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Health Research Policy and Systems
Published in: Health Research Policy and Systems 1/2017

Open Access 01-12-2017 | Research

Determinants analysis of outpatient service utilisation in Georgia: can the approach help inform benefit package design?

Authors: George Gotsadze, Wenze Tang, Natia Shengelia, Akaki Zoidze

Published in: Health Research Policy and Systems | Issue 1/2017

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Abstract

Background

The healthcare financing reforms initiated by the Government of Georgia in 2007 have positively affected inpatient service utilisation and enhanced financial protection, especially for the poor, but they have failed to facilitate outpatient service use among chronic patients. Non-communicable diseases significantly affect Georgia’s ageing population. Consequently, in this paper, we look at the evidence emerging from determinants analysis of outpatient service utilisation and if the finding can help identify possible policy choices in Georgia, especially regarding benefit package design for individuals with chronic conditions.

Methods

We used Andersen’s behavioural model of health service utilisation to identify the critical determinants that affect outpatient service use. A multinomial logistic regression was carried out with complex survey design using the data from two nationally representative cross-sectional population-based health utilisation and expenditure surveys conducted in Georgia in 2007 and 2010, which allowed us to assess the relationship between the determinants and outpatient service use.

Results

The study revealed the determinants that significantly impede outpatient service use. Low income, 45- to 64-year-old Georgian males with low educational attainment and suffering from a chronic health problem have the lowest odds for service use compared to the rest of the population.

Conclusions

Using Andersen’s behavioural model and assessing the determinants of outpatient service use has the potential to inform possible policy responses, especially those driving services use among chronic patients. The possible policy responses include reducing financial access barriers with the help of public subsidies for sub-groups of the population with the lowest access to care; focusing/expanding state-funded benefits for the most prevalent chronic conditions, which are responsible for the greatest disease burden; or supporting chronic disease management programs for the most prevalent chronic diseases and for special age groups aimed at the timely detection, education and management of chronic patients.
Footnotes
1
Starting from 2013, the Government embarked on Universal Health Coverage Agenda and expanded state-subsidised benefits, comparable to those offered under MIP, to the whole population. To evaluate the results of this initiative, in 2014, a health utilisation and expenditure survey was repeated and WHO and the World Bank supported the Government with survey data analysis. Nevertheless, at the time of this paper submission (December 2016), neither the dataset nor the complete technical report of this study had been released into the public domain. Instead, the high-level results of the survey were communicated in a short presentation prepared by the World Bank and WHO, which is not publicly available. Consequently, our analysis only speaks to the evidence arising from the 2007 and 2010 HUES datasets and regretfully does not include the findings stemming from the 2014 survey.
 
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Metadata
Title
Determinants analysis of outpatient service utilisation in Georgia: can the approach help inform benefit package design?
Authors
George Gotsadze
Wenze Tang
Natia Shengelia
Akaki Zoidze
Publication date
01-12-2017
Publisher
BioMed Central
Published in
Health Research Policy and Systems / Issue 1/2017
Electronic ISSN: 1478-4505
DOI
https://doi.org/10.1186/s12961-017-0197-5

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