title: Healthcare utilization and expenditures for chronic and acute conditions in Georgia: does benefit package design matter?
abstract: BACKGROUND
  In 2007 the Georgian government introduced a full state-subsidized Medical Insurance Program for the Poor (MIP) to provide better financial protection and improved access for socially and financially disadvantaged citizens. Studies evaluating MIP have noted its positive impact on financial protection, but find only a marginal impact on improved access. To better assess whether the effect of MIP varies according to different conditions, and to identify areas for improvement, we explored whether MIP differently affects utilization and costs among chronic patients compared to those with acute health needs.
  
  
  METHODS
  Data were collected from two cross-sectional nationally representative household surveys conducted in 2007 and in 2010 that examined health care utilization rates and expenditures. Approximately 3,200 households were interviewed from each wave of both studies using a standardized survey questionnaire. Differences in health care utilization and expenditures between chronic and acute patients with and without MIP insurance were evaluated, using coarsened exact matching techniques.
  
  
  RESULTS
  Among patients with chronic illnesses, MIP did not affect either health service utilization or expenditures for outpatient drugs and reduction in provider fees. For patients with acute illnesses MIP increased the odds (OR = 1.47) that they would use health services. MIP was also associated with a 20.16 Gel reduction in provider fees for those with acute illnesses (p = 0.003) and a 15.14 Gel reduction in outpatient drug expenditure (p = 0.013). Among those reporting a chronic illness with acute episode during the 30 days prior to the interview, MIP reduced expenditures on provider fees (B = -20.02 GEL) with marginal statistical significance.
  
  
  CONCLUSIONS
  Our findings suggest that the MIP may have improved utilization and reduce costs incurred by patients with acute health needs, while chronic patients marginally benefit only during exacerbation of their illnesses. This suggests that the MIP did not adequately address the needs of the aging Georgian population where chronic illnesses are prevalent. Increasing MIP benefits, particularly for patients with chronic illnesses, should receive priority attention if universal coverage objectives are to be achieved.
authors.affiliation: Curatio International Foundation, 37 Chavchavadze Ave., 0162, Tbilisi, Georgia. g.gotsadze@curatio.com.
authors.forename: George
authors.initials: G
authors.lastname: Gotsadze
authors.affiliation: London School of Hygiene and Tropical Medicine, Department of Health Services Research and Policy, Keppel Street, London, WC1E 7HT, UK. Adrianna.Murphy@lshtm.ac.uk.
authors.forename: Adrianna
authors.initials: A
authors.lastname: Murphy
authors.affiliation: Curatio International Foundation, 37 Chavchavadze Ave., 0162, Tbilisi, Georgia. n.shengelia@curatio.com.
authors.forename: Natia
authors.initials: N
authors.lastname: Shengelia
authors.affiliation: Curatio International Foundation, 37 Chavchavadze Ave., 0162, Tbilisi, Georgia. a.zoidze@curatioconsulting.com.
authors.forename: Akaki
authors.initials: A
authors.lastname: Zoidze
mesh_terms: D000208:Acute Disease / Q000191:economics*; D000328:Adult; D000368:Aged; D002908:Chronic Disease / Q000191:economics*; D003430:Cross-Sectional Studies; D005191:Family Characteristics; D005260:Female; D005846:Georgia (Republic); D005102:Health Expenditures / Q000639:trends*; D006296:Health Services / Q000706:statistics & numerical data; D006801:Humans; D007342:Insurance Benefits; D008297:Male; D010342:Patient Acceptance of Health Care; D011795:Surveys and Questionnaires; D019472:Universal Health Insurance / Q000191:economics