Browsing by Author "Verulava, Tengiz"
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Item Access to Medicines for Pension Age Population in Georgia(Ivane Javakhishvili Tbilisi state university, Faculty of social and political sciences, 2019-06) Verulava, Tengiz; ვერულავა, თენგიზThe pension age population belongs to the largest risk group within the insurance sphere. Healthcare for pensioners often represents catastrophic expenses and has become the major reason for their impoverishment. Families in Georgia spend about 60% of all their healthcare expenses on medicines, this being one of the highest rates across the world. There is some evidence that the high costs of medicines are due to a combination of factors, including insufficient usage/administering of generic medicines, lack or inadequate utilization of prescription mechanisms, insufficient financial limit for medicines within the state healthcare programs, and aggressive marketing by the pharmaceutical industry. The government has been trying to decrease the out-of-pocket spending via different strategies, including universal health coverage (UHC). Since February 2013, the Universal Health State Program came into force, targeting two million of uninsured citizens and providing a basic package for primary health care and emergency services. Pension age population form the largest at-risk group within the insurance sphere. The most rapidly increasing and unaffordable share of healthcare expenses falls upon medicines. This paper examines financial access to medicines and the satisfaction with the insurance policy within the Georgia State Health Insurance Program for pension age population. This paper examines financial access to medicines and the satisfaction with the insurance policy within the Georgia State Health Insurance Program for pension age population. Using a randomized selection method, 500 pension age persons were interviewed by means of direct questioning. According to the Social Service Agency, there are 45,455 pension age recipients of medical insurance in Tbilisi with a total of 673,183 pension age population across the country (National Statistics Service of Georgia, 2013). Out of the 500 persons (62.4% women and 37.6% men) interviewed. The sample population covered all the districts of Tbilisi. The interviews took place in clinics. The largest segment of the interviewed population was between the ages of 71-75 (35.2%). While the Georgia State Health Insurance Program for pension age population includes some compensation for medicines, medical insurance does not provide guarantee for financial accessibility to medical service. The results show that out-of-pocket payment is the most common health financing mechanism in Georgia. The cost of healthcare for pensioners often represents catastrophic expenses and becomes the major reason of their impoverishment. Based on the results, medication expenses represent one of the most important components of the medical service for the insured pensioner population. Over 55% of the pensioners have to buy medications at least once a month and 34% purchase them at least once or twice a week. Most of the interviewed insured population believes that buying medicines, combined with low financial accessibility to relevant medical services, is the most significant problem for their families. The awareness level of the insured persons about medication coverage and payments for medical services provided by the insurance package within a certain limit is low. The majority of those interviewed (64%) stated that their out-of–pocket expenses exceeded this limit; 20.4% exceeded that amount by 80 GEL or more. The fact that 32.8% of the insured population cannot afford medications prescribed by their doctors also points out at low financial accessibility for medicines. The majority of those insured did not know that the insurance company compensates medicine expenses within the policy annual insurance limit. Additionally, 58.8% of those who have to pay for certain types of medical services covered by the state insurance program out of their pockets were not aware about the limits. Reduction of catastrophic healthcare expenses should become the chief aim of the government health policy. It applies to the high-risk population, those under the poverty line and the pension age population, as well as to those with chronic diseases. Accordingly, based on the findings, it is reasonable to expand the insurance program for the pension population and also provide more reasonable coverage of medication expenses.Item The Attitude of the Orthodox Parishioners Toward Euthanasia: Evidence From Georgia(SAGE Publications, 2019) Verulava, Tengiz; Mamulashvili, Mariam; Kachkachishvili, Iago; Jorbenadze, RevazItem Cardiac Implantable Electronic Device Infections - Prevention, Diagnosis, Treatment and Impact on Quality of Life(Georgian Medical News, 2021) Kuridze, Nika; Rukhadze, B; Bakashvili, N; Verulava, Tengiz; Aladashvili, AFor several decades, highly refined cardiac implantable elec-tronic devices (CIED) are used to prevent and manage various types of cardiac pathology, which have saved the lives of many patients. Cardiac implantable electronic devices help maintain and improve the quality of life by regulating