Mammad Talibli: "Today`s atrociousness should not only make our health system think but also shake it"

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Question: According to the World Bank report, 78.6% of medical expenses in the country are financed by the population. But we see in the budget discussions every year that funds are allocated from the budget for health services. Where do these funds go?

Answer: It is necessary to separate two points related to health expenditures in Azerbaijan. The first is the unsatisfactory expenditure on health from the state budget. The second is due to the fact that access to health services at the expense of public funds is limited (the transition to compulsory health insurance will be introduced this year), forcing citizens to spend more on health from their pockets. However, the state budget must bear this burden of citizens by increasing health expenditures. When the state does not do this, the depth of poverty in the country goes even deeper. Because the expenses that weigh on a citizen's family budget increase his/her risk of impoverishment. Poverty is a greater threat to families whose food and health expenses dominate the family budget. In the United States, a family is considered poor if it spends more than 35 percent of its income on food. According to a study conducted in Azerbaijan a few years ago, the money spent by citizens on food alone in the country makes up 72% of family budgets. It did not include necessary expenses such as health, education, purchasing goods, and so on.

Question: In general, how much money has been allocated from the state budget for health services in recent years?

Answer: An interesting point is that there has been a relatively rapid increase in health expenditures in the post-oil period. At the peak of oil revenues (2006-2014), health expenditures in our country did not exceed 1% of GDP. However, according to the methodology of the World Health Organization, if the health budget of a country is less than 3% of GDP, it is enough to sound the alarm for that country.

Health expenditures in the Azerbaijani budget have increased over the past two years. In previous years, health expenditures did not exceed 1 billion manats of the state budget expenditures of 25 billion manats. However, for the first time in 2019, it amounted to 1 billion 42 million manats. Last year (2020), it was close to 1.4 billion manats. It is an increase of 33 percent in one year.

In the state budget for this year (2021), 1,409.0 million manats were allocated for health expenditures. This means that this year, about 5 manats for every 100 manats (more precisely 4 manats 90 gapiks) will be allocated for health expenditures.

Question: For what purposes were these funds allocated for health? Have those goals been achieved?

Answer: The wrong method in estimating health expenditures in Azerbaijan is that the main criterion is the amount of budget expenditures on health. This is also important. But the structure of these expenditures must be analyzed. That is, what percentage of these expenditures is spent on the purchase of new health equipment, what percentage of these expenditures is the salary of the staff working in the health system, what percentage of these expenditures is spent on administrative expenses, etc. These expenditures had to be optimized over the years so that the health system would not be overburdened, as seen in the pandemic. The main point to note is that the health budget should not be based on its amount. According to the main approach of the World Health Organization (WHO), per capita health expenditures are taken into account. Our health expenditures in 2003 were 15 times less than today's health expenditures. But it should be taken into account that the population of our country is now 2 million more than then. The WHO determines health expenditures per capita by dividing health expenditures allocated from the state budget by the population. If we divide health expenditures allocated from the state budget for 2020 by the population, it will be 136 manats. If we convert this amount into US dollars, it will be $80. This is one of the lowest rates in the world.

Question: How much do people spend on health during the year? And is it more or less compared to other countries?

Answer: The World Bank report you mentioned above states that 78.6% of medical expenses in Azerbaijan are covered by the population at their own expense. This means that 1 manat of the health expenditures of 5 manats in our country is covered by the state and 4 manats are paid by citizens. The WHO recommends that citizens pay $ 1 for every $ 5 or 20 percent for each country.

Question: People from Azerbaijan go to foreign countries - Iran, Georgia, Russia, Turkey, Israel, and other countries for treatment. Are these also taken into account when talking about the expenses on health services paid by the population?

Answer: This does not only call into question the quality of our health care system but also means monetary risk. That means the outflow of foreign currency from our country. While these countries benefit from health tourism, we lose. You mentioned Israel... Let me make a comparison. In recent years, oncological diseases have clearly prevailed among patients going to Israel. The highest dynamics among serious pathological diseases in Azerbaijan in recent years is the incredible increase in the number of oncology patients. There are many reasons for this, from the poor quality food consumed to genetically modified products, to the disturbed ecological balance, to the increase in waste. The number of oncology patients in Azerbaijan is about 50,000. The population of Israel and our country are approximately the same. Why do I say approximately? Israel has a population of 8.8 million. Azerbaijan has a population of 10 million. But the actual number of people living is between 7-8 million. In 2019, a total of 109 people were diagnosed with cancer in Israel. 104 of them were non-Jewish, only 3 were Jewish. Not hundreds, not thousands, but tens of thousands of people in Azerbaijan suffer from cancer. This should not only make our health system think but also shake it.

By the way, 45.6 million manats have been allocated from the state budget to the National Oncology Center for 2021.

Question: In general, health care in Azerbaijan was free. Now the Compulsory Health Insurance has been launched. I wonder why people have to pay for health care in this case?

Answer: Look how many years the transition to compulsory health insurance wasted our time with pilot projects. We have been localized in only 4 districts for several years. The failure of the transition to compulsory health insurance nationwide was observed with severe pathologies of the diseases subject to treatment. Those who appealed to someone's mercy and the Heydar Aliyev Foundation and received support partially solved their problems. Those who did not have access to them found a way out by selling their movable and immovable property immediately. In this way, thousands of families have fallen into poverty. Health reform is an area that requires expensive and flexible decisions. Every delayed reform means a lost human fate. The management of construction, economics, and farm is not like that. Therefore, the portrait of the person leading the health system should be completely different. Look how many years the Azerbaijani health system has been groaning under the feet of an irresponsible and corrupt minister, who is far from this field...

Question: What should be done to improve the performance of health services in Azerbaijan and, at the same time, to satisfy people?

Answer: Health reforms must be started. I do not say it should continue. It should start! Unlike the previous system, reforms must start at a sustainable, systematic, and professional level. Undoubtedly, the root cause of the government's weak attitude to health expenditures is not just related to the medical expenses of one citizen. Numerous empirical studies have shown that there is a positive correlation between the amount of health expenditures and life expectancy. Where health expenditures are high, life expectancy increases. Where health expenditures are low, life expectancy is reduced. Health expenditures and reforms are also a reaction of the state to how many years a citizen lives: do you want to shorten or prolong the life of your citizen?