Abstract
BackgroundTo quantify extent of catastrophic household health expenditures, determine factors influencing it and estimate Fairness in Financial Contribution (FFC) index in Georgia to establish the baseline for expected reforms and contribute to the design and fine-tuning of the major reforms in health care financing initiated by the government mid-2007.MethodsThe research is based on the nationally representative Health Care Utilization and Expenditure survey conducted during May-June 2007, prior to preparing for new phase of implementation for the health care financing reforms. Households' catastrophic health expenditures were estimated according to the methodology proposed by WHO – Ke Xu [1]. A logistic regression (logit) model was used to predict probability of catastrophic health expenditure occurrence.ResultsIn Georgia between 2000 and 2007 access to care for poor has improved slightly and the share of households facing catastrophic health expenditures have seemingly increased from 2.8% in 1999 to 11.7% in 2007. However, this variance may be associated with the methodological differences of the respective surveys from which the analysis were derived. The high level of the catastrophic health expenditure may be associated with the low share of prepayment in national health expenditure, adequate availability of services and a high level of poverty in the country. Major factors determining the financial catastrophe related to ill health were hospitalization, household members with chronic illness and poverty status of the household. The FFC for Georgia appears to have improved since 2004.ConclusionReducing the prevalence of catastrophic health expenditure is a policy objective of the government, which can be achieved by focusing on increased financial protection offered to poor and expanding government financed benefits for poor and chronically ill by including and expanding inpatient coverage and adding drug benefits. This policy recommendation may also be relevant for other Low and Middle Income countries with similar levels of out of pocket payments and catastrophic health expenditures.
Highlights
To quantify extent of catastrophic household health expenditures, determine factors influencing it and estimate Fairness in Financial Contribution (FFC) index in Georgia to establish the baseline for expected reforms and contribute to the design and fine-tuning of the major reforms in health care financing initiated by the government mid-2007
Reducing the prevalence of catastrophic health expenditure is a policy objective of the government, which can be achieved by focusing on increased financial protection offered to poor and expanding government financed benefits for poor and chronically ill by including and expanding inpatient coverage and adding drug benefits
Structure of the Health Utilization and Expenditure Survey (HUES) Questionnaire The questionnaire was developed by drawing on a number of existing questionnaires that had already been used in Georgia before and consisted of seven sections: a) household composition and demography; b) selfreported health status of household members; c) availability of health care facilities to the household; d) last medical service used by any household member during last 6 months, which provided information for each household member who had a medical consultation in the last six month
Summary
To quantify extent of catastrophic household health expenditures, determine factors influencing it and estimate Fairness in Financial Contribution (FFC) index in Georgia to establish the baseline for expected reforms and contribute to the design and fine-tuning of the major reforms in health care financing initiated by the government mid-2007. In response to the declining public spending during 1996– 1997, the government of Georgia, as other countries of former socialist block in Europe and Central Asia, has embarked on major health sector reforms, which separated health care provision from financing, helped the country establish a single purchaser in 1999 that contracted providers and introduced output-based payments as the predominant form of provider reimbursement. Since, growing public spending for health, increasing along with economic growth observed in the country during recent years, allowed decreasing slightly the share of private expenditure in THE. According to a recent national health accounts exercise, this share still stands at high level of 72% of THE [7] for 2006 This is the highest level of private expenditures on health in the European Region This is the highest level of private expenditures on health in the European Region (app. 25% in average), and exceeds the CIS average (app. 46%) [5]
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