Investor Presentation
ALDAGI
Eligibility
2
Provider choice
3 Co-payment
Price cap
сл
5
Limit
6
Financing model
STATE HEALTHCARE SPENDING MODEL
Universal Healthcare Program (UHP)
Urgent Treatment
Planned Treatment
All citizens of Georgia, except of those holding private insurance policies as of 1st
July 2013 and state insurance program beneficiaries
Any licensed hospital on the territory
of Georgia
In defined 500 medical cases 100% is
covered, in other cases - 70%
NO PRICE CAP | state finances costs
as per service provider price list
UHP provider list
70% of country's 4 the cheapest
service providers' average price
NO PRICE CAP for service provider,
state finances its share, rest is
financed by patient
In most cases up to GEL 15,000
Patient enters hospital by
ambulance
If eligible, medical case is
registered in UHP database
End of each month state transfers
funds to service provider
Within 30 days eligibility is
identified
Within 60 days guarantee letter is
issued
Patient presents guarantee letter
at service provider & pays only
co-payment share
End of each month state transfers
funds to service provider
State Insurance Program (SIP)
Population below poverty line, teachers,
elderly, children under 6, students,
people with disabilities, refugees
Provider list of respective private
insurance company
For 900K people 100%, for others
80%-100%
NO PRICE CAP | insurance
companies chose their provider list
In most cases up to GEL 15,000
Each month state transfers
predefined insurance premium to
private insurance company
Private insurer is a buyer of
medical services for state
insurance program beneficiaries
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