EVERYBODY, EVERYWHERE AND ALWAYS

Magazine R+ has long intended to write that introducing a mandatory health insurance (MHI) in Azerbaijan is long overdue. But the "alarm bell" that we could have done without was what happened with the two year old Imran Cafarzada in the Nabran Holiday Village resort. The tragedy that befell the toddler did not leave anybody indifferent: people immediately rushed to help and 11,000 manat were raised for his treatment in Germany. The president of Azerbaijan himself, upon hearing about this, took the issue under his personal control. That is, at the decision of the head of state, the government will shoulder all expenses to restore the baby's health.

Everybody is also aware of cases of TV journalists Haci Nuran and Gular Mammadova. Many people responded to calls by their friends and colleagues through the social networks, charity actions were held and soon the necessary funds were raised. And in the case of another journalist, Nicat Daglar, the head of state took the situation under his control.

Meanwhile, many people today require financial assistance in order to survive. Social networks are practically filled with reports about somebody in urgent need of expensive treatment in Azerbaijan or abroad. But it is just not feasible to help everybody. So many lives can and could have been saved if an established system of MHI operated in Azerbaijan.

Insurance in Azerbaijan

Through insurance it is possible to increase the volume of resources provided to health care, which will allow creating the necessary economic conditions for increasing the quality of medical service to the population. The necessary basis has been created for this in Azerbaijan: the law "On medical insurance" was passed back in 1999. However, the deficit of funds in the budget prevented its implementation. It is clear that today major efforts must be done in this direction since introducing this system right away is simply impossible.

The Azerbaijani Health Ministry believes that introducing the MHI is a multifaceted process that encompasses various issues, from salary deductions to the accreditation of medical facilities. Deputy Health Minister Elsevar Agayev said that the Cabinet of Ministers will decide on this only after all issues are resolved. Although back in 1999 Azerbaijan passed the law "On medical insurance", mandatory medical insurance is still not applied. "According to the legislation, the mandatory form of medical insurance is part and parcel of the state's social security and  ensures medical and pharmaceutical assistance to the population," he said.

It is already clear that three sources of funding for the MHI are being considered in Azerbaijan. Namiq Xalilov, head of the State Service for Insurance Supervision under the Azerbaijani Finance Ministry, reports that the draft project for the MHI aims to let each citizen of Azerbaijan have an opportunity to use a package of minimal medical services. The state officials have yet to reveal the mechanisms of developing this product, but the introduction of an effective system of medical insurance is one of the government's short-term plans.

"The time has come for actively applying mandatory health insurance in everyday life because over the past years as a result of the implemented social and economic policies the health care infrastructure has noticeably improved," Azerbaijani Finance Minister Samir Sarifov said during the forum.

So far only voluntary

What do insurance business professionals in Azerbaijan think about this? In a conversation with R+, Rafail Candirli, the deputy board chairman of one of the leading Azerbaijani insurance companies, said that currently incessant work is under way to improve the material and logistical base of the health care system. This is an integral part of applying the law "On mandatory health insurance". The repair of medical facilities, construction of new ones, supplying them with equipment and advanced technology, training of medical personnel: these are all general foundations for successful health insurance.

"Considering that our health care system still has the vestiges of the Soviet system, we are studying especially well the experience of former Soviet countries where mandatory health insurance is already enforced," the expert said.

He added that there is an undoubted advantage of medical insurance. With the right allocation of family budget and calculation of annual expenses it is quite easy to lay aside money for insuring oneself and family. The question that arises is if people actually need this? "Undoubtedly yes. We can describe it with a simple example. The head of the family is informed about the annual income of the family. He knows how much money is spent on food, clothes, and other necessities and how much remains for discretionary spending. As they say, no one is safe from trouble. In an accident it is possible to pay most of the expenses from the insurance policy, without damaging the family budget or consuming the main funds of the family income. This is much better than borrowing and getting into debt," the insurer said.

Mehriban Atakisiyeva, public relations specialist of another leading insurance company, told R+ that all conditions have been created in Azerbaijan for rendering quality and prompt medical help and services. Hence, mandatory health insurance can already be implemented. In her view, the only remaining problems are the relatively ill-developed culture of insurance, lack of information among the public about the insurance itself and its advantages. I would have made the expression "Insurance for everybody, everywhere and always" a slogan. Because in itself insurance is a very flexible and convenient fast-response system for rendering health care and other kinds of services. Spending a minimal amount of time citizens can receive high-quality insurance service when convenient for them. They will not have to stand in long queues and waste their precious time and nerves for this. It is enough to call an insurance agent who will without much effort do everything for them: appoint the time and place for a meeting to offer health care services," the insurance company's representative summed up. 

How does it operate?

Incidentally, the oldest system of health insurance exists in Germany. Back in 1883, during the reign of Kaiser Wilhelm I and Chancellor Otto von Bismarck, a law was passed that compelled every employee to bring part of his earnings to the so-called hospital account. This contribution accounted for two-thirds of the insured amount, with the employee paying the rest. This system still functions in Germany, although now it is certainly more complex and improved. The hospital accounts are non-commercial insurance funds, with the state strictly regulating their activities. The system of mandatory health insurance encompasses 90% of German citizens, with 8% taking out private insurance and the state paying for the remaining 2% of low-income people.

The situation is almost the same in France, only instead of hospital accounts large insurance funds operate there. Such systems of insurance function in Austria, Belgium, the Netherlands, Switzerland and many Eastern European countries. It is peculiarity is that the state spends relatively little on health care, placing the main burden on employers (50-60% of the payroll). Citizens themselves pay less: from 50-60% of the salary in France, to 13% in Italy, 9% in the Netherlands, and 7% in Japan. The result is that the rich pay for poor, healthy people for patients, employed for unemployed. The principle of social solidarity is at work and guarantees everybody, regardless of their income, the same level of medical service.

A different, budget-based, system operates in the UK, Sweden, Denmark and some North European countries. The majority of medical facilities there (almost 100% in Norway) belong to the state and health care is paid from the budget. Budget funds are allocated for doctors and medical facilities in accordance with the number of patients who visit them. That is, money is directed to cover the hospitals' expenses for patient care. What is more, in some cases state funds are allocated for private hospitals, which sign corresponding agreements to serve patients (specialized clinics with equipment lacking in state clinics in the given district).

When it comes to the USA, people are left to their own devices. Practically all of health care is private, large insurance funds exist and 80% of citizens have private insurances. In the absence of such an insurance treatment can result in sky-high bills.

According to WHO research, systems of health insurance possess an untapped potential to ensure universal access to health care. They facilitate an improvement in health because people who have a medical insurance are more likely to take advantage of health care services, both stationary and ambulatory, compared to people who do not have such insurance. However, today many low- and middle-income countries do not use such schemes to the full. In 2011, the 193 countries that are members of WHO expressed their readiness to reform their systems of funding health care to ensure universal access to medical services, but progress has been uneven, to say the least. WHO works with its member countries to support their efforts directed at ensuring universal access to health care. 

Undoubtedly, there are still many obstacles on the path to introducing MHI in Azerbaijan, and all of them require immediate attention. It is good that work is already under way in this direction. Time will show how the results will turn out …