An additional financial burden is placed on the healthcare facilities for joining the common E-Health information system “Armed” and use its services. Along with talking about the benefits of the system, beneficiaries of the system voiced several types of payments and quite serious costs.
According to the published tariffs on the official website of Armed, the medical institution should pay 1) monthly fee for connection to the system 2) for functional users of the facility 3) actual registration for the institution.
For example, the hospital will pay 80,000 drams monthly to join the system, 500 drams for each registered doctor and 1000 drams for each patient visit. You can see the full rates here.
“The idea of e-health operator is good but underneath the obsession with money … added a new burden on society,” Mr. Narek Vanesya, President of the National Council of Young Doctors said in an interview with Iravaban.net, adding that Armed can earn at least one or two $ million annually.
The state however has tried to alleviate the financial burden of medical institutions and subsidize only part of the fees charged for joining the system: for this purpose about 487 million 479 thousand drams was necessary this year. According to the March 15 decision, the government has already allocated 203 million 116 thousand drams for subsidizing the first 5 months.
Who operates an Electronic Healthcare System?
On 26 January, 2017, the Government adopted the 95th Decree, which approved the procedure on establishing a tender commission for transferring the electronic system on a concession contract. And on 20 July, 2008, by the government’s Decree 866-N, the results of the tender for conveying an e-health system to a concession agreement were approved. The decision states:
“To approve the tender for transmission of the electronic health care system under the management of the “Electronic Governance Infrastructure Implementation Unit “(EKENG) Closed Joint-Stock Company, implemented under the Credit Agreement (Second Public Sector Modernization Project) signed between the Republic of Armenia and the International Bank for Reconstruction and Development recognizing “Sylex SARL” company acting as a joint venture contract (Swiss Confederation) and “Maysis Secure” Limited Liability Company (the Republic of Armenia) the winner of the competition.”
Thus, “Armed” is operated by the “National Electronic Healthcare CJSC” CJSC, consisting of the Armenian “Maysis Secure” and the Swiss “TravelStar” companies.
Both Swiss and Armenian companies belong to the same person, Avet Eduard Manukyan, who is also the Director of the National Electronic Healthcare CJSC.
We learned from the State Register of Legal Entities of the Ministry of Justice of the Republic of Armenia that “Maysis Secure” was founded on 5 March, 2009.
In collaboration with Investigative Dashboard, we learn that “DollyStar”, according to Money House, was registered on 3 March, 2016 in Lausanne.
Consortium of Companies belonging to the Same Person and Terms of the Tender
A question arises as to why two companies belonging to the same person make a consortium and apply for a joint pre-qualification competition for establishing an Electronic Healthcare Information System Operator together. To answer this question, first you need to understand what conditions have been set in the invitation for the participants.
In the first part of the 9th point of the invitation to the tender, NES-17/1, the requirements of professional activity are defined:
“a. Participant of the contest for participation in the tender should have implemented in a country with a population of at least 3.0 million in the preceding 5 years personally (including as a member of a Consortium or as a subcontractor) or a subsidiary or a company with a capital of 50 or more percent, operation of a National Electronic Healthcare Information System (including at least the following essential and programmatic modules); (a) Integrated National Registry of Health Care Providers, (b) Patient Visitor Management Module, (c) Module of Patients’ Electronic Health Card, (d) Insurance degree of data between health care institutions and the real exchange module mode) or the successful development and operation of the project during the last 3 years in a row must be carried out by the system management software tools to improve the delivery and maintenance services.
- The Participant , within five yearspreceding the invitation to participate in the tender, be personally (including as a consortium member or subcontractor) or a subsidiary or more than 50% interest-bearing company (including a consortium member) must have implemented in Armenia development of an automated system of comprehensive insurance services provision, improvement of software tools and maintenance for at least one insurance company.”
For example, in 2017, when the contest was held, the “SYLEX Sàrl” Company did not have 5 years of experience, it was established in March 2016 and did not meet the second requirement for providing insurance services. Meanwhile, the other company of the joint venture “”Maysis Secure” was meeting both requirements.
