Baku, Azerbaijan, Aug.20
By Ilaha Mamedli - Trend:
The optimum amount of annual coverage under the contract of compulsory health insurance (CHI) in Azerbaijan is 250 AZN.
This sum will be enough to get appropriate free medical care under the insurance policy, says an expert in the field of insurance Hayal Mammadkhanly.
"At the moment within the frameworks of preparation for the introduction of the concept of mandatory health insurance in Azerbaijan various options are being worked out and the predicted amount of coverage is 50-60 AZN," he told Trend.
"However due to such a payment for an insurance policy people can't get adequate health care at the expense of insurance", said Mammadkhanly on Aug. 19.
Although the law "On Medical Insurance" in Azerbaijan was adopted in 1999, the compulsory health insurance in the country has not yet been applied. It is expected that the new system will be introduced in Azerbaijan in 2015.
In accordance with the law, a mandatory form of health insurance is an integral part of the state social insurance and ensures the provision of medicines and medical care to the population.
According to experts, the use of compulsory health insurance will lower costs for health services by approximately two times.
For the introduction of this type of insurance, the appropriate fee for the insurance policy must be determined, the infrastructure prepared, the connection of all the insurance companies to the system ensured, training in all health facilities provided, a single registry of patients created.
"That's a very difficult and time-consuming process", said the expert.
He said that this requires a large amount of technical work, reformation of the health care financing system, of the wage system in medical institutions. Furthermore, extensive methodological work in terms of descriptions of various diseases, the cost of services and so on must be carried out, Mammadkhanly added.
He went on to add that extended list of diseases usually falls on the mandatory medical insurance.
Common diseases, with the exception of chronic diseases and critical illness for which treatment is provided by the State, and other serious illnesses could be included here, he said.
"In this case, cosmetic and plastic surgery, treatment for HIV infection are also considered exceptions," Mammadkhanly added. "List of drugs also covers almost all diseases included in the compulsory health insurance. This does not exclude the possibility of the application of 10-15 percent of the franchise."
Although the use of the franchise reduces the cost of the policy which results in a lower premium, the insurance company gets profit in the sense that the cost of leaving of the insurance representative and the costs of conducting papers exceed the amount of damage, he said.
Thus, it is expected that the introduction of compulsory health insurance alongside with the recovery of the financial market will improve the quality of health care services and lead to a major restructuring of the insurance market, he added. This will affect both the size of the market and its structure, said the expert.
Mammadkhanly went on to add that CHI can also make a good stimulus for the development of voluntary health insurance. For example, someone will be able to purchase additional coverage not included in the package of the CHI, he noted.
Although all health facilities for the same services will be paid in the same amount, there are clinics where the same services will be more expensive and then patients who wish to be treated in these clinics will have to pay more, he added.
At present, voluntary health insurance is one of the most unprofitable ones, and many companies refuse to provide these services. However the loss ratio of 95 percent of this type of insurance is considered normal in the international experience.
During January-July 2014 the share of health insurance fell on 45.8 million AZN (24.3 percent of the fees for non-life insurance) with payments of 27.3 million AZN (37.3 percent). According to market participants, the increased premium for this type of insurance is related with the fact that now hospitals buy more expensive equipment, which in its turn leads to the provision of more expensive services.
There are 28 insurance companies in Azerbaijan.
The official exchange rate for August 19 is 0,7842 AZN / USD.
