Science, education and healthcare must keep pace with the demands of technological advancements. The current state of funding for science, education and healthcare is simply unacceptable for a nation that considers itself civilized (about 11% of GDP is allocated to education, science gets 0.24% of GDP and health 1.7%).

Technological modernization of science, education and healthcare as well as adaptation to modern challenges is of key importance. 

The reform of the healthcare system presupposes a transition from medical care to preventive care, comprehensive health insurance, and the development of high-quality pharmaceutical and biotechnology industries. Accordingly, the following should be the key directions of state policy:

Gradually increase the funding allocated to the healthcare sector to at least 3% of GDP within the next five years. 

Continuous professional development of teachers, lecturers and healthcare workers and implementation of large-scale state-sponsored training programs in accordance with the latest technological advancements. 

Make a gradual transition to comprehensive (compulsory) health insurance, based on the principle of "the rich pay for the poor, the healthy for the sick, the worker for the unemployed, and the young for the elderly." In order to provide universal insurance coverage in the next five years, along with the gradual increase of insurance premiums by individual policyholders (employees, employers, state budget), increase the coverage of new groups of the population, as well as the volume of insured medical care.

Draft relevant legislation to implement elements of outpatient treatment both at the national level and within the framework of international agreements.

Develop the production of medicines, pharmaceuticals, medical devices and equipment using the latest technologies, with an emphasis on their production in the fight against the epidemic.

Implement a special state program for the rehabilitation and integration of soldiers disabled in the Artsakh war.

By 2023, we will introduce a comprehensive health insurance system, ensure access to basic services for all citizens of the Republic of Armenia. We will make available a package of outpatient medicine, as well as a package of special, hard to obtain diagnostic tests. We will include mandatory medical examination packages for different risk groups. We will introduce practical mechanisms for quality control of medical care to ensure the effective implementation of the insurance system. 

As a result, while receiving health services, a citizen will not be required to cover the catastrophic expenses that can lead to impoverishment. We will guarantee access to high quality healthcare for every citizen.

We will conduct free preventive medical examinations to protect maternal and child health. We will also include free screening tests for teens to detect and treat reproductive health problems. Services aimed at early detection and coping with the issue of infertility, as well as additional testing at the early stage of pregnancy, aimed at identifying problems with mother and child, will be expanded and provided for free. We will also expand free screenings for non-infectious diseases and every citizen included in the risk groups will be able to pass a free examination for the early detection and treatment of cancer, cardiovascular diseases and diabetes.

As a result, we will have early detection of diseases and a more effective treatment, less premature mortality and a higher birth rate.

By 2023, we will introduce a complete electronic healthcare system. Citizens will have access to their medical records online. Through the electronic system it will be possible to register online to receive service in a medical institution, to receive the prescribed medicine from pharmacies with an electronic prescription, to automatically organize the process of transferring the disability certificate to an employer, to receive standard medical certificates. Electronic medical records will be available for use at various medical facilities.

As a result, more efficient and better quality services will be provided in the healthcare sector, which will contribute to the reduction of double examinations, and consequently reduction of expenses, both for the state and citizens. We will also ensure that health-related data is properly collected and analyzed, which will in turn lead to a targeted, efficient and transparent distribution of funds.

For the uninterrupted operation of the healthcare system in emergency situations, we will create reserve logistical resources, professional potential, necessary capacities and effective systems for their expansion and mobilization.

As a result, in case of the outbreak of an epidemic or any other emergency situation, we will have developed rapid response mechanisms that will include accessible medical services, drug stockpiles and medical personnel.

We will continue to develop primary health care services. We will make capital expenditures to improve building conditions, we will increase the salaries of primary healthcare providers by up to 50%. Every year we will provide online and offline professional training for medical staff. As a result, we will have more professional, highly paid medical staff in primary healthcare institutions.

We will ensure balanced territorial development of the healthcare system. The building conditions in 50 medical institutions across Armenia will be improved and those institutions will be equipped with the necessary equipment. As a result, the healthcare system will develop in the regions and medical care will become more accessible and have higher quality. We will have more modern, well-equipped medical institutions. The disproportionate and unequal distribution of medical services provided in the regions to the capital will be eliminated.

By 2025, we will introduce accreditation systems for medical organizations and licensing of medical staff. As a result, we will have quality control mechanisms for medical care.

We will encourage physical development and healthy living programs starting from pre-school, creating an environment for citizens to make informed behavioral decisions.
As a result, we will have citizens who have a healthy diet, lead a physically active lifestyle, free from harmful habits.

