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The graph keeps the 2024 provider architecture separate from the phased 2025 to 2026 purchaser transition.", "tags": [], "territory": "national framework with marz, municipal and Yerevan provider-management variation", "title": "A new national purchaser overlays decentralized provider management", "urls": [ { "kind": "url", "source": "not supplied", "url": "https://www.arlis.am/hy/acts/224417" }, { "kind": "source_reference", "source": "Statute of the Ministry of Health", "url": "https://www.arlis.am/hy/acts/123151" }, { "kind": "source_reference", "source": "Decision establishing the Universal Health Insurance Fund", "url": "https://www.arlis.am/hy/acts/218802/latest" }, { "kind": "source_reference", "source": "Law on Medical Care and Services to the Population", "url": "https://www.arlis.am/hy/acts/225396/print/act" }, { "kind": "source_reference", "source": "Health Systems in Action: Armenia 2024", "url": "https://iris.who.int/server/api/core/bitstreams/f2bfb8e7-3a26-47bc-af74-c49bde392209/content" } ] }, { "analytical_mapping": { "mapping_basis": "declared_from_2023_national_administrative_yearbook_and_2022_phc_facility_assessment", "mapping_group": "delivery_and_referrals", "mapping_id": "candidate-mapping:ARM:delivery:capacity-and-territory", "source_projection_ids": [ "country-improvement-source:ARM:nih-yearbook-2024", "country-improvement-source:ARM:phc-assessment-2024" ], "support_state": "candidate_supported", "target_slot": "facility-workforce-and-activity-context", "target_view": "delivery", "typed_fields": { "activity": "11.43 million PHC visits and 480,942 hospitalizations in 2023", "capital_concentration": "Yerevan held 48.8 percent of inpatient facilities, 66.5 percent of beds, 72.4 percent of physicians and 73.4 percent of facility-located hospitalizations", "inpatient_network": "125 inpatient facilities and 12,480 beds in 2023", "primary_care_network": "84 polyclinics, 239 rural ambulatories, 15 outpatient health centres, 53 narrow-specialty centres and 625 medical-obstetric posts", "rural_workforce_gap": "2022 survey recorded 3.8 physicians per 10,000 in rural PHC versus 6.2 in Yerevan and a 10 percent rural physician vacancy rate", "unit_boundary": "facilities, units, personnel, visits and hospitalizations retain their original definitions", "workforce": "13,943 physicians and 16,130 mid-level personnel, recorded as headcounts rather than full-time equivalents" } }, "annotation_status": "open", "authors": [], "availability": {}, "citation": "NIH Statistical Yearbook 2024, physical pages 192 to 232; World Bank PHC Assessment 2024, pages 13 and 40 to 44.", "country_ids": [ "ARM" ], "coverage_domains": [ "facility_data", "hospital_organization", "market_structure", "patient_flows", "primary_care", "utilization" ], "display_status": "shown_in_full", "document_type": null, "evidence_mode": "observed", "excerpt": null, "institution": null, "locator": { "description": "NIH tables 5.2, 5.4 to 5.11 and 6.5 to 6.7; PHC Assessment cited figures" }, "material_id": "material:b83c33e902bb895552cc9b17", "notes": [ "Do not add unit counts across tables with different inclusion rules.", "Facility-location activity is not resident-origin utilization." ], "origin": "candidate-analytical-mappings", "period": "2023 administrative activity and 2022 PHC facility survey", "publication_date": null, "publication_year": null, "record_kind": "candidate_analytical_mapping", "record_kind_label": "Candidate Analytical Mapping", "screening": { "previous_boundary_detected": false, "previous_visibility": "previously_not_projected" }, "source_layers": [ "official" ], "source_system": null, "source_version": { "detected_media_type": "application/pdf", "file_sha256": "3eb2f656602968f47c12fd8ad535825d1189334567a14ada20fc5b7ea245f9f7", "page_count": 267, "response_sha256": "3eb2f656602968f47c12fd8ad535825d1189334567a14ada20fc5b7ea245f9f7" }, "statement": "Armenia's service network combines a broad primary-care and rural-post footprint with hospital, bed and physician capacity concentrated in Yerevan. Administrative counts describe facilities and activity; they do not reveal individual patient origins or referral completion.", "tags": [], "territory": "national, Yerevan, urban and rural facilities, and marzes", "title": "Capacity is concentrated in Yerevan while primary care is territorially distributed", "urls": [ { "kind": "url", "source": "not supplied", "url": "https://nih.am/assets/pdf/atvk/ff14e3c27082c00737f3f4f9fc3b5493.pdf" }, { "kind": "source_reference", "source": "Armenia Primary Healthcare Assessment Report", "url": "https://documents1.worldbank.org/curated/en/099110524064012649/pdf/P181001-13e2d7e3-188f-4e95-8437-d6e8217c8146.pdf" } ] }, { "analytical_mapping": { "mapping_basis": "declared_from_active_ehealth_rule_phc_implementation_inquiry_and_purchasing_review", "mapping_group": "relationships_and_networks", "mapping_id": "candidate-mapping:ARM:networks:ehealth-and-coordination", "source_projection_ids": [ "country-improvement-source:ARM:ehealth-governance-843l", "country-improvement-source:ARM:phc-assessment-2024", "country-improvement-source:ARM:strategic-purchasing-2020", "country-improvement-source:ARM:ieg-health-modernization-2019", "country-improvement-source:ARM:chukwuma-purchasing-2021" ], "support_state": "candidate_supported", "target_slot": "formal-network-and-actual-coordination", "target_view": "delivery", "typed_fields": { "clinical_pathway_gap": "clear bidirectional primary-secondary pathways were reported absent for key