Baku. Farid Mirzayev, Konul Kamilgizi – APA. Interview with Zaur Aliyev, Director of Azerbaijan’s State Agency for Compulsory Medical Insurance under the Cabinet of Ministers
Q. Compulsory health insurance is a new notion for the citizens of Azerbaijan. What is compulsory health insurance? How will it benefit the Azerbaijani citizens?
A. As you know, funding of public hospitals in Azerbaijan is based on the quantitative indicators, hospital stock, medical staff and pharmacists. Thus, the number of patients, severity of diseases, professionalism of doctors and number of their patients and other important factors are not taken into account. The most effective step towards improving the quality of medical services may be compulsory health insurance. Introduction of compulsory health insurance is part of healthcare reforms and will strengthen the financial capacity of the healthcare system. This is a distinctive form of healthcare financing. The matter is about improving the quality of medical services, providing more efficient expenditure of public funds. The compulsory health insurance is a state social security system in protecting the interests and health of the citizens. This a social project of the government. Currently, public hospitals are financed from the state budget and private hospitals at the expense of citizens.
However, after the introduction of compulsory health insurance, all risks and funds will be concentrated. The collected funds will be used to pay medical expenses of insured citizens.
Under the instruction of President Ilham Aliyev, ensuring citizens’ access to health care is one of the main issues. For example, if the medical service needed by the citizen is not rendered in the hospital he applies and this service is expensive in private hospitals, his access to the health care is prevented and it aggravates his disease. Thus, we aim to provide access.
If the insured citizen can’t receive necessary medical service in the district or village he lives, the Agency prevent the financial risks he can face by providing his examination and treatment in neighboring district or in Baku. In a word, the insured citizen won’t have concerns over medical services.
At the same time, we will ensure the provision of quality medical services to all citizens. One of the main goals of compulsory health insurance is efficient and transparent use of available resources. The agency will make payments in the hospitals for each disease.
Q. Mingachevir and Yevlakh districts have been selected as pilot areas for the introduction of compulsory health insurance. When will it be introduced?
A. Mingachevir and Yevlakh have been selected as pilot areas given demographic indicators in the districts, as well as number of children, pensioners and economically active population, medical service network, material and technical conditions of medical facilities, especially hospitals, medical personnel and health care costs allocated from the state budget. Currently, the healthcare system is financed from the state budget. It is not easy to change all at once. We should prepare not only medical facilities, but also people for compulsory health insurance. The citizens don’t have enough information about compulsory health insurance. Public hospitals haven’t introduced compulsory health insurance so far. The main obstacle for applying compulsory health insurance all around the country is related with electronic data interchange.
I think the process of registration of citizens in hospitals in connection with the insurance will not cause difficulties. However, hospitals submitting data to the agency in electronic form and our making payment in electronic form are not so easy. It will take some time. Thus, we decided to select pilot areas for the introduction of compulsory health insurance. We are going to implement this process in stages. This process will cover all the country after the hospitals in Mingachevir and Yevlakh districts make use of compulsory health insurance. It will be introduced in most parts of the country in 2018.
Q. What will happen if a citizen is unable to pay for the insurance?
A. In general, economically active population must pay insurance premiums, because only in this case, we can expand the scope of the basic package of compulsory health insurance. However, a citizen, who fails to pay insurance premiums, will be able to get free access to some medical services (primary healthcare, emergency medical care, urgent surgery, etc.).
Q. Does the law “On medical insurance” meet today’s demand? Are there any gaps in the law?
A. There is a need for making amendments to the law “On medical insurance”. A new law should be adopted related to compulsory health insurance, or amendments should be made to the legislation. We have already submitted to the Cabinet of Ministers a draft law on amendments to the legislation.
Q. Is there any model of compulsory health insurance?
A. There are not a lot of models of compulsory health insurance in the world. Basically, two models – social health insurance and national health insurance – are applied. The first model is applied in many European countries. We have chosen a model similar to social health insurance model.
