Health-Care Reform in Georgia

76 D. Guramishvili ave,Tbilisi, 0141, Georgia IRAKLI TORTLADZE

TEL.:
(+995 32) 2 000 171; (+995 32) 2 141 181;
(+995 32) 2 143 583; (+995 596) 171 171;
FAX: (+995 032) 214 35 83
E-MAIL: info@esu.edu.ge
 საყოველთაო ჯანდაცვის
პროგრამა/უნივერსალური
სამედიცინო დაზღვევა

INTRODUCTION OF UNIVERSAL HEALTH PROGRAM

IN GEORGIA: PROBLEMS AND PERSPECTIVES
In 2006 The Ministry of Labour, Health and Social Affairs of Georgia has launched
implementation of “Health Insurance Programme for Socially Vulnerable Families”. Its
aim was to ensure medical service for the population below the poverty line. In 2012
the Health insurance programme was extended to children aged 0-5, pensioner
women above 60 years and men above 65 years, students and people with severe
disabilities
In 2007 Health Insurance programme covered only 4.1% of the population, in 2012 it
increased up to 37.9%, together with persons covered under private and corporate
Health insurance (12.9%), overall amounting was up to 50.8% insured persons

Despite the extension of the state health care programme

coverage, more than a half of the population of the country,
about 2 millions of persons had no insurance and in most
cases, were unable to cover the medical expenses from own
pocket. It shall be mentioned that the number of visits to
primary healthcare per person is 2.1 and with this indicator
Georgia ends up second in comparison to European countries
 To settle the problem, Universal health program has been introduced since
February 28, 2013.
2 300 000 uninsured persons became the beneficiaries of the Universal
Healthcare programme. The programme aims at providing financial support
for accessibility to healthcare to Georgian citizens who are not insured.
First tıme in the history of the country the state programme extends to
citizens of the country, as well as holders of neutral identification
cards/neutral travel documents and individuals without citizenship status.

Universal health care programme cover ambulatory

consultations of a family physician, planned and urgent
out-patient service, urgent in-patient treatment,
planned surgical operation (including daycare
inpatient) and related examinations in specified limit
The state money allocated
for healthcare almost 5
doubled from 2012 to 2013
and increased from 365
million to 634 million Gel
Universal Healthcare programme provides the beneficiary with the
opportunity of free choice of a medical institution. The programme
beneficiary has a right to select a healthcare provider throughout
Georgia and register with any family physician.
Further, in case of dissatisfaction with the service provided, a person
can change the provider once in two months. There is no any limit for
selection of a provider when obtaining emergency in-patient or out-
patient service.
 After introduction of Universal health Programme the visits to
family doctors has increased by 43%, specialized doctors – 18%,
programme beneficiaries took laboratory analysis by more that
17% prior to introduction of the programme, number of
instrumental examinations increased by 9%.

Thus, after introduction of Universal Health Programme, the visits

to the family doctor have considerably increased which is an
important achievement of the primary healthcare. In studying the
satisfcation, the number of satisfied and dissatisfied beneficiaries
was almost equal (35-36%). The negative side of the programme
was the limit of medicines, laboratory-diagnostic examinations in
the basic package of outpatient service.
 1. მიმწოდებელი ვალდებულია
მონიტორინგი შემთხვევის შესახებ შეტყობინება
გააკეთოს დაუყოვნებლივ, მაგრამ არა
Program monitoring უგვიანეს 24 საათის;
2. შეტყობინების გაკეთებისას
მიმწოდებელი ვალდებულია
დააფიქსიროს შემდეგი ინფორმაცია:
ა) მოსარგებლის სახელი, გვარი, პირადი
ნომერი და დაბადების თარიღი;
ბ) წინასწარი დიაგნოზი დადგენილი
კლასიფიკატორის შესაბამისად;
გ) შემთხვევის დაწყებისა და
დასრულების ზუსტი დრო.
3. იმ შემთხვევაში, თუ ვერ ხდება
პაციენტის იდენტიფიცირება,
მიმწოდებელი მაინც აკეთებს
შეტყობინებას
და პაციენტი დროებით ფიქსირდება,
როგორც „უცნობი“..
4. შემთხვევის კოდის ცვლილების ან
დამატების შემთხვევაში მიმწოდებელი
ვალდებულია გააკეთოს
განმეორებითი შეტყობინება არა
უგვიანეს შემთხვევის დასრულების ან
Georgia Quality Improvement System:
Options and Recommendations
 The Six Key Dimensions of Quality (WHO, 2006)

 EFFECTIVENESS Health care evidence-based that results in

improved health outcomes for individuals
and communities
 EFFICIENCY Health care that maximizes resource use
and avoids waste

 SAFETY Health care that minimizes risks and harm

to service users
 ACCEPTABLE/PATIENT- Health care that takes into account the
CENTERED preferences and aspirations of individual
service users and the cultures of their
communities

EQUITY Health care that does not vary in quality

because of personal characteristics such
as gender, race, ethnicity, geographical
location, or socioeconomic status.

