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Armenia Health System Review Health Systems in Transition Vol. 8 No. 6 2006 Armenia Health system review Tatul Hakobyan • Mihran Nazaretyan Tatyana Makarova • Movses Aristakesyan Hovhannes Margaryants • Ellen Nolte European Editors: Ellen Nolte • Erica Richardson on Health Systems and Policies Health Systems in Transition Written by Tatul Hakobyan, Ministry of Health Mihran Nazaretyan, School of Health Care Management and Administration Tatyana Makarova, Armenia Social Transition Program Movses Aristakesyan, Armenian Drug & Medical Technology Scientific Expertise Centre Hovhannes Margaryants, Ministry of Health Ellen Nolte, European Observatory on Health Systems and Policies Edited by Ellen Nolte, European Observatory on Health Systems and Policies Erica Richardson, European Observatory on Health Systems and Policies Armenia: Health System Review 2006 The European Observatory on Health Systems and Policies is a partnership between the World Health Organization Regional Office for Europe, the Governments of Belgium, Finland, Greece, Norway, Slovenia, Spain and Sweden, the Veneto Region of Italy, the European Investment Bank, the Open Society Institute, the World Bank, CRP-Santé Luxembourg, the London School of Economics and Political Science, and the London School of Hygiene & Tropical Medicine. Keywords: DELIVERY OF HEALTH CARE EVALUATION STUDIES FINANCING, HEALTH HEALTH CARE REFORM HEALTH SYSTEM PLANS – organization and administration ARMENIA © World Health Organization 2006, on behalf of the European Observatory on Health Systems and Policies All rights reserved. The European Observatory on Health Systems and Policies welcomes requests for permission to reproduce or translate its publications, in part or in full. Please address requests about this to: Publications WHO Regional Office for Europe Scherfigsvej 8 DK-2100 Copenhagen Ø, Denmark Alternatively, complete an online request form for documentation, health information, or for permission to quote or translate, on the WHO/Europe web site at http://www.euro.who.int/PubRequest The views expressed by authors or editors do not necessarily represent the decisions or the stated policies of the European Observatory on Health Systems and Policies or any of its partners. The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the European Observatory on Health Systems and Policies or any of its partners concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Where the designation “country or area” appears in the headings of tables, it covers countries, territories, cities, or areas. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by the European Observatory on Health Systems and Policies in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. The European Observatory on Health Systems and Policies does not warrant that the information contained in this publication is complete and correct and shall not be liable for any damages incurred as a result of its use. Printed and bound in the United Kingdom by TJ International, Padstow, Cornwall. Suggested citation: Hakobyan T, Nazaretyan M, Makarova T, Aristakesyan M, Margaryants H, Nolte E. Armenia: Health system review. Health Systems in Transition, 2006; 8(6): 1–180. ISSN 1817-6127 Vol. 8 No. 6 Health systems in transition Armenia Contents Preface ............................................................................................................v Acknowledgements ..................................................................................... vii List of abbreviations......................................................................................ix List of tables, figures and boxes ....................................................................xi Abstract ...................................................................................................... xiii Executive summary ......................................................................................xv 1 Introduction .........................................................................................1 1.1 Geography and sociodemography .............................................1 1.2 Political context .........................................................................4 1.3 Economic context ......................................................................6 1.4 Health status ..............................................................................9 2 Organizational structure .....................................................................15 2.1 Historical background..............................................................15 2.2 Organizational overview ..........................................................18 2.3 Decentralization of the health care system ..............................27 2.4 Population coverage, entitlements, benefits and patient rights .....................................................................31 2.5 Patient rights and empowerment .............................................39 3 Financing ...........................................................................................41 3.1 Revenue mobilization ..............................................................43 3.2 Third-party budget setting and resource allocation .................52 3.3 Payment mechanisms ..............................................................59 3.4 Health care expenditure ...........................................................74 4 Regulation, planning and management..............................................83 4.1 Regulation ................................................................................84 4.2 Planning and management .......................................................85 5 Physical and human resources ...........................................................89 5.1 Physical resources....................................................................89 5.2 Human resources .....................................................................92 iii Health systems in transition Armenia 6 Provision of services ........................................................................101 6.1 Public health ..........................................................................103 6.2 Primary/ambulatory health care .............................................108 6.3 Secondary/inpatient care........................................................114 6.4 Pharmaceutical care ...............................................................116 6.5 Rehabilitation and long-term care .........................................122 6.6 Palliative care .........................................................................123 6.7 Mental health care .................................................................123 6.8 Dental health care ..................................................................125 6.9 Alternative/complementary medicine ....................................126 6.10 Maternal and child health ......................................................126 7 Health care reforms .........................................................................131 7.1 Analysis of recent reforms .....................................................132 7.2 Future developments ..............................................................137 8 Assessment of the health care system ..............................................141 8.1 Quality assurance ...................................................................141 8.2 Health system accountability and safety ...............................144 9 Conclusions .....................................................................................147 10 Appendices ......................................................................................149 10.1 References .............................................................................149 10.2 Health care services covered under the Basic Benefits Package (2004) ......................................................................158 10.3 Budget allocation rates for ambulatory-polyclinic health care ..............................................................................160 10.4 Payment rates: ambulatory physician services ......................163 10.5 State-guaranteed free-of-charge hospital care and services rates ...................................................................164 10.6 HiT methodology and production process.............................176 iv Health systems in transition Armenia Preface he Health Systems in Transition profiles are country-based reports that provide a detailed description of a health system and of reform and policy Tinitiatives in progress or under development in a specific country. Each profile is produced by country experts in collaboration with the Observatory’s research directors and staff. In order to facilitate comparisons between countries, the profiles are based on a template, which is revised periodically. The template provides detailed guidelines and specific questions, definitions and examples needed to compile a profile. Health Systems in Transition profiles seek
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