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At the end of the year 2022, the Audit Chamber (AC) approved and published the results of the performance audit implemented towards the outpatient polyclinic medical care in the Ministry of Health. Within the framework of the Primary Health Care Program 5 measures are included, the majority of the measures is the outpatient polyclinic medical care services – about 98.5%. In 2019, the measure cost was about 25 billion AMD, in 2020 – about 26.6 billion AMD. On January 20, at the joint sitting of the NA Standing Committees on Financial-Credit and on Health Care, the Head of the Seventh Department of the RA Audit Chamber Khachik Papazyan presented the abovementioned data. The current conclusion of the Audit Chamber on the audit results carried out towards the outpatient polyclinic medical care services in the Ministry of Health was debated.

Introducing the main records, Khachik Papazyan indicated the restrictions of providing information on the identification of the beneficiaries in the electronic health ARMED system, the passes provided to the citizens, the data of the identification of the beneficiaries taking into account in the medical organizations or at the doctors or already taken into account were not provided to the Chamber within the framework of this measure.

The number of the accounted population was a basis for financing the measure, which, according to the AC representative, not only forms non correct picture on the factual need assessment in the republic, but does not give an opportunity to evaluate the correlation between the spent budgetary means and formulated non-financial result indices. The rapporteur noted that the Ministry of Health was suggested to set the real number of the beneficiaries as a result index instead of the number of the population and introduce a mechanism, which will enable regularly carrying out review of the beneficiaries’ real number. In such situation there was no opportunity to assess the purposeful efficiency of the measure.

During the audit, the Ministry did not provide sufficient information, which will substantiate the availability of the price formation of the medical care and service with free and privileged conditions guaranteed by the state and the accounting methodology, also there was no information on the formation of the price accounting committee, the establishment of the work procedure, the staff and the activity. It became a basis that during the period including the audit, applicable, distinct methodology for the numbers of the services and price accounting being forecast within the framework of the measure was introduced and applied in the Ministry. It was proposed to set the prices of those services conditioned by the abovementioned exclusively by preserving the legislative demands, having as a basis distinct and applicable methodology for price counting.

The rapporteur noted that the above enumerated problems did not give opportunity to form an opinion on providing a principle of saving the measure.

According to the conclusion, despite the absence of the Accounting Committee on established prices by law, nevertheless by the order of the Minister of Health service rendering prices were set and applied, not having any methodology and accounting as a basis. In response to the question of the Chair of the NA Standing Committee on Financial-Credit and Budgetary Affairs Gevorg Papoyan, how certain price was set for any disease, Khachik Papazyan assured that they were interested in the established procedure, but no information was provided or at least it was not accessible to the Audit Chamber.

The Head of the State Health Agency Aharon Barseghyan clarified that in 2022, the Committee had already been formed, some prices had been counted, as a result of which, appropriate changes of the prices for compensating services within the framework of the state order. In 2023, the framework of those services conditioned by the insurance introduction, should be carried out in the whole volume in order there will be possibility for assessing the financial loading of the comprehensive insurance. It was recorded with a separate line in the programme that the Ministry is obliged to introduce automated tool of price formation accounting on the basis of the price formation methodology. The Chair of the Standing Committee on Health Care Narek Zeynalyan touched upon the financing of the treatment in the outpatient-polyclinic conditions, which is carried out according to the per capita of the supplying population. He opined that we should change the methodology and work out other financing methods, which will promote the doctors’ sufficient motivation, the rise of salaries, the increase of the doctors’ self-education possibility. Gevorg Papoyan highlighted the legislative regulation of the problem.

As the Head of the State Health Agency assessed, we should carry out ‘more sensitive’ per capita financing. IN his turn Gevorg Papoyan emphasized the way of financing the doctor by the visitors’ number, which, according to the deputy, could be of motivating importance.

Aharon Barseghyan moted that in 2023, the number of the visits paid to the doctor by a citizen will be observed as an additional bonus payment for the doctor. “We try to create possible mechanisms that the doctors will be more concerned about inviting the citizens to preventive measures,” he documented.

According to the Chairman of the Audit Chamber Atom Janjughazyan, the primary problem is providing services, also the demand forecast.

The Deputy Minister of Health Artak Jumayan referred to the records of the conclusion, noted that at this moment there is considerable progress in the ARMED the digitalization of the system.

In their interpellation the deputies related to the methods of encouraging the doctors and making them accountable, the organization of the preventive visits, the accessibility of the health services, the purposefulness of the state financing of the health of the citizens not permanently residing in Armenia, the family medicine and other problems of the sphere.

Gevorg Papoyan and Narek Zeynalyan effectively assessed the debates. The cooperation of the Ministry of Health and the Audit Chamber was stressed, which will give opportunity for rectifying the shortcomings and organizing the work in more favourable way.