Skip Navigation
Armenia

Exploring Medical Assistance Program (AM0043)

Overview

At-a-Glance

Action Plan: Armenia Action Plan 2018-2020

Action Plan Cycle: 2018

Status: Active

Institutions

Lead Institution: Ministry of Healthcare

Support Institution(s): Ministry of Labour and Social Affairs of the Republic of Armenia and other state agencies Healthcare and social sector NGOs

Policy Areas

E-Government, Health, Marginalized Communities, Public Service Delivery, Records Management

IRM Review

IRM Report: Armenia Design Report 2018-2020

Starred: Pending IRM Review

Early Results: Pending IRM Review

Design i

Verifiable: Yes

Relevant to OGP Values: Access to Information Technology

Potential Impact:

Implementation i

Completion:

Description

9. Possibility of on-line listing of state guaranteed free of charge medical assistance and services for citizens living in under privileged conditions
Commitment Start and End Date Commitment Start: February 2019
Commitment End: August 2020
Lead implementing agency Ministry of Healthcare
Person responsible from implementing agency Tsaghkanush Sargsyan
Title, Department Advisor to the Minister of Healthcare of the Republic of Armenia
Email: ts.sargsyan@moh.amPhone (+374 60) 80-80-03 / 1130
Other actors involved Other state actors involved Ministry of Labour and Social Affairs of the Republic of Armenia and other state agencies
Civil society, private sector Healthcare and social sector NGOs
Issue subject to regulation At the moment, the citizen has to go from one medical institution to another, stand in queues, make a call, at best, to find out in which medical institution he or she can be listed and receive medical assistance and servicing that are free of charge for those living under-privileged conditions, as guaranteed by the state. And very often the medical institution can provide incorrect information.
Main objective Regulation of queues occurring in medical institutions through delivering online the limitations of financing, electronic referrals and registration, as well as reducing inconvenience related with patients’ time and financial costs, especially for marzes’ residents.

Brief Description of Commitment At the moment, to raise the public awareness of works actually done, existing places and listings in medical organisations carrying out medical assistance and servicing that are free of charge and under privileged conditions, guaranteed by the state, and to make it transparent, the website https://www.armed.am/govlimits/ has been created, in which the above-mentioned data in three colours — red (consumed), yellow (listed) and green (available), and financial thresholds are shown. The source of showing the thresholds is the data entered in the system for each medical organisation within the scope of state funding. The source of data will be more clarified and simplified for the citizen (these services are grouped as their aim is the threshold and financing for the medical organisation).
A possibility of on-line listing will also be created. The doctor providing referral will enter the number of the referral in the system and, in addition to the information entered regarding the issue; additional necessary documents will be attached by him/her as well. The patient will be listed from his or her page of the existing system, selecting the medical organisation, and attaching the referral. The doctor providing the referral will also be able to carry out on-line listing instead of the patient. Listing will be carried out in the selected medical organisation based on the application, and the patient will be informed about that. To avoid falsifications, the system will perform verification of the number of the referral during listing.
The citizen will receive information about the day of receipt of medical assistance at the given medical organisation and will have the opportunity to assess the given function from his or her page.
OGP challenge addressed by the commitment Enhancing public confidence, ensuring transparency of availability and improvement of the quality of public services, decrease of corruption risks.
Relevance to OGP values Transparency: on-line provision of information about the financial thresholds will ensure transparency of works done in medical organisations carrying out medical assistance and servicing that are free of charge and under privileged conditions, guaranteed by the state.
Participation and innovation: the possibility of on-line listing and feedback will ensure the participation of citizens in the healthcare sector will raise the level of responsibility of medical organisations and will improve the quality of service provided.

Ambition The commitment will ensure oversight over and transparency of services provided within the scope of the state funding in medical organisations.

