Georgia’s Medical Insurance Program for the Poor

Georgia launched its Medical Insurance Program (MIP) for the poor in 2006. This program draws from general tax revenues to provide comprehensive, means-tested health insurance to the poorest 20 percent of the population as identified by a proxy means test. The government contracts private insurance...

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Main Author:	Smith, Owen
Format:	Working Paper
Language:	en_US
Published:	World Bank, Washington DC 2013
Subjects:	access to services administrative costs Adult mortality Adult mortality rate aged agents applications Beneficiaries capitation cardiovascular disease chemotherapy child delivery child health civil conflict Communicable diseases community participation competitive bidding contraception Contraceptive prevalence contracts with providers cost-effectiveness costs of care delivery costs delivery of health care Dependency ratio depression developing countries diabetes disease risk factors doctors economic growth emergency care employment essential drugs fee-for-service fertility fertility rate finance management Financial Management financial protection financial risk financial risks fraud government support gross domestic product group insurance health behavior health care health care resources health care services health care utilization Health Coverage Health Economics health expenditure health expenditures Health Financing health indicators health insurance health maintenance health maintenance organization health maintenance organizations health outcomes Health Policy health promotion health reform health sector health services health spending health status Health System Health System Financing health system strengthening health systems Health Systems in Transition health workers healthcare services high blood pressure HIV/AIDS HMO HMOs hospital hospital beds hospital system hospitalization hospitals ill health illnesses immunization impact on health income income countries Infant Infant mortality Infant mortality rate infectious diseases informal payments inpatient care Insurance Insurance Companies insurance industry insurance markets integration lab tests life expectancy Life expectancy at birth live births living conditions loss ratio marketing Maternal mortality Maternal mortality rate Medical care Medical care costs Medical Insurance medical services mental mental health mental health care midwives Ministry of Health minority monthly premium morbidity mortality multiple insurance systems multiple insurers national government Neonatal mortality Nurses outpatient care outpatient services patient Patients pensions pharmaceutical spending pharmacies pharmacy physician physicians pocket payment pocket payments Policy Implications population groups pregnant women prenatal care prices of health services primary care primary care doctor primary care doctors primary health care Private Health Insurance Private Insurance Private Insurance Companies private insurer private insurers programs progress provider payment provision of care psychiatry Public Expenditure public health Public health expenditure public health system public hospitals public providers purchasing power quality of care radiation reimbursement rates respect risk factors rural areas safety net sanitation sanitation facilities service delivery service provision Skilled birth attendance Social Affairs Social Assistance social sector Social Services surgery Tuberculosis universal access urban development woman workers working-age population
Online Access:	http://hdl.handle.net/10986/13282

