Accessibility of Urgent Neurosurgery Diseases by the State Universal Healthcare Program in Georgia (country)
Tengiz Verulava. Doctor of Medical Science. Head of School “Health Policy and Management”. Ilia State University
Maka Gabuldani. Health Claims Management Consultant. Insurance company “Aldagi”.
Published “Gazi Medical Journal”, Vol 26 (2). С. 42-45. ISSN 2147-2092
Background. After introduction of the State Universal Healthcare Program in Georgia significantly has increased the financial access to the urgent health services, among them urgent neurosurgery services. The State Universal Healthcare Program covers 24 neurosurgery diseases. The aim of the research was to study the financial accessibility to the urgent neurosurgery services. Methodology, In-depth interview with the managers and medical personnel of the neurosurgery hospitals and direct interviews with the specially structured questionnaires with the patients or their family members have been applied. The Tbilisi University clinic “High Technology Medical Center” has been selected for the research. Results, the results of the research showed that the financial accessibility of health services has significantly improved after the introduction of the State Universal Healthcare Program. Although, Program is not financing the specific types of the urgent neurosurgery services and neither high-technological diagnostic tests (egg. CT and MRT). The financial limit defined by the State Universal Healthcare Program for the neurosurgery care is not enough. Some patients had to pay the significant amount of the cost of medical care that negatively effects on their financial accessibility. Conclusions, In order to increase the financial accessibility it is necessary to expand the list of the urgent neurosurgery diseases covered by the State Universal Healthcare Program, and in urgent cases to finance the high-technological diagnostic tests. It is important to define the financial limits for the urgent neurosurgery diseases that will avoid the high costs for the patients.
Keywords Health Care, Georgia, Financial accessibility
It is very important for the State to ensure equal financial access to medical services. The patients very often could not get the relevant medical services. Because of the insolvency, the financial obstacles negatively effect on the people’s health. Minimizing of these barriers is one of the main tasks of the healthcare system. Since 2007 the State has provided health insurance for target populations below the poverty line as well as certain other groups (schoolteachers, the military forces and the policemen), in total 1.2 million people. From September 1, 2012 the government launched extension of state-funded health insurance for additional 1 million target population (retirement age population, students, children 0-5 and children 0-18 with disabilities), that, together with already insured by states population, accounted 50.8% of Georgia’s population. From October, 2012 the new Government declared moving towards universal health coverage. Universal Health State Program targeted at 2 million uninsured population came into force from February 28, 2013 (minimal basic package (BP) provided as vertical programs for PHC and emergency services, specifically ambulatory (planned and emergency) and emergency hospital services). The annual financial limit (15000 GEL) for scheduled hospital health services (more than 450 urgent in-patient services, including 24 neurosurgery diseases) has been defined.
The aim of the study is to research the financial accessibility of the beneficiaries covered by The State Universal Healthcare program in case of the urgent neurosurgery diseases.
Research included qualitative and quantitative components. Qualitative research implied identification of suggestions made by managers and medical staff of the neurosurgery hospital. Within the qualitative component, discussions and in-depth interviews were held with focus groups. Within qualitative component, 1 focus group was implemented in in Tbilisi, May 2014.
At the second stage of research, some provisions for quantitative questionnaire were developed based on the problems identified within qualitative component. Based on the research aims, the Tbilisi University clinic “High Medical Technology Center” has been selected for the research, because this clinic is supposed to have one of the best neurosurgery departments in the country. The direct interview method has been applied. The interview was conducted through special structured questionnaires. Each questionnaire included open and closed questions; duration of interviews with the beneficiaries was 30-45 minutes.
200 beneficiaries (90.9%) of the selected 220 people agreed on participation in the study. 20 persons refused to participate, 12 of which were men and 8 women. 123 out of respondents were men (61.5%) and 77 – women (38.5%). Respondents aged under 45 years comprised 16%, 45 to 65 years 46%, and aged 65 years and older – amounted 37.5% (Table 1).
