Heath Fee Waiver Program, Armenia

Implementation. The State Health Agency makes payments to hospitals and polyclinics on behalf of the poor. These payments cover only about 45 percent of the cost of the health services, and hospitals tend to collect the remaining payments from patients (Lewis 2000 V forld Bank 2003c). 

A later analysis conducted after the expansion of eligibility for the basic benefits package to all poor families shows that basic benefits package recipients pay approximately 45 percent less in fees than nonrecipients and display a 36 percent increase in utilization, even though the level of health care utilization remains low (Angel-Urdinola and Jain 2006). In recent years, a change in the eligibility criteria increased the utilization of health care and reduced its costs for the poor. 

Lessons. Armenia s experience shows the importance of providing local institutions with alternative sources of revenue once fees have been eliminated or waived otherwise health facilities have a strong incentive to collect informal fees directly from patients. 

The possibility of stigmatization that could deter the poor from claiming waivers must also be avoided. Waiver applicants in a large public clinic in Cambodia, for example, were subjected to a public means test in the waiting room. Shame often led prospective applicants to forego their right to request a waiver. 

FOR PROTECTION AND PROMOTION THE DESIGN AND IMPLEMENTATION OF EFFECTIVE SAFETY NETS 

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