Oncological diseases have remained one of the leading causes of death globally. Cancer treatments are often complex and can be long, requiring significant financial needs. As of today, up to 40 thousand patients with cancer are registered in Georgia according to the Minister of Health.
Since January 1, 2015, Georgia has started implementation of the Population Cancer Registry, which contributed significantly to data processing and increased the validity of statistical data. According to the Population Cancer Registry, about 10 thousand new cases of cancer are registered in Georgia annually. The lowest number in the last 5 years was recorded in 2017 (8.7 thousand new cases). Over the following years, the number of annually registered new cases increased and 10,000 new cases were registered by 2019.
Source: Population-based cancer registry
According to the National Statistic office, the annual increase of cancer mortality is significant. The cancer death rate in 2019 (7,873 cases) is 2.5 times higher than in 2010 (3,085 cases), for instance. The major changes in mortality estimation methodology could be considered one of the causes for the growth rate over the ten-year period. In particular, statistics were presented as estimated data until 2014, while beginning with 2014 it has been based on registered data. Additionally, data on the causes of death in 2015-2017 has been revised following the information received from the National Center for Disease Control and Public Health (Verbal Autopsy, Cancer Registry and Stationary Electronic System).
Despite the importance of considering the changes in the methodology, cancer death rates are increasing, according to the latest updates that use the same methods for estimating mortality.
Source: National Statistics office of Georgia
Capabilities for cancer care in low and high-income countries are different, which is largely due to unequal access to modern technologies of treatment. Assessing the quality of cancer care in Georgia has heightened the need for another study. The purpose of this research is to evaluate cancer treatment state programmes and assess financial assistance programmes for citizens benefiting from the former. Specifically, the study examined the efficiency of the following state programmes:
- The State Universal Health Care Program
- Referral Service State Program
- Early Disease Detection and Screening
- Palliative Care of Terminal Patients
It is noteworthy that the research process coincided with the announcement of the decision by the Prime Minister of Georgia, according to which the annual reimbursement rate for non-surgical medical procedures will be significantly increased within the framework of the State Universal Health Care Program. In particular, the annual limit for the program for chemotherapy, radiotherapy, hormone therapy and medication was increased by 8,000 GEL. The study attempts to show the impact of this decision on the accessibility of the most appropriate treatment for patients with similar diseases.
In addition to state programs, the study gives an account of existing insurance policies of private insurance companies in terms of cancer care. For this purpose, IDFI requested various statistical data (number of insurance policies, requested and reimbursed funds, insurance premiums, defined limits, etc.) on private insurance policies for cancer care from LEPL Insurance State Supervision Service of Georgia. According to the explanation given by the agency, their data store contains the total figures by type of medical (health) insurance and, consequently, they could not provide data classification in regard to oncological diseases.
- According to the National Statistic office, the annual increase in cancer mortality is significant. Compared to the previous year, the number of those who died from cancer increased by 544 in 2019.
- Within the framework of the Universal Health Care Program, the percentages of co-payments for cancer treatment vary between 70% and 100% according to the classification of the beneficiaries.
- Among the beneficiaries with the lowest co-payment are those whose families are registered in the unified database of socially vulnerable families and have the social rating scores between 70,000 and 100,000.
- In the framework of the Universal Health Care Program, requests for cancer-related costs have been increasing dramatically over the past years. The requested amount in 2015 was approximately 50 million Gel, contrasted with 2019 (as of November), when it increased to 68 million GEL.
- The percentage for remuneration under the Universal Health Care Program varied from 72% to 75% in 2015-2019.
- Despite the 100% funding for socially vulnerable citizens (with a social rating score of up to 70,000), the reimbursement rate for surgical oncology has been decreased to 76% in 2019.
- Approximately 68% of the amount requested by socially vulnerable citizens is reimbursed annually. The rate of funding for surgical services is only 55%.
- As of August 2020, 446 applications regarding surgical oncology were submitted under the Referral Service State Program (funding requests amounted to 11.3 million GEL in total; 235 of them were approved, with a total of 1.3 million GEL), 3011 applications regarding cancer medications were submitted (funding requests amounted to 12.9 million GEL; 2,431 of them were approved with a total of 4.3 million GEL), likewise 2394 applications regarding other cancer-related services were submitted (out of which 1,155 were approved; a total of GEL 8.4 million has been requested, out of which 1.8 million GEL has been reimbursed).
- The Referral Service State program, along with other cancer-related municipal programs, given its limited budget, is unable to provide a significant portion of the funds requested. Additionally, inconsistent program management and dubious approval practices significantly increase the risk of unfair distribution of funding.
The analysis of the state programs implemented in the country for cancer treatment shows that citizens still face significant challenges in terms of access to full-fledged treatment. The bulk of funding for cancer treatment is provided by the Universal Health Care Program, under which the share of requested and reimbursed amounts shows that the program fails to provide full funding for minimal medical needs and oncological treatment for vulnerable groups even in the instances of 100% co-payment.
Increasing funding limits for non-surgical treatment from September 1, 2020, will significantly help improve access to such treatment, although the issues raised in the study call into question the Georgian government's decision to provide a full course of oncology treatment for citizens. For example, limits applied to oncological surgeries, co-payment percentages for certain vulnerable groups, and other factors still remain a challenge.
Various state and municipal programs provide a part of the resources needed for oncological treatment that goes beyond the funding of the universal health care program. However, given their limited budget, the percentage of this funding is often minimal. Additionally, inconsistent program management, dubious approval practices, and transparency-related challenges significantly increase the risk of unfair distribution of funding. Taking into account the conditions set for various programs, uneven opportunities are provided for the population depending on their region of residence in Georgia, such as, for example, the programs funded by the municipal budget, region limitations by the outpatient palliative care program, and so on.
Cancer treatment requires significant financial resources, which is characterized by a growing trend and significantly increases the burden on the state budget. Given the current economic situation in the country, including the pandemic-related circumstances, there is a significant risk facing the existing model of funding and the current quality of oncological treatment. Therefore, it is important to develop a long-term action plan for state-funded treatment of oncological diseases. Additionally, it is advisable to start discussing the introduction of a compulsory insurance system for oncological diseases within the framework of public-private partnership, taking into account the international best practices.
This material has been financed by the Swedish International Development Cooperation Agency, Sida. Responsibility for the content rests entirely with the creator. Sida does not necessarily share the expressed views and interpretations.
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