the heart rate, ter-minating life-threatening arrhythmias, and improving systolic function, including pacemakers, implantable cardioverter defi-brillators, and cardiac resynchronization therapy devices. Re-gardless of the benefits received after its implantation, in some cases, serious complication has appeared, such as CIED infec-tions, associated with severe morbidity, mortality, financial ex-penses and changes in the quality of life. Exactly, in this article will be addressed the issues of prevention, diagnosis, and treat-ment of this condition, which will help specialists to properly assess the problem and to find a way to effectively solve itItem Challenges and challenges of the Georgian health system(Ivane Javakhishvili Tbilisi State University Press, 2019) Verulava, TengizSince 2013, Georgia enacted Universal Healthcare (UHC) program. Inclusion of uninsured population in the UHC program will have a positive impact on their financial accessibility to the health services. Enactment of the UHC programs significantly raised the population refferal to the family physicians, and the specialists. Insignificantly, but also increased the frequency of laboratory and diagnostic services. Despite the serious positive changes caused by UHC program implementation there still remain the problems in the healthcare system. Also, it is desirable to raise the financial availability of those medical services, which may cause catastrophic costs. In this respect, such medical services must be involved in the universal healthcare program and been expanded their scale. For the purpose of effective usage of the limited funds allocated for health care services provision, the private health insurance companies should be involved in UHC programs. This, together with the reduction of health care costs will increase a competition in the medical market, and enhance the quality of health service.Item Challenges of the COVID-19 pandemic: German strategy(Ivane Javakhishvili Tbilisi State University, 2020-06-20) Verulava, TengizStrategies to combat global pandemics around the world include more or less strict quarantine or other restrictions. Nevertheless, the results achieved in the fight against coronavirus infection are different for all countries. The number of people infected with COVID-19 in Germany is one of the highest in the world, however, the mortality rate (1.6%) is lower than in Italy (12%), Spain, France and the United Kingdom (10%), China (4%) and the United Kingdom. In the States (3%). Germany works best among European countries in the crisis caused by the COVID-19 pandemic. This is evidenced by the results of a study conducted by experts from the Deep Knowledge Group. Germany ranks second in the world in terms of world security among countries that operate effectively in the context of the coronavirus pandemic. In the list of 40 countries published on the official page of Deep Knowledge Group, Germany lags behind only Israel. Reconstruction credit bank has a special role in the history of Germany in critical situations. During the pandemic, the Reconstruction Credit Bank will issue any loans to entrepreneurs so that companies do not stop working due to lack of funds. In order to save the economy, the government is ready to take over the management of strategically important companies. Despite the adoption of restrictive measures, most of the country's factories continue to operate. The main factor in the smooth operation of German production in the face of the pandemic is the introduction of digital technology in production systems long before. They created the "Industrial 4.0 Strategy", which involves training German companies for the fourth industrial revolution, or digital age. Germany has more ability and opportunity to protect the industry from the devastating effects of a pandemic. Germany’s success is linked to an efficient healthcare system. Germany spends $ 5,033.45 per capita per year on health care, which is significantly higher than in other countries. Another important factor in success is the sufficient number of hospitals and medical staff, hospital equipment. In Germany, the number of beds per 100,000 population is the highest in the European region. Germany is better equipped with artificial lung ventilation devices than other countries. Also, Germany has the opportunity to produce medical equipment and medicines inside the country. From the beginning of the spread of the infection in Germany, the laboratories already had a supply of diagnostic tests and, as a result, soon began mass testing. Early and mass testing has made it possible to identify patients with asymptomatic infections and mild severity in order to isolate them immediately, which has dramatically slowed the spread of the virus. The testing was particularly effective for medical personnel who had direct contact with those infected. The Robert Koch Institute has developed a control app that allows to collect data on the geographical distribution of Coronavirus. Experts attribute the success to the public's confidence in the government. Merkel's plan is based on the recommendations of the Robert Koch Research Institute. It may be too early to draw a conclusion from the global pandemic, but one thing is clear: the