Policy Implications of the first Systematic Tracking of Financial Flows for HIV/AIDS in Ukraine is presentation delivered by the nine health care experts in Toronto in August 2006.The presentation looks at background information of HIV/AIDS like prevalance, HIV/Aids statistics, HIV/AIDS spending, finances sources, expenditures by functions, comparison with other countries in the scope of expenditures by functions etc. Authors of the presentation: Yuriy Chechulin, George Gotsadze,Catherine Chanfreau, Liudmila Husak,Vinay Saldanha, Anastasiya Nitsoy, Viktor Galayda,Manjiri Bhawalkar, Tania Dmytraczenko. View the full version of the presentation.
Category: Publications
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Premium Estimates for the 2008 State Health Care Benefit Program for the Poor
As a result of technical assistance provided by the CoReform project the Government of Georgia in 2007 introduced targeted (to poor) health care benefit program in two pilot regions (city of Tbilisi and Imereti region) of Georgia covering approximately 180,000 individuals below poverty line. This program is aimed at paying for health care insurance coverage that population obtains from private insurance companies on the market. During fall 2007, the GoG made decision and announced to public that it will gradually expand program coverage to approximately 1.2 million individuals over the course of several years. In order to estimate reasonable monthly premium costs for people living below the poverty line, children and the elderly, and allocate budgetary resources accordingly, the MoLHSA requested USAID for assistance, through CoReform, to estimate Monthly Premium for the State Insurance Program to inform the State budget allocations for 2008. It is estimated that during 2008 up to 800 000 poor individual will receive such benefits. The project has developed a plan for immediate assistance with the calculations required for the 2008 budget spending.Monthly Premium estimations done by CoReform/CIF hired actuaries in December 2007 have already informed 2008 State Budget allocations approved on December 28, 2007 and reflected in the Government of Georgia (GoG) Decree #92, dated April 08, 2008, namely: a) average premium 11 Gel per month per person that makes 132 Gel per person per annum informed Article 6 (3) of the Decree in question and b) different premium coefficients estimated for different age groups and these coefficients are reflected in the Article 6 (4) of the said Decree.
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Premium Estimates for the 2009 State Health Care Benefit Program for the Poor
It is estimated that during 2009 up to 900 000 poor individual will be covered by the Program. Monthly Premium estimations done by CoReform/CIF hired actuaries in September 2008 have already submitted to the MoLHSA to inform 2009 State Budget allocations, namely: a) average premium 12.64 Gel per month per person that makes 151.68 Gel per person per annum; b) different premium coefficients estimated for the following scenarios: i) age and sex; ii) different age groups (age 0-49; age 50-74; age 75 and above); iii) age, sex and family size; iv) age, sex and region; The premium estimations informed GoG Decree #32 dated February 19, 2009, where average premium exceeds 12.64 GEL and equals 15 Gel per month, largely because of Government’s policy decision to further expand insurance package for the Poor.
Premium Estimates for the 2009 State Health Care Benefit Program for the Poor (ENG)
Premium Estimates for the 2009 State Health Care Benefit Program for the Poor (GEO) -
Cooperation in Health Care System Transformation in Georgia-CoReform Project, 2004-2009
In 2004 with the financial aid of the U.S. Agency for International Development (USAID) Mission in the Caucasus, the project “Cooperation in Heath System Transformation Project” commenced. The project was completed in September 2009. The project provided technical assistance to the Government of Georgia (GoG) to strengthen its capacity to transform the health system of the country into a more efficient, accountable, and transparent one. With the cooperation of the Ministry of Labor, Health, and Social Affairs (MoLHSA), Abt Associates (Abt), Care International (CARE), Emerging Markets Group (EMG), and Curatio International Foundation (CIF), the project was designed to assist the government of Georgia to improve its health care financing system, reproductive health support, family planning (RH/FP), and strengthen health institutions at the national level.
Activities were designed to position the GoG to adopt an innovative and comprehensive approach towards formulating solutions that address significant equity and affordability gaps in the health system, high abortion rates, and the limited donor coordination.
The project consisted of the following major components:
Health Financing and Policy Development;
National Health Accounts;
Family Planning and Reproductive Health;
Organizational Development and Donor Harmonization.