Comprehensive reforms are needed in the healthcare sector. During the last two years, the healthcare system has been demoralized. On the one hand, indecent attacks against and illogical dismissals of reputable doctors led to an outflow of qualified professionals from the system. On the other hand, the absurd changes made under the guise of reforms destroyed the already broken system. Ignoring the fact that Armenia is a war-torn country, the government closed down a number of regional hospitals, while others ended up on the verge of being closed. The problem of access to healthcare services remains unresolved, especially in regional communities. Armenia needs a new healthcare policy, which will be aimed at maintaining and improving the health of an individual and the larger public, reducing mortality rates, diseases and disability.

Priorities of the healthcare policy should be:

• Promotion of healthy lifestyle among the population;

• Training of staff and attracting qualified professionals to the system;

• Early detection and prevention of diseases;

• Introduction of an effective system aimed at preventing the occurrence and spread of infectious diseases, provision of quality, modern, comprehensive medical services.

To meet these goals:

1. Primary health care institutions (polyclinics) need to be strengthened and developed, which means:

• The need for radical reform of primary health care institutions, including the assessment of organizational and ownership forms, funding and management practices, workloads and services provided;

• The establishment of a wide network to provide preventive services and to conduct regular surveys among the population, especially vulnerable groups (children, the elderly, chronically ill patients, etc.);

• Ensuring the accessibility of services in primary healthcare institutions and the introduction of flexible support mechanisms for those in need. 

2. It is necessary to modernize medical institutions and services provided, and to expand the geography of healthcare services, which implies the following:

• Technical upgrading and modernization of existing medical institutions;

• The establishment of new medical institutions with accessible and affordable basic health services for citizens;

• Training and retainment of highly qualified professionals;

• Providing competitive healthcare services and exporting those services with state support; especially attracting patients from the North Caucasus, the Middle East, and Central and South Asia.

3. It is necessary to launch state-supported programs, which will be aimed at:

• Gradually reducing the intervention and participation of the state in providing healthcare services;

• Bringing healthcare services closer to the beneficiary (social workers, community, primary health care institutions);

• Promoting proactive behaviour among citizens, especially during the early detection and prevention of diseases (through the introduction of healthcare insurance, the application of mandatory principle for users of other state services and other means);

• Creating infrastructure that will ensure the proper, timely and complete provision of medical services;

• Involving civil society, communities and the private sector for the treatment or overcoming of certain diseases, and providing appropriate services to vulnerable groups as well as those in need;

Improving the business environment in areas of medicine, medical education and pharmacology.

Goal:

To have healthy, physically active citizens who have no reproductive problems and a long life expectancy.

Concept: From healthcare delivery that fights against diseases to preventive medicine.

Steps:
1. Ensure a reasonable, effective and comprehensive fight against COVID-19 and its consequences.
2. Introduce a quality, efficient, accessible and transparent healthcare system.
3. Provide free medical care only based on the principle of social justice and simultaneously provide state assistance to anyone who needs urgent medical attention.
4. We consider it important to ensure the high quality of provided medical services, accessibility, disease monitoring and early prevention, healthy lifestyle, increase of public health expenditures, introduction of an electronic healthcare system, market-competitive pricing of health services, development of a laboratory system, introduction of targeted, effective and transparent mechanisms for the allocation of state budget funds, modernization of regional hospitals, provision of new services by the healthcare system, capacity building of the healthcare system, medical tourism, introduction of narrow professional service groups and national quality development programs in Armenia, implementation of strategies to fight diabetes, cardiovascular diseases, thyroid and malignant tumors.
5. Provisions of introducing a health insurance system in the Republic of Armenia

The goal of the program is to solve the key social problem of the state - to ensure the protection and improvement of the health of Armenian citizens.
 

The implementation of the program will ensure the following positive developments:

• Beneficiaries of the system will be insured against unpredictable financial risks resulting from potential deterioration of health;

• The efficiency of expenditures made by the private and public sectors in the health sector will be improved;

• The quality of healthcare services will be improved by promoting and maintaining high standards;

• Mandatory annual medical examinations of the population will be provided, which are extremely important for early detection or prevention of diseases.

Plans and expected results:

• Equal access to residents throughout the country to quality medical services; ensure regional hospitals and polyclinics in the region on par with the capital, with the exception of specialized medical centers;

• Introduce a state insurance body, to compete with private organizations under equal conditions, and to allow socially vulnerable groups to receive necessary care;

• Mitigate mortality and cases of disability caused by common diseases by ensuring comprehensive screening programs;

• Policy development to encourage a healthy lifestyle; promote the importance of physical exercise, eliminate habits that are harmful to society;

• Place the issue of food safety under strict state control, gradually remove low-quality and artificial ingredients from the market, set higher standards, and impose tougher fines;

• Collect digital data on the mental health of society. 