conditions", "contract_reporting": "UHI-contracted providers must report through e-health", "current_handovers": "2022 to 2023 implementation respondents reported fragmented manual transfer of patient information", "formal_information_network": "unified e-health rules govern protected de-identified data, analysis and reporting", "integration_boundary": "shared information infrastructure is not treated as proof of integrated care", "pre_uhi_digital_gap": "e-referral and coordination modules existed but were not used until 2020 and data were not routinely used for purchasing quality" } }, "annotation_status": "open", "authors": [], "availability": {}, "citation": "Decision 843-L; World Bank PHC Assessment 2024 pages 46 to 48; Strategic Purchasing 2020 page 27; IEG 2019; Chukwuma et al. 2021 pages 5 to 8.", "country_ids": [ "ARM" ], "coverage_domains": [ "authoritative_review", "governance", "networks", "observed_referral", "patient_flows", "referral_design", "reform_history" ], "display_status": "shown_in_full", "document_type": null, "evidence_mode": "reported", "excerpt": null, "institution": null, "locator": { "description": "Decision 843-L sections 1 to 4; PHC Assessment pages 46 to 48; cited purchasing review pages" }, "material_id": "material:19d2b8c881aa3a6d7bf4f1f0", "notes": [ "Do not infer completed referrals or coordinated care from shared technology alone.", "Keep historical module non-use separate from current UHI implementation." ], "origin": "candidate-analytical-mappings", "period": "formal data governance current from 2022; observed implementation evidence through 2023", "publication_date": null, "publication_year": null, "record_kind": "candidate_analytical_mapping", "record_kind_label": "Candidate Analytical Mapping", "screening": { "previous_boundary_detected": false, "previous_visibility": "previously_not_projected" }, "source_layers": [ "grey_literature" ], "source_system": null, "source_version": { "detected_media_type": "text/html", "response_sha256": "82d34da4e5932a042ba3218735692cf3270d4815db999d495d09fd5e6b9eec5d" }, "statement": "Armenia has a governed unified e-health architecture and current UHI reporting duties, yet pre-UHI reviews and recent implementation interviews report underused referral functions, incomplete data use and fragmented manual handovers. 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Most observed evidence describes the preceding system and shows substantial self-presentation, hospital concentration, weak handovers and territorial capacity gaps. 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no single decentralization score is assigned" } }, "annotation_status": "open", "authors": [], "availability": {}, "citation": "Ministry Statute 728-L; UHI Law articles 27 to 32; Decisions 1953-A, 1982-N and 867-N; HSiA 2024 page 8.", "country_ids": [ "ARM" ], "coverage_domains": [ "actors", "autonomy", "decision_rights", "governance", "government_responsibilities", "hospital_organization", "market_structure", "ownership", "primary_care" ], "display_status": "shown_in_full", "document_type": null, "evidence_mode": "formal", "excerpt": null, "institution": null, "locator": { "description": "cited legal sections and HSiA physical page 8" }, "material_id": "material:37de418a4beed5f7f3a8b83f", "notes": [ "Keep approval, contracting, management and implementation roles separate.", "Do not turn reported hospital financial autonomy into unrestricted authority across workforce, capital and service mix." ], "origin": "candidate-analytical-mappings", "period": "current formal rights checked 2026-08-15, with hospital autonomy reported in 2024", "publication_date": null, "publication_year": null, "record_kind": "candidate_analytical_mapping", "record_kind_label": "Candidate Analytical Mapping", "screening": { "previous_boundary_detected": false, "previous_visibility": "previously_not_projected" }, "source_layers": [ "official" ], "source_system": null, "source_version": { "detected_media_type": "text/html", "response_sha256": "ba99a7d7638431914497918e4f0dc0273168bc6471f4b0c18a3aa48f7120e4fb" }, "statement": "National policy and licensing remain with the Ministry, the UHI Fund and its Board control contracting and reimbursement, territorial authorities manage most public delivery organizations, and hospitals exercise reported budget autonomy within purchaser, owner and regulatory constraints.", "tags": [], "territory": "national and territorial public-provider arrangements", "title": "Who decides depends on the function and reform period", "urls": [ { "kind": "url", "source": "not supplied", "url": "https://www.arlis.am/hy/acts/224417" }, { "kind": "source_reference", "source": "Statute of the Ministry of Health", "url": "https://www.arlis.am/hy/acts/123151" }, { "kind": "source_reference", "source": "Decision establishing the Universal Health Insurance Fund", "url": "https://www.arlis.am/hy/acts/218802/latest" }, { "kind": "source_reference", "source": "UHI provider contracting and reimbursement procedure", "url": "https://www.arlis.am/hy/acts/219009" }, { "kind": "source_reference", "source": "Medical care licensing procedure", "url": "https://www.arlis.am/hy/acts/212255" }, { "kind": "source_reference", "source": "Health Systems in Action: Armenia 2024", "url": "https://iris.who.int/server/api/core/bitstreams/f2bfb8e7-3a26-47bc-af74-c49bde392209/content" } ] }, { "analytical_mapping": {}, "annotation_status": "open", "authors": [], "availability": {}, "citation": "World Bank Independent Evaluation Group. Armenia: Achievements and Challenges in Improving Health Care Utilization, a Multiproject Evaluation of Health System Modernization 2004 to 2016. 