The FINANCIAL -- After almost four years since launching the Universal Health Care (UHC) System, the programme still has multiple systematic shortcomings, including resources and difficulty in programme implementation and the monitoring process.
Norway was one of the first countries to launch universal healthcare, back in 1912. Equal access to healthcare; public health improvement; less paperwork; encouragement of entrepreneurship; benefiting businesses and boost to the economy – are all believed to be the main pros of Universal Health Care.
The cons of Universal Health Care include: long waiting times; lead-up to a socialist state; medical abuse leading to rationing; increasing government debt; and finally, there is no free lunch - universal healthcare is not really free since the Government needs to generate a fund to support the programme. Hence, it leads to an increase in taxes. This is shown in the UK and other European countries where universal healthcare is being practiced with taxes increasing year after year. And last but not least, the cons of the system are no competition and no innovation - universal healthcare eliminates the free market for healthcare where prices may be lower. There is no incentive to create better medications or pursue better medical services. Universal healthcare will reduce the amount of money doctors can make thereby reducing the attraction of the practice. This could create a shortage of doctors in the long-run.
In 2013 the Georgian healthcare system was changed once more and the Universal Health Care (UHC) programme entered into force. Its main objective was to provide the population with healthcare services in a way to receive maximum benefits with minimal expenses. The programme includes all types of medical services, including inpatient, outpatient and emergency services. Unlike the previous programme, it isn’t limited by geographic principles for beneficiaries - hence, any Georgian citizen can receive medical services in any part of Georgia.
At a glance the programme is humane and is directed to help the population. But there are several important nuances, which should be considered while analyzing the UHC programme.
First of all, the UHC programme entered into force pretty spontaneously. Many of the participating medical facilities were informed about it quite superficially. This resulted in many shortcomings when providing the services. Many medical facilities weren’t ready for the increased patients’ flow after the programme’s launch. The newly-established electronic reporting system also had a negative influence. It caused losses for a number of medical facilities. Mostly, the losses were caused due to the following:
• Complicated performance submission process;
• Time delay in performance submission;
• Obstacles in processing from the Ministry;
• Delays in the transfer of funds to the medical facilities.
Overall, financial issues were caused for the most part for the medical facilities. As a result, many issues were created, like delays in salary transfers for medical personnel and the payment of bank liabilities.
A new problem has emerged since adapting to the programme: medical facilities have started using the programme to benefit personally. Medical data was counterfeited to receive increased income from the programme’s budget. Besides, patients were unnecessarily retained in medical facilities or placed in intensive care departments. This approach was an obvious violation of the patients’ rights, and in some cases even caused an aggravation in patients’ conditions. It is clear that the programme’s budget was infringed in this way. In addition to existing sanctions, the development of additional monitoring mechanisms became necessary, which required the mobilization of additional resources from the programme.
Retrospective analyzes of the first years of UHC programmes reveal that predictable minimum and maximum costs were not calculated neither in the short- and nor in the long-term perspectives. Accordingly, one more issue has been identified as an incorrectly planned budget. Most of the funds allocated for this programme were spent during the first half of the year and a budget deficit was developed during the second half. First of all its negative results affected medical facilities – the transfer of funds was delayed for them. On the other hand, beneficiaries have encountered problems: service delivery is delayed and they go into standby mode to receive medical services. This fact puts the programme baseline principles into question.
The main shortcoming of the UHC programme is absence of a preventive component. It is recognized that prevention is more cost-effective than treatment. The situation is reversed in the case of this programme, as the most costly and individual-oriented events are invested and public health/health promotion issues are, in fact, ignored. As preventive activities have long-term results unlike the medical manipulations (especially, surgical interventions), we can suggest that we are facing a political PR-campaign, which is aimed not at the population’s healthcare needs, but at obtaining their satisfaction and electoral votes in the future.
Overall, the UHC programme has multiple systematic shortcomings, including resources (material, human, time) deficiency, as well as difficulty in the programme’s implementation and monitoring process.
Differentiated packages entered into force on 1 May, 2017, which consider dividing beneficiaries considering their income and social status. This amendment is a step forward in terms of reducing healthcare costs. Real results will be seen at the end of the year, when they will be summarized.
Ana Zhulina is a Public Health specialist with 7 years of working experience in different fields of the Georgian Healthcare System. A global outlook and critical mind help her to find the main challenges in Georgian and global health issues and try to solve them in a theoretical manner.