Promotes efforts for implementation of SDG Goals or Targets 3.8 : Achieve universal health coverage, including financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all

Verifiable and measurable criteria for performance of commitment Start: End:
Ongoing Actions
Development of a task force for the listing system February 2019 April 2019
Improvement of the tables of limits in the system and block of information on provision of electronic referrals and creation of a listing block on the https://armed.am website of the http://www.ehealth.am software April 2019 August 2019
Pilot trial of the created system at several medical organisations. August 2019 September 2019
Correction of drawbacks identified during the pilot, revision of legal documents October 2019 November 2019
Introduction of feedback, and public awareness November 2019 August 2020

IRM Midterm Status Summary

9. Exploring Medical Assistance Program

Language of the commitment as it appears in the action plan: [81]

Brief description: At the moment, to raise the public awareness of works actually done, existing places and listings in medical organisations carrying out medical assistance and servicing that are free of charge and under privileged conditions, guaranteed by the state, and to make it transparent, the website https://www.armed.am/govlimits/ has been created, in which the above-mentioned data in three colours — red (consumed), yellow (listed) and green (available), and financial thresholds are shown. The source of showing the thresholds is the data entered in the system for each medical organisation within the scope of state funding. The source of data will be more clarified and simplified for the citizen (these services are grouped as their aim is the threshold and financing for the medical organisation).

A possibility of on-line listing will also be created. The doctor providing referral will enter the number of the referral in the system and, in addition to the information entered regarding the issue; additional necessary documents will be attached by him/her as well. The patient will be listed from his or her page of the existing system, selecting the medical organisation, and attaching the referral. The doctor providing the referral will also be able to carry out on-line listing instead of the patient.  Listing will be carried out in the selected medical organisation based on the application, and the patient will be informed about that. To avoid falsifications, the system will perform verification of the number of the referral during listing.

The citizen will receive information about the day of receipt of medical assistance at the given medical organisation and will have the opportunity to assess the given function from his or her page.

Milestones

9.1 Development of a task force for the listing system. [82]

9.2 Improvement of the tables of limits in the system and block of information on provision of electronic referrals and creation of a listing block on the https://armed.am website of the http://www.ehealth.am software.

9.3 Pilot trial of the created system at several medical organisations.

9.4 Correction of drawbacks identified during the pilot, revision of legal documents.

9.5 Introduction of feedback, and public awareness.

Start Date: February 2019

End Date: August 2020

Context and Objectives

Individuals who are entitled to receive free, state-supported medical care in Armenia (such as vulnerable social groups and patients with specified diseases) [83] must currently undergo a time-consuming procedure to receive such care. First, they must obtain a referral from a primary health-care institution, state medical commission, or other authorized state agency. Next, they have to find the medical organization (hospital) providing necessary services. Further, since the budget for free medical services is limited, citizens often have to be enlisted in a hospital and wait to receive care. According to studies by civil society organizations, wait times for medical care vary between two and 10 months.

Apart from being time-consuming, the procedure to enlist lacks transparency and opens the possibility for corruption. [84] For example, illegal payments or other informal mechanisms are applied to serve patients “out of queue,” or patients are offered to be served for a fee to receive timely and effective health care. Apart from corruption risks, the enlisting procedure creates several difficulties for vulnerable groups. Individuals may have to search for hospitals with available funding or negotiate with several medical institutions. Sometimes, they may have to travel to another region or city for medical assistance.

Information about the financial thresholds and remaining funding per medical institution is already provided online on the armed.am website, administered by the Ministry of Health. [85] This commitment aims to improve this information and allow citizens to reserve a place in the queue online to receive state-supported medical services in a specific institution. This commitment also includes a feedback mechanism for users to identify existing problems so that decision makers can apply targeted solutions based on the feedback received.

The IRM researcher and interviewed stakeholders see several limitations for this commitment. First, the use of internet for public services is still limited among the population. This is especially important considering that this commitment targets vulnerable groups who might lack the necessary computer equipment or internet access to use the newly available services. [86] Next, registration in the system (which is necessary in order to enlist) requires that the user have an ID card, [87] and most of the population does not have such a card. [88] Finally, some stakeholders doubt that citizens would prefer an electronic system to personal communication, particularly elderly people who do not use the internet. [89] However, as mentioned in the commitment, citizens can also enlist with a doctor referral. Thus, an alternative solution will be available in case the patient does not want or is not able to use the system her/himself.

