Expanding health insurance coverage in the Republic of Georgia: An evaluation of the new voluntary health insurance fund

Since the collapse of the Soviet Union in 1991, the Government of Georgia has attempted several major health system finance reforms. However, these reforms have not been successful at achieving the financial efficiencies or improvement in health outcomes as planned. With the Rose Revolution in 2003, and the installation of a new progressive government, a fresh set of health reforms was planned and subsequently launched. A key component of health reform in Georgia is the expansion of private health insurance coverage among the population. The Ministry of Health, Labor and Social Affairs (MoHLSA) has set a target of 80% insurance coverage by the year 2013. To achieve this goal, the MoHLSA established the Voluntary Health Insurance Program (VHIP) for those who are above the poverty line but still face financial hardships posed by catastrophic health risks. Under this program, the government subsidizes the premium with the individual contributing roughly 20% of the annual payment. During the open enrollment period 125,000 people joined the fund. Individuals can obtain insurance coverage from any of the ten private companies that agreed to the terms of the program with the MoHLSA. The service package includes emergency in-patient and out-patient care and primary preventive care. Using a health information database for the entire VHIP population and claims data from the insurers, the research team evaluated the cost effectiveness of the program and used descriptive statistics, multiple logistic regression models, and GIS mapping programs to compare utilization rates and geographical patterns with the national population.