2019. Executive Summary pages ix to x and report pages 32 to 35. https://documents1.worldbank.org/curated/en/725551557425652702/pdf/Armenia-Achievements-and-Challenges-in-Improving-Health-Care-Utilization-A-Multiproject-Evaluation-of-the-World-Bank-Support-to-the-Health-System-Modernization-2004-2016.pdf", "country_ids": [ "ARM" ], "coverage_domains": [ "authoritative_review", "governance", "networks", "observed_referral", "patient_flows", "primary_care", "referral_design", "reform_history", "utilization" ], "display_status": "shown_in_full", "document_type": null, "evidence_mode": "reported", "excerpt": "provision of care was fragmented", "institution": "World Bank Independent Evaluation Group", "locator": { "locator_type": "pages", "source_word_anchor": "provision of care was fragmented", "source_word_count": 6 }, "material_id": "material:8c3b7aaa163177a4b9b87f02", "notes": [ "Use as historical independent implementation evidence, not a current bypass prevalence estimate." ], "origin": "country-evidence-improvement-sources", "period": "historical reform evaluation published 2019", "publication_date": null, "publication_year": 2019, "record_kind": "country_improvement_source_lead", "record_kind_label": "Country Improvement Source Lead", "screening": { "previous_boundary_detected": false, "previous_visibility": "previously_not_projected" }, "source_layers": [ "grey_literature" ], "source_system": null, "source_version": { "detected_media_type": "application/pdf", "file_sha256": "f849a05b8b96e42f43620dba0aba4dd76fe36eabe0a61ab4364bab3091004f1c", "page_count": 100, "response_sha256": "f849a05b8b96e42f43620dba0aba4dd76fe36eabe0a61ab4364bab3091004f1c" }, "statement": "The independent evaluation documents fragmented primary care, perceived quality problems and self-referral to hospitals and emergency services despite facility modernization and primary-care investment.", "tags": [], "territory": "national modernization reforms evaluated for 2004 to 2016", "title": "Achievements and Challenges in Improving Health Care Utilization", "urls": [ { "kind": "url", "source": "not supplied", "url": "https://documents1.worldbank.org/curated/en/725551557425652702/pdf/Armenia-Achievements-and-Challenges-in-Improving-Health-Care-Utilization-A-Multiproject-Evaluation-of-the-World-Bank-Support-to-the-Health-System-Modernization-2004-2016.pdf" } ] }, { "analytical_mapping": {}, "annotation_status": "open", "authors": [], "availability": {}, "citation": "World Bank. Armenia Primary Healthcare Assessment Report: Strengthening Primary Healthcare. 2024. Pages 13, 36, 40 to 48. https://documents1.worldbank.org/curated/en/099110524064012649/pdf/P181001-13e2d7e3-188f-4e95-8437-d6e8217c8146.pdf", "country_ids": [ "ARM" ], "coverage_domains": [ "authoritative_review", "facility_data", "governance", "networks", "observed_referral", "patient_flows", "primary_care", "referral_design", "utilization" ], "display_status": "shown_in_full", "document_type": null, "evidence_mode": "observed", "excerpt": "remaining 64 percent of ACSC visits were registered in hospitals", "institution": "World Bank", "locator": { "locator_type": "pages_and_figures", "source_word_anchor": "remaining 64 percent of ACSC visits were registered in hospitals", "source_word_count": 10 }, "material_id": "material:b888c6361764cbbf4abb3dcb", "notes": [ "Ambulatory-care-sensitive classification signals potentially PHC-manageable care but does not prove every hospital encounter was avoidable.", "The 25-person inquiry is qualitative and not a national prevalence estimate." ], "origin": "country-evidence-improvement-sources", "period": "administrative encounters 2017 to 2020; facility survey 2022; interviews 2022 to 2023", "publication_date": null, "publication_year": 2024, "record_kind": "country_improvement_source_lead", "record_kind_label": "Country Improvement Source Lead", "screening": { "previous_boundary_detected": false, "previous_visibility": "previously_not_projected" }, "source_layers": [ "grey_literature" ], "source_system": null, "source_version": { "detected_media_type": "application/pdf", "file_sha256": "6eec3fc74eb5020fd4c2cbefc8eb2fadac5c949c36974671b0f603ec139973ef", "page_count": 76, "response_sha256": "6eec3fc74eb5020fd4c2cbefc8eb2fadac5c949c36974671b0f603ec139973ef" }, "statement": "The assessment finds that 64 percent of more than two million ambulatory-care-sensitive visits occurred in hospitals, documents rural physician and readiness gaps, and reports fragmented manual handovers and absent bidirectional clinical pathways in a 25-person implementation inquiry.", "tags": [], "territory": "national administrative analysis and 278-facility survey, with qualitative implementation interviews", "title": "Armenia Primary Healthcare Assessment Report", "urls": [ { "kind": "url", "source": "not supplied", "url": "https://documents1.worldbank.org/curated/en/099110524064012649/pdf/P181001-13e2d7e3-188f-4e95-8437-d6e8217c8146.pdf" } ] }, { "analytical_mapping": {}, "annotation_status": "open", "authors": [], "availability": {}, "citation": "Chukwuma A, Lylozian H, Gong E. Challenges and opportunities for purchasing high-quality health care: lessons from Armenia. Health Systems and Reform. 