If implemented, this commitment could allow citizens to enlist in a specific institution online. Online enlistment would help reduce personal interactions containing corruption risks. It could also facilitate an easier health-care enlistment process. Citizens will use online channels instead of having to visit medical institutions in person (and, for those who are less experienced with online forms, doctors can assist them in the online registration). However, given the limitations mentioned above, and the coverage of only several medical institutions in the period of action plan implementation, the potential impact of this commitment is assessed as moderate.

Next steps

The IRM researcher recommends the following steps be taken to ensure effective implementation and the strongest impact of the commitment:

  • Clearly specify the principles of selecting medical institutions for piloting the enlisting system.
  • Clarify the possibility to enlist without an ID card or with the help of doctors or other medical staff. If possible, citizens should be provided an opportunity to register in the system through a simple login and password entrance, which might be provided by their primary health-care institution. The ability to use the platform without an ID card should be provided without undermining the credibility and accessibility of the platform.

The possibility of providing feedback also needs clarification. The government should clarify whether feedback would be allowed on the enlisting process only or if it would accept general feedback on services provided by the medical institutions. It should also clarify how the feedback will be considered. Moving forward, the government can further address other transparency and accountability issues in the health-care system. Commitments can cover several issues mentioned in civil society organization reports, [90] as well as those mentioned by interviewed stakeholders, including the following:

  • clear and transparent procedures for monitoring health-care quality,
  • publication of health-care monitoring results,
  • transparency of the prices and volume of medicine purchased by state,
  • publication of the available list of state-provided medicine in medical institutions, and
  • publication of price lists and pricing mechanisms for paid medical services.
[81] Government of the Republic of Armenia, OGP Armenia Action Plan 2018-2020, https://www.opengovpartnership.org/wp-content/uploads/2018/12/Armenia_Action-Plan_2018-2020_EN.doc.
[82] In Armenian version: “Development of Terms of Reference for the listing system.OGP Armenia Action Plan 2018-2020, Armenian version, https://www.opengovpartnership.org/wp-content/uploads/2018/12/Armenia_Action-Plan_2018-2020_ARM.doc.
[83] Government of the Republic of Armenia, Decision № 318-N, "On State-Guaranteed and Free-of-Charge Medical Care and Service," 04 March 2004, https://www.arlis.am/DocumentView.aspx?DocID=128068.
[84] Regional Development and Research Center, and Transparency International Anticorruption Center, Corruption Risk Assessment in State-Guaranteed Medical Assistance Provided Free of Charge and under Privileged Conditions, 2016,  https://transparency.am/files/publications/1465990875-0-326756.pdf.
[85] “Works Actually Done, Existing Places and Listings in Medical Organizations Providing Medical Assistance and Services That Are Free of Charge and under Privileged Conditions, Guaranteed by the State,” Armed.am, https://www.armed.am/govlimits/.
[86] Gayane Martirosyan (World Vision Armenia), phone interview by IRM researcher, 19 February 2019.
[87] Tsaghkanush Sargsyan (Ministry of Health), phone interview by IRM researcher, 21 February 2019.
[88] According to the information provided by EKENG cjsc— the company authorized to issue electronic digital signatures in Armenia—about 1 million citizens of Armenia have ID cards (electronic communication with EKENG cjsc by IRM researcher, 06 March 2019).
[89] Liana Doydoyan (Freedom of Information Center of Armenia), interview by IRM researcher, 18 February 2019.
[90] Regional Development and Research Center, and Transparency International Anticorruption Center, Corruption Risk Assessment in State-Guaranteed Medical Assistance Provided Free of Charge and under Privileged Conditions, 2016https://transparency.am/files/publications/1465990875-0-326756.pdf.