In this system, the state is acting in cooperation with citizens. That is, economically active people, by paying insurance premiums, join the process of compulsory health insurance. The economic processes in the world, global crisis have an impact on countries’ economy and indirectly on the compulsory health insurance system.
Q. Will organ transplant operations be possible upon the introduction of compulsory health insurance?
A. No organ transplant operations are planned in early years.
Q. Is it specified what medical insurance packets (gold, silver) there will be?
A. The basic package of compulsory health insurance has been submitted to the Cabinet of Ministers. Specification of the packets as gold or silver mostly refers to the private sector. We will provide medical services to all citizens on the basis of a single basic package.
Q. To what extent is Azerbaijan’s healthcare system, doctors, hospitals ready for the introduction of compulsory health insurance?
A. Like citizens, state hospitals are not fully ready for this yet. It is normal. We will organize trainings for health workers. The main purpose of the agency is to provide the insured people with quality, high level and prompt services.
The introduction of compulsory health insurance will create a competitive environment among public hospitals. Quality is high in a competitive environment. However, this competition will be based on the services, doctors’ knowledge, and recovery of citizens' health status.
Q. Are there any plans to involve private hospitals in this process?
A. We think that as the scope of compulsory health insurance is expanded, involvement of private hospitals in the process will also increase. Private hospitals will provide the insured people with medical service not rendered in public hospitals. Our main goal is to provide quality medical services to citizens. All public hospitals and only the private medical institutions which offer services in a wide range will be involved in the compulsory health insurance process. We will choose the hospitals that will offer services on the basis of the basic package based on defined criteria.
Q. Which body will be empowered to carry out control over the accreditation of medical facilities for compulsory medical insurance?
A. According to the Statute of the Agency, we can participate in the accreditation process. But it is an issue that belongs to the Ministry of Health. Our main priority is to determine the basic package of compulsory health insurance and a single price list of medical services as well as to prepare our proposals on amendments and additions to the legislative framework. We submitted the documents to the Cabinet of Ministers in a short period of time and conducted certain calculations about the number of economically active and non-economically active population.
Q. Has the foundation for collection of funds already been created?
A. During the introduction of compulsory health insurance, the insurance premiums of economically inactive population will be paid by the state, while the insurance premiums of economically active population will be collected. For this purpose, a foundation may be created within the Agency for the collection of funds. Or the collection of funds can be regulated in other ways.
Collection of funds in a foundation or in the form of account is a technical issue. Proposals have been submitted to the government on the establishment of a foundation.
Q. There was an opinion on inclusion of the drugs to the package of services for inpatient treatment and there were also discussions as to including drugs for outpatient treatment to the package of services. Was this issue resolved?
A. We are planning to include to the package of services drugs only for inpatient treatment.
Q. How is the “family doctor” going to operate?
A. Health system consists of primary health care, outpatient and inpatient services. At present, negotiations are ongoing with the Ministry of Health for further development of the “family doctor”, the primary health care institution. The family doctor will be appointed in accordance with the number of the population. According to world standards, there will be one family doctor per 2,000 citizens, which is in keeping with the Health Ministry's normative acts. Every 2,000 people are insured citizens of a family doctor. They will visit this doctor first. A family doctor is not only supposed to direct the patient to a specialized doctor but will examine and treat the patient himself or herself. In other countries, family doctors even conduct some minor operations but it is not possible in Azerbaijan since the institution has been created newly. Our foremost goal for the time being is to provide citizens with access to medical services. Moreover, we plan to give extra bonuses to family doctors in compulsory medical insurance system. This will be possible on the basis of predetermined criteria. For example, if a family doctor has been able to keep the 1,000 people healthy on the basis of these criteria, his or her payment will be a little higher.
Q. What is the current stage of the efforts made towards the introduction of compulsory medical insurance?
A. On October 1, the Agency will begin preparatory works in the pilot areas (Mingachevir and Yevlakh) to inform the population and medical staff about compulsory medical insurance and the base package. Also, the populations of the pilot areas will be begin to be registered and contracts will be signed with medical facilities that will provide medical service.
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