Publication: Georgia’s Medical Insurance Program for the Poor
Loading...
Published
2013-01
ISSN
Date
2013-05-01
Author(s)
Editor(s)
Abstract
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.
Link to Data Set
Citation
“Smith, Owen. 2013. Georgia’s Medical Insurance Program for the Poor. UNICO Studies Series;No. 16. © World Bank. http://hdl.handle.net/10986/13282 License: CC BY 3.0 IGO.”
Digital Object Identifier
Associated URLs
Associated content
Other publications in this report series
Journal
Journal Volume
Journal Issue
Collections
Related items
Showing items related by metadata.
Publication Tajikistan - Second Programmatic Public Expenditure Review : Volume 4. Public Expenditure Ttracking Survey (PETS), Health Sector(World Bank, Washington, DC, 2008-06-12)This report, Second Programmatic Public Expenditure Review (PPER 2), is a sequel to PPER, which was published in July 2007. PPER 2 provides a detailed analysis of key public expenditure issues in Tajikistan and reports on the nonlending policy dialogue and technical assistance programs managed and coordinated by the World Bank. PPER 2 has a special focus on social sectors, especially the health and education sectors. Public Expenditure Tracking Surveys (PETS) carried out for the first time in Tajikistan in 2007 contributed to the findings in this report. The report also updates the macroeconomic and fiscal situation to take account of important developments in 2007 and analyzes the implications of energy sector reforms and investments for fiscal sustainability. This report is intended to contribute to improving the quality of life in Tajikistan through a comprehensive reform program. It spells out the macroeconomic, energy, and budget reforms necessary to achieve the growth the country seeks and, at the same time (and frequently via the same measures) the social welfare targets of the Millennium Development Goals (MDGs).Publication Toward Universal Coverage in Health : The Case of the State Guaranteed Benefit Package of the Kyrgyz Republic(World Bank, Washington DC, 2013-01)In this case study the paper describes the evolution of the Kyrgyz health care system and discusses challenges in ensuring universal access to basic health care services. Section one provides an overview of the Kyrgyz health system and of the national health care reform programs that started in 2001 with Manas (2001-2005) and which have been continued with Manas Taalimi (2006-2011), and the recently adopted Den Sooluk (2012-2016). Section two provides a detailed discussion of the SGBP that follows a universal approach as it applies to all citizens, and describes the management of public funds and the information environment of the State Guaranteed Benefit Package (SGBP). Section three draws lessons from Kyrgyz national health reforms for universal health coverage for other countries with very limited public resources, widespread poverty, and high levels of corruption. Section four discusses the remaining challenges for universal health coverage for the poor and how the provision of good-quality care forms an important part of the agenda for the recently adopted Den Sooluk program.Publication Integrating the Poor into Universal Health Coverage in Vietnam(World Bank, Washington DC, 2013-01)This case study is aimed at providing a descriptive assessment of the key features of Vietnam's Social Health Insurance (SHI), focusing on the impediments to integrating the poor into universal coverage. The trajectory of SHI in Vietnam is similar to that of many other countries in the East Asia and Pacific region. The poor were covered under a separate Health Care Fund for the Poor to begin with. The 2009 Law on Health Insurance merged all of the different programs into one. Health insurance premiums for the poor were fully subsidized by the government and enrolment became mandatory, resulting in almost complete enrollment of the poor by 2011. Vietnam has combined elements of contributory social health insurance with substantial levels of tax financing to provide coverage for the poor and informal sector. The case study is structured as follows. Section 2 describes the institutional structure and system characteristics of Vietnam's SHI. Section 3 addresses the main topic of the case study - the impediments to integrating the poor. Section 4 concludes by addressing the pending agenda.Publication Consolidation and Transparency : Transforming Tunisia’s Health Care for the Poor(World Bank, Washington DC, 2013-01)Since the 2011 popular revolution in Tunisia, calls for a new social contract have been made to improve social inclusion, including addressing gaps in health care coverage for the vulnerable households. This paper evaluates Tunisia's Free Medical Assistance for the Poor (FMAP) and seeks to identify opportunities to improve universal coverage in Tunisia. The study focuses on the structural and institutional framework of health care coverage for the poor in Tunisia in terms of strengths, weaknesses, and recommendations for achieving universal coverage. The paper reviews Tunisia's health financing and delivery system with a special emphasis on FMAP, and