Health Insurance Program under close scrutiny

The results of a preliminary audit concerning the State Health Insurance program turned out badly- reads the Chamber of Control’s statement released on February 2. A different version of events was offered regarding the issue by the Insurance companies, who claimed that they fulfilled their duties accordingly. Economic analysts also had their views as to what might have caused the outcome as voiced by the Chamber of Control.

Insurance companies spent 40% on serving the population from a budget of GEL 284 million. Only 171 000 cases were financed from the 808 000 citizens having insurance policies in 2008-2010, it means that only 21% used the insurance. The insurance companies gained GEL 170 million by neglecting the interests of medical staff and those insured.

The Chamber of Control concludes that the insurance sector is characterized by an ” inexistence of strict state control, dishonest activity of insurance companies, artificially limited access to the medical service, insufficiently informing the insurance owners, error in the database on insurance owners. “

The Chamber of Control of Georgia will start full audit of the program in the coming days. All the risk factors will be studied and the impediments and shortcomings, causing improper and wasteful expenditure of budget finances will be revealed.

In response to the statement, General Director of GPI holding, Giorgi Kvirikadze, commented that the Chamber of control represented its attitude quite negatively to the society and shadowed one of the most successful reforms in the country, “ it is a preliminary result and I cannot make a statement regarding the issue, however the Chamber of Control delivered information quite negatively to the society and due to such action put a show over one of the most successful reforms.” According to him, from the full number of insured people, the service has been used by 81 698 beneficiaries. “We have financed 208 184 cases. Among them 13 047 planned operations, 22 970 urgent operations, 4919 childbirth, 10 627 chemo- therapy, 21 129 ambulatory needed medicines.” as he explained. Taking into consideration of administrative and some other expenses like delivering polices, informing of potential beneficiaries and door to door campaigning and profit fee, from that allocated GEL 49,821million for GPI holding, the company gained a pure profit of GEL 5,545 million.

As economic analyst , Nodar Khaduri told The Messenger, such results of the Chamber of Control might be imposed due to two reasons, “ first is lack of competition, as far as I know, the insurance companies shared the regions which created no competition environment and an opportunity for the companies to act freely. The second reason is that the state might have made some mistakes while planning the reform, maybe there were not enough conditions and obligations presented against the insurance companies.”