Publication: Targeted or Untargeted? The Initial Assessment of a Targeted Health Insurance Program for the Poor in Georgia
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Published
2011
ISSN
1872-6054 (Electronic)
0168-8510 (Linking)
Date
2012-03-30
Author(s)
Chao, S.
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Abstract
The government of Georgia launched a Medical Insurance Program, a targeted health insurance program, in June 2006 to provide health insurance to the poor. Using administrative data from June 2006 to December 2006, this paper estimates the initial impact of the Medical Insurance Program relative to an untargeted health insurance program and assesses whether the benefits have reached the poorest among those eligible. The paper presents two main findings: first, the Medical Insurance Program has significantly increased beneficiaries' utilization of public health insurance for acute surgeries and inpatient services; and second, the benefits have reached the poorest among the beneficiaries. However, the findings are only applicable to the first six months of implementation and more analysis is required to understand the dynamics and long term impact of the reform.
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Publication An Evaluation of the Initial Impact of the Medical Assistance Program for the Poor in Georgia(World Bank, Washington, DC, 2008-04)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.Publication Health Insurance for the Poor : Initial Impacts of Vietnam's Health Care Fund for the Poor(World Bank, Washington, DC, 2007-02)Vietnam's Health Care Fund for the Poor (HCFP) uses government revenues to finance health care for the poor, ethnic minorities living in selected mountainous provinces designated as difficult, and all households living in communes officially designated as highly disadvantaged. The program, which started in 2003, did not as of 2004 include all these groups, but those who were included (about 15 percent of the population) were disproportionately poor. Estimates of the program's impact-obtained using single differences and propensity score matching on a trimmed sample-suggest that HCFP has substantially increased service utilization, especially in-patient care, and has reduced the risk of catastrophic spending. It has not, however, reduced average out-of-pocket spending, and appears to have had negligible impacts on utilization among the poorest decile.Publication Georgia’s Medical Insurance Program for the Poor(World Bank, Washington DC, 2013-01)Georgia launched its Medical Insurance Program (MIP) for the poor in 2006. This program draws from general tax revenues to provide comprehensive, means-tested health insurance to the poorest 20 percent of the population as identified by a proxy means test. The government contracts private insurance companies who serve as financial risk carriers and purchasing agents for the program. MIP is well targeted to the poor and has had a major impact on improving financial protection of its beneficiaries. It has also served as a launching pad for significant investments in hospitals and information technology (IT) systems. In brief, MIP is a program funded through general taxation that provides a fairly comprehensive benefits package of health services to the poorest 20 percent of the population as identified via a proxy means test. There are no copayments for services. Although run by a state purchaser during the first two years, since 2008 its key feature has been that private insurance companies are contracted by the Ministry of Health to bear financial risk and to purchase services from both public and private providers on behalf of poor beneficiaries. The government sets policy, pays a per capita premium per beneficiary to private insurers, and conducts program oversight. This case study provides an overview of how MIP is designed, its achievements to date, and challenges for the future. A key theme discussed in further detail, and of potential interest to other countries contemplating a push toward the achievement of universal health coverage, is the contracting of private insurance companies to purchase services on behalf of the poor. Some attention is also given to MIP's targeting approach.Publication Targeting Health Programs to Reach the Poor(World Bank, Washington, DC, 2000-02)In principle, the efficiency of poverty-oriented social programs can be increased dramatically through “targeting” an infelicitous term applied to efforts to focus development programs more directly on the poor. By one widely-cited estimate, a set of “perfectly targeted” programs -- that is, programs whose benefits reach all the poor and only the poor -- could eliminate poverty at less than 10% the cost of development programs that do not discriminate between poor and rich. No knowledgeable advocate of targeting, no matter how enthusiastic, would claim that the maximum attainable gain from targeting comes anywhere close to the theoretical maximum referred to above. But a measure does not have to be ideal in order to be worthwhile, and this raises the possibility that targeting might still have much to offer. The purpose of what follows is to explore this possibility.Publication Improving Health for the Poor in Mozambique : The Fight Continues(2002-02-01)The health sector in Mozambique has made significant progress in terms of increasing coverage of services. However, health remains a major concern in the area of poverty reduction. The study describes the health status of the population, especially of the poor, and how the sector responds to the needs. Huge inequalities continue to exist with regards to resource allocation, deployment of staff and availability of services among various geographic areas, between the urban and rural population, and between the poor and the non-poor. The study builds upon the existing studies on health and consolidates the sector knowledge. Based on the analysis, the study makes various recommendations on how the health sector reforms can be made more pro-poor by focusing on certain interventions, by targeting certain areas and population groups, by designing new delivery models that would bring the services closer to the population, and by improving financial management to serve the poor more effectively.
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