State health cover bought through private insurers, and its dismantling
From 2007 Georgia's health ministry contracted private insurance companies to buy care for the people covered by its state Medical Assistance Program, and medical policies in force at Georgian insurers reached 1,959,338 at the end of 2013. After the government moved purchasing to its own Social Service Agency under the Universal Health Coverage Program, policies in force fell to 535,505 at the end of 2014.
535,505 policies, medical (health) insurance policies in force at insurers, end of year, 2014. 1,959,338 policies, medical (health) insurance policies in force at insurers, end of year, peak, 2013. Insurance State Supervision Service of Georgia, insurance market statistics, number of policies, 12 months 2014, retrieved 2026-10-17.
The move, and what it needed
The health ministry paid private insurers, first through vouchers the poor could take to any insurer and from 2010 through regional tenders, to carry the risk and buy care for state beneficiaries. In 2013 a new government made its Social Service Agency the single purchaser, and the insurers' public book ran off.
Preconditions
- Private insurers with provider networks able to absorb a state book
- A state agency able to means-test beneficiaries and pay premiums monthly
- Political consensus on contracting out, which the 2012 change of government removed
Limits: The regulator counts policies, not people, and the count mixes the state programmes with voluntary corporate and retail cover. The 2014 value is in the 2014 Excel file at the source URL; the 2013 peak is in the 2013 file (https://insurance.gov.ge/en/Statistics/GetFile/543?type=4), and the same regulator's 2013 file without state programmes (https://insurance.gov.ge/en/Statistics/GetFile/431?type=4) gives 491,885 medical policies, so state programmes held about 1,467,453 policies at the end of 2013. That split is computed by subtraction, not published, and no split exists for earlier years. The year-end series in the same files was 1,311,287 in 2009, 1,915,952 in 2012 and 533,471 in 2015. The account of the arrangement and of the takeover comes from a World Bank knowledge brief (https://documents1.worldbank.org/curated/en/099802505242216398/pdf/IDU07bfac40d035c20431a0bc1b0755ced4057df.pdf, a PDF), which dates the Social Service Agency's takeover of purchasing to the start of 2013; the policy counts stayed high through 2013 and fell in 2014, and no source here explains the lag. The record documents the end of a public-private delivery model, not a loss of health coverage: the same brief reports that public health spending rose from 19.4 percent of current health expenditure in 2012 to 40.8 percent in 2019. The brief also reports that insurers had integrated with hospitals and contracted selectively, which is a reason the state ended the model.