Covid-19 and health insurance reform in Azerbaijan

The outbreak of the COVID-19 pandemic in early 2020 forced Azerbaijan to postpone the rollout of nationwide Mandatory Health Insurance (MHI) for 1 year. Launched in 2017 as a pilot in three districts, MHI was conceived as a way to tackle the underlying problems in health care financing and as a means to improve health service provision to the population. When the pandemic struck, the piloted MHI did not cover much of the country including the greater Baku area with a population of over 2.3 million inhabitants (out of the country’s total population of 10 million). Lack of health insurance left a large part of the populace uninsured during a major health crisis, though the government did provide a temporary social assistance through a generous fiscal relief package. Although the government adopted the Law on Medical Insurance in October 1999 (Mehtiyev, 2021), MHI was introduced nationwide only in April 2021. While the initial shock of the pandemic delayed the rollout of MHI, COVID-19 also revealed underlying weaknesses of the health system, prompting the authorities to speed up the introduction of MHI. This supports the view that COVID-19 encouraged incremental policy changes that were already under way before the coronavirus emergency rather than having opened a window of opportunity for a more structural reform in the health system (Bali et al., 2022). Over the past decades, Azerbaijan has taken steps to reform its social protection and health systems. A well-designed Targeted Social Assistance (TSA) program introduced in 2006 provides cash transfers to low-income households. Due to cash transfers and other social assistance programs, poverty levels dropped from 45% in 2003 to 6% in 2020. The government undertook a major overhaul of social policies in 2019, expanding the coverage of social assistance, increasing the minimum wage and pensions, and improving the delivery of social services through digitization and better information management (Johansson De Silva et al., 2023).