analyzes the main structural and targeting challenges the program faces. The distinctive characteristic of this paper is the focus on institutional design and organizational practice of FMAP. The legal and regulatory framework is assessed in terms of management, beneficiary targeting methods, benefits package, and the information environment. Section 2 provides an overview of health financing and service delivery in Tunisia, including the relationship between the FMAP and the main financing schemes. Section 3 describes key supply-side issues in terms of primary health care provision for the poor. Section 4 assesses the institutional framework of the FMAP in greater detail and its linkages to the health care delivery system. Section 5 focuses on beneficiary selection and targeting methods under the FMAP. Section 6 examines public financial management under the FMAP, which is followed by a discussion in Section 7 of the benefits package. Sections 8 and 9 describe the information environment of the FMAP and how this links to the special focus of future financing reforms. The concluding section discusses the pending agenda and priorities for the FMAP moving forward.Publication Timor Leste : Health Equity and Financial Protection Project(Washington, DC, 2014-01)This report analyses equity and financial protection in the health sector of Timor-Leste. In particular, it examines inequalities in health outcomes, health behavior and health care utilization; benefit incidence analysis; financial protection; and the progressivity of health care financing. Data are drawn from the 2009/2010 Demographic and Health Survey, the 2001-2002 and 2007-2008 Living Standards and Measurement Surveys as well as 2011-2012 Household Income Expenditure Survey, and the Ministry of Finance. All analyses are conducted using original data and performed using the health modules of the ADePT software.
Users also downloaded
Showing related downloaded files
Publication Continental Drying: A Threat to Our Common Future(Washington, DC: World Bank, 2025-11-04)Grounded in new evidence from satellite data, “Continental Drying: A Threat to Our Common Future” presents the first global assessment of freshwater reserves over the past two decades. The findings expose an alarming trend of “continental drying,” a persistent long-term decline in freshwater availability across vast landmasses. Not only are droughts and deluges becoming more unpredictable, but the total amount of freshwater available for use has also significantly declined. Continental drying, driven by global warming, worsening droughts, and unsustainable water and land use, is a silent but accelerating crisis—largely unknown to the public—that reshapes the global water narrative. Continental drying raises profound risks. This report reveals new empirical evidence showing how freshwater depletion leads to major job losses, reduced incomes, wildfires, and biodiversity threats. In the long term, the combined effects of drying and warming could push societies toward a tipping point where damage accelerates rapidly and adaptation becomes increasingly difficult. Against the backdrop of continental drying, global water consumption rose by 25 percent between 2000 and 2019, with about a third of this increase occurring in regions already experiencing drying. Compounding the pressure, a substantial share of water use in drying regions remains inefficient. Continental Drying identifies hot spots where rising demand and declining supply converge and explores where and how water savings can be realized. This report recommends a three-pronged approach to address the crisis: managing demand, augmenting water supply, and improving water allocation. Five cross-cutting levers—strengthening institutions, reforming water tariffs and repurposing subsidies, adopting water accounting, leveraging data and technological innovations, and valuing water in trade—are essential for effective implementation and to attract private investment to finance the approach. Beyond water, addressing trade barriers, investing in education and skills development, and improving access to markets and financial services are critical for strengthening job and livelihood resilience amid a continental drying crisis.Publication Kyrgyz Republic Country Climate and Development Report(Washington, DC: World Bank, 2025-11-03)This Country Climate and Development Report (CCDR) on the Kyrgyz Republic aims to support the country’s development goals amid a changing climate. The CCDR considers two policy scenarios up to 2050: the business-as-usual (BAU) and high-growth scenarios. As it quantifies the likely impacts of climate change on the Kyrgyz economy between now and 2050, the report highlights key government actions to best prepare for and adapt to climate impacts (referred to as “with adaptation” measures), with a particular focus on the time horizon up to 2030. The CCDR also outlines a path to net zero emissions by 2050 (referred to as “with mitigation” measures, “decarbonization,” or, simply, “net zero 2050”), highlighting associated development co-benefits.Publication Taxes, Spending, and Equity: