An Evaluation of the Initial Impact of the Medical Assistance Program for the Poor in Georgia
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World Bank, Washington, DC
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As part of the recent health reform
effort, the government of Georgia launched a Medical
Assistance Program in June 2006 to provide health insurance
to its poor population. So far the program covers slightly
over 50 percent of the poor and provides benefit coverage
for outpatient and inpatient care. This paper estimates
initial impact of the Medical Assistance Program and
assesses whether the benefits have reached the poorest among
those eligible, using utilization data from June 2006 to
December 2006. Based on the analysis using a regression
discontinuity design and a three-part model, the paper
presents two main findings. First, the Medical Assistance
Program has significantly increased utilization of acute
surgeries/inpatient services by the poor. Second, the
benefits have successfully reached the poorest among the
poor. These two findings indicate that government efforts
to improve the poor's access to and utilization of
health services are yielding results. The paper emphasizes
that the initial dramatic increase in surgeries must be
interpreted with caution, given the possible
misclassification or misreporting of acute surgeries in the
data. The paper also stresses the need to continue
monitoring implementation of the Medical Assistance Program
and further improve program design, particularly the
targeting mechanism, to achieve better efficiency,
effectiveness and overall equity in access to health care services.
Palabras clave
ACCESS TO HEALTH CARE, ACCESS TO HEALTH CARE SERVICES, ACCESS TO HEALTH SERVICES, ACUTE CARE, ADDITIONAL MONIES, AMBULATORY SURGERY, BENEFICIARIES, BENEFICIARY, BUDGET CONSTRAINTS, CONSUMER, CONTINGENCY, CONTRIBUTION, CONTRIBUTION RATES, COST CONTROL, COST OF CARE, COST SHARING, DELIVERY SYSTEM, DEMAND FOR HEALTH, DEMAND FOR HEALTH SERVICES, DRUGS, ECONOMIC REVIEW, EMPLOYMENT, EMPLOYMENT AGENCY, ENTITLEMENT, EQUITY IN ACCESS, EXPENDITURES, FAMILY MEMBERS, FEMALE EDUCATION, FINANCIAL BARRIERS, FINANCIAL CONSTRAINT, FINANCIAL SUSTAINABILITY, FISCAL POLICY, FORMAL EDUCATION, FREE CARE, FULL COVERAGE, GENERAL POPULATION, HEALTH CARE, HEALTH CARE COSTS, HEALTH CARE DELIVERY, HEALTH CARE FINANCE, HEALTH CARE FINANCING, HEALTH CARE REFORM, HEALTH CARE REFORMS, HEALTH CARE SYSTEM, HEALTH CARE SYSTEMS, HEALTH CARE SYSTEMS IN TRANSITION, HEALTH CARE UTILIZATION, HEALTH DATA, HEALTH ECONOMICS, HEALTH EXPENDITURE, HEALTH EXPENDITURES, HEALTH FACILITIES, HEALTH FINANCING, HEALTH FOR ALL, HEALTH INDICATORS, HEALTH INSURANCE, HEALTH INSURANCE COMPANIES, HEALTH INSURANCE COVERAGE, HEALTH INSURANCE MARKET, HEALTH INSURANCE PLANS, HEALTH POLICY, HEALTH REFORM, HEALTH SECTOR, HEALTH SERVICE, HEALTH SERVICE UTILIZATION, HEALTH SERVICES, HEALTH STATUS, HEALTH SYSTEM, HEALTHCARE, HEALTHCARE SERVICES, HEPATITIS C, HOSPITAL ADMISSIONS, HOSPITAL CARE, HOSPITALS, HOUSEHOLD EXPENDITURES, HUMAN DEVELOPMENT, ILLNESS, INCOME, INFANT MORTALITY, INFANT MORTALITY RATE, INFERTILITY, INFORMAL PAYMENTS, INPATIENT CARE, INSURANCE COMPANIES, INSURANCES, LACK OF INFORMATION, LEVEL OF EDUCATION, LIFE EXPECTANCY, LIVING CONDITIONS, LOW INCOME, MEDICAL CARE, MEDICAL COSTS, MEDICAL EXPENDITURES, MEDICAL FACILITIES, MEDICAL SERVICES, MEDICAL SUPPLIES, MEDICAL TECHNOLOGY, MEDICINES, MORAL HAZARD, MORTALITY, NATIONAL HEALTH, NATIONAL HEALTH SERVICE, NUTRITION, OUTPATIENT CARE, PATIENT, PATIENT TREATMENT, PATIENTS, PHYSICIANS, POCKET PAYMENT, POCKET PAYMENTS, POLICY RESEARCH, PRICE ELASTICITY, PRIMARY EDUCATION, PRIMARY HEALTH CARE, PRIVATE HEALTH INSURANCE, PRIVATE INSURANCE, PRIVATE INSURERS, PRIVATE INVESTMENT, PRIVATE SECTOR, PROBABILITY, PROVIDER PAYMENT, PSYCHOLOGIST, PUBLIC EXPENDITURES, PUBLIC HEALTH, PUBLIC HEALTH SYSTEM, REIMBURSEMENT RATES, RETAIL PHARMACIES, SAFETY NET, SECONDARY EDUCATION, SEXUALLY TRANSMITTED INFECTIONS, SHARE OF INPATIENT CARE, SOCIAL ASSISTANCE, SOCIAL HEALTH INSURANCE, SOCIAL INSURANCE, SOCIAL SERVICES, SURGERY, TOTAL COSTS, UNEMPLOYED, UNEMPLOYED PEOPLE, VISITS, WELFARE PROGRAMS, WELFARE REFORM