Armenia is a post-Soviet country in the South Caucasus bordering Turkey, Georgia, Azerbaijan and Iran. The economic crisis following Armenia’s independence in 1991 led to a substantial decline in access to and quality of health care services. The government’s commitment to free health care was becoming economically unfeasible in a climate characterized by rapid urbanization; lack of political momentum to enact impactful public health policies such as tobacco control; a weak primary care system; and low health service utilization. Patients often bypass the referral system and self-refer to specialists, risking an accurate diagnosis and timely care.
Armenia implemented substantive reforms after independence, including decentralization of service provision to regional governments, separation of purchasing and provider functions, and privatization of service. These reforms make up the new health system with self- or mixed-financed health services delivered by public and private service providers. During 2005-2019, total health expenditure as a percent of gross domestic product in Armenia nearly doubled from 5.86 percent to 11.38% and reached 12.24% in 2020 . Per capita current health expenditure (CHE) steadily grew from Int$ 313 in 2005 to Int$ 1721 in 2020, which is much higher than the average of 984 US dollars in the Commonwealth of Independent States in 2020. However, the share of out-of-pocket (OOP) spending in CHE in Armenia is not only the highest in the CIS, but also increased from 63% in 2005 to 85% in 2019. Today, OOP household spending remains the single largest source of financing health care, resulting in policy concerns around equity, financial protection, access, and the use of health services in Armenia.
The journey towards universal health coverage
A law adopted in 1996, On Medical Aid and Medical Services for the Population, created a system that allows patients to help pay for health care services and defined the legal, economic, and financial foundations of medical care provision based on the constitutional right to health care. In 2011, the Armenian government introduced copayments for adult emergency care services to increase government revenues. These copayments were introduced to better reflect the reality of payments at point of service. In 2023, the government announced phased introduction of comprehensive health insurance in Armenia after the concept of comprehensive health insurance was endorsed. First, a benefit package will be designed, including prices and a governmental cofinancing policy.