National Health Accounts was implemented by CIF in close cooperation with MoLHSA and an intersectoral working group represented by following agencies: Public Health Department, Ministry of Economy, State Statistic Department, Insurance State Supervision Board, Insurance Association, SUSIF, Ministry of Finances, Statistic and Disease Control Centre, and National Institute of Health and Social Issues. The main goal of the project was to implement and institutionalize National Health Accounts (NHA) as a policy tool and integrate it within broader health system reforms. This component took place in the period of September 2004 -September 2007.Family Planning and Reproductive Health has been implemented by Care International, which has specific responsibility to implement this component in close partnership with CIF. The main goal of the reproductive health (RH) and family planning (FP) policy component of the project was to achieve an improved legislative, regulatory, and policy framework to provide an adequate supply to the increased demand for quality reproductive health services. The RH/FP policy team strategy was to assist the MoLHSA by supporting the policy working group at national level. The activities of the reproductive Health Policy Working Group were designed to achieve objectives related to the improvement of access to RH/FP services. Target outputs of the policy working group included: a comprehensive review and analysis of the current policy and regulatory framework governing the provision of and access to family planning and reproductive health information and services; a National RH/FP Policy to enhance access to and delivery of quality RH services; the National RH Strategy for the purpose of providing guidance for activating the RH policy; and drafting legislation in support of the Georgian RH Policy, in order to provide the MoLHSA and the government with a legislative platform to implement the Policy (in progress). This second component of the project took place between October 2004 and September 2008.
Organizational Development and Donor Harmonization. The main goal of this component of the project was to achieve a “better functioning of the MoLHSA through improvement of the functioning of organizations within the health sector, establishment of coordinated linkage between policy planning, project design, and project implementation.” Since 2004, the CoReform OD Team has been providing significant assistance to the MoLHSA and its affiliated agencies to define their core functions, to put in place functional structures with clear roles and responsibilities, establish a health policy process that is more transparent and systematic, institutionalize donor harmonization and coordination as a routine function of the MoLHSA, and build the capacity of the Ministry staff to enable them to effectively carry our their newly defined roles and responsibilities. The key implementer of this component during the optional period (October 2006 – September 2009) is CIFs in close partnership with Abt Associates, which had been performing specific responsibilities in the Project Base Period (October 2004 – September 2006). The major strategies of the component are: the MoLHSA System Reorganization, Performance Improvement, Policy Cycle Management, and Capacity Building.
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15 Years For Serving Development, 2009
15 years anniversary publication spotlights some of the Curatio International Fondation’s (CIF) achievements in health system reform since 1994, thus shedding some light on the impact of CIF’s contributions, and to address the organization’s future aspirations. Published in December, 2009.
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Georgia Health Utilization and Expenditure Survey
The Health Utilisation and Expenditure Survey (HUES) was conducted in May/June 2007 and consisted of a nationally representative sample of 3,218 households.
The objectives of the survey were: to estimate household health expenditure and compare this with the Integrated Household Survey (IHS) estimates to provide adjustment factors; to provide information on reported health status, use of services and user satisfaction; and to provide a baseline for reforms in primary health care and sector financing, both nationally and for specific ‘pilot’ regions where additional support is being provided. A second round of the HUES is planned for 2009 and will provide follow-up information in each area.
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Health Reform and Hospital Financing in Georgia
The publication aims to analyze hospital financing and delivery of inpatient services, financial requirements of the hospitals, and their ability to meet these determinant requirements. There were different types of methods used during this work. By means of standardized questionnaire data on financial performance of 41 hospitals were collected. Patient survey, group discussions with hospital administrators, and interviews with policy-makers were also used. As a result it appeared that thirty-three hospitals were unable to recover full costs, and 29 were unable to recover full costs excluding capital consumption cost. Medium-sized hospitals recovered only 63.5% of full costs. They employed salary equalization policies, which increased the share of fixed costs, perpetuated the oversupply of medical personnel, and yielded low pays. Hospitals charged in excess of their officially accounted costs but, and due to the low collection rates, cost recovery rates were below the officially accounted costs (87.6%).In conclusion it can be said that low official reimbursement rates and patient unawareness of official hospital costs creates conducive environment for shifting major turnover of the real hospital costs to the patients, resulting in illegal patients charging.
Authors:Avtandil Jorbenadze, Akaki Zoidze, David Gzirirshvili, George Gotsadze.
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Reform strategies in Georgia and their impact on health care provision in rural areas: evidence from a household survey
This paper aims to contribute to the assessment of the impact of health sector reforms in Georgia. It mainly focuses on changes in the patterns of health services utilization in rural areas of the country as a function of implemented changes in healthcare financing on a primary health care (PHC) level. Our findings are based on a household survey, which was carried out during summer 2002. Conclusions derived from the findings could be of interest to policy makers in transitional countries. The paper argues that health financing reforms on the PHC level initiated by the Government of Georgia, aimed at decreasing financial access barriers for the population in the countryside have rendered initial positive results and improved access to essential PHC services. However, to sustain and enhance this attainments the government should ensure equity, improve the targeting mechanisms for the indigent population and mobilize additional public and private funds for financing primary care in the country. Read further.