Paper/Speech Details of Conference Program for the 19th NISPAcee Annual Conference Program Overview Health Care, Health Reforms and Their Implementation Author(s) Lianna Mkhitaryan AdInfoSys Management Institute Yerevan Armenia Lianna Mkhitaryan Title Successes and challenges of health reforms in Armenia File Paper files are available only for conference participants, please login first. Presenter Abstract The country started implementation of health reforms in the initial phase reforms in public sector soon after the adoption of the Constitution in 1995. The reform policies lunched during the past fifteen years were aimed at structural and regulatory changes of the inherited highly centralized health system. The changes of the sector were focused in three directions: • decentralization, devolution and privatization; • implementation of new approaches to financing; • optimization and increasing the system’s effectiveness. Major changes included decentralization and the alteration of financing mechanisms. The responsibility for provision of health care services and ownership of facilities was transferred to local (primary health care) and regional (hospitals) governments; financial responsibility was devolved to facility level. Subsequent adoption of the relevant legislation enabled privatization of hospitals and health care facilities in the pharmaceutical and dental care sectors. New approaches to health financing were focused on diversifying revenues for the health sector, improving financial management and sustainability by linking financing to the quality and volume of services provided. Measures on optimization and increasing health system’s effectiveness included: rationalization of the system through the restructuring, reorganization of functions, and redistribution of resources. However, increased autonomy and responsibility did not provide sufficient stimuli to increase the cost–effectiveness and quality of services. At present, the country is increasingly engaged in reforming the system to overcome a gap in the distribution of human and technological resources, lack of strategic planning and state budget financing, etc. The goal of the research is to examine and analyze national policies, processes and outcomes of health reforms implemented in Armenia during 1990-2010. The research will use documentary analysis and non-standardized interviews. Documentary analysis will be used to review secondary sources of information, including analytical, informational and statistical materials from various sources and media information. Interviews with officials from the Ministry of Health will be carried out to gather primary information. The research will be implemented in accordance with research protocol and will contain introduction and three chapters. Chapter 1 will present the history of reforming health system in Armenia and the changes taken place in a) the decision-making power over the allocation of resources; b) the distribution of financial risks in health care funding between and within public and private sectors. Chapter 2 will provide demographic characteristics and economic data, health care resources, expenditures and normative issues, will give descriptive assessment of health sector governance system and contextual and historical features of major political positions, postures and trends at five points in time: 1990, 1995, 2000, 2005 and 2010. Chapter 3 will examine outcomes of the reforms including analysis of real achievements and remaining issues, with particular focus on economy, services accessibility and quality. Chapter 4 will summarize major findings of the research and make a synthesis of the main policy-making and implementation problems, internal and external successes, failures and country specific reform problems.
