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International researcher studies health care issues at NMSU

Although the health care system in the U.S. may be imperfect, an international researcher is collaborating with colleagues at New Mexico State University to study what practices are successful in order to help cure health care woes in her native Armenia.

Visiting professor and Armenian researcher Tamara Tonoyan reviews documents in her office at New Mexico State University. (Courtesy photo)

Associate Professor Tamara Tonoyan has conducted research and participated in conferences in Armenia, Austria, Belgium, England, Germany, Hungary, Lithuania, Russia and in the U.S. at the Woodrow Wilson International Center in Washington, D.C., among other places.

Tonoyan's current research project is titled "Health care reform in Armenia: Finding ways to overcome challenges." The international researcher is working under a fellowship from the Carnegie Corporation of New York and her research aims at exploring ways to overcome problems in Armenia's health care system by analyzing the best practices of developed countries.

One of the ways Tonoyan analyzes health care systems is by looking at health services affordability. According to her research, the utilization of health care services is low in Armenia, despite the sufficient number of health care facilities and medical workforce. Demand for medical services in Armenia is four times less than supply. Many do not use the system because they do not have health insurance and cannot afford to pay for services out of pocket.

Utilization is low even for the 23 percent of Armenians who qualify for the government health care program "Basic Benefits Package," or BBP. Only 65 percent of those eligible for BBP use healthcare services. This is in part because the government sets payment at rates that may not cover providers' expenditures. As a result, BBP participants are pressured to give additional informal payments in exchange for health services.

"BBP is not based on real costs of services and thus contributes to unofficial or illicit payments," Tonoyan said. "Moreover, all services that are not included in BBP must be paid directly by the patient."

This is not a problem unique to Armenia. Tonoyan stated that while informal payments in Armenia may exceed 45 percent of the total health care resources, the rate is similar in the neighboring country of Georgia at 35-40 percent and is nearly double in Azerbaijan at 84 percent.

"In these conditions, many Armenians prefer the ostrich method," Tonoyan said. "It is better to not know about our diseases than to know and not be able to treat them because of lack of access to health care and especially medication."

In the U.S., the problem of drug affordability has been highlighted by the Medicare participant's plight of the "donut hole" or coverage gap many experience when their Medicare Part D prescription benefits run out. Until recently, many Americans were left paying the full cost of prescription medications once Medicare paid out $2,840. The Affordable Health Care Act now extends a 50 percent discount on brand-name prescription medications when participants reach the "donut hole."

Tonoyan hopes that by researching the health systems of developed countries with the help of NMSU colleagues, she can find strategies to make the health care in Armenia more responsive to the needs of the poor. She is also studying ways to reduce unnecessary medical costs and introduce effective policies and programs.

Toward that end, Tonoyan is working not only with NMSU researchers and professors in the College of Health and Social Services, but also with professors in the College of Business and the College of Education.

"I truly believe that increasing collaboration with U.S. colleagues, as well as gradual adoption of the most accessible procedures and technologies will be very fruitful," Tonoyan said. "This initiative gives me a chance to share my experiences, to compare my approach with the approaches of my U.S. colleagues and develop a new perspective."