Preventive Programs, Strengthening Primary Healthcare, and New Beneficiary Groups: The Vision for the Development of the Universal Health Insurance System

The introduction of the Universal Health Insurance system is an important component of the reforms being implemented in the healthcare sector. However, for the effective development of the system, alongside insurance, it is necessary to continuously strengthen primary healthcare, develop digital health, infrastructure, and human resources. Samvel Kharazyan, performing the duties of the Acting Director General of the Universal Health Insurance Fund, spoke about this at the studio of “1in.am.”

Referring to the first phase of the system’s implementation, Samvel Kharazyan noted that the queues observed during the initial period of the system’s operation were due to citizens’ preference for choosing a specific medical institution or specialist. While the workload was high in certain areas at the beginning, there are currently no such critical points. According to Kharazyan, some regions still face a shortage of narrow specialists; however, the system’s flexible mechanisms have made it possible to respond to this issue as well: specialists travel to the regions, combine their work at different medical centers, and provide consultations and perform surgeries. Kharazyan emphasized that the prices of services reimbursed by the Fund are the same for medical centers in Yerevan and the regions, while uniform requirements apply to their quality and conditions of provision.

According to Kharazyan, preventive healthcare is one of the key pillars of the system. The insurance package includes screening programs aimed at the early detection and prevention of oncological and cardiovascular diseases, diabetes, and other diseases. In parallel, work is being carried out to provide the necessary equipment, develop infrastructure, and train specialists. As part of the reforms, it is also planned to enhance the role of nurses. Education and training programs are being developed that will make it possible to transfer certain functions within preventive visits to nurses, while at the same time reducing the workload of doctors.

According to Kharazyan, another important task is to develop preventive behavior among the population. For years, due to financial constraints, many citizens sought medical care only after a health problem had already emerged, whereas one of the system’s goals is to encourage people to monitor their health while they are still healthy. Notably, from 2029, the use of relevant preventive services is planned to become a condition for fully benefiting from the insurance package.

According to the recorded data, the main healthcare burden continues to consist of non-communicable diseases, including cardiovascular, oncological and respiratory diseases, as well as diabetes. A significant proportion of these can be managed more effectively through early detection, continuous monitoring, and access to necessary medication. For this reason, prevention is viewed as an important means of reducing mortality and disability caused by diseases.

According to Kharazyan, particular attention is being paid to increasing trust in primary healthcare. Previously, due to limited funding, after a consultation with a family doctor, citizens had to pay for the necessary examinations and medications out of their own pockets. From this perspective, the introduction of insurance was revolutionary. According to Kharazyan, work is also being carried out in parallel to upgrade polyclinics and rural outpatient clinics and introduce digital tools.

Kharazyan noted that new beneficiary groups will join the system starting in 2027, creating a new stage of development for the Fund while also presenting new challenges. It is also planned to assess the impact of the insurance package on citizens’ out-of-pocket healthcare expenditures through relevant studies and surveys.

The vision for the further development of the system includes the continued inclusion of cost-effective services, the application of flexible financing mechanisms, and the development of the capacity to respond rapidly to changes in the healthcare sector.