Azerbaijan gradually transitioned to compulsory social health insurance
Overcoming the challenges by planning long-term
Azerbaijan enjoyed a dynamic economic growth after independence. Yet budgetary allocations for health in Azerbaijan were lower than in all other CIS countries in the 1990s and the 2000s. Out-of-pocket payments accounted for the largest share of the total health expenditure [1-2]. In 2014–2016, health expenditure per capita dropped sharply due to reduced budget revenues from oil. In 2019, the estimated universal health service coverage index in the country was 65.3, while out-of-pocket spending was at 68% of current health expenditure [2].
In 1999, the government introduced compulsory health insurance as an additional source of funding [3]. But it was not implemented immediately due to high prevalence of informal employment reported as 58% in 2001 [4], and difficulty in regular contribution payments for a large number of people [5]. This necessitated gradual shift and reform towards compulsory health insurance.
In 2007, the parliament established the State Agency for Mandatory Health Insurance (SAMHI), and in 2016 compulsory health insurance was piloted in two regions [1]. With a gradual rollout, health insurance covered the entire population by April 2021 [3].
The essence of compulsory health insurance model in Azerbaijan
The compulsory health insurance guarantees access to a comprehensive package of both inpatient and outpatient services and covers citizens of Azerbaijan, foreigners permanently or temporarily residing in the country, and stateless persons. Voluntary affiliation is allowed for those who are not eligible for mandatory participation [6]. Significant investments have been made to promote and enhance the impact of such health insurance through information and communication technologies and the integration of digital health services and tools [3].
Azerbaijan has unique reform design features. Medical services within the specified package are provided to citizens across public and private health care providers. Public health care organizations are subordinate to the Azerbaijani Management Union of Medical Territorial Units (locally called “TƏBIB”) – a public legal entity under the State Agency for Compulsory Health Insurance. This entity governs all health care providers participating in the national insurance system, including coordinating the activities of private providers. Providers subcontract services if they are not available immediately.
REFERENCES
[1] Ibrahimov F., Ibrahimova A., Kehler J., and Richardson E., Azerbaijan: health system review. Copenhagen: WHO Regional Office for Europe, 2010. Accessed 11 February 2022.
[2] Global Health Expenditure Database. Geneva: World Health Organization. Accessed 11 February 2022.
[3] P4H Network (2022). “Country Briefs: Social Health Protection and Health Financing Reforms”. Briefing Note for Azerbaijan, prepared by the International Labour Organization. Accessed on February 21, 2023.
[4] Novruzov N., Informal economy in the world and in Azerbaijan. KANT Social Sciences & Humanities. 2021:30–38. doi: 10.24923/2305-8757.2021-5.3.
[5] Bayramov B., Hasanov R., and Gasimova N., Perspectives on the Analysis and Development of Social Policies in Azerbaijan. In: Tajmazinani AA, editor. Social Policy in the Islamic World. Cham: Springer International Publishing, 2021: 225–240.
[6] Jafarova LA., Mammadov VG., and Mammadova LE., Azerbaijan’s Healthcare Legislation: Major Developments Amid the COVID-19 Pandemic. Eur J Health Law. 2021: 1–18. doi: 10.1163/15718093-bja10057.
