Market participant: Elimination of paid services in Azerbaijani public health facilities not agreeable with health insurance development concept

Azerbaijan, Baku, July 22 / Trend A.Akhundov /

Liquidation of the fee-based services and closure of the self-supporting accounts at the public health institutions in Azerbaijan is inconsistent with the idea of developing the health insurance market, said Anar Bayramov, Chairman of the Azerbaijani Insurance Company A-Qroup, the present-day leading health insurance company in the country.

"Since Azerbaijan abolished the self-supporting accounts at the public health institutions, they have no bills and no prices for medical services", he said. "Thus we cannot pay for medical care, as a result of [medical] state institutions being dropped from the health insurance system."

Therefore, he said, private clinics now have no competitors in the face of public health institutions and can dictate their terms to the insurance companies.

"Now, only private medical institutions can build relationships with insurance companies. Three years ago, we worked with the state medical institutions, which can in some ways compete with private medical institutions. It is clear that if there is absolutely no competition, no good will come of this. They can dictate the terms", Bayramov said.
On the other hand, he said, in a country which adopted the concept of mandatory medical insurance, public hospitals must adapt to this type of payment.

"They [public health institutions] should have tariffs, offer paid services, and the staff must understand that the insurance company will pay for these services", Bayramov said.
The director of the department of policy in health and reforms of the Public Health and Reforms Center under the Azerbaijani Health Ministry, Tohfa Jamilova, said the compulsory medical insurance does not stipulate any cash payments made by citizens or introduction of any paid services.

"Services in the compulsory medical insurance market are guaranteed by the state services, so the public will be provided free of charge. In connection to this, cancellation of paid services at public health institutions is completely feasible", Jamilova said.

In cases of voluntary insurance, companies themselves determine the service fees. In the case of compulsory insurance the state itself sets the tariffs and covers their costs.

Compulsory health insurance in Azerbaijan is planned to be introduced in 2011, Parliamentary Social Policy Committee Head, MP Hadi Rajabli told Trend earlier.
"The reason for the delay in the introduction of a new type of compulsory insurance is the lack of a mechanism", Rajabli said.

He said the law on compulsory health insurance in Azerbaijan was adopted in 1999, but its introduction was delayed for five years in order to simplify the tax burden. Later other justifications were brought up for the postponement.

"There are two types of financing health care services - from personal funds and budget in Azerbaijan. The list of funding sources will extend to two more - at the expense of compulsory medical insurance and funds of charitable and religious institutions", said Rajabli.

In December 2009 the Cabinet of Ministers of Azerbaijan established an Agency for compulsory health insurance. Creating the health insurance system is part of health system reforms, improving the quality of medical services. Annually the Public budget allocates funds for the implementation of this system. System testing took place in the Siyazan district, which was chosen as a pilot location.

The State Social Protection Fund of Azerbaijan (SSPF) earlier suggested its involvement in collecting funds for medical insurance, given the experience of the accumulation of contributions for compulsory social insurance. After the president's decision, the funds will be assembled by the Agency.
The exact percentage of transfers from the population's income will be specified after preparatory work is completed. "Most likely, these payments will be about 2.5-3 percent of the salary fund, taking into account the experience of countries where the compulsory health insurance is introduced", Rajabli said.

Under the SSPF recommendations, it was proposed to set payments on compulsory medical insurance, transfers of which will be implemented to a special fund for compulsory health insurance. The State Fund even offered to take on the collection of these funds.
The fund's studies have shown that $200 million have been spent for medical care in the country each year. To date, only a few companies and joint ventures carry out health insurance.

According to the State Insurance Supervision Service of the Finance Ministry, the Azerbaijani insurance companies collected premiums at 17.069 million manat (17.37 percent of total fees) and paid compensation to 9.282 million manat (34.7 percent of total payments) on the voluntary medical insurance, within six months.

Medical insurance is carried out in the form of compulsory and voluntary insurance.
Compulsory medical insurance, being part of the state social insurance program, provides a population with medical and medicinal aid in an amount corresponding to the program of compulsory health insurance. Voluntary health insurance, in addition to the established program of compulsory health insurance, provides medical and other public services through a contract for voluntary health insurance.

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