2021;7(1):e1898186. Pages 5 to 8. https://documents1.worldbank.org/curated/en/709271626075588582/pdf/Challenges-and-Opportunities-for-Purchasing-High-Quality-Health-Care-Lessons-from-Armenia.pdf", "country_ids": [ "ARM" ], "coverage_domains": [ "authoritative_review", "autonomy", "decision_rights", "governance", "market_structure", "networks", "observed_referral", "referral_design", "reform_history" ], "display_status": "shown_in_full", "document_type": null, "evidence_mode": "reported", "excerpt": "quality is not routinely monitored", "institution": "Health Systems and Reform", "locator": { "locator_type": "sections", "source_word_anchor": "quality is not routinely monitored", "source_word_count": 6 }, "material_id": "material:d95fb56b6710d05651a0fa7e", "notes": [ "Do not carry pre-UHI purchaser-performance findings forward as measured UHI Fund performance." ], "origin": "country-evidence-improvement-sources", "period": "literature review and interviews through 2020", "publication_date": null, "publication_year": 2021, "record_kind": "country_improvement_source_lead", "record_kind_label": "Country Improvement Source Lead", "screening": { "previous_boundary_detected": false, "previous_visibility": "previously_not_projected" }, "source_layers": [ "research_literature" ], "source_system": null, "source_version": { "detected_media_type": "application/pdf", "file_sha256": "b4b25561d56c80776fe97f322136c48921eaf8aa2f719c385aff187d05ea90d6", "page_count": 11, "response_sha256": "b4b25561d56c80776fe97f322136c48921eaf8aa2f719c385aff187d05ea90d6" }, "statement": "The study reports that output rather than quality dominated monitoring, purchaser and Ministry roles overlapped, quality data were not routinely used, e-referral modules were initially unused and rural spatial monopolies constrained selective contracting.", "tags": [], "territory": "national purchasing architecture before UHI", "title": "Challenges and opportunities for purchasing high-quality health care", "urls": [ { "kind": "url", "source": "not supplied", "url": "https://documents1.worldbank.org/curated/en/709271626075588582/pdf/Challenges-and-Opportunities-for-Purchasing-High-Quality-Health-Care-Lessons-from-Armenia.pdf" } ] }, { "analytical_mapping": {}, "annotation_status": "open", "authors": [], "availability": {}, "citation": "Government of Armenia. Decision 1953-A establishing the Universal Health Insurance Fund and approving its statute. 25 December 2025. Statute sections 1 to 5 and operative paragraph 9. https://www.arlis.am/hy/acts/218802/latest", "country_ids": [ "ARM" ], "coverage_domains": [ "actors", "decision_rights", "governance", "government_responsibilities", "reform_history" ], "display_status": "shown_in_full", "document_type": null, "evidence_mode": "formal", "excerpt": "հիմնադիրը Հայաստանի Հանրապետությունն է", "institution": "Government of Armenia", "locator": { "locator_type": "sections", "source_word_anchor": "հիմնադիրը Հայաստանի Հանրապետությունն է", "source_word_count": 4 }, "material_id": "material:e4d870cd130c64fd649ab144", "notes": [ "The transition direction does not prove that the State Health Agency has already ceased every function." ], "origin": "country-evidence-improvement-sources", "period": "in force from 2025-12-25", "publication_date": null, "publication_year": 2025, "record_kind": "country_improvement_source_lead", "record_kind_label": "Country Improvement Source Lead", "screening": { "previous_boundary_detected": false, "previous_visibility": "previously_not_projected" }, "source_layers": [ "official" ], "source_system": null, "source_version": { "detected_media_type": "text/html", "response_sha256": "d399767cb3a0a30a595886cc2561f164d2186cef1749ff939de9fa2ca60436c3" }, "statement": "The Government established the UHI Fund as a separate legal entity, authorized the Ministry of Health to act for the state founder, and directed preparation for transfer and discontinuation of the prior State Health Agency.", "tags": [], "territory": "national UHI purchaser and its state founder", "title": "Decision establishing the Universal Health Insurance Fund", "urls": [ { "kind": "url", "source": "not supplied", "url": "https://www.arlis.am/hy/acts/218802/latest" } ] }, { "analytical_mapping": {}, "annotation_status": "open", "authors": [], "availability": {}, "citation": "Government of Armenia. Decision 529-L amending the Health System Development Strategy 2023 to 2026. 18 April 2024. Article 1 and strategy annex. https://www.arlis.am/hy/acts/191998", "country_ids": [ "ARM" ], "coverage_domains": [ "governance", "government_responsibilities", "networks", "primary_care", "reform_history" ], "display_status": "shown_in_full", "document_type": null, "evidence_mode": "formal", "excerpt": "2023-2026 թվականների զարգացման ռազմավարությունը", "institution": "Government of Armenia", "locator": { "locator_type": "sections", "source_word_anchor": "2023-2026 թվականների զարգացման ռազմավարությունը", "source_word_count": 4 }, "material_id": "material:4eda761af295df580c114c46", "notes": [ "A strategy entry is a reform objective, not evidence that every action was completed." ], "origin": "country-evidence-improvement-sources", "period": "strategy window 2023 to 2026", "publication_date": null, "publication_year": 2024, "record_kind": "country_improvement_source_lead", "record_kind_label": "Country Improvement Source Lead", "screening": { "previous_boundary_detected": false, "previous_visibility": "previously_not_projected" }, "source_layers": [ "official" ], "source_system": null, "source_version": { "detected_media_type": "text/html", "response_sha256": "cbb4f1eb8ff94b9454fb08cfa888c69f7e86e6c6904d0a07a4ab74f9406ccca4" }, "statement": "The amended national strategy keeps primary care, quality, digital infrastructure, workforce and system development on the formal reform agenda through 2026.", "tags": [], "territory": "national health strategy", "title": "Health System Development