ORIGINAL ARTICLE The Armenian healthcare system: recent changes and challenges Arsen Torosyan & Piotr Romaniuk & Krzysztof Krajewski-Siuda Received: 25 June 2007 / Accepted: 4 October 2007 / Published online: 13 November 2007 # Springer-Verlag 2007 Abstract Background Armenian healthcare reforms have been car- ried out since independence in 1991, but achieved their full scale starting in 1995–1996. Although the healthcare system has already been modified and changed for 10 years, there is a lack of research in this regard. Objectives This paper aims to present the organization of the healthcare system in Armenia, its changes and challenges throughout the reform process. Methods This paper is mainly based on a review of the relevant professional literature, a review and interpretation of legal acts in the healthcare field, and a review of research and assessment works done by several international and local organizations. Results There are still large numbers of elements typical for the Soviet Semashko model in Armenian healthcare structures. Implemented reforms have separated the institu- tions of the public payer and the providers, but did not manage to change the model of financing to be based on compulsory insurance. The level of financing is similar to the average in Central and Eastern Europe, but is based mainly on out-of-pocket payments contributing to about 80% of all system resources. The informal payments reach even 45% of expenditures. The structure of hospital beds remains ineffective, and there are still no mechanisms of increasing the quality of services. Privatization has been applied, but the role of private providers is still limited. Conclusions The reforms have not caused satisfactory improvement in healthcare performance, although the health indicators are better than at the beginning of the transformation period. The stability of the reforming processes in previous years as well as the engagement of international institutions is a chance for positive changes in the near future. Keywords Healthcare system . Healthcare reforms . Armenia . Post-communist countries Introduction The Republic of Armenia is one of the smallest of the former Soviet republics. This mountainous country covers 29,743 km 2 and has a population of about 3.2 million (National Statistic Service of RA 2006). After declaring independence in September 1991, Armenia became a sovereign republic headed by a president. Since this time the country has entered a path of transition towards a free market economy, although impeded by numerous difficul- ties. The dissolution of the Soviet Union exacerbated ethnic and national tensions, contributing to the outbreak of armed conflict between Armenia and Azerbaijan over the Nagorno-Karabakh region. Although a cease-fire has been held since 1994, tensions remain high, causing the borders with Azerbaijan and Turkey still to be closed. Armenia’s early years of independence have been impacted by severe economic decline and energy shortages. The transition to a market economy has been hampered by the legacy of central planning, major economic shocks J Public Health (2008) 16:183–190 DOI 10.1007/s10389-007-0160-y DO00160; No of Pages A. Torosyan National Institute of Health, Ministry of Health of Armenia, Yerevan, Armenia P. Romaniuk : K. Krajewski-Siuda (*) Department of Health Policy, Faculty of Public Health, Medical University of Silesia, ul. Piekarska 18, 41-902 Bytom, Poland e-mail: zpz@slam.katowice.pl