id	okr-10986-13282
recordtype	oai_dc
repository_type	Digital Repository
institution_category	Foreign Institution
institution	Digital Repositories
building	World Bank Open Knowledge Repository
collection	World Bank
language	en_US
topic	access to services administrative costs Adult mortality Adult mortality rate aged agents applications Beneficiaries capitation cardiovascular disease chemotherapy child delivery child health civil conflict Communicable diseases community participation competitive bidding contraception Contraceptive prevalence contracts with providers cost-effectiveness costs of care delivery costs delivery of health care Dependency ratio depression developing countries diabetes disease risk factors doctors economic growth emergency care employment essential drugs fee-for-service fertility fertility rate finance management Financial Management financial protection financial risk financial risks fraud government support gross domestic product group insurance health behavior health care health care resources health care services health care utilization Health Coverage Health Economics health expenditure health expenditures Health Financing health indicators health insurance health maintenance health maintenance organization health maintenance organizations health outcomes Health Policy health promotion health reform health sector health services health spending health status Health System Health System Financing health system strengthening health systems Health Systems in Transition health workers healthcare services high blood pressure HIV/AIDS HMO HMOs hospital hospital beds hospital system hospitalization hospitals ill health illnesses immunization impact on health income income countries Infant Infant mortality Infant mortality rate infectious diseases informal payments inpatient care Insurance Insurance Companies insurance industry insurance markets integration lab tests life expectancy Life expectancy at birth live births living conditions loss ratio marketing Maternal mortality Maternal mortality rate Medical care Medical care costs Medical Insurance medical services mental mental health mental health care midwives Ministry of Health minority monthly premium morbidity mortality multiple insurance systems multiple insurers national government Neonatal mortality Nurses outpatient care outpatient services patient Patients pensions pharmaceutical spending pharmacies pharmacy physician physicians pocket payment pocket payments Policy Implications population groups pregnant women prenatal care prices of health services primary care primary care doctor primary care doctors primary health care Private Health Insurance Private Insurance Private Insurance Companies private insurer private insurers programs progress provider payment provision of care psychiatry Public Expenditure public health Public health expenditure public health system public hospitals public providers purchasing power quality of care radiation reimbursement rates respect risk factors rural areas safety net sanitation sanitation facilities service delivery service provision Skilled birth attendance Social Affairs Social Assistance social sector Social Services surgery Tuberculosis universal access urban development woman workers working-age population
spellingShingle	access to services administrative costs Adult mortality Adult mortality rate aged agents applications Beneficiaries capitation cardiovascular disease chemotherapy child delivery child health civil conflict Communicable diseases community participation competitive bidding contraception Contraceptive prevalence contracts with providers cost-effectiveness costs of care delivery costs delivery of health care Dependency ratio depression developing countries diabetes disease risk factors doctors economic growth emergency care employment essential drugs fee-for-service fertility fertility rate finance management Financial Management financial protection financial risk financial risks fraud government support gross domestic product group insurance health behavior health care health care resources health care services health care utilization Health Coverage Health Economics health expenditure health expenditures Health Financing health indicators health insurance health maintenance health maintenance organization health maintenance organizations health outcomes Health Policy health promotion health reform health sector health services health spending health status Health System Health System Financing health system strengthening health systems Health Systems in Transition health workers healthcare services high blood pressure HIV/AIDS HMO HMOs hospital hospital beds hospital system hospitalization hospitals ill health illnesses immunization impact on health income income countries Infant Infant mortality Infant mortality rate infectious diseases informal payments inpatient care Insurance Insurance Companies insurance industry insurance markets integration lab tests life expectancy Life expectancy at birth live births living conditions loss ratio marketing Maternal mortality Maternal mortality rate Medical care Medical care costs Medical Insurance medical services mental mental health mental health care midwives Ministry of Health minority monthly premium morbidity mortality multiple insurance systems multiple insurers national government Neonatal mortality Nurses outpatient care outpatient services patient Patients pensions pharmaceutical spending pharmacies pharmacy physician physicians pocket payment pocket payments Policy Implications population groups pregnant women prenatal care prices of health services primary care primary care doctor primary care doctors primary health care Private Health Insurance Private Insurance Private Insurance Companies private insurer private insurers programs progress provider payment provision of care psychiatry Public Expenditure public health Public health expenditure public health system public hospitals public providers purchasing power quality of care radiation reimbursement rates respect risk factors rural areas safety net sanitation sanitation facilities service delivery service provision Skilled birth attendance Social Affairs Social Assistance social sector Social Services surgery Tuberculosis universal access urban development woman workers working-age population Smith, Owen Georgia’s Medical Insurance Program for the Poor
geographic_facet	Europe and Central Asia Georgia
relation	UNICO Studies Series;No. 16