Increase quality of life and average life expectancy:

• Significantly reduce financial costs of post-illness treatment through the introduction of health insurance;

• Boost medical tourism;

• Make Armenia a leader in the region by providing quality and competitive medical education for foreign students;

• Increasing the competency of medical practitioners is the driving force of improving healthcare. This could be achieved by setting clear standards, facilitating state-sponsored training abroad, depoliticizing the sector, ensuring fair competition, providing adequate compensation, and developing fair liability mechanisms in the event of a medical error;

• Create incentive to practice and work in regional hospitals.

Considering the COVID-19 pandemic, the state must provide timely and targeted medical care, both inpatient and at-home treatments. Medical care, from testing to full recovery, must be covered by the state budget.

It is also necessary to review the procedure for providing state benefits. Servicemen, families of victims of the Artsakh War, those still missing in action as well as families of those who were disabled during the war, socially vulnerable groups and other beneficiaries defined by law should receive the state benefits that they are entitled to. The system for providing state benefits must be fully accredited.

Medical quality assessment and control systems should be introduced, as well as legislative classification of medical organizations and application of new and fair approaches to financing of medical organizations based on their classification.

A new law should be drafted for medical workers, which would include systems of social, legal, professional guarantees as well as risk insurance for the professional activity of medical workers.

Step by step, sector by sector 

Our healthcare system will not be built from scratch but will instead be rebuilt and repaired within a system that is already working and has a certain structure. The only effective option that will not lead to a total collapse is the “step by step, sector by sector” approach, when modernization carried out in one sector will not hinder the work of other sectors.

We will develop and launch projects, as a result of which:

1. Diagnostic and therapeutic procedures will be developed for all diseases and conditions. The work will be carried out with the support of specialized medical professional associations and the chairs of Yerevan State Medical University who will produce evidence-based guidelines. Along with recent developments in the field of medicine, those guidelines will be regularly updated and provided to all doctors.

2. All healthcare professionals must pass a qualification exam. The test material should cover knowledge of evidence-based medical procedures. The exam should be computer-based, following best-known international standards.

3. A system of universal and mandatory healthcare insurance will be introduced, along with private insurance companies. Each individual pays for the insurance in accordance with their income. Initially, state insurance will cover expenses of health conditions that are not covered by private insurance companies. In the future, state insurance may expand coverage.

4. One of the most important components of preventive medicine is screenings, which increases the chances of detecting diseases at an early stage, ensuring a full recovery. All possible and effective screenings will be introduced as soon as possible, become affordable and implemented throughout the country. Proper organization of screening examinations can significantly increase the efficiency of polyclinics.

5. Oncology will be one of the first areas to be fully covered by universal health insurance and will be monitored to ensure that it complies with evidence-based medicine, without out-of-pocket costs, incomplete and delayed steps. Thus, the allocation of insurance funds can be easily monitored and made more efficient. In addition, the introduction of screening programs will reduce the number of cases of cancer, which in turn will reduce the amount of money spent in the field of oncology.

6. Today, the costs of treatment of myocardial infarction are being reimbursed through state benefits. Although the treatment saves the patient's life, it does not prevent irreversible deterioration of health. One of the most important principles of preventive medicine is to stop irreversible damage to health, which is possible if the patient begins treatment before the development of the disease, preventing additional costs to the state. The next stage will include all cardiological diseases; followed by pediatrics, diabetes, and other clinical areas, based on urgency.

7. Tobacco addiction is a disease, the treatment of which can prevent the development of most cardiovascular diseases and many types of cancer. The fight against smoking must be clearly distinguished from the fight against smokers. Similar campaigns tackling obesity can be implemented to prevent a number of deadly diseases.

8. To mitigate bribes and kick-backs in the healthcare system, it is necessary to set standards and oversee prices for tests, examinations and screening, which should be affordable  so that private centers can make a profit by setting their prices close to state set prices, but not so much to encourage bribery. By setting significantly higher prices, private medical centers will simply be left out of the competition.

As a priority, the deadly COVID-19 epidemic will be halted by providing the population with the required quantity and quality of vaccines. Adequate hospital conditions will be created, specialists and services working against the epidemic will be significantly encouraged.

A new short-term and long-term strategy will be drafted for the development of the healthcare system. Professional, legal and social protection of medical workers will be prioritized.

Clinical guidelines and procedures for over 100 most common diseases will be developed and introduced within one year and monitored through an electronic healthcare system. As a result, we will have treatment criteria that are standardized, evidence-based and widely practiced. Health insurance will become more affordable and have broader coverage.

The principle of “No citizen without access to proper treatment” will be introduced. In fact, free healthcare for the population will be provided on the basis of a minimum basic healthcare package. Health problems should not be the reason for the impoverishment of citizens or the deterioration of their social situation. The issue of full access to the health services for socially vulnerable groups will be resolved.

Every region will have at least one medical center, which in terms of its technical equipment, professional expertise and quality of services will not be inferior to medical centers of the capital, Yerevan.

Experienced doctors and young specialists will be encouraged to work in the regions. 

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