Impact of Targeted Health Insurance on Health Service Utilization, Expenditures and Health Status among IDP Populations in Georgia

Grant awarded: £138,590

Lead organisation: Health Research Union

Partnering organisations: Abkhazeti, National Centre of Disease Control and Public Health (NCDCPH)

Project length: 2015 – 2017 (COMPLETED)

Study locations: Georgia

Principal Investigator: Maia Butsashvili

  • Training of interviewers

  • Meeting with Minister of Health and Social Affairs of Abkhazia

  • Conducting an interview


Purpose:

The research was intended to evaluate the impact of targeted health insurance on the health of individuals displaced within Georgia by conflicts with Russia during/prior to 2008. The research aimed to measure outcomes on healthcare utilization (frequency and access), expenditures and self-reported health status (including birth outcomes) amongst IDPs. The study intended to conduct a Health Utilization and Expenditures Survey (HUES) to measure differential outcomes for IDP households covered by the targeted health insurance program, and analyse factors, such as urbanization, compact settlement or integration and their impact on health utilization and expenditures. The study also sought to enable comparison with health outcomes and expenditure amongst the general population in Georgia.

Progress and outcomes achieved:

A Health Utilization and Expenditures Survey was successfully undertaken amongst IDPs in Georgia. A total of 1,319 questionnaires were completed, enabling the research team to collect and analyse data from over 4,300 household members relating to self-reported health expenditures, healthcare utilization and health status of IDP populations. The survey was carried out among IDP currently living in Georgia mainly residing in compact settlements - specifically built accommodations or administrative buildings allocated by the Municipal Government.

The ability to make comparisons with non-IDP populations was more limited than anticipated at the study outset, due to changing restrictions on the availability of HUES results from the general population. Changes to the health insurance schemes during the study period meant packages overlapped, and comparison between participants of targeted and non-targeted schemes did not demonstrate any significant differences.

Key findings:

  • State supported universal health care and targeted healthcare benefit packages for specific population groups have improved access to health services and reduced financial burden on patients. However, it has not provided full protection to households against health care costs, and out of pocket payments varied considerably.
  • Awareness of universal healthcare and targeted health benefit packages amongst IDPs is suboptimal.
  • A majority of IDPs think that the quality of healthcare services has improved over the last three years.
  • Self-treatment continues to be more commonly practiced by IDPs than by the general population.

Key outputs:

  • Policy brief (produced in Georgian for national Government and other stakeholders)
  • Research report
  • Peer reviewed article published in Georgian Medical News (in English, Georgian and Russian)
  • Two further peer-reviewed articles expected to be published.

Next steps:

HRU plans to work with Government and NGO partner Abkhazeti to increase the level of awareness among IDP populations about the services they are entitled to. The HUES survey findings will act as a baseline to determine future trends of health expenditures, healthcare utilization and health status amongst IDP and non-IDP populations, enabling assessment of the fast-changing healthcare policies and operational models among IDPs.

Quotes:

“Internally displaced people are an especially vulnerable population group in Georgia. Implementing household surveys posed challenges, such as problems in accessing rural settlements and their non-responsiveness. To overcome these challenges, we worked with a Georgian NGO ‘Abkhazeti’ which has more than 19 years of experience of engaging with the IDP population in Georgia. This organization had regional representatives in all target settlements, and their activities ensured that our interviewers had access to the communities.” Maia Kajaia, Project Manager, Health Research Union.

“We found that awareness of health programs is extremely low among IDP populations. The vast majority, over 90%, don’t know that there are healthcare programs covered by the government. The most important intervention that is needed following our research is to work with IDPs to increase their level of awareness about the services they are entitled to.” Maia Butsashvili, PI, Health Research Union.

Elrha is a registered charity in England and Wales (1177110).

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