description	Georgia launched its Medical Insurance Program (MIP) for the poor in 2006. This program draws from general tax revenues to provide comprehensive, means-tested health insurance to the poorest 20 percent of the population as identified by a proxy means test. The government contracts private insurance companies who serve as financial risk carriers and purchasing agents for the program. MIP is well targeted to the poor and has had a major impact on improving financial protection of its beneficiaries. It has also served as a launching pad for significant investments in hospitals and information technology (IT) systems. In brief, MIP is a program funded through general taxation that provides a fairly comprehensive benefits package of health services to the poorest 20 percent of the population as identified via a proxy means test. There are no copayments for services. Although run by a state purchaser during the first two years, since 2008 its key feature has been that private insurance companies are contracted by the Ministry of Health to bear financial risk and to purchase services from both public and private providers on behalf of poor beneficiaries. The government sets policy, pays a per capita premium per beneficiary to private insurers, and conducts program oversight. This case study provides an overview of how MIP is designed, its achievements to date, and challenges for the future. A key theme discussed in further detail, and of potential interest to other countries contemplating a push toward the achievement of universal health coverage, is the contracting of private insurance companies to purchase services on behalf of the poor. Some attention is also given to MIP's targeting approach.
format	Publications & Research :: Working Paper
author	Smith, Owen
author_facet	Smith, Owen
author_sort	Smith, Owen
title	Georgia’s Medical Insurance Program for the Poor
title_short	Georgia’s Medical Insurance Program for the Poor
title_full	Georgia’s Medical Insurance Program for the Poor
title_fullStr	Georgia’s Medical Insurance Program for the Poor
title_full_unstemmed	Georgia’s Medical Insurance Program for the Poor
title_sort	georgia’s medical insurance program for the poor
publisher	World Bank, Washington DC
publishDate	2013
url	http://hdl.handle.net/10986/13282
_version_	1764423087672000512
spelling	okr-10986-132822021-04-23T14:03:07Z Georgia’s Medical Insurance Program for the Poor Smith, Owen access to services administrative costs Adult mortality Adult mortality rate aged agents applications Beneficiaries capitation cardiovascular disease chemotherapy child delivery child health civil conflict Communicable diseases community participation competitive bidding contraception Contraceptive prevalence contracts with providers cost-effectiveness costs of care delivery costs delivery of health care Dependency ratio depression developing countries diabetes disease risk factors doctors economic growth emergency care employment essential drugs fee-for-service fertility fertility rate finance management Financial Management financial protection financial risk financial risks fraud government support gross domestic product group insurance health behavior health care health care resources health care services health care utilization Health Coverage Health Economics health expenditure health expenditures Health Financing health indicators health insurance health maintenance health maintenance organization health maintenance organizations health outcomes Health Policy health promotion health reform health sector health services health spending health status Health System Health System Financing health system strengthening health systems Health Systems in Transition health workers healthcare services high blood pressure HIV/AIDS HMO HMOs hospital hospital beds hospital system hospitalization hospitals ill health illnesses immunization impact on health income income countries Infant Infant mortality Infant mortality rate infectious diseases informal payments inpatient care Insurance Insurance Companies insurance industry insurance markets integration lab tests life expectancy Life expectancy at birth live births living conditions loss ratio marketing Maternal mortality Maternal mortality rate Medical care Medical care costs Medical Insurance medical services mental mental health mental health care midwives Ministry of Health minority monthly premium morbidity mortality multiple insurance systems multiple insurers national government Neonatal mortality Nurses outpatient care outpatient services patient Patients pensions pharmaceutical spending pharmacies pharmacy physician physicians pocket payment pocket payments Policy Implications population groups pregnant women prenatal care prices of health services primary care primary care doctor primary care doctors primary health care Private Health Insurance Private Insurance Private Insurance Companies private insurer private insurers programs progress provider payment provision of care psychiatry Public Expenditure public health Public health expenditure public health system public hospitals public providers purchasing power quality of care radiation reimbursement rates respect risk factors rural areas safety net sanitation sanitation facilities service delivery service provision Skilled birth attendance Social Affairs Social Assistance social sector Social Services surgery Tuberculosis universal access urban development woman workers working-age population Georgia launched its Medical Insurance Program (MIP) for the poor in 2006. This program draws from general tax revenues to provide comprehensive, means-tested health insurance to the poorest 20 percent of the population as identified by a proxy means test. The government contracts private insurance companies who serve as financial risk carriers and purchasing agents for the program. MIP is well targeted to the poor and has had a major impact on improving financial protection of its beneficiaries. It has also served as a launching pad for significant investments in hospitals and information technology (IT) systems. In brief, MIP is a program funded through general taxation that provides a fairly comprehensive benefits package of health services to the poorest 20 percent of the population as identified via a proxy means test. There are no copayments for services. Although run by a state purchaser during the first two years, since 2008 its key feature has been that private insurance companies are contracted by the Ministry of Health to bear financial risk and to purchase services from both public and private providers on behalf of poor beneficiaries. The government sets policy, pays a per capita premium per beneficiary to private insurers, and conducts program oversight. This case study provides an overview of how MIP is designed, its achievements to date, and challenges for the future. A key theme discussed in further detail, and of potential interest to other countries contemplating a push toward the achievement of universal health coverage, is the contracting of private insurance companies to purchase services on behalf of the poor. Some attention is also given to MIP's targeting approach. 2013-05-01T20:59:12Z 2013-05-01T20:59:12Z 2013-01 http://hdl.handle.net/10986/13282 en_US UNICO Studies Series;No. 16 CC BY 3.0 IGO http://creativecommons.org/licenses/by/3.0/igo World Bank World Bank, Washington DC Publications & Research :: Working Paper Publications & Research Europe and Central Asia Georgia

Georgia’s Medical Insurance Program for the Poor

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