29 January 2020 16:11

Medical territorial divisions have been approved

The State Agency on Mandatory Health Insurance has approved the creation of “Medical Regional Divisions for Administrative Territorial Entities of the Republic of Azerbaijan”. The Regional Medical Division is a group of medical institutions in the public health system subordinated to the Administration of the Regional Medical Divisions (TABIB) situated by administrative territorial entity. Medical Regional Divisions were classified by territorial administrative entities on the basis of population number, geographical area, transport infrastructure, network and capability of medical facilities, the number of doctors and middle medical staff.  In total, the Agency has identified thirteen regional medical divisions. One regional medical division includes several state medical facilities by city/districts. 

Except for three regional medical divisions, inter-regional state medical facilities have been defined in rest of the regional medical divisions. The aim is to ensure the efficient use of resources and human capacity of medical facilities, to optimize their operation and to provide access to various types of medical care. Due to the high number of state medical facilities in Baku, Sumgait, and Ganja cities inter-regional state medical facilities were not defined for those cities. The amount of copayment varies depending on the place of registration of insured person and location of visited medical facility by administrative territorial entity.

A co-payment is a fixed amount of money insured person pays when a medical service is received. The amount of the co-financing will apply to all insured persons in case of non-compliance with the terms set out in the benefit package when applying for specialized outpatient and inpatient care. The terms of the co-financing are determined by the benefit package and paid directly to the medical facility. Implementation of co-financing will begin from April 1st, 2020.

The amount of co-payment for outpatient and inpatient care is paid as follows:

Within the Administrative Territory: 
When applying for outpatient medical care at a medical facility by place of registration without a referral of family doctor, co-payment in the amount of 5 (five) manats must be paid for each insurance event. For example, if you are registered in Sheki and without consulting your family doctor, you go directly to a medical facility in Sheki to see a specialist doctor. Because of not complying with the terms and conditions set out in the benefit package, it’s necessary to pay a co-payment in the amount of 5 (five) manats to the medical facility.

Within Regional Medical Division
When visiting a medical facility in another administrative area within Regional Medical Division without a referral, the co-financing amount of 5 (five) manats will be paid for each insurance event. For each insurance event over 100 (one hundred) manats, the co-financing amount of 30 (thirty) manats will be paid for in-patient services. For example, a citizen registered in Gakh must pay the co-payment of 5 (five) manats to a medical facility in Shaki for receiving outpatient care without a referral. In addition, following the examination of a specialized doctor, copayment in the amount of 30 (thirty) manats will be paid for receiving in-patient service priced over 100 (one hundred) manats.

Outside the Regional Medical Division: 
When applying for outpatient medical services at a medical facility located outside the medical regional division where a citizen is registered, co-financing amount of 15 (fifteen) manats must be paid for each insured event. The co-financing amount of 90 (ninety) manats will be paid for each insurance event over 100 (one hundred) manats when applying for in-patient medical services. For example, a citizen registered in Sheki should pay a copayment of 15 (fifteen) manats for each insured event when applying to a medical facility in Shamakhi for an outpatient service without referral. In addition, following the examination of a specialized doctor, co-payment in the amount of 90 (ninety) manats will be paid for in-patient service priced over 100 (one hundred) manats.

At the same time, a copay in the amount of 20 (twenty) manats must be paid for all magnetic resonance and computer tomography services provided in an outpatient setting. All medical services for the insured are provided upon referral of a doctor (such as a qualified physician, family doctor, field general practitioner, or field pediatrician). All laboratory and diagnostic services provided without medical prescription are not covered by mandatory health insurance and must be paid by patients themselves.
You can see below the map of the “Regional Medical Divisions of Administrative Territorial Entities of the Republic of Azerbaijan”.