Abstract
BackgroundThe 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.MethodsWith 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.ResultsThe 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.ConclusionsThe 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.
Highlights
The present study focuses on the program “Medical Insurance for the Poor (MIP)” in Georgia
Considering all the above, we suggest that the extended MIP coverage and increased financial access provided by the program, were most likely not able to reverse the adverse effects of economic slow-down and escalating health expenditure and have only cushioned the negative impact for the poorest by decreasing the poor/rich gradient in the rates of catastrophic health expenditure
MIP has contributed to an improvement in all three dimensions – population, service and cost coverage, and managed to improve financial protection of the beneficiaries that used health services against expenditure related to inpatient care
Summary
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. Georgia has chosen its own path in reforming the health financing system by allocating general government revenues to purchase relatively comprehensive coverage for the poor identified through the means testing system. Fragmentation of the national pools is another problem in countries where mandatory coverage is provided through competing private health insurance companies. These countries (Switzerland, Netherlands and Czech Republic) are compelled to use cross-subsidization between multiple pools to improve equity and viability of the health financing system [15]
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