According to our latest public opinion poll^[1], conducted nationwide, one of the major obstacles to the success of the country’s universal healthcare and public insurance programs^[2] is a lack of public awareness and trust in these.

One of the most important findings from this poll is that around one third of those polled are willing to contribute financially to their healthcare and not be totally dependent upon the government, which is a sound and reassuring attitude. Below are some of our major findings:

1. Public Awareness of Healthcare Rights Remains Poor

Current state of affairs: As of January 1, 2014 the universal healthcare program, which was designed for those that had no health insurance, covered around 3 million people. As of April 1, 2014, however, the program saw a sudden jump in numbers of beneficiaries after a public insurance program for the socially vulnerable was incorporated into it^[3]. Thus after the universal healthcare program started on February 28, 2013, all Georgian citizens have either full or partial coverage, whereas:

1.1. 18% of the 1918 respondents polled do not know^[4] that they have health insurance, which, extrapolated to the population, means that the number of people who are not aware that they have health insurance is between 490,000 and 680,000. We will examine the public awareness of healthcare rights in detail in a separate publication.

Public Awareness of Healthcare Rights (as of January 1, 2014)

1.2. Most of the people, who know they are covered by the universal healthcare &  health insurance program, do not know how they are able to access free medicines. Fewer people are confused as to whom they should file complaints about treatment.

Current state of affairs: 1. Universal healthcare program covers medicines only for urgent inpatient and outpatient care  at a medical service provider participating in the program. 2. If any of the medical service providers participating in a universal healthcare program fails to comply with its commitments, beneficiaries of the program can have recourse to the Agency for Social Services under the Ministry of Labour, Healthcare, and Social Affairs or the health insurance mediation service, while those who are under the remaining public health insurance scheme (Government Decree #165) should approach their insurer or the health insurance mediation service.  

• 75% of the 1,918 respondents say that they do not know when they are entitled to free medicines under their universal healthcare program, while 10% say  that they do not know. However, the 10%, who claim that they know when they are entitled to free medicines, are not fully informed when exactly they can be provided with free medicines. Normal outpatient treatment, as opposed to urgent outpatient treatment, does not entitle beneficiaries either in or outside the clinic to free medicines. For detail see the chart below.

• When asked who you should go to first, if a clinic, hospital or insurer fails to comply with its public health commitments, about 50% of those asked give predominantly correct answers. But the opinion poll showed that public awareness of the health insurance mediation service or its role is quite low (2% of those polled are aware of its existence)   

2. Public Trust in Universal Healthcare or Public Insurance Programs is Low

2.1. Only 17% of respondents believe that their insurance package will indeed cover the entirety of their medical expenditures. For detail see the chart below.

Current state of affairs: Universal healthcare offers: 1. the normal outpatient services provided by a family doctor and nurse 2. urgent outpatient services to deal with situations that do not require a 24 hour stay at a medical service provider 3. urgent inpatient services when a prolonged delay (several hours) in medical treatment could result in the loss of a limb, an organ, or life.

Urgent inpatient services is defined widely and encompasses more than 450 medical conditions, including non-surgical treatments.

2.2. 31% of respondents believe that their healthcare expenditures will remain the same despite their being in a universal healthcare program. For detail see the chart below.

2.3. 52% of respondents believe that even though they are insured by the government, they will still have to incur additional healthcare expenditures (this question includes universal healthcare program as well). For detail see the chart below.

3. The most important finding from this poll is that a sizeable proportion of the country’s population are willing to contribute financially to their healthcare and not be totally dependent upon the government, which is a sound and reassuring attitude.

