Additional Contributions from Income for Health Insurance: What is Known

Starting in 2024, a comprehensive health insurance system will be implemented in Armenia. The Ministry of Health proposes that working citizens allocate a monthly amount from their income to the state for the health insurance of all residents of Armenia. This information is reported by Hetq.am.

If a person has no income or is below the average level, healthcare services will be funded from the state budget, which is also generated from the taxes paid by these working citizens. "The state's co-financing amount will be determined based on the income and behavior of beneficiaries," the proposed draft states.

Deputy Minister of Health Lena Nanushyan states that the amount of the contribution will depend on the list of services included in the package. If more services are added, the amount will increase, and vice versa. In a discussion in 2022, the deputy minister mentioned that working citizens would contribute 6% (of which 3% would be from the employer), but no specific number is mentioned in the presented draft.

According to data from the end of 2019, 21.6% of the population in Armenia is employed, and this group will bear the primary burden of the universal insurance. Of course, insured individuals over the age of 18 will enjoy a much broader range of services. However, the Ministry of Health justified that part of the population in Armenia often falls into poverty due to healthcare costs.

According to the developers of the project, the implementation of the system will not only reduce morbidity and mortality rates, but will also “contribute to the development of human capital and economic growth.” The list of services provided by health insurance has been compiled by studying and analyzing people's accesses. The Ministry of Health stated this last year. Deputy Minister Lena Nanushyan stated that the proposed package includes the best services, and "covers 90-95% of the entire spectrum."

What is included in the list of surgeries?

The Ministry of Health indicates that the package includes "nearly all surgical services," except for surgeries performed using the latest technologies (including plastic surgeries), most of which are not feasible in Armenia. Specifically, included are pediatric and neonatal surgery, general, vascular, maxillofacial, endocrine, thoracic surgery, ophthalmic, orthopedic and traumatological, neurosurgical, micro-surgical, gynecological, ENT, and urological surgeries. For insured individuals under and over 18, these will be completely free, while for those over 18, these surgeries will be free only in emergency cases.

In dentistry, surgical treatment for up to two teeth will be performed for both insured and uninsured citizens. For individuals under 18, this service will be free of charge without limitations. Endovascular surgery will also be free for children, while for insured and uninsured individuals, this service will only be free until the age of 78.

Cardiac surgeries for children will be free, and insured individuals over 18 will have the opportunity for heart stenting with the installation of up to 3 drug-coated stents, arrhythmology (device installation for a minimum of 3 years of operation). For uninsured individuals over 18, heart stenting will be free with the installation of only 1 stent, and only in emergency cases (more detailed information is provided below).

Also included in the package are surgeries for malignant neoplasms.

Cancer Treatment

Since 2019, surgeries for malignant neoplasms have been performed free of charge in Armenia. This package also states that surgeries for malignant neoplasms and radiation therapy services, as well as chemotherapy medical assistance and services for children, are fully covered by the state. Antineoplastic drugs are also provided, but which specific drugs are not mentioned.

Individuals over 18 who will have universal health insurance will receive surgery for malignant neoplasms and radiation therapy with compensation for up to 22 sessions, chemotherapy medical assistance and services with compensation of up to 1.6 million drams. They will be provided with pain relief medications and narcotics or psychoactive substances.

Individuals over 18 without insurance will have access to half as much in terms of malignant neoplasms surgery and radiation therapy—up to 10 sessions and 10 times less in funds for chemotherapy medical assistance and services, limited to 150,000 drams.

This group will receive the same pain relief medications and narcotics or psychoactive substances from the state for free.

Treatment for Cardiovascular Diseases

As mentioned, cardiovascular services, including cardiac surgery, arrhythmology, and endovascular surgeries, will be 100% guaranteed for children under 18. Insured individuals over 18 will have the opportunity to receive heart stenting with the installation of up to 3 drug-coated stents, arrhythmology (device installation for at least 3 years of operation). Uninsured individuals will only have the option for stenting with only one stent installed in urgent cases, meaning nothing has changed for them, as the free heart stenting state program has been in effect in Armenia since 2015.

The Ministry of Health emphasizes in the project that "the entire economy of Armenia suffers losses due to diseases or material and non-material investments not made by individuals with disabilities from an early age." Moreover, the years of life lost due to disabilities from cardiovascular diseases in Armenia amount to 4,306 per 100,000 population, which equates to approximately 350 deaths annually caused by these diseases.

According to estimates from experts involved in the project, cardiovascular diseases and diabetes can reduce GDP by 6.77% in low- and middle-income countries. In Armenia, 60% of individuals under 60 with disabilities are affected due to cardiovascular diseases and diabetes.

Diabetes Treatment

For those with diabetes, nothing will change as both insured and uninsured individuals will continue to receive antidiabetic drugs for free from the state.

Transplant Services

The Ministry of Health announces that transplant services are also included in the insurance, but upon reviewing the appendix, it becomes clear that this service is 100% compensated for those under 18, while individuals over 18 with insurance will have the state cover 30% of transplant expenses. Uninsured individuals over 18 will not benefit from this service.

Epilepsy

As with those with diabetes, individuals with epilepsy, regardless of age or insurance status, will continue to receive free antiepileptic medications, as was done before the insurance.

Screening Programs

Preventive medical assistance, screening programs, mandatory medical examinations, and laboratory-instrumental diagnostic examinations will be 100% free for under 18 and insured individuals over 18. Uninsured adults will benefit from screening programs only.

Laboratory-Instrumental Examinations

Individuals under 18 and insured adults will receive consultation from their primary care physician, and if necessary, they will get referrals for consultations with specialists and referrals for laboratory-instrumental examinations based on medical indications, including special and difficult-to-access laboratory-instrumental diagnostic studies, free of charge. Uninsured individuals over 18 will also benefit from these services but in a limited quantity; for example, they will receive only consultations from a primary care physician and referrals based on medical indications for general laboratory-instrumental studies (general blood and urine examination, biochemical blood tests (up to 7 components)). These individuals will receive consultations from specialists only if registered with a chronic illness, and not more than 4 visits per year.

Specialized consultations and mandatory laboratory-instrumental diagnostic studies during pregnancy monitoring will be free for representatives of all groups, both insured and uninsured.

Palliative Care Services

This service will only be provided free of charge to insured individuals over the age of 18, while, according to data from 2022, there are about 3,000 children in Armenia who need palliative assistance.

Some dental services are also included in the package, but expensive services such as implant placement are not included. Dental medical services will be free for children under 18. Citizens with insurance will receive free urgent dental medical assistance (examination and tooth extraction, surgical treatment for up to 2 teeth, dental prosthetics for individuals aged 63 and older). In the case of uninsured adults, only individuals aged 63 and older will have the opportunity for examination and tooth extraction, surgical or therapeutic treatment for up to 2 teeth, and dental prosthetics.

Assistance Provided to Pregnant Women

Specialized consultations during pregnancy monitoring, mandatory laboratory-instrumental diagnostic tests, as well as obstetrical, prenatal, and postnatal medical assistance and services will be free for representatives of all age groups, both insured and uninsured.

Other Services

Medical assistance for intestinal and other infectious diseases will be free for children under 18 and insured individuals over 18, while uninsured individuals will only benefit from this service during exacerbations. Medical services for tuberculosis, HIV/AIDS, mental and neurological illnesses, hemodialysis, as well as outpatient emergency medical assistance in hospital conditions will be free for everyone.

Medication Package for Chronic Diseases

The Ministry of Health states that a package of medications applied in primary care for chronic diseases has also been calculated and studied, which will also be available to individuals.

For further details, please visit the website.