Assessing efforts towards universal financial risk protection in low- and middle-income countries

Insurance for Poor: Georgia’s Path to Universal Coverage. A Case Study

Attainment of universal coverage is one of the longstanding national health-policy goals in Georgia. However, practical steps towards achieving this goal were made only in recent years with new health financing reform initiatives.
The purpose of the case study is to assess the impact of these new health financing initiatives – equity of access to essential health care services and financial protection against health care costs – which, together, are two key dimensions of universal coverage plans. From this perspective, the study will focus on the State Health Programme for Medical Assistance to the Poor (MAP), one of the most important health-financing policy instruments developed by the Georgian government to eventually provide universal coverage for the population.

Due to its scale and anticipated breadth of coverage (more than 17% of the country population), MAP will undoubtedly have implications beyond the target population. Thus the study will attempt to explore (a) the extent to which policy content, context, actors and processes of the MAP design and implementation have affected the outcomes of this policy initiative, and (b) the views of policy makers and other stakeholder on the potential of the MAP programme as a viable and effective health-financing policy instrument for attaining universal coverage of the Georgian population.

To achieve these objectives, the study intends to respond to the following research questions, among others:

• How and to what extent have utilization patterns for health care services by MAP’s targeted population changed?
• How and to what extent have the levels of out-of-pocket expenditures for health care services incurred by the MAP target population changed?
• How and to what extent do health care service utilization and out-of-pocket expenditure patterns of the MAP target poor population compare to the same patterns observed in non-targeted poor population with similar social and economic conditions?
• How, to what extent and why were equity impacts achieved through changing patterns in catastrophic health expenditures? How has MAP contributed to the observed changes?
• How and to what extent has the studied policy initiative affected the breadth and depth of the achieved coverage (compared against the desired targets included in the initial design)?

The research team will work closely with the main policy- and decision-makers involved in the MAP design and implementation, seeking their engagement at the inception phase of the case study. The regular production and dissemination of several policy briefs with concrete policy recommendations are also anticipated to maintain interest and engagement of the policy- and decision-makers at various stages of the case study implementation.


Project description

Programme: Assessing efforts towards universal financial risk protection in low- and middle-income countries

Research title: Insurance for Poor: Georgia’s Path to Universal Coverage. A Case Study

Thematic Research Area: Health Financing

Grantee Country: Georgia

Grantee Institution: Curatio International Foundation

Programme coordinator: Dr Ketevan Chkhatarashvili

Start date: Autumn/ Winter 2010

Status of grant: Completed

Related publications/policy briefs

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