Free hospitalization for acute respiratory infections in children: what effect and how much does it cost for Armenia?

  • Sergey Sargsyan Arabkir Medical Center – Institute of Child and Adolescent Health, Yerevan State Medical University, Yerevan, Armenia
  • Diana Andreasyan National Institute of Health, Yerevan, Armenia
  • Samvel Kharazyan Health Economists Association, Yerevan, Armenia
  • Olga Denisiuk Alliance for Public Health, Kiev, Ukraine
  • Karapet Davtyan Tuberculosis Research and Prevention Center, Yerevan, Armenia
  • Roni Zachariah United Nations Children’s Fund / United Nations Developmental Program / World Bank / World Health Organization Special Programme for Research and Training in Tropical Diseases, World Health Organization, Geneva, Switzerland
Keywords: morbidity, mortality, health system, SDGS, universal health coverage, SORT IT


Introduction: The “Child Certificate” program, launched in Armenia in 2011, made hospitalization for children less than seven years free in order to improve access to hospitalization, reduce out-of-pocket expenses and ensure Universal Health Coverage. We aimed to estimate trends in the number of outpatient and hospitalized acute respiratory infection (ARI) cases and related under-five mortality.

Methodology: Cross-sectional study using data from national databases before (2008-2011) and after (2012-2017) Program implementation. The diagnosis of ARI was based on the International Classification of Disease (ICD-10).

Results: The average hospitalization per 1000 children under 14 and infants increased by 85% and 75% respectively, compared with the period before the introduction of the Program, while the frequency of outpatient visits remained unchanged. The ARI-related mortality in children less than five years and in infants decreased by 11% and 19%, respectively. Financial allocations for ARI-associated hospitalizations amounted to 2.1 billion Armenian drams in 2011 and increased to 3.3 billion drams in 2016 (an increase of 57%). For pneumonia, this increase was 108% (from 0.35 to 0.72 billion).

Conclusions: The introduction of free hospitalization for ARI led to an increase in the hospitalization rates. There was a favorable decline in under-five mortality and an exponential increase in financial allocations. The reasons for hospitalization should be investigated to ensure rational hospitalization with parallel improvement of primary care to reduce delayed presentations. It is necessary to find ways addressing the growing financial allocations for ARI-associated hospitalization.

How to Cite
Sargsyan S, Andreasyan D, Kharazyan S, Denisiuk O, Davtyan K, Zachariah R (2019) Free hospitalization for acute respiratory infections in children: what effect and how much does it cost for Armenia?. J Infect Dev Ctries 13:051S-056S. doi: 10.3855/jidc.11158
The Armenian SORT IT Course