Abstract
BackgroundIn 2007 the Georgian government introduced a full state-subsidized Medical Insurance Program for the Poor (MIP) to provide better financial protection and improved access for socially and financially disadvantaged citizens. Studies evaluating MIP have noted its positive impact on financial protection, but find only a marginal impact on improved access. To better assess whether the effect of MIP varies according to different conditions, and to identify areas for improvement, we explored whether MIP differently affects utilization and costs among chronic patients compared to those with acute health needs.MethodsData were collected from two cross-sectional nationally representative household surveys conducted in 2007 and in 2010 that examined health care utilization rates and expenditures. Approximately 3,200 households were interviewed from each wave of both studies using a standardized survey questionnaire. Differences in health care utilization and expenditures between chronic and acute patients with and without MIP insurance were evaluated, using coarsened exact matching techniques.ResultsAmong patients with chronic illnesses, MIP did not affect either health service utilization or expenditures for outpatient drugs and reduction in provider fees. For patients with acute illnesses MIP increased the odds (OR = 1.47) that they would use health services. MIP was also associated with a 20.16 Gel reduction in provider fees for those with acute illnesses (p = 0.003) and a 15.14 Gel reduction in outpatient drug expenditure (p = 0.013). Among those reporting a chronic illness with acute episode during the 30 days prior to the interview, MIP reduced expenditures on provider fees (B = -20.02 GEL) with marginal statistical significance.ConclusionsOur findings suggest that the MIP may have improved utilization and reduce costs incurred by patients with acute health needs, while chronic patients marginally benefit only during exacerbation of their illnesses. This suggests that the MIP did not adequately address the needs of the aging Georgian population where chronic illnesses are prevalent. Increasing MIP benefits, particularly for patients with chronic illnesses, should receive priority attention if universal coverage objectives are to be achieved.
Highlights
In 2007 the Georgian government introduced a full state-subsidized Medical Insurance Program for the Poor (MIP) to provide better financial protection and improved access for socially and financially disadvantaged citizens
35% of the population reported they suffered from a chronic illness, and about 20% of these individuals were covered by MIP
Crude analysis suggests that formal outpatient service utilization and selftreatment among chronic disease sufferers not reporting any acute health episode during the 30 days prior to our survey was roughly equal between MIP-insured and -non-MIP individuals, and this patient group was significantly less likely to administer self-treatment (4.4%, compared to those reporting only acute health problems or chronic conditions with acute episode: 27.8% and 35.8% respectively)
Summary
In 2007 the Georgian government introduced a full state-subsidized Medical Insurance Program for the Poor (MIP) to provide better financial protection and improved access for socially and financially disadvantaged citizens. Studies evaluating MIP have noted its positive impact on financial protection, but find only a marginal impact on improved access. While the Georgian government officially declared universal access to care for all in 1995, the public-funded benefit package introduced at that time only included limited preventive and curative services, without adequate financial means. Viewed as a cheaper option than visiting a health care provider–especially by chronic patients—the increase in self-medication was facilitated by weak enforcement of pharmaceutical regulations, enabling individuals to purchase prescription drugs from pharmacies over the counter, without a prescription [5]. A 2010 study revealed that approximately one in every five individuals (20.8%) reported self-treatment as a substitute for accessing the formal health system [6]
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