The Healthcare System in Azerbaijan: Compulsory Health Insurance, Care Pathway and Health Risks

According to the European Observatory on Health Systems and Policies, the Azerbaijani system remained highly centralised until 2021. Reforms separated the functions: the Ministry of Health sets health policy, manages the public health centres and supervises tertiary hospitals; the State Agency for Compulsory Health Insurance (DTSEA, SAMHI in English) is the public purchaser of care; the administration of regional medical divisions (TABIB) is the main public provider. Compulsory health insurance was introduced in 2021, after a four-year pilot phase, and covers emergencies, primary, outpatient and hospital care.

Funding remains mostly provided by the State budget, supplemented by compulsory insurance and a few earmarked taxes. Most providers belong to the State; the private sector is developing, especially in Baku, and operates independently of the public system. In towns, primary care is provided by polyclinics and women’s consultation centres; in rural areas, by midwife and nurse posts, village dispensaries and the outpatient services of small hospitals. World Bank indicators put current health spending at just over 4% of GDP, and life expectancy at birth at about 75 years.

The DTSEA indicates that those insured are Azerbaijani citizens, recognised refugees and people under the UNHCR mandate, as well as foreigners and stateless persons residing temporarily or permanently in Azerbaijan, when they pay the compulsory contribution and hold a temporary or permanent residence permit issued by the State Migration Service. Access therefore follows resident status: on the agency’s page, it rests on the residence permit and not on the short-stay e-visa.

The contribution rate does not appear on the agency page consulted: it should be confirmed with the DTSEA (line 142 or call centre 1542 for compulsory health insurance questions) and the employer, who withholds the employee share. Employees seconded by a French employer in principle keep the French scheme, but remain liable for any local contributions, as the page working in Azerbaijan recalls. The breakdown of reimbursements by status is detailed in healthcare reimbursement in Azerbaijan.

For scheduled care, the insured person consults the family doctor of the primary care facility at their registered address; they may choose and change family doctor without restriction, and the doctor refers them to a specialist if necessary. The specialist is also accessible directly, whatever the address, and may refer to hospitalisation. Prescribed laboratory tests, instrumental and radiology examinations are free within the basket; outpatient MRI and scans involve a 20% co-payment of the basket tariff.

The basket, called “Xidmətlər Zərfi”, includes 3,318 services. It excludes in particular cosmetic procedures, plastic surgery, dental care and in vitro fertilisation. When a service is not available in TABIB or ministry establishments, the DTSEA issues a referral to a contracted private or departmental establishment; the referral and the resulting services are free, and it is valid for 10 working days. Going to a private establishment without a referral, outside an emergency, means paying yourself. Certain university clinics and the Baku health centre are directly accessible for hospitalisation, on test results attesting to the medical need.

France Diplomatie indicates that public hospitals are in principle inexpensive but poorly equipped, except those in Baku, and that the capital’s foreign medical centres have most of the necessary treatments; in case of serious illness or accident, patients sometimes get treated abroad. Consultations in the capital’s foreign centres may cost USD 50 to 250, i.e. about €45 to €224 at the Central Bank rate. The French embassy publishes in its “Medical care” section a list of medical centres in Baku.

The emergency numbers are 112 (general number, English-speaking operators 24 hours a day), 101 for the fire brigade, 102 for the police, 103 for ambulances and 104 for gas. The French embassy in Baku can be reached on +994 12 490 8100. In an emergency, the DTSEA specifies that the insured person may go directly to a nearby private or departmental establishment: it then invoices the agency. France Diplomatie warns that a patient without insurance covering all medical costs and repatriation may be refused access to care, including in a life-threatening emergency.

The European Observatory specifies that compulsory insurance covers outpatient medicines for the national vertical programmes, and covers neither other outpatient medicines nor dental care. France Diplomatie adds that certain medicines, notably painkillers, are not available in Azerbaijan: a chronic treatment is prepared before departure, in its original packaging and with a prescription written in international nonproprietary name. Dental care, outside the basket, is paid directly or falls under supplementary insurance.

For families, preparation for maternity and paediatrics is done with the insurer before settling, as international contracts generally apply waiting periods. The guide expat health insurance and the page repatriation and assistance present the selection criteria.

The French embassy recalls, in its sheet on payment of healthcare costs, that the French State does not pay hospitalisation, medical care or medical repatriation costs abroad: everyone arranges their own cover. A stay of less than 30 days comes under travel insurance with assistance. A long stay combines, depending on status, the local compulsory health insurance once a residence permit has been obtained, retention of the French scheme for a seconded employee, the CFE (Caisse des Français de l’étranger, the voluntary social protection body for French expatriates) or an international contract.

Three checks are needed before departure: cover for medical repatriation and evacuation, the validity of the contract in the areas that France Diplomatie advises against, and access to the desired establishments with or without advancing costs. Once resident, the DTSEA insured person chooses their family doctor, keeps their identity documents and residence permit for any consultation, and notes the numbers 103 and 112. The family finds out in the same way for each of its members, as affiliation is checked per person.

France Diplomatie notes, in its Health sheet, sporadic cases of malaria from May to October in the north of the country, as well as typhoid fever, avian influenza, rabies and tuberculosis, with associated prevention measures. Occasional alerts report rises in measles cases. Tap water is not drinkable, even if large hotels have filtration systems; checks on imported meat and fresh produce are random and the cold chain is not always respected, especially in summer.

The French vaccination schedule must be up to date, in particular for diphtheria, tetanus, polio, whooping cough and measles. Depending on the length and conditions of stay, the ministry mentions hepatitis A and B, typhoid fever, tuberculosis (children under 15 on frequent or prolonged stays), rabies and mpox in case of risk exposure. A consultation with a doctor or an international vaccination centre, early enough before departure, makes it possible to draw up the suitable programme. Mountain stays and road travel outside Baku are prepared with the advice in the page living in Azerbaijan.