Exploring Medical Assistance Program (AM0043)

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

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.

9. Exploring Medical Assistance Program

Completion: Substantial

The Ministry of Health has improved the information on available funding by medical institutions and type of assistance by providing contact details and location of institutions on the armed.am website. [48] The new enlisting system allows users to register on a wait list of preferred medical institution by inputting the doctor’s electronic referral number. Since 1 April 2020, doctor referrals have been provided electronically, and the enlisting has been carried out only through the electronic platform. As a first step, the enlisting has been implemented by the doctors who provided the referral based on the patient’s preferences. Due to COVID-19, the government postponed the planned public awareness-raising activities and feedback collection. [49]