Using general practitioner selection as a social technology tool to catalyze primary health care reform: The Armenian case

Many countries with diverse healthcare systems have as a goal the expansion of physician selection and the empowering of patients. Patient choice is a more critical issue in the PHC service where in A.Donabedyan's famous formulae Healthcare = Art-of-Care + Technology-of-Care the “art of care” makes the choice a more complex concept. A collection of tools and techniques as social technology elements are used for meeting multiple objectives set by the patient choice. In many healthcare systems it is important to use social technologies to make the businesses less about making money and more about serving human needs. The Government of Armenia (GoA) has initiated the implementation of an open enrollment system which recognizes a patient's right to select a PHC provider of their choice and empowers enrollment in the general practitioner's system. The new choice-based system will shift the primary healthcare system from administratively defined district populations' to a more effective “customer service” approach. This will be accomplished through new policies and procedures, improved infrastructure, complex financing mechanisms, and IT application in HIS. The USAID-funded Primary Healthcare Reform (PHCR) project assists the GoA in achieving its main goal – to reform the PHC service in Armenia from the current inefficient system towards an active one which will satisfy the healthcare needs of the population. Knowledge accumulated during the introduction period in early 2007 will be analyzed and recommendations will be provided on subsequent policy decisions to strengthen the selection process. Lessons learned from Armenia can be applied to other countries.