The Universal Healthcare Programme attracts substantial criticism – sometimes it is justified, at other times less so. However, there has been a lack of detailed reviews and reports containing evidence-based and substantiated discussions of the issues surrounding the programme. In October-December 2021, two non-governmental organisations conducted a study that examined the attitudes of different stakeholders towards the existing service tariffs under the Universal Healthcare Programme (UHP) as well as the ongoing pricing process. The aim of the study was to gather evidence and describe the problems related specifically to UHP tariffs. The study was conducted using a mixed methodology consisting of desk research, qualitative research, and quantitative research.
Below we will share several important findings of this study that we would like to see discussed in front of a wider audience.
The process of determining the costs of medical services under the Universal Healthcare Programme is not transparent. Specifically, different respondent groups have different views regarding the transparency of the process: State employees believe that the pricing policy has been transparent and that providers have been involved in the pricing process. In turn, providers and public health experts state that while there has been some communication with stakeholders, the pricing decisions have been made unilaterally by the ministry based primarily on the programme’s budget. More importantly, the ministry has never employed an official pricing methodology. Some experts believe that the decision-makers have avoided setting a clear methodology that would place the pricing process within a certain framework and limit the ministry’s room for manoeuvre in case of unforeseen challenges.
Prices have essentially remained unchanged since 2013. Providers openly state that the current low prices threaten the financial sustainability of medical institutions and the quality of their services. In truth, the prices put in place in 2013 are inadequately low. Since then, a number of changes have been made in an attempt to further lower prices, with particular focus on the Ordinance of the Government of Georgia N520 from 2019 and its subsequent negative impact.
It may seem that these problems do not concern ordinary Georgian citizens, but in the long term, they will affect the quality of medical services provided to patients. The planning process for each and every issue must take the best interests of patients into account. Despite increased state spending on healthcare, Georgians still pay a large share of their medical expenses out of their own pocket. The percentage of patients who are pushed into poverty by high medical bills is growing. All respondents stated that buying medicine constitutes the most serious financial burden for patients. The government does not normally regulate or control service prices. It is therefore difficult for patients to know exactly what they are paying for, often leaving them confused.
There are also conflicting attitudes towards Ordinance N520. Most private providers and experts insist that the fixed tariffs proposed by the government for certain intensive therapy services and cardiac surgery in 2019 only served one purpose, namely, to reduce budget spending. Other risks, such as service quality and the financial sustainability of hospitals, were not considered. On the other hand, ministry employees believe that the initial dissatisfaction of providers with Ordinance N520 has already subsided and that the sector is constructively working with the ministry on a pricing policy that will gradually be implemented in other fields as well.
There is also a lack of clarity regarding the introduction of diagnosis-related groups (DRGs). According to the Ministry of Health, gradual implementation of DRGs has already started, while experts are complaining about delays in this process. Moreover, the ministry’s decisions regarding the need and the timeline for wide implementation of the DRG system are currently unclear.
The study also shows that inadequate tariffs may create negative stimuli among private providers. Notably, none of the respondents opposes the pricing process, but providers and experts want the process to be transparent and involve all stakeholders. Most providers and experts believe that the pricing process should not focus blindly on reducing tariffs. Instead, there should be a rational evaluation of quality medical services with a clearly defined pricing tool.
During the survey, respondents expressed several views in the form of recommendations that are summarised below. Further details can be viewed in the report itself.
- Implement the recommendations issued by local and international experts simultaneously and promptly;
- Continue implementing planned strategies in the following areas: a) Devising a uniform pricing policy; b) Implementing the DRG system; c) Selective contracting; d) Implementing the primary healthcare reform guide;
- Devise long-term policies for healthcare;
- Review the UHP design: What types of services will be funded by the government, to what extent, and through which copayment system for different sections of the population;
- The programme design should encourage, rather than prevent beneficiaries from purchasing insurance packages;
- Replace the programme administrators and introduce a level of intermediaries who will be responsible for service utilisation management (independent third parties or people acting on behalf of insurance companies);
- Improve UHP management, quality control and monitoring; devise relevant and specific KPIs for evaluating (among others) the effectiveness of primary healthcare; analyse ambulatory care sensitive conditions (ACSCs);
- Analyse the outcomes and forecasts related to Ordinance N520 and revise them accordingly;
- Settle on an official pricing methodology; • Give patients the right to choose (balance billing) under the condition that the state will set the upper price limit on services by codes;
- Use the state negotiating authority to purchase expensive medical equipment and optimise costs through consolidated tenders;
- Manage human resources and find the right balance between the services of expensive doctors and medium-level medical personnel.