ACCESIBILITY Health care that is timely, geographically

reasonable and provided in a setting where
skills and resources are appropriate to
medical need.
 Quality Management throughout the Health System

SYSTEM LEVELS CHARACTERISTICS AND RESPONSIBILITIES

FOR QUALITY
• Population-based indicators
• Focus on overall system strategies
HEALTH SYSTEM •
QUALITY
Responsibility of high level managers and political authorities

INFORMATION SUPERVISION/INFORMATION

QUALITY OF A • Indicators on the quality of the specific services for the specific population
HEALTH CARE served by the institution
INSTITUTION/CENTRE • Focus on optimizing resources and regulating processes
• Indicators on the quality of the organization
• Responsibility of the managers of the institution
INFORMATION
SUPERVISION/INFORMATION

QUALITY OF • Indicators on satisfaction, technical quality and effectiveness for specific

INDIVIDUAL conditions and type of patients
HEALTH CARE • Focus on clinical quality on a broad sense
• Responsibility mostly of clinical personnel
Planning for Quality
 World Bank
 Quality of care assessment in PHC and recommendations for
development of PHC improvement strategy
 Recommendations on development of national quality
improvement organizations

 USAID SUSTAIN
 Health leaders capacity building in quality - Harvard School of Public
Health
 Recommendations on strategies to improve quality of health services
 10 Key Ingredients of Quality Improvement
1. Quality Measurement
2. Public Reporting
3. QI Campaigns
4. QI Capacity Building
5. Decision Supports
6. Patient Engagement
7. Accreditation
8. Quality Assurance and Regulations
9. Accountability and Incentives
10. Quality Planning
 1. Quality Measurement
What needs to Quality data collected from in- and out-patient settings
be done?
Multiple dimensions - timeliness, effectiveness, etc.

Patient-level or Institutional-level quality data

Baseline for NCDC collects disease surveillance and utilization data

Georgia
Institutional-level data

No quality data - adverse events, re-admissions, best practices, etc.

 2. Public Reporting
What needs to Report by individual health care organization
be done?
Specific benchmarks for performance

Motivate managers to improve quality

Increase public accountability

Baseline for NCDC collects disease surveillance data

Georgia
Only regional level reporting
 3. QI Capacity Building
What needs to Training by quality agencies
be done?
Coaches to increase QI skills in health care workforce

Moving from culture of blame to culture of improvement

Training in root cause analysis, implementing tests of change, team-

building, conflict resolution, etc.

Baseline for No national infrastructure / quality agency

Georgia No application of QI tools/ instruments
 4. QI Campaigns
What needs to Quality agencies launch campaigns on specific topics - reducing
be done? wait times, adverse events, nosocomial infections, etc.

Recruit health care organizations to participate voluntarily

Baseline for No national campaigns exist

Georgia
USAID/Health Care Quality Improvement Project initiative in
Imereti Region
 5. Decision Supports
What needs to Practical tools – flow-sheets, standard orders, etc.
be done?
Embed into EMR where possible, but EMR not a prerequisite

Baseline for USAID/Health Care Quality Improvement Project initiative in Imereti

Georgia Region – flow-sheets for chronic disease management

USAID/SUSTAIN – flow-sheets for obstetric conditions

 6. Patient Engagement
What needs to Designing strategies for intervening with patients to improve
be done? quality

Participate in system redesign

Baseline for Campaigns for Universal Health Care Program

Georgia
Limited experience
 7. Accreditation
What needs to A self-assessment and external peer assessment process
be done?
To accurately assess level of performance in relation to established
standards and to implement improvements

Baseline for USAID/SUSTAIN project for perinatal hospital accreditation

Georgia
 8. Quality Assurance and Regulations
What needs to Government entities conduct inspection of facilities
be done?
Licensing bodies issue licenses to providers

Increasing emphasis on recertification

Baseline for The State Regulatory Agency for Medical Services inspects facilities,
Georgia issues licenses, investigates complaints

Gaps in use of quality criteria in inspections

Major concerns regarding consistency of clinical skills in workforce

 9. Accountability and Incentives
What needs to Ties quality expectations to funding arrangements
be done?
In- and out-patient services

Baseline for No funding mechanisms yet which account for quality

Georgia
 10. Quality Planning
What needs to Detailed QI plans, timelines and expectations
be done?
Assigning roles and responsibilities

National, subnational, individual facility

Baseline for MDGs but no subnational or institutional targets and indicators

Georgia
Example of immunization