Four years since its launch, important changes have been enacted within the universal healthcare programme. The state replaces the universal principle with a targeted approach. Moreover, a medication component has been added to the state healthcare programme. Since launching the universal healthcare programme, healthcare experts, governmental opposition, NGOs, media and FactCheck as well have been constantly emphasising the ineffectiveness of the programme alongside its excessive spending. Our recommendation was to make the programme more targeted and focused on those people with the least access to healthcare. Providing funds for medicine within the framework of the healthcare programme was also important because more than half of healthcare expenses is spent on medication. Another recommendation was to have private insurance companies implementing the state healthcare programme. In this case, the state purchases health insurance packages from a private insurance company and, in so doing, faces no financial risk. Statistics of the last years (2014-2016) demonstrate that the state is unable to cap universal healthcare programme expenses. In spite of this, no changes have been made to the universal healthcare programme. The Ministry of Health, Labour and Social Affairs will try to limit expenses through the use of differentiated packages and selective contracting of the hospitals.   Differentiated packages of the universal healthcare system Since 1 May 2017, Georgian citizens with a higher income level whose annual income exceeds GEL 40,000 cannot use the universal healthcare programme. Citizens with a medium level income, whose monthly income is more than GEL 1,000 but does not exceed GEL 40,000 annually and do not have private health insurance, can use the limited package of the universal healthcare programme. People in this category (even if they have a private insurance package) still have access to funding for oncologic diseases as well as childbirth/caesarean section. Low income (less than GEL 1,000) citizens, self-employed individuals and persons with irregular income will retain access to the universal healthcare programme; although, with some limitations. If people in this category purchase a private insurance package, they will be entitled to funds only for urgent and oncologic services together with childbirth/caesarean section. Socially vulnerable citizens and persons who are registered in the database of socially vulnerable people whose rating points are between 70,000 and 100,000 as well as children from the ages of six to 18 years,  teachers and people with limited capabilities will be fully entitled to all of the services provided by the universal healthcare programme. Additionally, they are not restricted from using a private insurance package at the same time.   A medication funding component has been added to the universal healthcare programme From summer 2017, citizens registered in the database of socially vulnerable families whose rating points do not exceed 100,000 will receive funding for medication for chronic ailments. Namely:

• Medication for chronic heart and cardiovascular diseases
• Medication for chronic lung diseases
• Medication for diabetes (type 2)
• Medication for thyroid diseases

A programme beneficiary has to be a co-payer and pay 10% of the total value of the medication(s) which should not be less than GEL 0.05 and more than GEL 1. According to the ordinance of the Government of Georgia dated 25 April 2017, the list of medications which would be funded by the universal healthcare programme was also determined. In total, 24 types of medication will be funded within the framework of the programme. List of medications:

1. Enalapril
2. Losartan
3. Amlodipine
4. Metoprolol
5. Amiodarone
6. Isosorbid Dinitrat
7. Varparin
8. Clopidogrel
9. Digoxin
10. Furosemide
11. Spironolactone
12. Atorvastatin
13. Metformin
14. Gliclazide
15. Glimepiride
16. Thiamazole
17. Levothyroxine
18. Budenoside (inhalation suspension)
19. Budenoside (inhalation aerosol)
20. Albuterol
21. Salmeterol/fluticasone
22. Salbutamol
23. Tiotropium Bromide
24. Methylprednisolone

  According to the calculation of the Ministry of Health, Labour and Social Affairs, the number of people who might benefit from the medication programme is approximately between 150,000 and 200,000. The Ministry of Health, Labour and Social Affairs has already announced a tender to purchase the medicines. The main emphasis for purchase will be on the quality of the medication. As FactCheck was informed by the Ministry of Health, Labour and Social Affairs, it is expected that citizens will be able to use this programme from July 2017. The budget for the medication programme is set at GEL 3,360,000. This budget is calculated for a period of six months. As the Ministry of Health, Labour and Social Affairs assumes that at least 150,000 persons will use this programme, it means that an average of GEL 22.4 is allocated per person for the six months which works out to GEL 3.7 per person on a monthly basis. The expected amount of programme beneficiaries and the programme’s budget do not correspond with each other. Therefore, at the end of the year, we will see that programme’s budget is insufficient or a much lesser number of people will actually benefit from this programme.