Gotsadze George, Murphy Adrianna, Shengelia Natia, Zoidze Akaki
Curatio International Foundation, 37 Chavchavadze Ave., 0162, Tbilisi, Georgia.
London School of Hygiene and Tropical Medicine, Department of Health Services Research and Policy, Keppel Street, London, WC1E 7HT, UK.
BMC Health Serv Res. 2015 Mar 4;15:88. doi: 10.1186/s12913-015-0755-x.
In 2007 the Georgian government introduced a full state-subsidized Medical Insurance Program for the Poor (MIP) to provide better financial protection and improved access for socially and financially disadvantaged citizens. Studies evaluating MIP have noted its positive impact on financial protection, but find only a marginal impact on improved access. To better assess whether the effect of MIP varies according to different conditions, and to identify areas for improvement, we explored whether MIP differently affects utilization and costs among chronic patients compared to those with acute health needs.
Data were collected from two cross-sectional nationally representative household surveys conducted in 2007 and in 2010 that examined health care utilization rates and expenditures. Approximately 3,200 households were interviewed from each wave of both studies using a standardized survey questionnaire. Differences in health care utilization and expenditures between chronic and acute patients with and without MIP insurance were evaluated, using coarsened exact matching techniques.
Among patients with chronic illnesses, MIP did not affect either health service utilization or expenditures for outpatient drugs and reduction in provider fees. For patients with acute illnesses MIP increased the odds (OR = 1.47) that they would use health services. MIP was also associated with a 20.16 Gel reduction in provider fees for those with acute illnesses (p = 0.003) and a 15.14 Gel reduction in outpatient drug expenditure (p = 0.013). Among those reporting a chronic illness with acute episode during the 30 days prior to the interview, MIP reduced expenditures on provider fees (B = -20.02 GEL) with marginal statistical significance.
Our findings suggest that the MIP may have improved utilization and reduce costs incurred by patients with acute health needs, while chronic patients marginally benefit only during exacerbation of their illnesses. This suggests that the MIP did not adequately address the needs of the aging Georgian population where chronic illnesses are prevalent. Increasing MIP benefits, particularly for patients with chronic illnesses, should receive priority attention if universal coverage objectives are to be achieved.
2007年，格鲁吉亚政府推出了一项由国家全额补贴的贫困人群医疗保险计划（MIP），旨在为社会和经济上处于弱势的公民提供更好的经济保障，并改善他们获得医疗服务的机会。评估MIP的研究指出了其对经济保障的积极影响，但发现其对改善医疗服务可及性的影响微乎其微。为了更好地评估MIP的效果是否因不同情况而异，并确定需要改进的领域，我们探讨了MIP对慢性病患者与急性病患者在医疗服务利用和费用方面的影响是否存在差异。
数据来自2007年和2010年进行的两项具有全国代表性的横断面家庭调查，这些调查考察了医疗服务利用率和支出情况。两项研究的每一轮调查都使用标准化调查问卷对约3200户家庭进行了访谈。采用精确匹配技术评估有无MIP保险的慢性病患者和急性病患者在医疗服务利用和支出方面的差异。
在慢性病患者中，MIP对门诊药物的医疗服务利用或支出以及降低医疗服务提供者费用均无影响。对于急性病患者，MIP增加了他们使用医疗服务的几率（OR = 1.47）。MIP还与急性病患者医疗服务提供者费用减少20.16拉里相关（p = 0.003），门诊药物支出减少15.14拉里（p = 0.013）。在访谈前30天内报告患有慢性病且有急性发作的患者中，MIP降低了医疗服务提供者费用支出（B = -20.02拉里），具有边际统计学意义。
我们的研究结果表明，MIP可能提高了急性病患者的医疗服务利用率并降低了他们的费用，而慢性病患者仅在病情加重期间略有受益。这表明MIP没有充分满足格鲁吉亚老年人口中慢性病普遍存在的需求。如果要实现全民覆盖目标，应优先关注增加MIP福利，特别是针对慢性病患者。