Strategy 2023 to 2026", "urls": [ { "kind": "url", "source": "not supplied", "url": "https://www.arlis.am/hy/acts/191998" } ] }, { "analytical_mapping": {}, "annotation_status": "open", "authors": [], "availability": {}, "citation": "National Institute of Health, Ministry of Health of Armenia. Health System Performance Assessment: Armenia 2022. Method pages 23 to 25; Figures 164 and 169 to 171, physical pages 180 and 186 to 187. https://www.nih.am/assets/pdf/atvk/034a311b3e152c3bd512a99c97994151.pdf", "country_ids": [ "ARM" ], "coverage_domains": [ "networks", "observed_referral", "patient_flows", "primary_care", "referral_design", "utilization" ], "display_status": "shown_in_full", "document_type": null, "evidence_mode": "observed", "excerpt": "the patient was admitted to the hospital", "institution": "National Institute of Health, Ministry of Health of Armenia", "locator": { "locator_type": "figures", "source_word_anchor": "the patient was admitted to the hospital", "source_word_count": 7 }, "material_id": "material:506e5badbd039613fdb8123d", "notes": [ "The 35.1 percent figure is hospital admission after referral, not referral attendance or completion.", "Self-reported pathway estimates differ from administrative hospitalization distributions." ], "origin": "country-evidence-improvement-sources", "period": "2022 survey reference period", "publication_date": null, "publication_year": 2022, "record_kind": "country_improvement_source_lead", "record_kind_label": "Country Improvement Source Lead", "screening": { "previous_boundary_detected": false, "previous_visibility": "previously_not_projected" }, "source_layers": [ "official" ], "source_system": null, "source_version": { "detected_media_type": "application/pdf", "file_sha256": "41eaa8758d272e11500c7372060f8e54af28b98c4386a4554d42b65cc2076096", "page_count": 237, "response_sha256": "41eaa8758d272e11500c7372060f8e54af28b98c4386a4554d42b65cc2076096" }, "statement": "In the weighted 2,500-household survey, 42.4 percent of hospitalized adults arrived through PHC referral, 40.3 percent self-presented and 15.4 percent arrived through emergency services; 35.1 percent of PHC hospital referrals resulted in admission.", "tags": [], "territory": "national household survey of residents aged 15 years and older", "title": "Health System Performance Assessment Armenia 2022", "urls": [ { "kind": "url", "source": "not supplied", "url": "https://www.nih.am/assets/pdf/atvk/034a311b3e152c3bd512a99c97994151.pdf" } ] }, { "analytical_mapping": {}, "annotation_status": "open", "authors": [], "availability": {}, "citation": "Tsaturyan S, Scarpetti G. Health Systems in Action: Armenia 2024. European Observatory on Health Systems and Policies and WHO Regional Office for Europe; 2024. Page 8. https://iris.who.int/server/api/core/bitstreams/f2bfb8e7-3a26-47bc-af74-c49bde392209/content", "country_ids": [ "ARM" ], "coverage_domains": [ "actors", "authoritative_review", "autonomy", "decision_rights", "governance", "government_responsibilities", "hospital_organization", "market_structure", "networks", "ownership", "primary_care", "referral_design", "reform_history" ], "display_status": "shown_in_full", "document_type": null, "evidence_mode": "reported", "excerpt": "directly manages only a small number", "institution": "European Observatory on Health Systems and Policies and WHO Regional Office for Europe", "locator": { "locator_type": "section", "section": "Organizing the health system", "source_word_anchor": "directly manages only a small number", "source_word_count": 6 }, "material_id": "material:7b2a636c6bb00e212b5d841e", "notes": [ "Use this as the pre-UHI provider architecture and do not overwrite the 2025 to 2026 purchaser transition.", "The reported public share is approximate and not a universal ownership classification." ], "origin": "country-evidence-improvement-sources", "period": "system description published 2024 using mainly 2022 data", "publication_date": null, "publication_year": 2024, "record_kind": "country_improvement_source_lead", "record_kind_label": "Country Improvement Source Lead", "screening": { "previous_boundary_detected": false, "previous_visibility": "previously_not_projected" }, "source_layers": [ "review_literature" ], "source_system": null, "source_version": { "detected_media_type": "application/pdf", "file_sha256": "eb121fb78ae7a72ce86cd8d2a89f0461af26969535015b39cac0f3360490c098", "page_count": 24, "response_sha256": "eb121fb78ae7a72ce86cd8d2a89f0461af26969535015b39cac0f3360490c098" }, "statement": "The 2024 profile describes a decentralized provider system: regional and local authorities manage most public hospitals and primary care, the Ministry directly manages few specialized facilities, mixed public and private providers deliver publicly funded care, and hospital gatekeeping under the BBP is limited.", "tags": [], "territory": "national architecture with regional, municipal and Yerevan ownership variation", "title": "Health Systems in Action: Armenia 2024", "urls": [ { "kind": "url", "source": "not supplied", "url": "https://iris.who.int/server/api/core/bitstreams/f2bfb8e7-3a26-47bc-af74-c49bde392209/content" } ] }, { "analytical_mapping": {}, "annotation_status": "open", "authors": [], "availability": {}, "citation": "National Institute of Health, Ministry of Health of Armenia. Health and Health Care Statistical Yearbook 2024. Tables 5.2, 5.4 to 5.11 and 6.5 to 6.7, physical pages 192 to 232. https://nih.am/assets/pdf/atvk/ff14e3c27082c00737f3f4f9fc3b5493.pdf", "country_ids": [ "ARM" ], "coverage_domains": [ "facility_data", "hospital_organization", "market_structure", "ownership", "patient_flows", "utilization" ], "display_status": "shown_in_full", "document_type": null, "evidence_mode": "observed", "excerpt": "MAIN HEALTH RESOURCES AND SERVICE UTILIZATION, 2023", "institution": "National Institute of Health, Ministry of Health of Armenia", "locator": { "locator_type": "tables", "source_word_anchor": "MAIN HEALTH RESOURCES AND SERVICE UTILIZATION, 2023", "source_word_count": 7 }, "material_id": "material:82c40752385f2d4edb749021", "notes": [ "Facility, bed, workforce and activity shares use different denominators and must not be merged into one public-private score.", "Yerevan facility activity is not the same as utilization by Yerevan residents." ], "origin": "country-evidence-improvement-sources", "period": "2023 activity and capacity", "publication_date": null, "publication_year": 2024, "record_kind": "country_improvement_source_lead", "record_kind_label": "Country Improvement Source Lead", "screening": { "previous_boundary_detected": false, "previous_visibility": "previously_not_projected" }, "source_layers": [ "official" ], "source_system": null, "source_version": { "detected_media_type": "application/pdf", "file_sha256": "3eb2f656602968f47c12fd8ad535825d1189334567a14ada20fc5b7ea245f9f7", "page_count": 267, "response_sha256": "3eb2f656602968f47c12fd8ad535825d1189334567a14ada20fc5b7ea245f9f7" }, "statement": "Administrative reports record 125 inpatient facilities, 12,480 beds, 13,943 physicians, 480,942 hospitalizations and 11.43 million PHC visits, with ownership-sector and territorial distributions kept denominator-specific.", "tags": [], "territory": "national and marz-level administrative service records for 2023", "title": "Health and Health Care Statistical Yearbook 2024", "urls": [ { "kind": "url", "source": "not supplied", "url": "https://nih.am/assets/pdf/atvk/ff14e3c27082c00737f3f4f9fc3b5493.pdf" } ] }, { "analytical_mapping": {}, "annotation_status": "open", "authors": [], "availability": {}, "citation": "Manukyan C, Antonyan L, Hovhannisyan M, Terzan L, Libaridian L. Healthcare quality in rural Armenia: Focus group perceptions. BMC Health Services Research. 2025;25:1512. doi:10.1186/s12913-025-13545-4. Results. https://www.ebi.ac.uk/europepmc/webservices/rest/PMC12642249/fullTextXML", "country_ids": [ "ARM" ], "coverage_domains": [ "authoritative_review", "observed_referral", "patient_flows", "primary_care", "referral_design", "utilization" ], "display_status": "shown_in_full", "document_type": null, "evidence_mode": "observed", "excerpt": "often go directly to the sub-specialist", "institution": "BMC Health Services Research", "locator": { "locator_type": "sections", "source_word_anchor": "often go directly to the sub-specialist", "source_word_count": 7 }, "material_id": "material:befe4bc8df6476d6ca20d137", "notes": [ "This purposive one-province qualitative study cannot estimate national bypass or access prevalence." ], "origin": "country-evidence-improvement-sources", "period": "16 focus groups conducted March to June 2022", "publication_date": null, "publication_year": 2025, "record_kind": "country_improvement_source_lead", "record_kind_label": "Country Improvement Source Lead", "screening": { "previous_boundary_detected": false, "previous_visibility": "previously_not_projected" }, "source_layers": [ "research_literature" ], "source_system": null, "source_version": { "detected_media_type": "application/xml", "response_sha256": "3705cdb609aaa40d013ef920658dfe097f7a321f1052e3c138cce0dc786f1ae2" }, "statement": "More than 100 participants in rural Lori described bypassing local family physicians for subspecialists and identified road and physician-availability barriers.", "tags": [], "territory": "15 rural villages in Lori Province", "title": "Healthcare quality in rural Armenia: Focus group perceptions", "urls": [ { "kind": "url", "source": "not supplied", "url": "https://www.ebi.ac.uk/europepmc/webservices/rest/PMC12642249/fullTextXML" } ] }, { "analytical_mapping": {}, "annotation_status": "open", "authors": [], "availability": {}, "citation": "Republic of Armenia. Law on Medical Care and Services to the Population, current consolidated text. Articles 32 and 43. https://www.arlis.am/hy/acts/225396/print/act", "country_ids": [ "ARM" ], "coverage_domains": [ "autonomy", "governance", "hospital_organization", "market_structure", "networks", "ownership", "primary_care", "reform_history" ], "display_status": "shown_in_full", "document_type": null, "evidence_mode": "formal", "excerpt": "անկախ դրանց կազմակերպական-իրավական և սեփականության ձևերից", "institution": "National Assembly of the Republic of Armenia", "locator": { "locator_type": "legal_articles", "source_word_anchor": "անկախ դրանց կազմակերպական-իրավական և սեփականության ձևերից", "source_word_count": 5 }, "material_id": "material:25fe42cb9fd841606c425fd0", "notes": [ "Legal recognition of ownership forms is not a facility inventory or proof of market share." ], "origin": "country-evidence-improvement-sources", "period": "current consolidated text retrieved 2026-08-22", "publication_date": null, "publication_year": 2026, "record_kind": "country_improvement_source_lead", "record_kind_label": "Country Improvement Source Lead", "screening": { "previous_boundary_detected": false, "previous_visibility": "previously_not_projected" }, "source_layers": [ "official" ], "source_system": null, "source_version": { "detected_media_type": "text/html", "response_sha256": "69f0ddd2dbbb2eb2684b3271e34c64255e85a1c502db520bf3e9c70cb758d243" }, "statement": "Current law recognizes state and municipal health companies and non-commercial organizations, permits state-funded purchasing regardless of organizational or ownership form, and allows direct payment for uncovered, elective or expedited services.", "tags": [], "territory": "national medical organizations across legal and ownership forms", "title": "Law on Medical Care and Services to the Population", "urls": [ { "kind": "url", "source": "not supplied", "url": "https://www.arlis.am/hy/acts/225396/print/act" } ] }, { "analytical_mapping": {}, "annotation_status": "open", "authors": [], "availability": {}, "citation": "Republic of Armenia. Law HO-459-N on Universal Health Insurance. Adopted 17 December 2025, consolidated 8 May 2026. 