INSURED TREATMENT

The nationwide introduction of compulsory health insurance (CHI) has begun since the beginning of this year. The collection of insurance premiums will begin in April. It is expected that the entire process will be completed before the end of the year and will take place in four stages, one stage per quarter. At the first stage, CHI will be fully implemented in 20 northern regions of Azerbaijan, at the second—in 17 western regions, at the third—in 14 southern regions, and in the last quarter in Baku, Sumgait and on the Absheron Peninsula. More than ₼900 million will be allocated from the budget for these purposes.

Territorial division

Despite the government’s determined intention to introduce CHI in Azerbaijan in a short time, in practice this turned out to be a very difficult task. Serious problems in the healthcare sector, lack of personnel, high costs, etc. forced the authorities to shift the deadlines each time. The originally planned introduction date of January 2020 was later canceled. Instead, the system will be introduced in four stages throughout the country.

At the same time, it would be naive to expect that the CHI will immediately solve all the problems with the quality of medical services in the country. The fact that free medicine, despite the noble and right objective, has long outlived itself in a market economy. It was necessary to replace it with a compulsory medical insurance system that has been tested throughout the developed world and provides basic medical care for minimal fees. In fact, the list of services approved by the Cabinet of Ministers of Azerbaijan last year is by no means “basic” and includes a wide range of emergency and urgent medical care services, specialized outpatient and inpatient care.

According to the head of department of the State CHI Agency for work with regional centers, Shukur Eyvazov, at the first stage, citizens will be able to use 3,000 medical services as part of the CHI. “This number covers about 60% of the medical services provided in Azerbaijan. As you know, we already have several state programs to combat oncology, AIDS, diabetes and so on. These programs are not yet included in the compulsory health insurance package,” Eyvazov said.

Furthermore, if necessary treatment cannot be provided by state clinics, private clinics can also be involved in the CHI program, and treatment there will be absolutely free.

Compulsory health insurance also ensure the provision of medical services at home. Patients will be taken care by a family doctor, and in emergency and urgent cases—by a team of ambulance and emergency medical care.

There is no insurance limit on the number of services for one patient—citizens of Azerbaijan can use compulsory health insurance throughout the year an unlimited number of times.

There are some nuances regarding the territorial location of medical facilities. Recently the State Agency for Compulsory Health Insurance approved the document titled Medical territorial divisions in the administrative territorial units of Azerbaijan. Thus, there will be 13 such divisions managed by a new legal entity, Association for Management of Medical Territorial Units (TƏBİB). According to the new rules, in order to receive CHI, it is necessary to be registered in the clinic determined according to the address indicated in the identity card. families already selected in this clinic The doctor (he will replace the local doctor) must issue a referral for treatment of the patient on an outpatient or inpatient basis in medical institutions, again within the framework of a certain territorial division. If the patient decides to go beyond it, then co-financing of medical services comes into effect. Simply put, then one will have to pay extra for treatment (₼5-90) depending on the type service. But we must take into account that this does not apply to emergency medical care, which is free nationwide.

Medical obligation or interest?

Meanwhile, this part of the issue caused the most dissatisfaction among potential patients in social media. Because these limits limit the right to choose a custom medical institution. People living outside the territory of registration temporarily will have to travel long distances to receive treatment. However, the arguments of the representatives of the State Agency are also understandable—without these restrictions it is almost impossible to regulate the flow of patients in one medical institution and provide high quality services. In this case the question is the quality of services and qualifications of doctors, but this is the problem that will be solved in a year...

According to the head of the State Agency for Compulsory Health Insurance, Zaur Aliyev, it is planned to attract doctors with foreign education to regional hospitals. “I think some of them are showing interest in this. In addition, we are studying the possibility of opening medical faculties in state clinics in some regions. We will also strengthen control so that doctors who have completed their residency education and were appointed to district hospitals work there for at least three years,” Z. Aliyev said. He admitted that the situation with the first-aid facilities in the villages is unsatisfactory, as there are no doctors, adequate equipment, but the agency will work towards eliminating all problems.

It is a good promise, but how realistic is it for doctors to stay in the districts voluntarily? As part of the implementation of compulsory health insurance, doctors will receive allowances for their salaries. The main principle of their appointment, according to the approved rules for remuneration of doctors and medical personnel working in the CHI system, is the quality of the medical services provided.

At the same time, reception conditions have been developed for doctors receiving patients, which is based on the permissible number of patients that can be examined in one shift or month. For each patient examined by the doctor, he will get additional interest to the salary depending on the size of the patient's insurance.

For example, therapists and pediatricians can accept no more than 20 patients during the day, for each of which the state agency will pay them an additional 7% of the applicable tariff for this service. In the case of obstetrician-gynecologists during surgical interventions, payment for doctor's services will increase by 15% of the tariff. And the assistant doctors will get 3% extra to their salaries after each operation. Dentists will receive the highest percentage of accruals—60% of the insurance payment after excluding the cost of all supplies.

In addition, the State Agency intends to increase the salary of surgeons, resuscitators, emergency doctors, obstetricians and gynecologists working on night shifts. Unlike doctors, the middle and junior medical personnel will continue to receive a fixed allowance in the amount of ₼40-790, depending on working conditions. By the way, the maximum allowance is for nurses.

How interesting these allowances will be for experienced doctors with good practice and considerable income is, of course, a good point. But all over the world private medicine is considered to be better than state medicine, while not everyone can afford it. We can hope that these allowances will help raise the level of state clinics in Azerbaijan, make medical services truly free, and eliminate corruption and bribery among medical staff. By the way, the state agency promises to fight with this evil zealously and asks citizens in no case to “thank” the doctors over the insurance paid...

Moreover, even the amount of co-financing, tariffs of medical services that are not included in the package of services, and other payments in medical institutions that use compulsory health insurance can now be made cashless by means of a bank card issued by the State Agency for Compulsory Health Insurance attached to the International Bank of Azerbaijan. In the future, the bank card will allow you to take advantage of other special preferences and additional benefits in the health sector.

Commission payments since April

Collection of CHI fees will begin in April 2020 for the entire employed population of the country. Resident of Baku will also pay fees, although the CHI system will cover the capital only by the end of the year. According to the State Agency, this is necessary to create a certain financial base in order to cover insured events immediately after the start of compulsory health insurance.

According to amendments to the law “On Compulsory Health Insurance”, representatives of the private and non-oil sectors will pay 1% of their salaries not exceeding ₼8,000 to the CHI fund in 2020. In 2021, deductions for this category of population will reach 2%. At the same time, employers will be required to pay 1% of the employee salaries in 2020 and 2% in 2021. In addition, 0.5% will be additionally deducted from the part of salaries exceeding ₼8,000.

Employees of oil and public sector will pay 2% of the salary less or equal to ₼8,000 and an additional 0.5% of the amount exceeding ₼8,000. For employers this indicator will also be 2% and 0.5%, respectively.

There is also a social package for children, students, pensioners, those who receive targeted social assistance, pregnant women, refugees, as well as foreign nationals and stateless persons. For them, the cost of service package will be ₼90 per year, which will be covered from the state budget.

Certainly, 1-2% of the salary is a tiny fraction, and it is unlikely that anyone will oppose paying the fees in exchange for free medical services. The real question is how much the expectations of the insured and the promises of the insurers will match the real situation in the future. So far, we can observe a certain level of distrust in society, the overcoming of which will take time and painstaking joint work of all involved structures. After all, we have waited long enough for the CHI to finally come to Azerbaijan. And now we need to give it a chance to take root in the country.