Health Reform in Armenia: An Integrated and Synergistic Model

Four key nationwide primary healthcare (PHC) reform initiatives of the Armenian MOH are (1) a dedicated and systematic Quality Assurance (QA) program built on international best practices that includes five “dimensions” and five “tools”, (2) a “Pay for Performance (P4P)” program where salary bonuses are paid to health facility staff for meeting ten predefined quality of care output targets, (3) an open enrollment (OE) system in which all Armenians enroll with a PHC physician of their choice and, among other things, is used for contracting with and financing of all PHC facilities according to the number of people enrolled with each PHC physician, and (4) a computerized health management information system (HMIS) that ties together the enrollment database and the patient encounter database, thus facilitating ‘enrollment-based financing' and P4P processing.

While any single one of these reform initiatives would provide added value to the health system, it is the combination and simultaneous implementation of the four reforms which generates substantial synergistic effects and benefits. For example, the P4P program aligns the incentive structure with burden of disease priorities and rewards achievement of quality outputs rather than inputs. Enrollment-based financing not only empowers patients to choose their own physician but also drives quality improvements through competition among providers for patients according to the quality of care provided. These and other synergistic relationships are presented and analyzed.

The paper concludes with an analysis of the challenges experienced during implementation of the reform program.