4. Paying for services
Adequate funding for health is important to manage the excess demands on the health system. This section considers how countries are PAYING FOR COVID-19 SERVICES. Health financing describes how much is spent on health and the distribution of health spending across different service areas. The section also describes who is covered for COVID-19 testing and treatment, whether there are any notable gaps (in population coverage and service coverage), and how much people pay (if at all) for those services out-of-pocket.
4.1 Health financing
As part of a larger Eastern Partnership support package, on 30 March 2020 the European Commission provided €20 million of new funds to mitigate the impact of the COVID-19 pandemic on the Georgian health system (including the purchase of medical equipment) and around €70 million redirected funds to alleviate socioeconomic consequences. The MoILHSA will provide personal protective equipment (PPE) to all public and private facilities
Under the Economic Support Plan (1 April 2020) an additional GEL 351 million will be allocated within the Crisis Budget to pay for pandemic response work. So far, all medical services related to COVID-19 have been financed from the state budget. Discussion with the private insurance industry on their roles and financial contributions is underway. A funding mechanism for the treatment of people diagnosed with COVID-19 has been developed. The Social Services Agency (SSA) reimburse facilities in accordance with the conditions set out in Resolution #36 of the Government of Georgia (February 21, 2013) on UHC and Resolution #674 (Appendix #20, December 31, 2019) on the management of new COVID-19 cases. The clinics are required to report the actual costs of medicines, diagnostics, and consumables used to treat COVID-19 cases.
The Government has introduced a temporary transfer to public and private hospitals in the form of a global budget to ensure standby readiness and to compensate the facilities for losses in revenue due to COVID-19. The Government has established thresholds—number of registered COVID-19 cases—for engaging facilities in the response plan. Once the threshold is met, the facility is notified and must empty its premises within 48-96 hours to accept COVID-19 patients. SSA will transfer funds to facilities to compensate them for revenues lost as a result. To ensure that medical facilities are on standby and ready to receive COVID-19 patients, the Government has developed a mechanism to compensate the designated facilities for idle capacity. The MoILHSA has estimated the cost per unoccupied bed using expenditure data provided by the facilities for the last three months. Facilities with 80 beds or fewer will receive on average GEL 100 per bed, and those with more than 80 beds will receive GEL 120 per bed. This fixed amount includes the salaries of medical staff, utility bills, and operational costs. The Government has defined three stages for standby readiness based on the number of cases (1,050 beds in the first stage, 2,000 beds in the second stage, and 4,000 beds in the third stage) ( http://documents.worldbank.org/curated/en/949581588712278110/pdf/Georgia-Emergency-COVID-19-Response-Project.pdf ).
As part of the Crisis Response Plan (see Section 6.1 Transition measures: measures in other sectors), the StopCoV Fund proceeds of GEL 133.5 million will be used for the needs of the medical sector and hospitals engaged in fighting COVID-19 (to be categorised as “other revenues” and in expenditures). The Government has committed to covering the costs of organizing quarantine spaces and sponsoring flights that returned Georgians from different parts of the world (total cost: GEL 45 million) as well as healthcare costs and virus containment measures (total cost: GEL 285 million); and improving healthcare infrastructure to accommodate COVID-19 patients (total cost GEL 60 million).
Georgia’s healthcare system spent over 200 million GEL (about $60.2 million) on its Covid-19 response in 2020. $45.7 million were spent under the loan agreement between Georgia and the International Bank of Reconstruction and Development (IBRD) and the Asian Infrastructure Investment Bank. Of this, about $1.65 million was spent on personal protective equipment for medical workers and diagnostic materials, including COVID-19 tests ($29.3 million). Georgia spent 3.16 million GEL (about $952,000) in providing quarantine spaces with medical staff. A total of 6.3 million GEL (about $1.9 million) was spent in diagnosis and treatment of Covid patients, while 62.1 million GEL (about $18.6 million) was spent on medical bed supplies. In 2020 the Health Ministry spent 19.1 million GEL (about $5.7 million) on the purchase of personal protective equipment.