You are here » Home » Telling Our Story
Success Story
USAID-backed mediators help strengthen ties between vulnerable individuals and insurers
Helping Newly Insured Navigate Health Plans
Photo: CoReform
A mediator consults insurance clients.
“…We are going to create a special
mediation service that will be an
independent impartial agency to
adjudicate between individuals/
hospitals and the insurance
sector.”
- President Mikheil Saakashvili
during the annual report to
the Parliament, February 2010
More than 1.5 million newly insured Georgians are now able to
better navigate the complex world of health insurance thanks to
a USAID-initiated Health Insurance Mediation Service (HIMS).
The new service is part of the Government of Georgia’s Ministry
of Labor Health and Social Affairs (MOLHSA) and serves
Georgians by resolving disputes and strengthening interactions
between vulnerable individuals, insurers, and health care providers.
Since 2007, USAID has supported government efforts to ensure
that Georgians below the poverty line are protected from
unaffordable out-of-pocket spending for health care. In 2008,
the government launched a pilot program to use public funds to
purchase private health insurance for 180,000 Georgians living
below the poverty line. Since then, the program has dramatically
expanded to cover 1 million Georgians, including vulnerable
populations throughout the country.
Creating a successful public-private partnership was not without
challenges. Not long after the Georgian government established
its pilot program, many Georgians struggled with questions
about insurance coverage and services. For answers,
they turned to MOLHSA, and it soon became clear that disputes
between private insurers and the newly insured were
more than the agency was able to handle.
In response, USAID teamed up with the Georgian Insurance
Association to establish HIMS. Since its foundation in May
2008, the mediation service has curtailed thousands of disputes
and has gained respect as an impartial third party. In addition,
HIMS has educated tens of thousands of citizens on health insurance
basics and the rights and entitlements of the insured.
In July, the Government of Georgia officially incorporated the
USAID-supported mediation service into MOLHSA. In addition
to officiating disputes between private insurers and consumers,
the scope of HIMS has been expanded to cover contention between
health care providers and insurers as well.
Print-friendly version of this page (533kb - PDF)
Click here for high-res photo
Back to Top ^
|
RSS Feed for Recent Telling Our Story Updates