International Patterns and Lessons for Developing Countries(Washington, DC: World Bank, 2025-11-17)Taxes and public spending underpin the basic administration of government and finance the human capital and infrastructure investments needed for economic growth. They can also have a significant and immediate impact on poverty and inequality. The question of how public finance can support longer-term growth objectives while promoting equity has become even more important in recent years, given the high fiscal deficits and debt levels most countries emerged with in the aftermath of the COVID-19 pandemic. These included the increasing cost of debt and the need to restart environmentally sustainable growth while helping households address the learning losses and other social scars caused by the pandemic. This paper examines the global evidence on which households pay which taxes and who benefits from what spending, and critically, the net effect on different households across the income distribution. The aim is to identify the patterns and lessons that emerge for designing progressive fiscal policies. A global dataset of 96 countries is assembled, spanning all regions of the world and all national income levels, grounded in the Commitment to Equity (CEQ) approach to fiscal incidence.Publication Digital Africa(Washington, DC: World Bank, 2023-03-13)All African countries need better and more jobs for their growing populations. "Digital Africa: Technological Transformation for Jobs" shows that broader use of productivity-enhancing, digital technologies by enterprises and households is imperative to generate such jobs, including for lower-skilled people. At the same time, it can support not only countries’ short-term objective of postpandemic economic recovery but also their vision of economic transformation with more inclusive growth. These outcomes are not automatic, however. Mobile internet availability has increased throughout the continent in recent years, but Africa’s uptake gap is the highest in the world. Areas with at least 3G mobile internet service now cover 84 percent of Africa’s population, but only 22 percent uses such services. And the average African business lags in the use of smartphones and computers as well as more sophisticated digital technologies that catalyze further productivity gains. Two issues explain the usage gap: affordability of these new technologies and willingness to use them. For the 40 percent of Africans below the extreme poverty line, mobile data plans alone would cost one-third of their incomes—in addition to the price of access devices, apps, and electricity. Data plans for small- and medium-size businesses are also more expensive than in other regions. Moreover, shortcomings in the quality of internet services—and in the supply of attractive, skills-appropriate apps that promote entrepreneurship and raise earnings—dampen people’s willingness to use them. For those countries already using these technologies, the development payoffs are significant. New empirical studies for this report add to the rapidly growing evidence that mobile internet availability directly raises enterprise productivity, increases jobs, and reduces poverty throughout Africa. To realize these and other benefits more widely, Africa’s countries must implement complementary and mutually reinforcing policies to strengthen both consumers’ ability to pay and willingness to use digital technologies. These interventions must prioritize productive use to generate large numbers of inclusive jobs in a region poised to benefit from a massive, youthful workforce—one projected to become the world’s largest by the end of this century.Publication Direct and Indirect Impacts of Transport Mobility on Access to Jobs: Evidence from South Africa(Washington, DC: World Bank, 2025-11-12)Access to jobs is essential for economic growth. In Africa, unemployment rates are notably high. This paper reexamines the relationship between transport mobility and labor market outcomes, with a particular focus on the direct and indirect effects of transport connectivity. As predicted by theory, wages are influenced by the level of commuting deterrence. Generally, higher earnings are associated with longer commute times and/or higher commuting costs. Local accessibility is also important, especially for individuals with time constraints. Both direct and indirect impacts are found to be significant in South Africa, where job accessibility has been challenging since the end of apartheid. For the direct impact, the wage elasticity associated with commuting costs is significant. Returns on commute are particularly high for women. Local accessibility to socioeconomic facilities, such as shops and health services, is also found to have a significant impact, consistent with the concept of mobility of care. To enhance employment, therefore, it is crucial to connect people not only to job locations but also to various socioeconomic points of interest, such as markets and hospitals, in an integrated manner. This integration will enable individuals to spend more time working and commuting longer distances.