Table 1: The composition respondents based on sex and age:
The State Universal Healthcare program defines 24 urgent neurosurgery diseases (including: subarachnoid haemorrhage, intracranial haemorrhage, Traumatic brain injury). The research result showed that the list of the urgent neurosurgery diseases covered by the State Universal Healthcare Program is limited and don’t include such diseases, like: Arteriovenous malformation in brain, brain and spinal tumors, discogenic radiculopathy, pathological fractures of spine, also the program don’t includes cerebral infarction, surgical treatment of traumatic peripheral nerve lesions…
During the research in-depth interview has been conducted with the representatives of the The Ministry of Health, Labor and Social Affairs of Georgia. According to their statements, the previous state healthcare programs were financing all urgent cases and unlike the current situation the amount of diseases were not strictly defined. Accordingly, in the past the patient was financially protected in any urgent cases. In this research study the diseases of the hospitalized patients are diverse (Table 2).
Table 2: Distributions of hospitalization for cerebrovascular diseases by age, 2014 (May, June, July)
The research result showed that, according to the majority of beneficiaries (92%) the most positive side of The State Universal Healthcare Program is improved accessibility to the medical services and coverage of a bigger part of population. The majority of respondents (83% of respondents) are informed that the urgent neurosurgical diseases are covered by The State Universal Healthcare Program. Approximately 87% was not informed that the high-technological diagnostic tests, such as Computer and Magnetic Resonance Tomography are not financed by this program.
According to the majority of beneficiaries they need more information about medical services and the procedures that are financed by the State Universal healthcare program. The managers and medical personal of the neurosurgical department noted that some patients suppose that all medical services are free, but actually, there are diseases and medical services are uncovered by the program and they have to inform patients about it.
Respondents satisfaction based on the following components of medical care has been assessed: patient admission procedures, flexibility/rapidity of medical procedures in hospitals, politeness and attention of medical staff, general condition of medical ward (wall, floor, ceiling etc.) cleanliness, sanitation (linen, toilet, ward) the doctors’ attitude (politeness, attention) and professionalism, attitude (politeness, attention) and professionalism of nurses, the time that doctors spend with patients, in-patient days, patient discharge procedures rapidity/flexibility, hospital staffs’ responses to the needs of patients, patient satisfaction with urgent neurosurgical hospital services. The majority of patients are satisfied with in-patient service. According to different parameters of medical services, their number varies between 83-93%. The reason of the beneficiaries’ dissatisfaction (7%) was mainly conditions for sick-nurses in the hospitals.
82% of respondents think that it is necessary to expand the program, they suggest particular services to be added to neurosurgical diseases benefit package. They think that the most important is to be covered high-tech diagnostic tests such as CT and MRT (72%). The research result showed that for the treatment of the urgent neurosurgery diseases, the reimbursement within the state universal healthcare program amounted 81% of the whole cost of treatment, the left 19% comes to private insurance or money paid by the patients. 45% of the respondents had to share the treatment cost. Among them 9% of the respondents had to pay more then 3000 $, 10% of the respondents -2000$-3000$, 12 % of the respondents – 1000$-2000$, 14% of the respondents – 100$-1000$. 13% of the respondents did not get financial support for the high-technological diagnostic tests (egg. Magnetic Resonance Tomography – MRT), necessary for their urgent neurosurgery treatment. 12% of the patients were insured by private insurance, therefore, their medical service costs had been financed by the private insurance company. According to the research results, the limit (15 000 GEL) defined by the State Universal Healthcare program was not enough for the treatment of the 9% of the patients. 36% of the respondents had to co-pay 30% of the cost defined by the State Universal Healthcare Program.
The research results showed that the State Universal Healthcare Program has improved the financial accessibility of the population to the medical services. Despite the fact that the population is ensured with the basic medical service package, the specific types of the urgent neurosurgery diseases and high-technological diagnostic tests (egg. Computer and Magnetic resonance tomography – MRT) are not financed by the State Healthcare Program. Neither, the financial limit (15000 GEL) defined by the State Universal Healthcare Program for the urgent neurosurgery treatment is not enough. Some patients had to cover the part of their treatment costs (in some cases more then 2000$), that negatively effects on their financial accessibility.
The following recommendations have been defined based on the research: In order to increase the financial accessibility of the people it is necessary to expand the list of the urgent neurosurgery diseases in the State Universal Healthcare programs. Also, to be financed high-technological researches such as Computer and Magnetic resonance tomography (MRT). It is important to include the urgent neurosurgery diseases with such a financial limit that the catastrophic costs for the patients could be avoided.
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