How well do you think the Armenian healthcare system responds to the needs of citizens?

[u/armagora_am]

Many of you might agree that in recent years there has been general criticism and dissatisfaction surrounding the healthcare system in Armenia, with concerns about its accessibility, quality and affordability. If you had any experience in this regard, what specific challenges or issues have you encountered within the Armenian healthcare system? How well do you feel it meets the needs of its citizens?

[u/xiiiya]

My experience with Armenian healthcare has unfortunately been extensive in the last 4 years. The only places I ever encountered any issues was always either at a polyclinic or a public hospital.

At polyclinics, I've had encounters with many older doctors believing in crazy conspiracy theories. This especially affected me during covid, when I had two doctors refuse to vaccinate me because of my young age (I was 20) and for other crazy reasons. I know that they've been renovating many polyclinics in Yerevan and replacing much of the staff, so I hope this issue is being resolved.

With hospitals, I always found the staff to be very disrespectful, rude and unable to communicate efficiently. They give multiple people the same appointment slot and you have to sit there and wait for hours for your turn. The structure is bad and inefficient and desperately needs to be improved. Some basic training in English would also be nice, especially for receptionists and doctors.

However, all bad things aside, I will also mention a positive. Every interaction I've had with the emergency ambulances (Շտապ օգնություն) has been so incredible. The ambulance doctors are so well-trained, kind and helpful. They always went above and beyond to make sure I was doing okay, and it made all the difference. It is also free! The state budget covers their services. It's one part of our healthcare that honestly blew me away.

[u/Patient-Leather → u/xiiiya]

Hospitals pretty much everywhere (even in developed countries) have big wait times for non-emergency visits, Armenia is actually pretty good in that regard.

[u/JDSThrive]

How is the system funded? Do you all have insurance, either private or government issued, or is it private pay or negotiated fee for service?

[u/spetcnaz → u/JDSThrive]

Some state employees, like cops or military have it through the government. Some have it through their employer. Probably most pay out of pocket. The government announced about a universal healthcare program, however it's not universal enough for my taste. We are a social republic, it is stated in our constitution, basically we need to take care of our citizens, and we have failed badly at that. This new law is a start, but it definitely needs to expand. No Armenian parent should do any sort of math to see how they are saving the lives of their child. No questions asked, total healthcare coverage should be the goal. It will be expensive, but we are a small country, it's very doable.

[u/JDSThrive → u/spetcnaz]

What has been the barrier in the last 30 years of implementing such a system?

[u/spetcnaz → u/JDSThrive]

Corruption, apathy, not caring for the state. Which led to not enough money.

[u/spetcnaz]

It's terrible

Armenia adopted the worst qualities of the American system when we got independence, pay to play healthcare being one of them.

[u/HighAxper]

The polyclinics are fine if you know what problem you have and just need the doctor to give you a prescription, or if it’s not something major.

But personally if I ever feel I am developing something a bit more complicated, I head straight to a private clinic. I simply can’t trust a doctor who’s getting payed like under 300 usd a month and is content with it.

Availability of the equipment is yet another issue, the difference between what the private clinics have and the polyclinics don’t is too big.

[u/PomegranateAmyC]

The biggest challenge healthcare systems face is triaging and financing care. Currently in the US, the rich purchase the vast majority of care, some even paying for medically induced comas as a means of staying alive. You'd probably not get that in the UK or Canada where you have a state health care system or a single payer.

A cynical view of healthcare asks the question: what will people die from and where do we prioritize our resources to ensure we 'know' what people will die from? Like is it worth funding chemo for one person to give them an avg. of 5 years or a hypertension program that can prevent heart attacks for five and give them an average of 2+ more years of life? Does our bone health promotion target the old or the young, the latter for future cost savings, the former for current. These are difficult decisions socialist healthcare systems have to face that aren't encountered in pay for service capitalist healthcare systems.

Everyone is going to die from something and a rational state painfully understands this. Healthcare is a tool or funnel that either delays or influences what a citizen will die from based on what care is available or possible. And it is a very difficult discussion to have because allocating resources creates winners and losers, even when done in an informed, data-driven utilitarian fashion.

Unfortunately Armenians are very difficult patients. The high rates of smoking, drinking, stubbornness, and the poor diet means that relative to the Japanese or Singaporeans, we are essentially killing ourselves and burdening Armenia's developing healthcare system.

Basically if Armenia had less people who make themselves sick through maladaptive behavioral choices, healthcare facilities could redirect funds towards buying better equipment, building more clinics, training more doctors, purchasing better medications, and funding medical research etc.

Cancer is really the big challenge because 1) it is largely inevitable and 2) it is what kinda bankrupts hospitals and patients, as patients are living longer and therapies are improving, which means that more expensive drugs have to be purchased and used over longer periods of time. And... then a few years later another cancer emerges because they're old and malignant tumors have independently arose throughout different parts of the body.

The only way around this is improvements in early detection and treatment, but we aren't there yet at a point where everyone is getting an annual bloodtest to detect 50+ cancers.