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Iobidze M, Chikhladze N,
Loria L
The
State Health
Insurance In
Georgia
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სადაზღვევო ბაზრის შემოსავლის წყაროები:
საქართველოს სადაზღვევო
ბაზარი
კერძო დაზღვევის
სახეები
სახელმწოფო სადაზღვევო პროგრამები
სადაზღვევო ბაზრის შემოსავლის წყაროები:
Georgian Insurance
Market
Private Insuranc
e
State Insuran
ce Progra
m
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Since 2007 the Government of Georgia took
the responsibility to purchase insurance
package from the private companies for its poor
citizens and for the certain categories of the
public servants, such as teachers, employers of
military forces and the Ministry of Internal
Affairs.
Since 2010, there were held tenders, as a
result different private insurance companies
serving different regions of the State
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problems
The poor quality of medical services Interpretatio
n of coverage and exceptions in
favor of insurance company
neglecting to
subsidize of some
specific diseases
Choose of the private
insurance
company
False promise of compensati
on
getting the medical
services in desired hospital
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(წყარო: PSI საზოგადოებრივი განხილვები ჯანმრთელობს დაცვა და სოციალური)
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Research was conducted in Imereti, where the most of
the people are insured by the State insurance program.
(61 142 family, 181 218 people, 2011 year).
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Research object:
Research was conducted in Imereti region to find out the
awareness level of the the vulnerable citizens and
teachers on insurance system and medical services, also their rights and procedural issues, within the State insurance program. . Using random sampling
method I made inquiries more than 280 vulnerable citizens and teachers from Kutaisi,
Bagdati, Vani and Tskaltubo. On base of research I made
some conclusions and references.
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No74%
yes26%
No37%
yes63%
vulnerable citizens teachers
Did you choose the insurance company yourself?
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Quality service25%
Insurance package
3%
Unquali-fied personal48%
other24%
Quality service33%
Insurance package23%
Unquali-fied
personal.
19%
other25%
vulnerable citizens teachers
What don’t you like in your insurance company and
what you would improve?
Other:Need a run to get finance; The right to visit on desired doctor.;Dentist serviceTo compensate all kinds of analysis.
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yes43%
No57%
yes77%
No23%
vulnerable citizens teacher
Did you read the insurance contract during the insurance proceedings?
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Did you get whole information what kind of medical services
you can get within your insurance contract?
yes No part.0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
50%
25% 26%
49%
yes No part0%
10%
20%
30%
40%
50%
60%
70%
63%
14%23%
vulnerable citizens teacher
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Are you informed, where you can get medical services within your insurance
contract?
partially 45%
Yes40%
No15%
yes 65%
No14%
partially 21%
vulnerable citizens teacher
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Do you know where you need to call to get an additional
information?
Yes62%
No14%
partially 24%
yes65%
No11%
partially24%
vulnerable citizensteacher
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Are there any facts to refrain from an insurance reimbursement?
yes25%
No75%
yes29%
No71%
teachervulnerable citizens
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Does the acceptance of the insurance policy make
available to get medical care?
yes No part. didn't use0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
43%
0%
22%
35%
yes no part. didn't use0%
10%
20%
30%
40%
50%
60%
53%
17%19%
11%
vulnerable citizens teacher
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Is your policy enough to get preferred medical service?
0.65
0.35
yes Nodidn't use
64%
25%
11%
yes NoDidn't use
vulnerable citizens teacher
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Do you like the quality of the medical services in hospitals?
yes40%
No25%
Didn’t use35%
yes65%
No24%
Didn’t use11%
vulnerable citizens teacher
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Will you change something in your insurance package?
yes43%
No57%
yes39%
No61%
vulnerable citizens teacher
Visit to desired doctor;get the desired medicine;
service of dentist; To compensate all kinds of analysis;
To explain better the privilege of policy;“To simplify the insurance proceedings, otherwise healthy man
will become ill !!!
Yes:
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C o n c l u s i o n:The most of beneficiaries know the hospitals where
they can get the medical service, but they are
displeased, because they want to get medical service in
other hospitals.
The most of beneficiaries said that the insurance
policy made the medical service more available. But
they had the facts that company didn’t compensate the
service.
They are not satisfied with the quality of services and
the professional skills of the employees' of insurance
companies
The majority know what kind of medical services they
can get within the insurance package, but they are
dissatisfied with the fact that insurance companies do
not reimburse specific diseases.
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Recommendations:
It is necessary to improve population awareness of the broad masses and service quality of the
insurance companies;
Inform the insured population how to utilize the services;
Allow people to choose the insurance provider;
Make clear definition of the provisions, including the rights of the insured citizens, in the insurance
contracts.
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Thanks for your attention!!!