Georgian Healthcare Fails Low-Income Groups
State-funded insurance scheme captures only minority of population.
Georgian Healthcare Fails Low-Income Groups
State-funded insurance scheme captures only minority of population.
Georgia’s state-funded health insurance scheme is still two years away from covering the whole country, and in the meantime only a quarter of the population has cover.
Since treatment and medicines are expensive, many people face ruin if a family member becomes seriously ill or has a long-term condition.
“I have seven children, and welfare benefits aren’t enough for anything,” said Madona Dekanidze, who lives in the village of Erisimedi in the eastern Sighnaghi district. “One of my children has cerebral palsy and can’t walk. Special footwear for him costs 300 laris [180 US dollars].... I have to get new shoes for him every 22 days because his feet are growing. It’s now been three months and I don’t have the money for the shoes or for the trip to get them.”
Georgia has shifted from the free healthcare system of the Soviet era to one based on private insurance. By law, patients can choose between private insurance and signing up – depending on their eligibility – with one of 26 state firms providing free insurance, which are aimed at various groups such as children and the elderly. In practice, the majority fall outside the free system but are too poor to pay for insurance themselves.
The state-funded insurance scheme targeting the least well-off was introduced in 2007. According to figures from last year, 900,000 people – 25 per cent of the population – were covered by the scheme last year. But it is not entirely free – eligible patients still have to find 25 per cent of the cost, and pay for medicines almost in full.
Nor does the free scheme cover the entire country. According to Otar Toidze, who chairs the Georgian parliament’s health committee, it will take at least two years before it is truly nationwide.
“At the moment, a quarter of the population is insured. Teachers are insured, as are members of the armed forces, some actors, and people who work for state concerns,” he said. “The state pays for emergency treatment, psychological care and some cancer cases regardless of age and need.”
On the cost of medicines charged to people under the state scheme, Toidze said efforts were being made to increase subsidies for them.
Gela Mtivlishvili, a lawyer from the non-government Centre for Civic Activity, said claimants in the state-funded programme sometimes face serious problems in getting insurance firms to pay out.
“There have been cases where insurance companies have delayed payments for planned operations, resulting in a deterioration in patient health,” he said. “Not long ago, a man lost an eye because a decision on paying for an operation wasn’t taken in time.”
In his annual report to parliament last year, Georgia’s human rights ombudsman Giorgi Tugushi highlighted the plight of large swathes of the population who were not deemed poor enough to qualify for free insurance, but could not afford to take out a private policy.
“A person may not be in serious need, but still be on the verge of it. Illness and a long course of treatment can ruin him,” Miranda Akhvlediani, who works in the ombudsman’s office, said.
Toidze was reluctant to discuss the situation facing the majority of Georgians who do not have their own insurance but cannot join the state-funded scheme. “In every country there always are people who aren’t insured, and Georgia is no exception,” he said.
Another concern highlighted in the ombudsman’s report was that when the small minority who can afford to pay apply for cover, they find private insurers are selective about who they will take. In his report to parliament, Tugushi said new legislation was needed to put an end to this.
“Private insurance companies generally avoid insuring anyone with a genetic condition, and also elderly people as it costs them more to provide cover,” Akhvlediani said. “But there has to be a way for these people not to be excluded from treatment.”
Toidze confirmed to IWPR that the authorities were working on laws prohibiting this kind of discrimination, and predicted this would take about two years to complete.
Tea Topuria is a freelance journalist in Georgia.
