This presentation was made by Armen Manukyan, Armenia, at the 2nd Health Systems joint Network Meeting for Central, Eastern and Southeastern European Countries held in Tallinn, Estonia, on 1-2 December 2016

1. Reforms in financing
mechanisms to strengthen TB
services in Armenia
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2. Introduction
TB service structure in Armenia includes
both out-patient and in-patient services.
Most TB services are delivered as inpatient
care.
In 2013 more than 65% of cases were
detected in inpatients, and almost 95% of all
TB patients were admitted to hospitals
during the intensive phase of chemotherapy;
in 2014 in Yerevan, the hospital admission
rate was 74.4%.
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3. Previous financing mechanisms
for TB care in Armenia
• payment for outpatient TB services was based on
the size of the population served (capitation
standard rate) - Lack of incentives to improve
performance.
• payment for inpatient TB services was based on
the number of bed–days, which could not exceed
the approved treatment cost per case. The cost per
bed–day included not only the cost of treatment
(drugs) and food for patients but also other
services, such as remuneration of health providers
and other staff, cleaning and other expenses -
Incentives to maximize length of stay.
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4. Previous financing mechanisms
for TB care in Armenia
TB funding in 2013
• for inpatient services – about 80%
• for outpatient services – 20%.
This resulted in underestimation of the role of
outpatient services in TB diagnosis, treatment
and prevention and and underutilization of
this potential. Reorganization of the
administration, human resources and
finances for TB services was therefore needed.
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5. Revised financing mechanisms
for TB care in Armenia
•
IN-PATIENT TB SERVICES
• Fixed Costs
(provision of facility maintenance costs such as wages,
utilities etc.)
+
• Variable Costs
(cost of medicine and food based on the number of
discharged patients)
 The basic or fixed hospital costs include the
salaries of medical staff and other hospital personnel
and no longer depend on the number of hospitalized
patients - Decreasing the incentive of health
providers to maximize the length of hospitalization. 5

6. Revised financing mechanisms
for TB care in Armenia
OUT-PATIENT TB SERVICES
• Per capita
(based on the number of served population)
+
• Performance-Based Incentive Payment
(depending on achievement of certain indicators)-
Increasing the incentive of health providers
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7. Outcomes of the revised
financing mechanisms for TB
care in Armenia
• Reduction in hospitalization rate of TB patients
• Modernization and straightening of out-patient TB
services
• Improving the quality of both in-patient and out-patient
TB services
• Introduction of new methods and models of care
• Early detection and diagnosis of TB
• Improvement of treatment success rate
• Achievement of higher satisfaction for both patients and
the medical staff
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8. THANK YOU !!!
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