Bundled Payment Methods: An Alternative Payment Method to Contain Healthcare Costs in Georgia

Containing healthcare costs remains one of the priority topics of the Georgia health system from the perspectives of both the public and private sector. Government expenditure on health has been increasing between 2013-2019 after the introduction of the Universal Health Coverage program, but with the existing health financing methods (capitation, fee for service, input-based payment covering salaries, and fee for medicines, supplies and utilities), the efficiency of increased investment of public financing in healthcare remains questionable. On the other hand, the private health insurance sector is developing under the competitive market environment with promising outcomes but claims management is becoming rather challenging.

Since there is a considerable growth in healthcare expenditure in Georgia, driven by both supply and demand, the health system would benefit by implementing alternative payment models that will reduce costs and improve the quality of care. As mentioned above, existing health financing methods encourage financial resource growth but do not stimulate healthcare providers to work efficiently and improve care coordination for delivering quality care.

The aim of this document is to provide evidence to inform ongoing deliberations regarding alternative payment methods to reduce cost and improve the quality of care. Specifically, it attempts to inform the following question: What are the effects of bundled payment methods on healthcare spending, service utilization, and quality of care?

According to Georgia’s healthcare system development vision for 2030, the MoIlHSA was preparing the system to move the healthcare sector towards the DRG payment model. Although volume still pays in the DRG system and bundled payment is the type of DRG with an advanced scheme to stimulate coordination of care across different levels of providers and contain costs, and evidence synthesis document has been prepared to feed the discussion around health financing reforms and equip decision-makers with evidence.

The document has been prepared jointly by CIF in the frame of the Strategic Policy Fellowship Program authored by Mariam Davitadze (the fellow) and Lela Sulaberidze. The program is launched as part of the K2P Mentorship Program for Building Institutional Capacity for HPSR and Delivery Science. The project is funded by The Alliance for Health Policy and Systems Research.

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