An Actuarial Model for Costing Universal Health Coverage in Armenia

Rouselle F. Lavado, George Schieber, Ammar Aftab, Saro Tsaturyan, Hiddo A. Huitzing

• Editorial: Asian Development Bank
• Año: 2020
• ISBN:
  9789292626013
• Categoría: Negocios y empresa
• Categoría: Seguros

The Asian Development Bank seeks to assist the Government of Armenia in undertaking major health financing reforms to achieve universal health coverage (UHC) within the context of the Sustainable Development Goals and improving health system performance. Critical to the development, evaluation and implementation of such UHC policies is the need for accurate information of the expenditure implications and revenue needs of alternative policy choices. This report provides guidance in the design, construction, calibration, evaluation, implementation, use, and refinement of a UHC model to assess the expenditure impacts and the revenue requirements to finance alternative universal health insurance (UHI) policies. It develops an actuarial UHC costing model that relies on the most recent and complete health insurance claims data to estimate expenditures and revenue needs for achieving UHC. The report focuses on the development and operationalization of this actuarial model as a tool for assessing the health financing and fiscal implications of Armenia's key UHI policy decisions.

APPENDIX 1

Actuarial Model Documentation

I. Databases

Data for the actuarial model were curated from the State Health Agency (SHA) database for 2016 Social Package and State Order eligibles. Both programs include different population groups, usually categorized by age, marital status, employment status, disability, and military service. In addition, data for primary health care (PHC) were obtained from the budget, which is based on capitation rates and the assigned population of each facility.

A. Social Package Database

In January 2012, a package of social benefits for public and civil servants was introduced, which included mandatory health insurance. The beneficiaries of the Social Package, irrespective of job position and salary, have access to the Social Package services. The package not only covers health insurance, but it also provides monthly redemption of mortgage credits, tuition fees at accredited universities and vacations in Armenia. This study focused, we focus on the health insurance and the related services covered in the package.

In addition to civil servants, members from the following groups are also included in the Social Package data of 2016

• asylum seekers and their family members;

• beneficiaries included in the poverty beneficiary system with 30.1 and more unit;

• beneficiaries of Social Package;

• compulsory military service personnel (ordinary and lance sergeant);

• disability group – (ii)

• family members of command officials of the Ministry of Defense of Armenia;

• family members of police soldiers; and

• family members of rescue service workers.

Based on discussions with SHA, the Social Package database is supposed to include only the beneficiaries of Social Package, and only due to an error in data entry would someone have any other eligibility group listed. Therefore, cases from other groups were filtered out and all cases in the Social Package came from the database of civil servants.

B. State Order Database

State Order utilizes public resources to finance, through provider contracts, PHC, and emergency services for all Armenian citizens in the eligibility groups included in the order, with copayment exemptions for the poor and vulnerable. In addition, selected inpatient services are provided for free for the poor, vulnerable, and other specific categories.

The following groups are available in the State Order data (listed in alphabetical order):

• arrested individuals, detainees, and prison inmates;

• asylum seekers and their family members;

• beneficiaries approved by the N44- A Ministerial Order of the Republic of the Armenian Ministry of Health dated 13.01. January 2016;

• beneficiaries included in the poverty (family) beneficiary system with 30.01 and more unit;

• beneficiaries included in the poverty beneficiary (family) system with 36.01 and more unit;

• beneficiaries of Social Package;

• children (up to 18 years of age) under the dispensary control;

• children aged up to 18 years in single parent household;

• children from large families (up to 18 years old) with four and more children;

• children up to age 7 years of age;

• children with disabilities, up to 18 years of age;

• children left without parental care (up to 18 years of age), and individuals considered children left without parental care (aged 18–23 years);

• command officials of the Armenian Ministry of Defense;

• compulsory military service personnel (ordinary and lance sergeant);

• convicted persons;

• disability group – (i);

• disability group – (ii);

• disability group – (iii);

• family members of compulsory military service personnel (ordinary and lance sergeant);

• family members of command officials of the Armenian Ministry of Defense;

• family members of officers registered in the special service personnel reserve of the administrative bodies of the Armenian Ministry of Defense, Armenian police, Armenian national security;

• family members of participants in military actions for the protection of Armenia;

• family members of penitentiary and compulsory service personnel of the Armenian Ministry of Justice;

• family members of the Armenian Police service personnel;

• family members of the rescue service workers;

• former soldiers receiving pensions for long service or disability;

• great Patriotic War veterans and persons equated to them;

• individuals getting care at orphanages and nursing homes;

• individuals holding special civil positions at the administrative bodies of the Armenian Ministry of Defense, police, national security;

• individuals not included in the above-mentioned groups;

• family members of armed forces reservists;

• family members of military service personnel who died while serving in the military or protecting Armenia;

• military and pre-military individuals (inpatient medical care, and the hospital examination for pre-military age population);

• officers registered in the special service personnel reserve of the administrative bodies of the Armenian Ministry of Defense, police, national security;

• participants of the Chernobyl nuclear power plant accident elimination;

• participants in military actions for the protection of Armenia;

• pensioners;

• Armenian police service personnel;

• national security service soldiers;

• recipient of the additional medical examination referred by authorized medical social state body;

• rescue service workers;

• single nonworking pensioners;

• single parent (with child up to 18 years of age);

• soldiers and their family members; and

• women of reproductive age, pregnancy, childbirth, and the postpartum period.

These 45 groups are present in State Order data (2016). Similarly, as with Social Package, we can see an incorrect data entry for beneficiaries of the Social Package. This entry belongs to the Social Package. Upon discussion with SHA, records that were erroneously classified as beneficiaries of the Social Package were affirmed as State Order beneficiaries. These records were distributed to three e...