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CDD and Health Georgia Community-Based Health Insurance

CDD and Health Georgia Community-Based Health Insurance. Sarbani Chakraborty, ECSHD October 31, 2002. CDD and Health – A Framework. Level of community involvement can vary (low to high intensity) Government failure and market failure Evolutionary process

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CDD and Health Georgia Community-Based Health Insurance

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  1. CDD and Health Georgia Community-Based Health Insurance Sarbani Chakraborty, ECSHD October 31, 2002

  2. CDD and Health – A Framework • Level of community involvement can vary (low to high intensity) • Government failure and market failure • Evolutionary process • Ultimately need to strengthen relationships between policy-makers, providers and community/households.

  3. Georgia – Background and Context • Economically hard hit by the transition and civil war following independence • Large-scale collapse in the delivery of basic health services, deterioration in infrastructure • Currently 80% of health expenditures are on an out-of-pocket basis, growing prevalence of diseases

  4. The CDD Context • Serious institutional and governance challenges • Wide-spread skepticism among the public about the ability of the government to deliver on their promises • Distortions in the economic environment has limited the growth of a formal private sector • Community bonds and relationships have increasingly strengthened in this environment

  5. Community-based Health Insurance: Rationale • Communities are paying on an out-of-pocket basis which affects timely access to health services, increases uncertainty and some evidence of payments being catastrophic • Improving certainty, risk pooling, especially for hospital care • Social insurance system is still weak, very small private insurance market, community distrust of government and private sector

  6. Pilot Schemes • Implemented by international NGO (International Medical Corps) • Seven schemes implemented over less than two years • Collect resources on pre-paid basis and provide a comprehensive package of services based on community demands

  7. Early Results • Schemes were up and running in less than 6 months indicating strong community demand • Utilization of primary care increased • Changes in government financing patters affected community contributions • Concerns with management arrangements

  8. Next Steps • Expanding pilot from 7 to 36 in three years • Combine government funding with community contributions to provide a comprehensive package of services • Create a network among the schemes to increase the size of the risk pool, create economies of scale in management

  9. Challenges • The process in time and resource intensive • Ultimately not a solution to the problems in health financing in Georgia • Attention of donors and other partners needs to be on correcting Government failure • There is a need to combine public and private sources of financing but probably should happen through the development of private insurance

  10. Final Comments • CBHI may generate other spin-off affects (greater provider accountability to community, community empowerment) which might create reasons for scale-up • Need to closely monitor and evaluate (almost a three year research project).

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