By Nane Atshemian
Public healthcare, which is only partly subsidized by the state, remains effectively off limits to the majority of Armenia’s population hamstrung by poverty and especially rampant corruption among medical personnel.
Government research, backed up by anecdotal evidence, indicates that most Armenians suffering from various illnesses continue to turn to doctors as a last resort, when hospitalization becomes their only chance of survival.
The thriving practice of informal payments at virtually every government-funded hospital or policlinic means they remain reluctant to seek even those medical services that are officially free of charge. According to the most recent household survey conducted by the National Statistical Service in 2003, only one in three people with health problems visit a medical facility.
Government officials admit that the Soviet-era policlinics, which are responsible for prophylactic treatment of virtually all diseases, still operate at a fraction of their capacity. Random polling on the streets of Yerevan helps to understand why.
“I try not to use their services,” said one middle-aged woman. “Why? Because of the money. I don’t want to spend any extra money.”
“I can state for sure that nothing is free of charge there,” said an elderly man. “Even if you are a pensioner, a disabled person or a war veteran, they still extort payments from you. They don’t do anything without money.”
However, there are a number of policlinic services, mostly medical check-ups and consultations, which are subsidized by the stated and are therefore supposed to be free charge. The list of those services is even longer for socially vulnerable groups of the population. Patients are either unaware of that or, more likely, forced to make informal payments to doctors and other medical personnel.
The de facto bribes range from 1,000 to 50,000 drams ($100) or even higher. They go up sharply after hospitalization.
Ruzanna Yuzbashian, who heads the prophylactic department at the Armenian Ministry of Health Care, does not deny that the illegal practice is widespread. “I don’t know how much they pay,” she told RFE/RL. “Medical institutions are limited liability companies and they agree the amount of their fees with their founders. But I can assure you that specialized policlinic consultations are much cheaper than hospital services.”
So far there have been no reported cases of doctors or other medical staff prosecuted on corruption charges. Some Western donor agencies implementing social projects in Armenia have suggested that the authorities tackle the problem by setting up a special telephone hotline for victims of healthcare bribery. The Health Ministry does not seem to like the idea, though.
Yuzbashian added that policlinic budgets will grow considerably this year in line with a 32 percent surge in government spending on healthcare which is projected to reach 32.3 billion drams ($68 million). She said that individuals above the age of 65 will be exempted from all policlinic payments as a result.
It remains to be seen whether elderly Armenians will enjoy the exemption in practice. With medical sector corruption continuing unabated, omens are not quite encouraging.
Children under the age of 7 as well as pregnant women, for example, have long been entitled to 100 percent free healthcare, including operations. “Services relating to pregnancy, delivery, post-birth care are totally covered by the state budget regardless of the age and social status of patients,” said Karine Saribekian, head of the Health Ministry’s maternity care center.
Yet Armenia’s maternity hospitals are among the most corrupt in the country. Having a child in Yerevan typically costs parents at least $200, a big sum by Armenian standards. As one young woman who gave birth recently put it, “The sum depends on whether you are treated by a [medical] professor or an ordinary doctor.”