On April 8, 2019, IWPR Tajikistan hosted an expert meeting “Introduction of the Insurance System in Healthcare of Tajikistan”. Experts, representatives of public and private organizations, independent analysts and journalists discussed the observed problems in the healthcare system of Tajikistan, the prospects for the introduction of the insurance system and offered their recommendations.
Discussion highlights:
- The specific mechanisms of the universal insurance system should be elaborated and studied in detail in the near future;
- All information on the proposed measures should be in open access and available to the public and, in particular, to expert community;
- The measures to be implemented should be accompanied by public awareness raising campaigns;
- The prices of medical services in public health facilities should be revised to better match market prices;
- The universal insurance system can be effectively linked to e-government services.
The investigation of Tajik journalist “Corruption in the Dushanbe Health Center No.1” was published on cabar.asia at the end of February. The author of this article told about his experience of visiting the capital’s polyclinic and corruption he saw there. The publication of the piece caused a resonance in social networks. Readers commenting on the publication had opposite views: while some proposed to “bring back the order”, others pointed out that the insufficient salary of doctors does not allow them to miss the opportunity to collect payments informally.
The idea of introducing universal health insurance to the country’s healthcare system was among the proposed methods of elimination of informal payments put forward by the experts Bearing in mind a variety of the expert opinions on the specifics of how such a system is to function, IWPR Tajikistan hosted an expert meeting on the introduction of the insurance system.
The experts were able to share their vision of the implementation of such a system in a face-to-face interactive mode and offer recommendations for the effective resolution of existing problems of Tajikistan’s healthcare.
IWPR Tajikistan Program coordinator Sharaf Davlatov started the discussion by defining the scope of the problem. Having presented the format of the round table, he specified that the recommendations of the participating experts would be extremely important both for decision makers and for informing the public.
According to the chief specialist of the Ministry of Health and Social Protection of the Population of the Republic of Tajikistan Safar Saifuddinov, about 100 thousand people work in the health care system today, and on average, a citizen visits medical institutions about 7 times per year.
Over the last 17 years, the budget of the Ministry of health has grown 60 times — from 29 million somoni (about $3 million) in 2002 to 1 billion 740 million somoni (almost $184.5 million) in 2019.
The healthcare system features programs for provision of the free medical care to the population: Program of State Guarantees on Provision of the Population with Medical and Sanitary Assistance for 2017-2019 and Resolution of the Government No. 600 “On the Procedure for Providing Medical and Sanitary Services to Citizens of the Republic of Tajikistan by Institutions of the State Health Care System”. According to the regulations of these programs, citizens who fall under the definition of preferential groups receive medical services free of charge.
According to Safar Saifuddinov, more than 50% of patients receive medical services under the preferential system.
“The goal of our programs is to reduce the number of informal payments made by other 50% of patients,” he said.
The programs adopted provide carefully calculated price lists for the provision of health services. This, according to Saifuddinov, should help to reduce the number of informal payments in medical institutions.
Nigora Abidjanova, director of Open Society Institute Assistance Foundation – Tajikistan Public Health program, indicated that any initiatives related to the provision of social support to the population must necessarily take into account the demographic and economic conditions in the country. She specified that in the implementation of programs of free medical services provision it is necessary to take into account the sharp growth of the population of the country in recent years. Accordingly, funding for such initiatives should be increased.
Moreover, it is necessary to carry out explanatory work on the taxation of private companies for health insurance of their employees, said the lawyer of the organization “Justice and Legal Relations” Abdulmajid Rizoev.
According to him, the introduced norms should also enable insurance companies to verify the fact of treatment. The expert concluded that due to these factors, the health system is not yet ready to introduce universal insurance.
Today, the private medical institutions are the main partners of private insurance companies. According to the Medical Insurance Department Head of BIMA Insurance Ilkhom Rasulov, state medical institutions are not yet ready to work with insurance companies.
The expert sees a reason in the low prices for medical services established by public hospitals and clinics. To make up for the cost of their labor, medicaments and procedures, employees are forced to accept informal payments. In private clinics, on the contrary, the prices for services are higher, which allows insurance companies to work with them.
Experts Muzaffar Olimov and Mikhail Petrushkov expressed their doubts about the effectiveness of the proposed system of compulsory universal insurance.
Olimov noted that the level of public trust in compulsory universal insurance will be insufficient due to the well-established opinion that it is impossible to get quality services for low prices.
In turn, Petrushkov drew the attention of the participants to the need to change the established price lists for medical services, raising them to the level of the real cost of labor, medicaments and procedures, before introducing a system of universal insurance.
During the discussion, the participants considered the possibility of using e-government services to support the implementation of insurance programs. Opinions differed: some supported the idea, others questioned it, referring to the existing problems in the field of communications in Tajikistan and the geographical limitation of the use of online services (only Internet users from the capital and major cities will use such a system).
Read more: Internet in Tajikistan Will Become More Expensive
Sharaf Davlatov summarized the meeting by outlining the main recommendations of the participants:
- The specific mechanisms of the universal insurance system should be elaborated and studied in detail in the near future;
- All information on the proposed measures should be in open access and available to the public and, in particular, to expert community;
- The measures to be implemented should be accompanied by public awareness raising campaigns;
- The prices of medical services in public health facilities should be revised to better match market prices;
- The universal insurance system can be effectively linked to e-government services.
At the end of the meeting, the experts expressed the hope that such discussions will continue, and the recommendations will be taken into account by decision-makers.
Central Asian countries’ expert meetings will be continued in order to promote the stability, peace and reconciliation in the region.