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 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.

Bibliographic Details

Main Author:	Smith, Owen
Format:	Working Paper biblioteca
Language:	en_US
Published:	World Bank, Washington DC 2013-01
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
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