We believe that the information gathered from the survey and the recommendations voiced by stakeholders will act as a catalyst for an open dialogue that will help improve public and private partnerships. Only a transparent and inclusive process of policy dialogue and decision-making can find common ground in the interests of the population, the state, and the private sector, as well as realise the country’s aspirations for universal healthcare through rational, evidence-based, and balanced policy changes.
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A user’s posture, motion, and even the muscles emphasized can considerably differ primarily based on the design of the equipment. Figuring Out this distinction is essential for guiding users and guaranteeing their goals align with the machine they choose. In the sprawling realm of fitness equipment, the nuances between similar machines can make all the difference, particularly in terms of effectiveness and consumer enchantment. The V Squat and Hack Squat, regardless of both being leg-focused, have distinctive attributes that differentiate them. The V Squat machine, incessantly referred to as the vertical squat, has become a outstanding fixture in modern fitness center settings.
If you need a functional, full-body exercise that engages your core and stabilizing muscle tissue, the squat is most likely going the better choice. Nonetheless, when you’re seeking to isolate the quads or want more assist throughout your workout, the hack squat could be a more appropriate choice. With hack squats, you want to keep management as you lower and carry the weight, and also you need core and lower physique energy for stability. A nylon weightlifting belt can help you here as a end result of it will help your decrease again and it will make the train safer. And while we’re on the subject of security, correct foot placement and physique alignment are essential to forestall accidents and maximize muscle activation.
Understand how to use the landmine attachment for simple squats to quad hypertrophy. But I actually have been pondering of switching to again squats and primarily eliminating the squat from my exercise. Nothing loopy serious—but im 21, 6″4.5’ and my decrease back is normally sore. I now always have to do a treadmill warmup and stretches to maintain my again in examine. If you’re training for quadricep hypertrophy, there’s no cause you can’t hack squat too! If you’re struggling to grow cussed quads, recovering from damage, or entering a contest where you need your quads to look aesthetic, the hack squat is a great move to add to your routine.
If common squat progression coaching is feeling uninteresting, the landmine may be an efficient way to activate your quads and shake issues up mentally. You’ll feel more excited and motivated to work out when you break out of a too-strict routine and try different equipment. Landmine exercises are giving a whole new that means to explosives and the landmine hack squat is not any exception. I’m excited about swapping out the leg press as an alternative of the hack squat, I’ll list out the pros and cons down here. For those seeking a top-notch V squat machine, the York Barbell STS Energy Front Squat Machine stands out. It takes the essential elements of a V squat machine and elevates them, offering customers a robust and reliable piece of equipment that is excellent for enhancing their squatting routine. In this part, we’ll discuss the advantages and downsides of hack squats.
This makes it easier to work inside your natural range of movement to keep away from accidents. While both machines focus on the decrease physique, their mechanics and required type vary significantly. Your gym probably has a delegated hack squat among the leg exercise machines.
Usually thought of the Smith Machine of squats, hack squats get a foul rep as a result of they’re seen as too straightforward and never authentic. The machine’s fixed path may be a bit too restrictive for some (this problem is normally overcome with time as the person will get more adjusted). Additionally, if you’re looking to improve your balance and useful strength – V squats are a higher choice. One Other con is that there is much less focus/isolation of the quads when compared to hack squats. V squats also require more balance and demand a certain quantity of technique, which in flip, makes V squats less beginner-friendly. And lastly, V squats can actually prove to be troublesome to master for athletes with restricted core strength (so think of that as a prerequisite). Some folks may just like the V squat better as a outcome of it allows for a natural squat position, and others may choose the hack squat because of the assist it provides.
The back squat , or somewhat generally known as the conventional traditional squat, is one of the most carried out lower body exercises on the planet. This exercise can serve different purposes and supply every kind of benefits if carried out correctly. This makes the barbell squat a complete physique transfer compared to the quad-dominant hack squat. Functional deficits and technical components can limit your back squat performance too.
Concerning constructing your lower body, belt squats and, leg presses usually take center stage. Both are helpful for constructing leg power, although every has unique advantages. We will study how belt squats against back squats and belt squats vs barbell squats measure up when it comes to efficacy in this weblog together with an intensive comparison of belt squats in opposition to leg presses.
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