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"Open Door" day to strengthen public participation in compulsory health insurance - P4H Network

“Open Door” day to strengthen public participation in compulsory health insurance

The State Agency for Compulsory Health Insurance of Azerbaijan had “Open Doors” for the media and civil society on April 5, 2024, to share how the single payer monitors health care quality in light of social health insurance launched across the country. The monitoring focused on how health insurance is arranged at public health care facilities and on the quality of medical services.

The State Agency for Compulsory Health Insurance of the Republic of Azerbaijan (hereafter — Agency) held an “Open Door” day in order to strengthen public participation in compulsory health insurance, ensure transparency, and inform the public about the Agency’s activities. Media and civil society representatives got acquainted with the procedure of monitoring by the Agency, conducted in public healthcare organizations, as stated in its news publication.

Aynura Ahmadova, Head of the Marketing and Public Relations Department, gave an opening speech at the event. She reminded that the single payer aims to ensure a smooth use of health insurance by the people, to improve health service quality and, as a result, to increase public satisfaction. It was noted that the work on monitoring is done in 2 directions. The single payer’s tasks are: 1) to evaluate business processes on how compulsory health insurance is organized in healthcare organizations, and 2) to evaluate of the quality of healthcare services provided within health insurance coverage.

A presentation on the first direction was made by the Bayali Mammadov, Head of the Monitoring Department, who said that the single payer has monitored 101 state (public) healthcare organizations across the country in 2023. He added that they used certain criteria that helped them to assess the organization of services covered by compulsory health insurance, the admission and registration processes, the availability of digital services, and sufficiency of supplies and equipment. According to Mr. Mammadov, after analyzing the results of the monitoring, the discovered deficiencies were sent to TABIB — the owner for all state (public) healthcare organizations in Azerbaijan.

Nijat Shirinov, Head of the audit expertise department for public healthcare organizations, made a presentation on the second direction. He stressed that one of the main goals of the Agency is to ensure access to high-quality medical services. He said that “Quality of the service does not just mean building renovations, modern technological equipment, and supplies. The quality of medical care is based on a chain of mechanisms, including all examination and treatment procedures, starting from  the electronic registration at the initial visit by the patient, and requires control at every stage.” N. Shirinov also described the criteria sued to monitor the quality, efficiency and timeliness of care.

As the newly independent post-Soviet countries are implementing compulsory social health insurance, they are all implementing the function of health service quality monitoring by the payer to ensure value for money. Different countries are approaching the implementation differently, but the common feature in the design of the social health insurance model is that the single payer (the health insurance fund or its regional branch) acts as the purchaser of health services on behalf of people (patients / users) and therefore, has a duty to monitor the quality of care and other services. In addition to auditing (monitoring) clinical care quality, the payer also ensures the user-friendliness and accessibility of health insurance services

The State Agency for Compulsory Health Insurance, 101 medical institutions were involved in monitoring by the agency, SACHI of Azerbaijan