GSAC Analytics

How to reform the healthcare system. Suggestions from a participant

How to reform the healthcare system. Suggestions from a participant

problems of the existing system

  1. The public health system, created after 2012, is defective from the beginning, due to the principle and idea inherent in it to provide a large number of citizens of a poor country with decent medical care at the expense of the budget. The idea is utopian that is either an extremely limited service or not enough for everyone. As a result, both problems are evident. Services are provided for a limited list of diseases, they are often not paid in full (the patient pays extra). For services not from the list, the patient pays himself, without the right to use an insurance policy. Otherwise, he cannot apply for state funding at all. Where can a socially disadvantaged person get 30%, if they financed 70%? The savings are very relative. It is much cheaper to buy an insurance policy and not pay extra. So what is the social nature of this project, if the patient pays in any case, with rare exceptions? The costs of these “services” from the budget grow from year to year and reach cyclopean figures, and there is no increase in the level of service. The current government insists on precisely this option for solving the problem because it is such a system that makes it possible to use corruption schemes to withdraw money from the budget, using the saw-rollback system, in collusion between the Ministry of Health and the management of clinics. The Ministry of Health is very “careful” in the selection of clinics that provide services for a budget account. There should not be “strangers”, by definition. That is why the regulatory pressure on clinics from the Ministry of Health has greatly increased. The principle of “everything for them, for others there is law” is being implemented. From year to year, the number of senseless regulations increases, allowing the Ministry of Health to have leverage over health care facilities and silence about the real problem of corruption in the system. This system does not meet the needs of the socially disadvantaged part of the population, for which it was introduced, judging by the declarations of the GM.
  1. The existing health insurance system is also not devoid of flaws, which are less noticeable, but no less significant. The problem is that due to the state “free” medical program and the economic downturn in the country, the number of beneficiaries of insurance companies has significantly decreased and, as a result, the ability of insurance companies to finance medical services to patients has decreased. Insurance companies have increased requirements for clinics providers to provide discounts on their services. As a result, clinics providers began to save money by reducing the cost of services – salaries of doctors, medical staff, the cost and quality of medicines and consumables, which in turn reduced the quality of their services. Dumping has become a priority for the clinic, not quality in the medical services market.

What is offered:

  1. Refuse from direct financing of medical services by the Ministry of Health to clinics. Instead, you need to define and have an accurate list of those who need free health care. Determine which areas are not covered by insurance companies. After that, instead of direct and often incomplete financing, give the citizen a voucher to pay for an insurance policy for a fixed amount per year (at least GEL 600) in any insurance company of the citizen’s choice. Leave funding only for those areas that go beyond the services of insurance companies – emergency care, oncology, hospices, etc. It is necessary to reduce the regulatory pressure emanating from the Ministry of Health, removing senseless and unnecessary regulations. Instead, it is necessary to move to an educational and training form of influence and ask with a healthcare facility and an insurance company as the largest beneficiary and recipient of the service, which will allow to reduce budgetary costs, improve the quality and volume of services provided, increase the efficiency of insurance companies, improve the competitive environment in the medical services market, provide assistance not partially, but in full and to those who really need it.
  1. In view of the fact that insurance companies receive additional funds and hundreds of thousands of new full-fledged beneficiaries under the state insurance program, they can be offered the following changes in their activities.
  • Complete refusal to treat patients in the insurance company by its employees.
  • Insurance companies are solely involved in financing treatment in private clinics.
  • Refusal of provider agreements with clinics and service of their clients at low prices, as this is fraudulent. Treatment of a patient, the operation cannot have two prices – “wholesale” and “retail”. Here either one is too high or the other is too low and the service is of poor quality …
  • The insurance company does not have the right to refer a patient to a specific clinic to a specific doctor, etc. The patient chooses both the insurance company and the clinic and the doctor himself. The patient’s referral is permissible in any region of the country, at any time and in any healthcare facility.
  • Family doctors stop working for the insurance company and become employees of health care facilities.
  • An insurance company and a clinic, as well as a network of pharmacies, cannot belong to the same owner, due to the prevention of corporate collusion.
  • The insurance company is obliged to spend at least 90% of the funds received on the treatment and prevention of diseases with an annual report and audit.
  • To improve the competitive environment, improve service and exchange experience, foreign insurance companies can be allowed to work in the medical services market, on equal terms with local ones.

Based on the foregoing, it seems possible, without going beyond the existing budget, to provide high-quality medical care for the population, and in the future to maintain and strengthen the trends of its improvement and development.The most important thing is that these changes make it possible to effectively counteract corruption schemes of officials from medicine, nepotism, embezzlement, corporate collusion, kickbacks, postscripts, etc., which manifested themselves so clearly during the existence of the system that has developed today. The ultimate goal is to provide 100% full insurance policies and medical care for the entire population of the country, without harming its economy.

Ираклий Дарцмелия, (Irakli Dartsmelia), Doctor.