Part 2, paragraph 9, of the invitation to tender specifies requirements for financial resources:
“a. During the last 5 years, the Participant has the right to make, either directly (including as a consortium member or subcontractor) or its subsidiary or a company with a 50% or more of its own, implement a nationally integrated electronic health care system or a health insurance service, must have a cash flow equivalent at least to USD 500,000 .
- The Participant personally or through the Consortium of Participants shall have at least 100,000 US Dollars offree circulating assets at bank accounts for at least ten days prior to the deadline for submission of the Common Prequalification Application.
There are no documents verifying that financial conditions have been met by “Maysis Secure”. Instead, papers on meeting these requirements were presented by “SYLEX Sàrl”. Particularly, Jorgana Kovachevich, President of Croatian Erichsson Nicholas Tesla JSC has confirmed that “SYLEX Sàrl” Company has received payments over $ 500,000 from Erickson Nicholas Tesla for its programs and services in the implementation of a national integrated health electronic system in the Republic of Kazakhstan during one year preceding the preparation of this document.”
The Swiss Bank has also provided data for the account, which showed that it had a circulation of over $ 100,000 in the bank account during the past 90 days.
And so it becomes clear why a joint venture agreement has been signed by two companies of the same person.
Linkage of the Winner’s Company with the Former Minister
As we have already mentioned, one of the conditions for the pre-qualification competition was the development of an automated system of comprehensive health insurance services, improvement and maintenance of software tools for at least one insurance company in Armenia. Only the consortium of “Maysis Secure” and “SYLEX Sàrl” companies met this condition.
Ingo Armenia insurance company had submitted a document meeting this condition. The document states that since 26 September, 2012, till the time when the document was submitted, Ingo Armenia had contractual relations with “Maysis Secure” and the latter implemented the automated insurance management system during that period, and its maintenance.
This document was submitted on 17 March, 2017. Meanwhile, the pre-qualification competition for procurement under the HHEKEN-MASTZB-N17/1 code was organized by EKENG on 27 February, 2017.
As it is known, prior to the period from September 2016 to May 2018, when Levon Altunyan was the RA Minister of Healthcare, he had been Executive Director of Ingo Armenia since 1999.
Moreover, Levon Altunyan signed the 3088-A decree two weeks after assuming the office on 27 September, 2016, by which a number of committees, including high-tech healthcare and the unified information system of the RA healthcare system, (e-health care system) were created.
The composition of this committee was also approved by the order of the Minister: Vardan Gevorgyan, was appointed the Chairman of the commission, Arman Melkonyan and Armen Parsadanyan the advisors to the Minister were appointed the members of the commission. Vardan Gevorgyan, the Chairman of the Commission, is also Deputy Director of Ingo Armenia.
Iravaban.net has also contacted former Minister Levon Altunyan to clarify these issues. The latter mentioned that these issues are not related to him. And former Minister’s spokesman Anahit Haytayan explained that the competition was not organized by the Ministry, so the questions about the conditions of the competition should not be directed to them.
By the way, EKENG was ready to provide all the tender documents, but the competitors did not provide sufficient answers.
And to the question as to what relationship insurance services might have with eHealth (As it is unclear why such conditions related to the insurance company and providing insurance services have been set, and there is no reasoning why such services should have been provided just in Armenia. And there is only the impression that this condition were set to secure the victory of the “Maysis Secure” and the “SYLEX Sàrl” consortium. “Anahit Haytayan noted that one of the former governments programs was the transition to mandatory health insurance, as international experience shows that it was needed for reform of the system.
In relation to the Chairman of the Commission on Proposals for the Implementation of the Electronic Healthcare System, Anahit Haytayan mentioned that Vardan Gevorgyan worked on a voluntary basis and it was difficult to find another specialist who was well aware of the situation.
By the way, according to the Government Resolution 866-N, the Minister Health has been authorized to conclude the Concession Agreement. And according to the Concession Agreement, disputes between the parties (conceded and operator) in case of not being resolved in good faith, will be settled by London International Arbitration and the proceedings will be conducted in accordance with the rules of the UNCITRAL.