Recently, the "shadow cabinet" of the opposition Armenian National Congress (ANC) party presented a reform program for the healthcare system. Ex-minister for Health (2000-2003) Ararat Mkrtchyan talks to "VK" about the main points of the program and the current situation in the Armenian healthcare system.
- What differences are there in the health indicators of today in Armenia with those of the Soviet period? What diseases are most widespread in Armenia and why?
- The average life expectancy has not changed a lot in comparison with the Soviet period, it has even increased a bit - for women these figures are 73.8 years, and for men - 70.4. But there some specific demographic changes, such as a two-fold reduction in the birth rate . The average age of the population shows that nowadays Armenia is a country with an aging population. Most of the childbearing Armenian population is abroad.
Heart and oncological diseases cause 70% of mortalities. Unfortunately there is a tendency to an age decrease of the population vulnerable to these diseases. This is caused by ecology, stress and other global
processes, which affect the population's health and of course defects of the healthcare system in general.
- What characterizes the healthcare system today?
- The system, unfortunately, is affected by a phenomenon of "gigantomania" and oligarchic tendencies, just as it was in the Soviet period. I regret to say that, among other issues, the healthcare system can be characterized by a scheme, whereby inner circles make decisions proceeding from their own financial interests. This is a new tendency in the healthcare system, but it badly affects the democratic development of this sphere.
The other characteristic feature of the today's healthcare system is irrational medical services and personnel assignment all over the country. The system is ineffective. The Soviet period bequeathed large hospitals, which are a burden on the budget and tax-payers, but still remain ineffective. Our healthcare system needs radical changes and modernization, which is reflected in our program.
- What is the main aim of the ANC's healthcare program? How do you see the resolution of the system's disadvantages?
- The ANC's healthcare program provides for the main principles of healthcare in Armenia - solidarity, fairness and transparency. The core of the program is the idea that the system should provide for a specific knowledge of how to protect oneself from a disease, rather than treat it. The situation in the country is the following: the
health care system passively waits for a person to become sick, and only afterwards starts working - this is absurd. Nowadays, healthcare systems all over the world are switching to disease prevention. And this is one of the main issues in our program - health protection. We propose the creation of a public health service, which will monitor the public health situation, and draw up programs aimed at disease prevention.
The other important step is increasing the system's effectiveness and its rationalization, in particular reduction of administrative expenditures. According to our data, on average hospitals spend 80% of their income on administrative payments and only 20% on health itself. Armenia needs small and compact hospitals, which don't need excessive financial resources.
- What scheme of financing do you offer?
- The existing system of medical payments is the most regressive today. Most of the diseases are unpredictable and when something happens to a person he is forced to seek money in order to pay for treatment.
We offer to implement a system of multi-financing - from budget, private payments, and individual medical savings accounts. Moreover, the program provides for compulsory health insurance - the most "civilized" way of payment for medical help, implemented in Europe and some CIS states, in particular Russia. This will result in better accessibility of medical services and social equality and fairness in this sphere. Within the framework of the program we propose to allot no less than 3% of the national GDP, currently this figure amounts to 1.6% of GDP spent on healthcare.
- It is a well known fact that the Armenian healthcare system is corrupt. Does your program provide for measures to reduce this?
- The reforms I've mentioned will, without doubt, decrease the level of corruption, but we do not expect it to be fast and easy. Meanwhile, according to the data of "Transparency International", healthcare, education and the judicial system are among top three most corrupt sectors in Armenia.
- Why hasn't the system been reformed yet?
- The reformation of any sphere requires three important conditions: financing, human resources and what matters most - political willingness. In case one of lack of even one of these factors, reform is impossible.
Interviewed by Susanna Petrosyan, Yerevan. Exclusively for VK.
