People in Georgia are increasingly able to access publicly financed health coverage, but high out-of-pocket costs continue to place a burden on those seeking care, according to the recent report published by the Barcelona Office for Health Systems Financing of the World Health Organization (WHO/Europe) on July 15.

The publication Can people afford to pay for health care? New evidence on financial protection in Georgia is based on data collected annually between 2013 and 2018. The findings are part of a series of country-based reviews monitoring financial protection in health systems across the WHO European Region.

“In 2013 Georgia introduced a series of important reforms that dramatically increased the share of the population entitled to publicly financed health services,” said Silviu Domente, WHO Representative in Georgia. “The data in the report, however, point to a situation where gaps still persist in terms of protecting people from financial hardship caused by out-of-pocket payments for health care.”

In 2013 Georgia introduced its Universal Health Care Programme, which extended access to publicly financed health services to most of the population. The reforms led to a much needed increase in public spending on health, but out-of-pocket payments have remained high, with 1 in 6 households experiencing catastrophic health spending. The impact of out-of-pocket payments has been particularly felt by poorer households.

“The data in the report show that the reforms did not provide enough coverage of outpatient medicines, which are the main driver of catastrophic out-of-pocket payments in Georgia,” explains Triin Habicht, Senior Health Economist at the WHO Barcelona Office for Health Systems Financing. “Out-of-pocket payments account for 48% of overall spending on health, higher than the average for the WHO European Region.”

Financial protection and universal health coverage

Financial protection is measured using two main indicators: catastrophic out-of-pocket payments and impoverishing out-of-pocket payments.

According to WHO’s new analysis, Georgia has a relatively high incidence of impoverishing and catastrophic health spending when compared to other countries in Europe. The report notes that this is primarily due to limited coverage of outpatient medicines, a complex system of user charges (co-payments) without an annual cap on co-payments or exemptions for poorer people or those with chronic conditions, and the prioritization of inpatient and emergency care over primary care.

People often pay out of pocket to bypass primary care and seek care directly from specialists, partly due to a low level of trust in primary care providers.

Increased public investment in health still needed

Strengthening financial protection will require increased public spending on health, especially in primary care, as well as action to address gaps in coverage and make better use of resources. The report recommends that the government should invest in improving the quality of primary care; prioritize greater protection from out-of-pocket payments for low-income households and people with chronic conditions; and introduce stronger regulation of health service volumes and prices (including medicine prices).

WHO supports countries to move towards universal health coverage – leaving no one behind
Financial protection is central to universal health coverage, which means everyone can access the quality health services they need without experiencing financial hardship. Universal health coverage is at the heart of the European Programme of Work, WHO/Europe’s strategic framework.

Through the WHO Barcelona Office for Health Systems Financing, WHO/Europe undertakes context-specific monitoring of financial protection in over 30 countries, including Georgia. The WHO Barcelona Office also provides tailored technical assistance to countries to reduce unmet need and financial hardship by identifying and addressing gaps in coverage.