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Decision 867-N, current consolidated medical care licensing procedure. Medical-care procedure sections 8 to 17. https://www.arlis.am/hy/acts/212255", "country_ids": [ "ARM" ], "coverage_domains": [ "actors", "decision_rights", "facility_data", "governance", "market_structure", "ownership" ], "display_status": "shown_in_full", "document_type": null, "evidence_mode": "formal", "excerpt": "գործում են միայն լիցենզիայում նշված վայրում", "institution": "Government of Armenia", "locator": { "locator_type": "sections", "source_word_anchor": "գործում են միայն լիցենզիայում նշված վայրում", "source_word_count": 6 }, "material_id": "material:333aab4e99449c40ce8109c1", "notes": [ "Site licensing does not demonstrate service volume, quality or market competition." ], "origin": "country-evidence-improvement-sources", "period": "current consolidated procedure checked 2026-08-22", "publication_date": null, "publication_year": 2025, "record_kind": "country_improvement_source_lead", "record_kind_label": "Country Improvement Source Lead", "screening": { "previous_boundary_detected": false, "previous_visibility": "previously_not_projected" }, "source_layers": [ "official" ], "source_system": null, "source_version": { "detected_media_type": "text/html", "response_sha256": "459af929a1ab50235a3437b0ddd8279ed4307a3bef799420913bf12b34261b14" }, "statement": "Medical organizations and individual entrepreneurs require site-specific licences and must meet stated facility, staffing and equipment requirements.", "tags": [], "territory": "all licensed medical organizations and individual entrepreneurs", "title": "Medical care licensing procedure", "urls": [ { "kind": "url", "source": "not supplied", "url": "https://www.arlis.am/hy/acts/212255" } ] }, { "analytical_mapping": {}, "annotation_status": "open", "authors": [], "availability": {}, "citation": "Prime Minister of the Republic of Armenia. Decision 728-L approving the Statute of the Ministry of Health. 11 June 2018. Sections I(1), II(10), III(11) and IV(12-18). https://www.arlis.am/hy/acts/123151", "country_ids": [ "ARM" ], "coverage_domains": [ "actors", "decision_rights", "governance", "government_responsibilities", "reform_history" ], "display_status": "shown_in_full", "document_type": null, "evidence_mode": "formal", "excerpt": "մշակում և իրականացնում է", "institution": "Prime Minister of the Republic of Armenia", "locator": { "locator_type": "sections", "source_word_anchor": "մշակում և իրականացնում է", "source_word_count": 4 }, "material_id": "material:96b995f36548edcd07458474", "notes": [ "Do not convert national policy and licensing authority into ownership of every provider." ], "origin": "country-evidence-improvement-sources", "period": "current consolidated ARLIS text checked 2026-08-15", "publication_date": null, "publication_year": 2018, "record_kind": "country_improvement_source_lead", "record_kind_label": "Country Improvement Source Lead", "screening": { "previous_boundary_detected": false, "previous_visibility": "previously_not_projected" }, "source_layers": [ "official" ], "source_system": null, "source_version": { "detected_media_type": "text/html", "response_sha256": "ba99a7d7638431914497918e4f0dc0273168bc6471f4b0c18a3aa48f7120e4fb" }, "statement": "The Ministry of Health develops and implements national health policy, sets standards, assesses quality, issues sector licences and manages only the organizations formally subordinate to it.", "tags": [], "territory": "national Ministry of Health and organizations subordinate to it", "title": "Statute of the Ministry of Health", "urls": [ { "kind": "url", "source": "not supplied", "url": "https://www.arlis.am/hy/acts/123151" } ] }, { "analytical_mapping": {}, "annotation_status": "open", "authors": [], "availability": {}, "citation": "World Bank. Strategic Purchasing for Better Health in Armenia. 2020. Pages 27, 32, 47 and 92. https://documents1.worldbank.org/curated/en/174831600184459793/pdf/English-Strategic-purchasing-for-better-health-in-Armenia.pdf", "country_ids": [ "ARM" ], "coverage_domains": [ "authoritative_review", "autonomy", "decision_rights", "governance", "market_structure", "networks", "observed_referral", "patient_flows", "referral_design", "reform_history" ], "display_status": "shown_in_full", "document_type": null, "evidence_mode": "reported", "excerpt": "Bypassing the primary care provider is not monitored", "institution": "World Bank", "locator": { "locator_type": "pages_and_figures", "source_word_anchor": "Bypassing the primary care provider is not monitored", "source_word_count": 8 }, "material_id": "material:d53e5c18c0b488091a982814", "notes": [ "Historical SHA findings do not establish the performance of the new UHI Fund.", "Hospitalization referral shares do not measure all outpatient specialist pathways." ], "origin": "country-evidence-improvement-sources", "period": "evidence