Public opinion on the universal healthcare program - საერთაშორისო გამჭვირვალობა - საქართველო

Public opinion on the universal healthcare program

29 October, 2015


The two main findings about healthcare from the Transparency International Georgia 2015 public opinion poll [1] are that:

1. A minimum of 1.5 million adult, Georgian citizens are ready to share the financial burden of their health insurance with the government;

2. Of those surveyed 36% have not used planned outpatient care, which means that at least GEL 1.1 million is spent monthly on the 1.1 million beneficiaries who do not use these services [2].

The most important findings from our public opinion poll are as follows:

1. Quite a large proportion of the Georgian population believe healthcare is their own as well as the government’s financial responsibility. Specifically, approximately 46% of respondents (a minimum of 1.5 million adult citizens) are willing to finance their own insurance together with the government. Such a large share of the population allows the government of Georgia to shift from the current egalitarian to a differentiated approach. The differentiated approach will help free up resources, which can then be directed to the socially vulnerable population’s health care, e.g., of those surveyed 46% are willing to pay for their own health insurance, 5 percentage point decrease from 2013.

Chart 1. Ability and willingness to pay for a desired health care package [3]

1.1. Of those surveyed 57% believe that individuals who have an above average income should pay more for health insurance, and their payments should partially finance the health insurance of those who have low incomes. Of those surveyed, 18% believe that every person should take care of their own health, and regardless of income should cover their own healthcare costs..


Chart 2. Who should take responsibility for health insurance

1.2. Of those surveyed 25% believe that the government should partially pay for healthcare, which is 9 percentage points lower than in 2013. The number of respondents who think that the government should fully pay for healthcare rose by 4 percentage points compared with 2013. Extrapolating from these statistics, we conclude that a minimum of 1.2 million adults believe that beneficiaries of health insurance programs and the government should share costs.


Chart 3. Who should pay for citizens’ healthcare expenses – citizens or the government? 


1.1 Of the surveyed universal healthcare beneficiaries, 36% have not used outpatient care, which means that at least GEL 1 million is spent every month on 1.1 million beneficiaries who do not benefit from this service.

Currently, there are five main packages in the universal healthcare program (minimal, basic, targeted, elderly, and veteran) which cover the country’s entire population (about 3.7 million people according to the 2014 preliminary census data). The universal healthcare program consists of three main components:


1. Outpatient care, which requires registration;

2. Emergency outpatient care, which does not require registration;

3. Emergency inpatient care, which does not require registration.


64% of the surveyed beneficiaries of the universal healthcare program said that they are registered with a participating medical institution, 29% said that they are not registered (the Social Service Agency automatically registers these beneficiaries in the database for outpatient care services), while 7% said that they did not remember or refused to answer the question. Therefore, it is possible to say that 36% of the surveyed population do not use outpatient care services, which, extrapolated to the population, returns about 1.1 million beneficiaries. As the government pays from GEL 1.11 to GEL 2.15 for each registered beneficiary, more than GEL 12 million is spent per year on beneficiaries who do not benefit from the services they are registered for.


2.1.Asked if they were registered for the universal healthcare program with a participating medical institution, 64% of those surveyed said they were.

Chart 4. Registration for the universal healthcare program

2.3. Asked if they have paid costs not covered by the Universal Health Care Program for outpatient services during the last two years, 21% said yes, 47% said no, and 32% said that they did not need such services.

Chart 5. Respondents who had to pay for costs not covered by the Universal Healthcare program

Chart 6. Share of respondents denied planned outpatient care by the medical institution where they are registered

Chart 7. Share of respondents denied planned outpatient care by healthcare package

Now that the Ministry of Labor, Health, and Social Affairs has used a variety of means to inform the public about the universal healthcare program we believe the beneficiaries of the universal healthcare program bear a greater responsibility for the low level of their awareness about registration for outpatient services

3. Recommendations:

Transparency International Georgia believes that Georgia’s Ministry of Labour, Health, and Social Affairs should:

  • No longer automatically register passive beneficiaries, when they neither know with which institution they are registered nor generally that they are registered.

  • Consider that a sufficiently large share of the population is ready to be financially responsible for their own healthcare together with the government, if the government were to offer them a suitable package. We believe that this is an extremely important fact which gives the government of Georgia an opportunity to switch from the current egalitarian approach to a differentiated one. The government should establish what the expectations of the population willing to pay are in regards to health care packages. This will free up resources to provide better healthcare for the socially vulnerable population as well as in general. In our opinion, the best path to take would be for the government to replace the universal healthcare program with a state health insurance program based on the principle of co-payment for specific categories of beneficiaries, have insurance companies implement the program, and allow every beneficiary the opportunity to select the insurance company they want.


[1] We interviewed c1867 respondents throughout the country. The survey describes public opinion as of April of 2015.

[2] For our calculations, we used the 18-85+ Georgian speaking population in the areas covered by the survey (3,185,586 people) as of the 2013 presidential elections rather than the population of the entire country, because those under the age of 18 and respondents from certain regions did not participate. Thus we selected 1867 respondents from a population of 3,185,586 people with the aim of achieving a demographically and geographically representative sample.

[3] Please note that in the charts we have rounded percentages +/- to integers to make them easier to read. Due to this, the rounded percentages may not add up to exactly 100 percent. 

Author: Mikheil Kukava