their own pocket for the acquisition of drugs.
18. Increase the level of drugs' affordability. Best international practices on drugs' price regulation should be introduced with the view to ensure affordability of drugs. Subsequently, the following measures should be implemented: (a) establish wholesale and retail commercial mark-up ceilings on drugs; (b) develop "positive" list of drugs, sold at concessional terms with prices much lower than in market; (c) establish ceiling on profits of pharmaceutical companies; (d) impose state monitoring on prices of drugs included in the "Main Drug List"; (e) fix ceilings on mark-ups for minimum prices established on drugs, etc. The state should develop and introduce standards for establishment and operation of pharmacies in rural and particularly remote and frontier regions, in order to ensure availability of drugs.
19. Introduce a system of specialized control over the drugs' circulation. In order to supply population with effective, secure and high-quality medicines, the state should carry out efficient supervision of pharmaceutical businesses and introduce a new system for their certification and assessment.
20. Establish a "Drug and Food State Agency". The state should establish a "Drug and Food State Agency" through the respective reorganization of the existing structures within the Ministries of Health and Agriculture. The new agency should perform unified monitoring of imported and domestic drugs, food supplements, verify food quality and safety, in order to ensure their conformity with standards and reduce the paperwork burden imposed on producers and importers.
Human Resources
Given the crucial role of the staff working in the health sector in assuring quality and scope of the provided medical services, the state should put special emphasis on solution of the problems existing in that area and take practical steps in order to solve them.
21. Enhance management of human resources. Criteria and procedures for allocating state orders in the sphere of medical education should be revised. Demand for specialists should be determined based on modeling methods used in international practice. Students financed under the sate order should sign contracts with the state, under which they will have a commitment to work after graduation from the University in a medical institution selected by the Ministry of Health for a definite period of time.
22. Promote continuous medical education. Medical education and programs on postgraduate specialization and continuous professional development should be revised in compliance with the best practices to improve professional skills of medical staff.
23. Increase the role and improve living standards of health care providers. Salaries of health care providers should be increased. The salary amount must be adequate with their level of education, working experience and actual performance. It should be calculated based on performance indicators, such as number of served patients. The amount of salaries should reach such a level that could ensure their decent living.
Legislation
The legislation should be revised in order to ensure integrity of the rights of people receiving medical services and the health care system.
24. Assure legislative reforms. New laws "On Health", "On Public Health", "On Health Insurance", "On Insurance of Professional Hazards of Medical Workers and Pharmacists", "On Drugs and Food Supplements" should be adopted.
25. Publicity and accountability of the program. The Government should present annual reports on health status of the RA population and health care programs implemented.
As a result of implementation of the above-mentioned activities following outputs and outcomes could be expected within the next 10 years
01 July 2010
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| 2010-02-22 | Armenian National Congress - "100 Steps" PROPOSAL/PROGRAM FOR A SYSTEMATIC REFORM OF SOCIO-ECONOMIC POLICIES The Armenian National Congress presents for public consideration ‘100 Steps', a systematic proposal for social-economic reform which has as its fundamental goal the radical reform of the economic system created in Armenia, and the creation of a sustainable economic development with the active participation of the people. The essence of the current system is the ultra concentration of economic resources in the hands of a few oligarchs and their extended families, and the exploitation of state levers to secure that group's extraordinary gains. Illegal tax and customs permissions, monopolies, servicing of the extravagant gains of importers by an artificial evaluation of the Dram and trampling of the rights of property ownership, have caused a dramatic decrease in production and a tragic decrease in export, free market competition, as well as unfounded increase in costs and a general fall in business activities and the economy, bringing about daily worsening of the social-economic condition of the population. The transfer of the basic burden of taxes on small and middle-level business and the arbitrariness of state bodies suffocate business enterprises based on private initiatives, suppresses the population's creative energy and faith in its own strength, bringing about emigration and poverty. Radical reforms are imperative to change the current situation. Only the mass popular movement which does not depend on or is obliged to the oligarchs, is in a position to come forth, in the name of the people and development of the state, against the current system and with the necessary consistency to actualize such systematic changes. The Armenian National Congress is ready to submit to the judgment of the people a program which shows that the Congress is not simply limited by assurances of political will to pass such reforms, but also has very concrete solutions and mechanisms to actualize those goals. The proposal for the reform of social-economic policy is presented by the decision of the political council of the Armenian National Congress. The proposal was prepared by the economic committee of the Congress, under the direction of Hrand Bagratyan's scientific leadership, and includes the proposals and observations of the political parties which are members of the Congress. The document presented below shows only general approaches to social-economic and structural policies. It includes the position of the Congress in fiscal, monetary, financial policy, encouragement of business, and fundamental problems of social policy. Only agriculture from the section on rural economic policy is represented here, bearing in mind the tragic condition created there as a result of the politics of the past 10 years. Policies on economics, public life, and other spheres of governance (industry, trade, services, health, education, science, social security and insurance, environmental protection, tourism, sports, youth, law-enforcement, armed forces, the Judiciary, state and self government) will be published later, one by one. >>> Read the whole program |
| 2010-02-22 | «100 քայլ» (Մաս 2) |
