Promoting universal financial protection: health insurance for the poor in Georgia - a case study

Type Journal Article - Health Research Policy and Systems
Title Promoting universal financial protection: health insurance for the poor in Georgia - a case study
Volume 11
Publication (Day/Month/Year) 2013
Background: The present study focuses on the program “Medical Insurance for the Poor (MIP)” in Georgia. Under
this program, the government purchased coverage from private insurance companies for vulnerable households
identified through a means testing system, targeting up to 23% of the total population. The benefit package
included outpatient and inpatient services with no co-payments, but had only limited outpatient drug benefits. This
paper presents the results of the study on the impact of MIP on access to health services and financial protection
of the MIP-targeted and general population.
Methods: With a holistic case study design, the study employed a range of quantitative and qualitative methods.
The methods included document review and secondary analysis of the data obtained through the nationwide
household health expenditure and utilisation surveys 2007–2010 using the difference-in-differences method.
Results: The study findings showed that MIP had a positive impact in terms of reduced expenditure for inpatient
services and total household health care costs, and there was a higher probability of receiving free outpatient
benefits among the MIP-insured. However, MIP insurance had almost no effect on health services utilisation and the
households’ expenditure on outpatient drugs, including for those with MIP insurance, due to limited drug benefits
in the package and a low claims ratio. In summary, the extended MIP coverage and increased financial access
provided by the program, most likely due to the exclusion of outpatient drug coverage from the benefit package
and possibly due to improper utilisation management by private insurance companies, were not able to reverse
adverse effects of economic slow-down and escalating health expenditure. MIP has only cushioned the negative
impact for the poorest by decreasing the poor/rich gradient in the rates of catastrophic health expenditure.
Conclusions: The recent governmental decision on major expansion of MIP coverage and inclusion of additional
drug benefit will most likely significantly enhance the overall MIP impact and its potential as a viable policy
instrument for achieving universal coverage. The Georgian experience presented in this paper may be useful for other
low- and middle-income countries that are contemplating ways to ensure universal coverage for their populations.

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