Tuberculosis care services in Armenia: What has changed since the 2014 reform?

Abstract

Introduction: In efforts to reach the 2020 Tuberculosis targets, the WHO advocates for an outpatient, people-centered model of TB care. To this end, the TB care system in Armenia underwent structural and financing reforms in 2014. Financing mechanism for inpatient TB facilities was changed from a fee per bed/day to a mixed type of financing that includes fixed and variable costs eliminating incentives for unnecessary and extended hospitalizations. Unfortunately, outpatient facilities continue to be financed through per-capita mechanism, resulting in high number of referrals and draining resources. This study aimed to assess the implementation of these reforms within the Armenian TB care system.
 Methodology: This was a retrospective cross-sectional study using nationwide programme data and survey data collected from healthcare facilities.
 Results: In 2017 a total of 901 TB patients were registered in outpatient facilities. Only 7.6% of total TB cases were diagnosed in outpatient facilities and 30.9% of the presumptive TB cases were referred to inpatient facilities. The number of hospitalizations was reduced by 76% from 2013 to 2017. The average duration of stay reduced as well from 55+ days to 37 days. However, the proportion of smear negative TB patients remains high among all hospitalized patients (63.8%).
 Conclusions: Overall, the reform has been successful, however unnecessary hospitalizations persist. Our results indicate there a need to go upstream for a structural and financial reform of the outpatient sector to complete Armenia’s TB healthcare reform and improve both patient outcomes and efficient use of system resources.

Public health benefits of shifting from hospital-focused to ambulatory TB care in Eastern Europe: Optimising TB investments in Belarus, the Republic of Moldova, and Romania

“…This revealed the potential savings that could be realised by prioritising ambulatory care. However, prioritising TB treatment delivery from hospital-focused to ambulatory care [28][29][30] will involve more than decision-making on funding reallocation. This transition will require shifting emphases in care models through changes in clinical guidelines, changes in how funding flows to facilities, or through incentives.…”

Public health benefits of shifting from inpatient to outpatient TB care in Eastern Europe: optimising TB investments in Belarus, the Republic of Moldova, and Romania

“…Collecting costing components and deriving cost per treatment course by TB treatment modality, DS, MDR, and XDR, and as well as whether delivered in-hospital or at outpatient care facilities or in the community then allowed comparison of potential saving and health gains that could be realised by prioritising ambulatory care. However, prioritising TB treatment delivery from inpatient to outpatient care (18)(19)(20) will involve more than decision-making on funding reallocation. This transition will require shifting emphases in care models through changes in clinical guidelines, changes in how funding flows to facilities, or through incentives.…”

Satisfaction of tuberculosis patients to healthcare services at the global level: A systematic review

“…This might be because TB care has received more attention than care for the general population. In Armenia, hospitalisation for TB patients was reduced by 76% in 2017 compared to the 2013 baseline, and the average length of hospital stay was reduced from 55 or more days to 36 days (Lylozian et al, 2019 ).…”