Page 130 - Azerbaijan State University of Economics

Christian Elsner, Dennis Häckl: Health Economic value generation in the Azerbaijan Republic:
simulatedresults for a integrated telecardiology care program

Overall the AR health care system acts as an integrated model where the providers are

owned by the payors. The public health providers, as state institutions, have limited financial and

managerial autonomy: Public health care facilities receive input-based payments based on the

number of beds or staff through prospective fixed line-item budgets. That means, that a hospital

will get paid regardless of whether it has no patients or is fully occupied. Underspending is

penalised over reductions in allocations because the next year budgeting process is based on last

years expenditures. The installed payment mechanism does not provide any incentives for hospital

administrators to reduce costs to improve efficiency or to reward better performing facilities.

In the field of congestive heart failure it is hard to get exact data for the incidence and

prevalence in the AR. For the simulation model an extrapolation from Healthgrades© was used

[http://www.rightdiagnosis.com/c/congestive_heart_failure/stats-country.htm]. Due to a shifted age-

structure compared to the US and Germany, where roughly 2% of the 40-59 aged, 5% of the 60-69

aged and 10% of the over 70 aged population suffer from CHF, the rate in the AR may be slightly

lower per se – an effect, which may be compensated due to a poorer treatment regime. According to

Healthgrades© an overall rate of 1.764 % CHF patients in the AR can be estimated. Taking into

account, that the AR has 9.49 MIO inhabitants [http://en.wikipedia. org/wiki/Azerbaijan], this

represents a number of 167.551 people relevant for an innovative CHF therapy.

To the knowledge of the authors there are no special telemedical care programs for CHF

underway in the AR. A first medical Internet and telemedicine station in the Azerbaijan Republic

was establishedin June 1997. In the consequent years consultations were carried out with

international clinics in specialties such as cardiology, ophthalmology, endocrinology and surgery

– but up to date there is no systematic approach to care for CHF patients systematically over a

telemedical approach.A telemedical approach with patient-morbidity oriented budgeting and a

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