Starting from April 1, 2021, compulsory health insurance covers the entire population of the country, spanning to all of its cities and regions. The “service envelope” (basic benefits package) includes primary care, emergency care, specialized outpatient care, laboratory services, physiotherapy, invasive radiology, and inpatient care.
Medical services within the specified package are provided to citizens across all health care providers, public and private, subordinate to the Azerbaijani Management Union of Medical Territorial Units (in native abbreviated as “TƏBIB”, a public legal entity under the State Agency for Compulsory Health Insurance, which manages health care providers participating in the national insurance system). In case if services in public health care organizations are not available, then other public or private health care organizations should provide services on a contractual basis.
In order to benefit from compulsory insurance services, citizens should first consult a family doctor, except in emergency cases. Family doctors are available in public primary health care institutions and are chosen in accordance with a national regulation (“procedure for referring insured persons to a public primary health care institution”). A family doctor issues a referral to a qualified specialist doctor if needed. When seeking medical care on the basis of a referral, an identity card needs to be presented to the registrar of the health care entity.
Except for a few health care organizations dedicated to treating COVID-19 cases only, all health care providers in the country, public and private, now serve patients under the compulsory health insurance scheme.
The launch of compulsory health insurance reform in Azerbaijan has been gradual, with key steps implemented in the last six years. State Agency for Compulsory Medical Insurance was established back in 2007 by the order of the President of Azerbaijan, but started its activities only after Presidential Decree #765 signed on February 15, 2016.
First, the compulsory health insurance has been launched as a pilot in two regions (Mingachevir and Yevlakh region since 2016); then a third region (Agdash region since 2018) joined. Since January 2, 2020, 24 more regions we covered by health care services under compulsory health insurance scheme. This meant that participating health care providers were now accessible to all the citizens. The number of participating regions was expanded again since January 1, 2021, covering a total of 36 regions and cities, but not yet the capital Baku and several other regions. Finally, only since April 1, 2021, compulsory health insurance covers 100% of regions of the country.
From the start of its operation, during the first five years, contributions for compulsory health insurance were made for citizens at the expense of the state budget.
Only from January 1, 2021, employers and employees started contributing to the national compulsory health insurance scheme by paying the fees. In accordance with the “Medical Insurance” Law of Azerbaijan, the collection of contributions for compulsory medical insurance which began from January 1, was intended for employers and employees working in the state and oil sectors, employers and employees working in the non-state and non-oil sectors, individuals performing work (services) on the basis of civil contracts, and individuals performing business activities. According to the State Agency for Compulsory Medical Insurance, with a salary of up to AZN 8,000 (approx. 4700 USD) a month, employers and employees of the state and oil sectors must pay 2% for compulsory medical insurance (from the salary fund of the employer and from the salary itself, respectively), if more than AZN 8,000 – an additional 0.5% is added.
According to a member of the working group on preparatory work on compulsory health insurance in medical institutions, director of the Central Hospital of Yevlakh region Azer Ismayilov, work is underway in medical institutions to improve the compulsory health insurance system, which helpd to increase the much-needed health financing. “Outpatient and polyclinic services will be provided in polyclinics. For this purpose, in the inpatient departments of hospitals, personnel who provide outpatient services are transferred to polyclinics. In order to improve the quality of emergency and urgent medical care, under the leadership of the State Agency for Compulsory Medical Insurance, ambulance departments were opened within hospital admission departments and severity-based “triage” procedures were introduced”, said Azer Ismayilov.
In addition, Azerbaijan is embarking into an ambitious digitaliziation of its health care and work is underway to create an information and communication technology (ICT) infrastructure, equip health providers with computers and provide access to the Internet. A compulsory health insurance database and corresponding software are being created. Staff of the reception and registration departments is being trained on software use to ensure data-based management of health care organization. The software allows online registration of citizens admitted to hospitals, store information about the clinical wards where a patient received care, details on health care team, prescribed examinations and treatment received (outpatient and inpatient). Digitalized health care will also facilitate citizens’ access to information on diagnoses and laboratory test results.
To summarize, starting from April 1, 2021, citizens across Azerbaijan can access all health care facilities as part of the nationally introduced health insurance scheme. To access health benefits, with the exception of emergency and urgent cases, a person must seek initial care from their family doctors. Primary health care facilities include polyclinics, family health centers and rural health centers. Citizens must document their choice of a family doctor by filling out an application. After having chosen a family doctor, a person can access all the specialized medical services guaranteed under the compulsory health insurance benefits package across the country.
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