ORDER OF THE PRESIDENT OF THE AZERBAIJAN REPUBLIC

of January 10, 2008 No. 2620

About approval of the Concept of reform of system of financing of health care and application of compulsory medical insurance in the Azerbaijan Republic

The successful economic policy performed in recent years in the Azerbaijan Republic created favorable circumstances for bringing the medical services rendered to the population to modern standards, strengthenings of material and technical resources of this system. In health sector number of state programs on prevention of the main diseases is accepted, issues of financial provision of their execution are resolved.

At the same time without implementation of radical reforms in the principles of financing of health care system it is impossible to bring quality of the medical services rendered to the population to desirable level.

For the purpose of creation of new economic bases of financing of health care system of the Azerbaijan Republic, enhancement of management of this area, further improvement of quality of the medical services rendered to the population and the beginning of application of compulsory medical insurance I decide:

1. Approve the Concept of reform of system of financing of health care and application of compulsory medical insurance in the Azerbaijan Republic it (is applied).

2. Charge to the Cabinet of Ministers of the Azerbaijan Republic:

2.1. in two-month time to prepare and approve the Actions plan on implementation of this Concept covering 2008-2012 in case of coordination with the President of the Azerbaijan Republic;

2.2. exercise control over the implementation of this Concept and the corresponding Actions plan provided for approval and to regularly inform on it the President of the Azerbaijan Republic;

2.3. within the powers to resolve other issues following from this Order.

3. This Order becomes effective from the date of its signing.

Approved by the Order of the President of the Azerbaijan Republic of January 10, 2008 No. 2620

The concept of reform of system of financing of health care and application of compulsory medical insurance in the Azerbaijan Republic

Public health care, further improvement of quality of medical attendance in the Azerbaijan Republic, being one of the main directions of the pursued social and economic policy, constantly are in the center of attention of the state.

The high development happening in recent years in national economy promoted significant growth in the public expenditures sent to health sector. As a result of the reforms undertaken in the field of health care number of the important state programs directed to public health care was accepted, improvement of material and technical resources of medical institutions is reached.

Along with the above, without enhancement of the existing funding mechanisms for health care system it is impossible to bring quality of the medical services rendered to the population to desirable level.

From this point of view there was need of further deepening of reforms for health care system, the organization of financing of industry on new bases, and the present situation caused adoption of this Concept.

I. Present situation and problems in health sector

Though the intensive development observed in recent years in economy of the Azerbaijan Republic created conditions for significant increase in amount of the budgetary funds allocated in health sector, radical improvement of qualitative indexes in the field still is not reached, the new model of health care designed to serve strengthening of health of the population is not created.

From 1992 to 2003 birth rate indicators steadily fell, the process only in recent years this began to improve.

Despite rather stable level of indicators of death rate, in separate years cases of their growth were fixed.

Since 1992 till present the indicator of general population morbidity of the republic radically did not change, on each 100 thousand people of the population about 18 thousand cases were fixed. According to data for 2006, the indicator of security of the population with beds in medical institutions constituted in the republic of 813 beds on each 100 thousand people of the population that exceeds the indicator which is available in the developed European countries (631).

The number of doctors exceeds 30 thousand people that constitutes about 365 doctors on each 100 thousand people. It corresponds to average value in the European countries (352). At the same time, there is problem low high-quality level and amount of the primary health care given to the population. Analyses show that it is connected, first of all, with discrepancy between stationary and out-patient and polyclinic services, number of doctors of general and narrow profiles. So, now the public medical institutions providing primary medical care are not fully completed by specialized doctors.

In recent years all weight of primary medical attendance laid down on stationary servicing. Prevalence in hospitals of highly skilled doctors and application of modern methods of diagnostics practically allowed most of stationary doctors to render to the population mainly out-patient and medical services.

On the other hand, still remaining discrepancy of material and technical resources to modern requirements, shortage of the necessary medical equipment, inadequate level of providing with free medical care interfere with receipt of specialized stationary medical attendance by inhabitants of the remote settlements. Financing of this sphere relies on the methods which remained in inheritance from former system that is on quantitative indices, first of all, fund of beds and number of workers.

Out of attention there were also questions of advanced training and professionalism of personnel in health care system, instead the number of health workers considerably increased.

Migration and chaotic placement of the population as a result of occupation more than 20 percent of the territory of the republic even more aggravated the problems which are available in the field of the medical and sanitary help to citizens. One more of problems is strengthening of inflow of the population from regions to the capital for receipt of medical attendance.

Thus, the above-stated problems led to deterioration in infrastructure of health care, rise in price of medical attendance and emergence of financial difficulties when using it, to the low level of its quality.

II. Main objectives and principles of reform of system of financing of health care

Main objectives of reform of system of financing of health care is the following:

* the organization of financing of health care system on new economic bases and growth of opportunities of use of the population of medical services;

* increase in level of medical attendance by more rational use of the public funds allocated for health sector;

* improvement of health of the population and increase in average life expectancy.

For achievement of the above-stated purposes implementation of reforms on the basis of the following principles is provided:

* providing all citizens with free medical attendance at the level of the services entering in basic (the main services) packet;

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