Giorgi Gotsadze's blog – what does the state offer to patients

The benefits of universal healthcare that were offered to us in 2013 are undeniable!

Many people have been given the opportunity to undergo surgery or to be treated for a disease that has plagued them for a long time and was unaffordable to them due to lack of financial resources. By introducing a universal health care program and financing the cost of treatment, even partially, from the state budget, the state has taken care of the health of the citizens and made medical services financially affordable for a large part of the population.

Since 2013, this tremendous advantage has slowly petered out, year after year, and the care for patient’s health has been replaced by care for budget-saving.

I wonder what has changed in universal healthcare since 2013. To understand the problem, let's focus on a few notions and their meaning.

Giorgi Gotsadze, the President of Curatio International Foundation, Healthcare field specialist, researcher

What is the connection between the cost of the service and the state tariff ?!

The cost of the service, this is the price that a medical facility attaches to a particular service. For example, consider appendicitis surgery, which depending on the complexity, may cost 1800 GEL in one clinic, -2000 GEL in another, and somewhere, maybe more. In all cases, this price is agreed with the state and the medical facility is prohibited from changing the price under the universal health care program. Most of the hospitals (except the newly built ones) have last agreed on a price with the state in 2013 and the price set for the services has not changed since then.

You probably all know how much the costs of food and utility bills have risen since 2013, and most of the citizens of Georgia have felt this increase in their own pockets. In addition, 1 US dollar cost 1.66 GEL in 2013, but 3.27 GEL in 2020, that is, almost twice as much. The national currency has depreciated by 100%.

Our healthcare is largely based on imported products. Medicines, transfusions, surgical equipment, disposable supplies, and diagnostic equipment are imported from abroad, including operating tables and even the bed and the pump you see in the ward. About 45% of the cost of appendicitis surgery is products purchased in foreign currency. While the national currency depreciated by almost 100% in 2013-2020, it turns out that the part of the cost of a 2000 GEL operation that depended on foreign currency was 900 GEL in 2013, while in 2020 it costs 1800 GEL to purchase the same material.

And against this background, hospitals that face the increased service costs are unable to change prices due to state bans. Who suffers as a result, that I will tell you later.

After reviewing the contents of the notion of price, I will discuss the importance of the tariff. The concept of tariff is the amount set by the state for a specific medical service. The state tariffs are used to finance, in our case, the appendix operation with a specific and limited amount.

When setting the tariff, the state does not take into account the price of services. Although the cost of appendectomy may be 1800 or 2000 GEL, the tariff set by the state in most cases may be inconsistent with the cost – for example, 1200 GEL. This does not come as a surprise to any healthcare official, as no one has published a scientific paper or tariff calculation methodology since 2013, let alone the general phrases uttered by the Minister when announcing universal health care on television. In other words, since 2013, the tariff calculation has been so opaque and closed that it is equivalent to a "state secret".

Who is the victim?!

If a person belongs to a group that is 100% funded by the state for appendicitis surgery, and this person undergoes the surgery at a facility where the cost of the operation is 2000 GEL, it turns out that the state will fund 1200 or 1600 GEL (depending on the severity of the disease) and this person will have to bring the remaining amount from home. In other words, it turned out that a "fully funded patient" from the state has to pay extra money from his own pocket.

What we get eventually is that state treats the ordinary patient unscrupulously, or expects the patient to be an expert on healthcare, and when he needs the appendectomy, he has to find out the prices in different hospitals and make a choice in search of a cheap facility.

Would it be impossible to introduce a system where the patient is not required to possess the expert knowledge and he knows that if he has to receive the service for free, it means that he receives it for free, and if the patient has to pay 30% of the price, then what the 30% means in GEL -100 GEL or 3000 GEL? Systems of many countries do not expect health expertise from the patients and therefore have simple systems.

As the saying goes, "the devil is in details," and it is to these details that the good of universal health, the health of the patient, and his financial protection are sacrificed. It is as a result of ignorance of and opacity in these details that, in many cases, patient dissatisfaction is directed to the service provider or medical staff who is in direct contact with the patient. Ultimately, "Georgian-style" tariffs and health policies that do not have long-term goals hurt not only the patient but also the healthcare system and, presumably, the quality as well.

What could be the solution?!

No one is against the effective spending of the state budget if the budget savings are not made at the expense of the patient's health, his safety and the deterioration of the quality of services provided.

The question arises, how to go forward, what could be the solution?!

First is the disclosure of the "secret methodology" of tariff calculation to ensure the scientific value of the approaches used and the reliability of the calculation. Georgia does not need to reinvent the bicycle, because there are already proven scientific approaches in the healthcare economy that we can use.

Second, to adjust the prices set in 2013, taking into account the increased utility bills and labor resources or the depreciated GEL exchange rate.

Third, to provide information to the population and make it easier for them to make a choice, so that they know clearly that if they need appendectomy, they will receive it for free. If one has to pay 30% of the price, then how much is this amount – 300 GEL or some vague 30% of something he has no idea about. We must explain the benefits of the new system to the population and inform them adequately. It will also be necessary to display these fixed prices in the public space – the Internet - to ensure universal access to information.

And finally, it is necessary to have a constant dialogue of experts with involvement of the stakeholders, so that decisions are made by consensus and not in the form of directives, when the public official unilaterally creates and sets rules, without taking much into account the long-term interest of the patient or healthcare sector.