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More Healthcare Providers: A Crisis in the Health System

Author(s): G. G. Jerbashian1
Affiliation(s): 1Policy, Knowledge Management Team, Project NOVA, Yerevan, Armenia
Keywords:

Health workforce imbalance, health human resource planning, access to and quality of healthcare

Background:

Unlike many developing nations facing huge shortage of health workforce, Armenians experience poor access to healthcare, although the number of physicians is 38.2 per 10,000 inhabitants compared to the average 24.0 in the United States or 34.0 in France (2005), having much better health indicators. Compared to 26.5 in the United States and 17.5 in France, in 2005, the Armenian state medical university alone produced 40.1 medical graduates per 1,000 practicing physicians. Most of these lacking clinical skills freshmen reside and stay to practice medicine in the capital. The Armenian healthcare system is characterized by overstaffed hospitals with low (48%) utilization, inadequate distribution of medical workforce across the country with 76.9 physicians (per 10,000 inhabitants) in the capital vs. 17.6 elsewhere, high level of unmet need for healthcare, and widespread informal payments. The medical workforce has not reduced, despite the hospital beds substantial cutback (49.8%) due to the recent Governmental reforms. Some 95.0% of women paid out-of-pocket money for state-funded pregnancy and delivery care. Despite well developed physical network of health facilities, large number of people eligible to the wide range of state guaranteed free-of-charge services, 39.5% of sick people report not seeking medical assistance because of financial constraints.

Summary/Objectives:

1 – Analyse the systemic, structural, and regulatory barriers jeopardizing the efficiency of the healthcare system.
2 – Analyse the extent to which Armenians experience lack of access to healthcare.
3 – Reveal the adverse outcomes of ‘excessive’ healthcare.
4 – Analyse the factors influencing the never-ending increase of prices in healthcare.
5 – Develop policy interventions aiming at increasing access to and quality of healthcare, while improving the efficiency of healthcare system.

Results:

Our study identified oversupply of medical workforce as one of the critical factors influencing the interminable increases of prices in healthcare and spread of corruption in the system. On the basis of trends in several national health indicators, adverse outcomes of care are observed in Armenia. Reasons include but are not limited to excessive number and unbalanced distribution of medical workforce in the country. Our analysis indicates steady growth of medical fees and informal payments. Having too many physicians in Armenia does not contribute to better access to and quality of healthcare. The existing healthcare system needs restructuring, specifically as it relates to human resources planning and workforce management. Health system inefficiency in Armenia is stipulated also by low salaries of health providers ‘justifying’ their demand for ‘under-the-table’ payments, and overgrowing number of physicians in the country. Having too many physicians in Armenia does not contribute to the better access to and quality of healthcare. Existing healthcare system needs restructuring, specifically as it relates to the human resources planning and workforce management. Along with customizing the medical workforce skill mix to local health needs, raising public awareness on free-of-charge healthcare services guaranteed by state, introducing proper incentives for retention of health workers in rural areas and regional centres, there is a definite need for strict regulations on medical education and practice, including: solid licensing and (re)-accreditation system, preparation of scientifically sound number of medical cadre and their equitable and balanced distribution across the country.

Lessons learned:

1 – Explain why an excessive number of healthcare providers can actually increase medical fees, induce informal payments while not improving health outcomes, and, hence, be a burden to public health.
2– Formulate policy interventions contributing to the efficiency of the healthcare system and better health outcomes.

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