and interviews compiled through 2020", "publication_date": null, "publication_year": 2020, "record_kind": "country_improvement_source_lead", "record_kind_label": "Country Improvement Source Lead", "screening": { "previous_boundary_detected": false, "previous_visibility": "previously_not_projected" }, "source_layers": [ "grey_literature" ], "source_system": null, "source_version": { "detected_media_type": "application/pdf", "file_sha256": "b262b5d04b33bdb1b1448da34a4cd3265198d9e2b4ff5c82afdfabcd183a5a7c", "page_count": 130, "response_sha256": "b262b5d04b33bdb1b1448da34a4cd3265198d9e2b4ff5c82afdfabcd183a5a7c" }, "statement": "Before UHI, the assessment found overlapping purchaser-policy roles, weak use of data for quality purchasing, rural spatial monopolies and weak hospital gatekeeping: 26.8 percent of hospitalizations followed PHC referral and 37.6 percent were self-referrals.", "tags": [], "territory": "national purchasing and referral architecture before UHI", "title": "Strategic Purchasing for Better Health in Armenia", "urls": [ { "kind": "url", "source": "not supplied", "url": "https://documents1.worldbank.org/curated/en/174831600184459793/pdf/English-Strategic-purchasing-for-better-health-in-Armenia.pdf" } ] }, { "analytical_mapping": {}, "annotation_status": "open", "authors": [], "availability": {}, "citation": "Government of Armenia. Decision 1982-N on UHI contracts, registration and reimbursement. 25 December 2025. Sections 1 to 9. https://www.arlis.am/hy/acts/219009", "country_ids": [ "ARM" ], "coverage_domains": [ "autonomy", "decision_rights", "governance", "hospital_organization", "market_structure", "networks", "primary_care", "referral_design", "reform_history" ], "display_status": "shown_in_full", "document_type": null, "evidence_mode": "formal", "excerpt": "ըստ մարդաշնչի փոխհատուցվող ծառայությունների", "institution": "Government of Armenia", "locator": { "locator_type": "sections", "source_word_anchor": "ըստ մարդաշնչի փոխհատուցվող ծառայությունների", "source_word_count": 4 }, "material_id": "material:5e03477e21fa74f51142a704", "notes": [ "Payment mechanics do not establish provider ownership or unrestricted managerial autonomy." ], "origin": "country-evidence-improvement-sources", "period": "active from 2025-12-30", "publication_date": null, "publication_year": 2025, "record_kind": "country_improvement_source_lead", "record_kind_label": "Country Improvement Source Lead", "screening": { "previous_boundary_detected": false, "previous_visibility": "previously_not_projected" }, "source_layers": [ "official" ], "source_system": null, "source_version": { "detected_media_type": "text/html", "response_sha256": "c231b983016da326b23d34cdac345feaa5546f7de0024e8ceff24ad6ec175296" }, "statement": "The UHI Fund contracts and reimburses eligible providers; primary care combines registered-population, performance and quality components, while hospital payment may use activity, bonus or maintenance-cost routes.", "tags": [], "territory": "national UHI-contracted providers and pharmacies", "title": "UHI provider contracting and reimbursement procedure", "urls": [ { "kind": "url", "source": "not supplied", "url": "https://www.arlis.am/hy/acts/219009" } ] }, { "analytical_mapping": {}, "annotation_status": "open", "authors": [], "availability": {}, "citation": "Government of Armenia. Decision 843-L on governance of de-identified unified e-health database information. 9 June 2022. Sections 1 to 4. https://www.arlis.am/hy/acts/163802", "country_ids": [ "ARM" ], "coverage_domains": [ "governance", "networks", "patient_flows", "referral_design", "reform_history" ], "display_status": "shown_in_full", "document_type": null, "evidence_mode": "formal", "excerpt": "պաշտպանությունը չարտոնված օգտագործումից", "institution": "Government of Armenia", "locator": { "locator_type": "sections", "source_word_anchor": "պաշտպանությունը չարտոնված օգտագործումից", "source_word_count": 3 }, "material_id": "material:8c0123e0239df2856d2eadaf", "notes": [ "Data governance does not by itself prove bidirectional clinical coordination or completed referrals." ], "origin": "country-evidence-improvement-sources", "period": "effective from 2022-06-11", "publication_date": null, "publication_year": 2022, "record_kind": "country_improvement_source_lead", "record_kind_label": "Country Improvement Source Lead", "screening": { "previous_boundary_detected": false, "previous_visibility": "previously_not_projected" }, "source_layers": [ "official" ], "source_system": null, "source_version": { "detected_media_type": "text/html", "response_sha256": "82d34da4e5932a042ba3218735692cf3270d4815db999d495d09fd5e6b9eec5d" }, "statement": "The active procedure governs protection, internal identifiers, analysis and reporting for de-identified information in the unified e-health database.", "tags": [], "territory": "national unified e-health information architecture", "title": "Unified e-health data governance procedure", "urls": [ { "kind": "url", "source": "not supplied", "url": "https://www.arlis.am/hy/acts/163802" } ] }, { "annotation_status": "open", "authors": [], "availability": {}, "citation": "World Bank Documents and Reports. 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Armenia – Primary Healthcare Assessment Report : Strengthening Primary Healthcare. 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Historical evolution of healthcare systems of post-soviet Russia, Belarus, Kazakhstan, Kyrgyzstan, Tajikistan, Turkmenistan, Uzbekistan, Armenia, and Azerbaijan: A scoping review.. 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