3. 1. 47% of respondents are ready to pay GEL 1-30 and more each month for precisely the type of health insurance they want, which, extrapolated to the population, means that about 1.6 million Georgian adults are ready to share financial responsibility for healthcare with the government. As of December 31, 2013 there were 363,329 corporate and individual private health insurance contracts: 1. 344, 156 corporate health insurance contracts (excluding 128, 538 civil servants insured by the government)   2.  19,173 individual health insurance contracts, while, as shown by our research, at least 4 times as many people (1.6 Georgian adults) are ready to share financial responsibility for healthcare with the government. This finding is supported by our 2012 opinion poll, which showed that around 30% of the beneficiaries of the public health insurance scheme designed primarily for the socially vulnerable stood ready to contribute GEL 5 per month towards their access to the medical services that were not covered by the scheme. We believe this readiness by so many people to contribute towards their health insurance should prompt the government to abandon its equalization approach in preference for a differential approach, and thereby direct some of the freed-up resource towards better healthcare, including  for the socially vulnerable. For detail see the chart below.

3.2. 34% of the 1,918 respondents polled believe that healthcare expenditures should be shared between those who are insured and the government. This, extrapolated to the population, means that about 1.6 million Georgian adults believe that individuals should share responsibility for healthcare with the government. But 60% believe that healthcare is entirely the government’s financial responsibility. For detail see the chart below.

3.3. 52% of respondents polled believe that those who have higher than average income should pay more for their health insurance and thus subsidize the healthcare expenditures of those with a lower income, while 31% of the polled believe that everyone should pay the same for their health insurance.

4. We have the following situation regarding pharmaceuticals:

4.1. Monthly pharmaceutical expenditures remain high: in the 30 days preceding the poll more than ¾ of the polled had spent about GEL 100 on medicines: 25% had spent less than GEL 20, 27% had spent GEL 21-50, 22% - GEL 51-100.

4.2. It is of interest that 59% of those polled, when they buy medicines, pay attention to country of manufacture, while 39% do not. For detail see the chart below.

4.3. The respondents trust Russian pharmaceuticals most, which are followed by pharmaceuticals produced in the EU even though compliance of Russian pharmaceutical production with GMP is highly questionable. Trust in those countries which manufacture pharmaceuticals  is distributed as follows:   

4.4. More than half the 1,918 respondents polled  prefer buying pharmaceuticals from PSP or Aversi. For detail see the chart below.

4.5. The reasons they give are as follows:

5. Recommendations

Transparency International Georgia believes that the Ministry of Labour, Healthcare and Social Affairs should ensure that:

• all beneficiaries know that they are covered

• beneficiaries of universal healthcare are adequately informed about their rights and benefits, and terms and conditions thereof

• the Agency for Social Services eliminates the factors that are undermining recipients’ trust in the universal healthcare program

• healthcare policy calculations have room for the  number of people who are ready to contribute financially towards their health insurance (for detail see ch 3.1. above), which, we believe, should prompt the government to abandon its equalization approach in preference for a differential approach, and thereby direct some of the freed-up resource towards better healthcare, including  for the socially vulnerable.

[1] We took a geographically and demographically representative sample of 1,918 adults from a targeted population of voters in the 2013 presidential elections (3.186 million people), rather than Georgia’s entire population. We have thus excluded 18 year olds as well as residents of certain geographical areas that were not covered.

[2] At the time of public opinion poll there were two public insurance programs apart from universal healthcare: one public insurance program designed  primarily for the socially vulnerable and the other for old-age pensioners, children aged 0-5 and students. The latter will most likely continue until September 2014.

[3] This public insurance program, designed primarily for the socially vulnerable, was implemented by preselected insurance companies per Government Decree #218.

[4] A first draft of this questionnaire was tested on the public, however, we found that the majority of respondents were unable to distinguish between the two terms: "universal healthcare" and "public insurance program", e.g., the question about whether respondents knew that they had health insurance includes beneficiaries of both the universal healthcare and public insurance programs. Therefore, we referred to these collectively, in most of our questions, as "health insurance". But later based on the other questions (so called status questions) we were able to identify ourselves which of these two programs they fell under, in more than 50 per cent of cases.