The FINANCIAL -- About one third of the population of Georgia is insured, according to the Georgian Insurance Association

Written by Nana Mghebrishvili

The number of insured people has increased significantly during the last four years. But the Georgian Insurance Association believes the state’s intervention is necessary in cases when individuals can’t manage to insure themselves.
About 300,000 citizens of Georgia who are employed, aren’t insured. Employers should encourage employees to get insured.
The Association believes that in the condition of a proper insurance system, about two thirds of the Georgian population could be insured during the next three years. Good infrastructure is very important. In recent times lots of local and foreign investments have been put into the rehabilitation of medical infrastructure. But it isn’t enough. Adequate knowledge is necessary not to ruin it.
According to Devi Khechinashvili, Head of the Georgian Insurance Association, case management has to be the main guideline of the healthcare system. It has to replace the primary healthcare system. Case management involves lots of processes.
First of all there must be guidelines and protocol for doctors. Doctors have to be part of a system which makes them protect the rules. There has to be an organization which will impose regulations and guidelines. 
Ethic and law norms have to be stronger in the case of breaking these guidelines and protocol. Doctors have to write prescriptions according to protocol. Chairmen will be controlled by kind of information systems.
The knowledge and education of doctors has to be increased as well. They have to know that cooperating with pharmacy companies is one of the main problems of healthcare system development. Currently most doctors have contracts with pharmacy companies and appoint their patients the drugs of their partner companies.
Doctors confess that the generic share of their prescribed medicine is very low - about 30 percent. They know that generics have the same effect as brand drugs, but again because of contracts with pharmacy companies they refuse to prescribe them. In reality there are lots of huge pharmacy companies which produce only generic drugs. Generic use is accepted throughout the whole world and has to be implemented in Georgia as well. This process will cause optimization of pharmacy expenses.
A list of essential medicines would be good as well. Lots of countries or just organizations have their list of essential medicines. Doctors are obliged to appoint medicines from that list. The lists are exhaustive and contain all medicines necessary for diseases. An approximate number of medicines has to be 500. Actually Georgia has such a list of essential medicines for people insured under the state insurance system. But doctors almost never follow them. Lists are available for patients as well but they can’t choose adequate medicines without a doctor’s assistance.
It would be good if a patient had a special plastic card containing all the information about his/her illness, diagnosis, prescriptions. Such cards would be good while buying medicines too.
Having a list of essential medicines, wide use of generics, and following guidelines would cause   optimization of pharmacy expenses, which is really necessary. 50 percent of healthcare expenses goes on medicine. It is three times higher than in normal countries and is a result of the low awareness of doctors. Later this money has to be spent on better healthcare services.
The service has to be better financed and more accessible. All this would be approached after the systematic work and training of doctors. The university educational system also has to be changed. Knowledge of the problems and solutions has to be taught from universities as well.
In 2009 liberalization of the pharmacy market happened and competition between companies increased. It caused improvement of service and delivering quality. But still competition has to become more pluralistic. Currently some clinics import medicines themselves. That is also good and such cases have to be more common. The situation has to be the same in the regions of Georgia. But the solution to this problem is already clear and it’s a sign of the market liberalization and increased competition.