New healthcare program positive, but not without challenges

The state-issued health insurance in Georgia is becoming available on a massive scale. A new universal healthcare program launched recently will guarantee insurance for all non-insured citizens, as well as holders of neutral identification cards/neutral travel documents and individuals without citizenship status.

Transparency International Georgia recently published their assessment of the program and recommendation on the web-page. The organization revealed both positive and problematic issues about the new program.

Unlike other state insurance programs, the Universal Healthcare program covers hundreds of groups of illnesses and conditions. The program includes more beneficiaries, who are provided with detailed information on what illnesses their insurance covers. “Beneficiaries seeking to register for out-patient services are free to choose among medical service providers participating in the program on the condition that they can only change their medical center of choice once every two months.”

TI Georgia finds it to be a very positive fact that the government has considered one of their recommendations issued in 2012 and the program finances preventative care.

Although the program offers a very good healthcare plan to beneficiary, there still may be some challenges about it.

While the program offers insurance for all non-insured individuals, TI Georgia recommends the government “to differentiate between the non-insured portion of the population in order to ensure that budget expenditures and the corresponding fiscal burden does not grow too large”, or to include people in the program based on their income. The organization also recommends enclosing the program guidelines or protocols for the diseases/medical conditions it covers. “The existence of guidelines and protocols facilitates reimbursements between insurance companies and non-private clinics and helps resolve disputes over the appropriateness of prescribed treatments.”

According to Transparency International, one of the program's negative aspects may also be the fact that the state insurance’s share of the health insurance market is approximately 75%, hence development and the whole existence of the market depends on the government’s decisions as to the implementation of the state insurance program.

If the new insurance program will insure all non-insured individuals, then it is expected that there will be a sharp increase in the number of these individuals at the expense of those insured in the private sector. In particular, if the state will insure everyone, there is a significant chance that employers will no longer expend resources on insuring their own employees.

The program will insure all non-insured individuals, “then it is expected that there will be a sharp increase in the number of these individuals at the expense of those insured in the private sector,” as employers will no longer expend resources on insuring their own employees. Also, the Social Service Agency may not be able to manage the program effectively, which will ultimately increase the program costs. “For example, medical service providers are paid for emergency out-patient and in-patient care on a case-by-case basis. Thus, medical service providers can deliberately aggravate a patient’s diagnosis or give a patient a different diagnosis in order to receive additional compensation/reimbursement for the treatment.”

TI Georgia recommends the Social Service Agency to create an effective mechanism for monitoring and protecting the rights of beneficiaries and expresses the readiness to get involved in discussions about its recommendations.