Transparency International Georgia releases new report on Health Insurance Industry

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For immediate release

Tbilisi, July 27, 2012 - Transparency International Georgia released its latest report, The Georgian Health Insurance Industry, today. The report  examines government-run health insurance schemes as well as the current state of the wider Georgian health insurance industry and accessibility of adequate healthcare in order to assess effectiveness, efficiency and sustainability of the current and past public insurance schemes and propose recommendations to the government of Georgia (the GoG), the National Bank, the insurance regulator, and insurers.

Some of the report’s key findings and recommendations:

  • The Government of Georgia (the GoG) must implement the corrective action, address the inconsistencies in the design of both Public Insurance Scheme (PIS) and the Expanded Public Insurance Scheme (EPIS) and put in place the right incentives described throughout the report.

  • The GoG must put in place health care quality assurance system. The Agency for Social Services should monitor the satisfaction as well as the utility of the PIS and the EPIS beneficiaries to see how the schemes are working.

  • Hospitals must be run by independent management companies rather than insurers’ subsidiaries.

  • The GoG must resume a voluntary insurance scheme to put untapped resources to use, which, can help ensure sustainability of the insurance as well as improve the quality of health care in the country.

  • The GoG must open up competition by switching from regional assignment to free circulation of its PIS and EPIS insurance vouchers. The two major criteria assessing an insurance scheme are: whether its beneficiaries can choose their insurer and their medical institutions. The first choice is unequivocally limited, while the second remains largely unrealized. The public insurance schemes will clearly improve if the two obstacles are removed.

  • The relevant government decrees and the insurance contracts/policies should detail the rights of the public insurance beneficiaries to a degree that will enable them to take full advantage of their insurance.

  • The Ministry of Labor, Health Care and Social Affairs (MoLHSA) must complement its list of drugs that the public insurance beneficiaries can receive with a 50% discount. Around 20% of the social beneficiaries targeted within our insurance survey were unable to find the medicines they needed on the list. We suggest that the MoLHSA conduct a survey to figure out which drugs should be added to the list.  

  • Although the relevant government decree does not limit the PIS beneficiaries right to buy their medicines only at particular pharmacies, Insurance Company Alpha, a daughter company of Aversi, limits the right unlawfully since it tells its beneficiaries that they can buy medicines only at Aversi’s pharmacies.

    More detailed findings and recommendations are provided in the report.

     

The study was funded by the Embassy of the Kingdom of the Netherlands in Georgia.

The launch of this report was organized with the financial support of Sida.

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