The Soviet domination of the health system in Armenia was such that no traces of pre-Soviet healthcare traditions were discernible at the time of independence in 1991. Rather, the country inherited a highly centralised system. The entire population was guaranteed free medical assistance, regardless of social status, and had access to a comprehensive range of secondary and tertiary care.

Immediately after independence, Armenia faced devastating economic and sociopolitical problems, which led to a decline in health status and put overwhelming strain on the healthcare system.1 However, the most compelling pressure for the health sector reform was the impossibility of sustaining existing health services in the new economic climate. Armenia was simply not in a position to continue to fund a cumbersome, expensive, and insufficient system and was obliged to devise a broad reform programme.

Despite the radical nature of health sector reform in Armenia, the core organisational structure of the system has undergone very little change. All the hospitals …