Commitments

  1. Open Data in Official Declarations

    AM0035, 2018, Asset Disclosure

  2. Government Grant Transparency

    AM0036, 2018, Fiscal Transparency

  3. Beneficial Ownership Register

    AM0037, 2018, Anti-Corruption Institutions

  4. Modernization of Community Website

    AM0038, 2018, E-Government

  5. State Water Cadastre

    AM0039, 2018, E-Government

  6. Land Cadastre

    AM0040, 2018, E-Government

  7. Integrated Social Services

    AM0041, 2018, E-Government

  8. Unified Information System for Management of Education

    AM0042, 2018, Capacity Building

  9. Exploring Medical Assistance Program

    AM0043, 2018, E-Government

  10. Platform for Submitting Petitions

    AM0044, 2018, E-Government

  11. Public Service Dashboard

    AM0045, 2018, E-Government

  12. State Travel Transparency

    AM0027, 2016, E-Government

  13. Accountability for Grants of the Government

    AM0028, 2016, E-Government

  14. Transparency of the State Budget

    AM0029, 2016, Fiscal Transparency

  15. "Open Data" in Official Declaration:

    AM0030, 2016, Anti-Corruption Institutions

  16. Portal for Community Decisions.

    AM0031, 2016, Capacity Building

  17. Accountability Licensing

    AM0032, 2016, Capacity Building

  18. Accessibility of Integrated Social Services

    AM0033, 2016, E-Government

  19. "One-Stop-Shop" Pilot Project Within Military Registration Offices

    AM0034, 2016, Capacity Building

  20. Digitization and publication of data in the “Republican Geological Fund” SNCO

    AM0016, 2014, Extractive Industries

  21. Ensuring Transparency in Mining

    AM0017, 2014, Extractive Industries

  22. Ensuring Public Awareness About Health Care Financing

    AM0018, 2014, E-Government

  23. Ensuring Transparency of Asset and Income Declarations of the RA High-Ranking Officials

    AM0019, 2014, Asset Disclosure

  24. Online Broadcasting of the State Procurement Appeals Board Sessions

    AM0020, 2014, E-Government

  25. Community Microsurvey Introduction in 10 Communities

    AM0021, 2014, E-Government

  26. Ensuring Open, Transparent, Participatory and Accountable Process of State Policies and Legislative Reforms

    AM0022, 2014, E-Government

  27. Public Awareness on the Lawmaking Activity of State Governance Bodies

    AM0023, 2014, E-Government

  28. Ensuring Transparency of the Election of Governing Boards of the RA General Secondary Education Institutions and of the Annual Budget Planning and Expenses of Ra General Secondary Education Institutions

    AM0024, 2014, Education

  29. Knowledge and Capacity Building of Public Servants in the Freedom of Information and Anticorruption Field

    AM0025, 2014, Capacity Building

  30. Ensuring Transparency of Local Self Government Bodies of Large Communities

    AM0026, 2014, E-Government

  31. Reviewing the Regulatory Normative Legal Acts (Regulatory Guillotine Project)

    AM0001, 2012, Legislation & Regulation

  32. Improving Internal Audit System for the Public Sector

    AM0002, 2012, Audits and Controls

  33. Improving Procurement Procedures

    AM0003, 2012, Capacity Building

  34. Improving Budget Planning and Reporting Systems Through Full Utilization of Program Budgeting

    AM0004, 2012, Audits and Controls

  35. Promoting Transparency and Objectiveness in Tax Administration

    AM0005, 2012, Conflicts of Interest

  36. Fight Against Corruption

    AM0006, 2012, Anti-Corruption Institutions

  37. Introduction of a Unified Payment System (Portal)

    AM0007, 2012, E-Government

  38. State Car Inspection Improvements

    AM0008, 2012, Infrastructure & Transport

  39. Implementation of an Electronic System for Consular Services

    AM0009, 2012, Citizenship and Immigration

  40. Implementation of Mail-Armenia System

    AM0010, 2012, Citizenship and Immigration

  41. Introduction of e-Statistics System

    AM0011, 2012, E-Government

  42. Introduction of e-Documentation Sharing System in Urban Communities

    AM0012, 2012, E-Government

  43. Ensuring Transparency of Asset Declarations

    AM0013, 2012, Asset Disclosure

  44. Standardization of Offical Websites Content

    AM0014, 2012, E-Government

  45. Improvement of Knowledge and Skills of Public Servants on Access to Information

    AM0015, 2012, Capacity Building