pursuit of technological innovation allows Germany to relatively reduce the negative consequences of a pandemic.Item Context and issues of social health insurance introduction in Georgia(Archives of the Balkan Medical Union, 2021) Verulava, Tengiz; Jorbenadze, AvtandilThe social health insurance system, unlike general tax financing system is more focused on market mechanisms. Despite the achievements, the introduction of social health insurance in Georgia turned out to be way too difficult. Due to ongoing economic crises, the state failed to finance its promised commitments, resulting in a chronic shortage of funding for health care system. The new government abandoned the idea of building a social insurance system and switched to a general tax financing model, where the state takes a dominant lead, and the healthcare is financed from state budget. Given that the social insurance system is the best way of mobilizing additional funds and therefore providing sustainable funding for health sector, it is advisable to promote social insurance development. The healthcare sector needs consistent, continued and successive reforms. Despite the change of governments, the strategic course should not change drastically in the long run and the achievement should not be denied due to the political climate change.Item Distance learning - a new 21st century trend in the age of global pandemics(Ivane Javakhishvili Tbilisi State University Press, 2021) Verulava, TengizDue to the COVID-19 pandemic, the transition to distance learning has completely changed the normal practice of teaching in educational institutions. Despite the difficulties, it has some advantages, as distance learning allows us to improve the method of education delivery and focus on new technologies. Online e-learning can be a platform that makes the education process more student-centered, creative and flexible. E-learning helps reduce the cost of education and can be effectively implemented without time and geographical boundaries. It can be said that the standards by which we were guided in many areas of our lives will fundamentally change in the post-pandemic period. Online tuition is particularly effective and easily accessible to students living in rural and remote areas. It is perceived by the World Health Organization as a necessary tool to meet educational needs, especially in developing countries. The full opening of educational institutions will not put them back in the same situation as it was before the COVID-19 pandemic. Higher education institutions should use the opportunity to strengthen evidence-based practices and make the learning process more responsive to the changing needs of higher education.Item Factors that influence tobacco use in Georgian youth(Malta Medical Journal, 2020-11-13) Verulava, Tengiz; Nemsadze, Davit; Jorbenadze, Revaz; Dangadze, BekaObjective: Social environment, especially education, levels of awareness, friends and parental behavior greatly affects the use of tobacco among teenagers. The research aims to identify various factors that promote tobacco use in youth. Method: Qualitative and analytic cross-sectional descriptive research method was carried in among students from Tbilisi State University. Results: Most respondents have started tobacco consumption at juvenile age. The community played a decisive role in starting tobacco use. Respondents started using tobacco with their classmates and close friends. The survey has shown that tobacco consumption was perceived as a positive social behavior among teenagers. Introducing the tobacco control laws that prohibit tobacco consumption and advertising in public places, particularly near schools are of paramount importance. Conclusion: Interventions that focus particularly on multiple risk factors may have an impact on the use of tobacco by adolescents. Where possible, such programs should be personalized to ensure that they address the specific set of risk factors that has a bearing on each individual's tobacco use.Item Family Support Policy in Georgia: Challenges and Reform Options(Bulletin of the Georgian National Academy of Sciences, 2020) Verulava, Tengiz; Jorbenadze, RevazGeorgia experienced demographic crisis in recent decades. The severe demographic situation is caused by low birth rate, increased mortality, aging and is also contributed by poor economic conditions, unemployment and high rate of migration. The study aims to document the drastic loss of population in Georgia and to asses which model best describes the current family support policy in Georgia according to the Gauthier’s typology (1996), which includes four models of family policies: pro-natalist, pro-traditional, pro-egalitarian and non-interventionist. The study argues that the overall outcome puts Georgia in the non-interventionist model of family support policies. The family support policy in Georgia does not create adequate conditions for settling demographic problems. The financial assistance measures, such as: one-time financial aid for a childbirth, help in covering childcare costs and tax benefits are not even available. It is recommended that the state develop a family support policy program that will target low and middle income families across the country to improve the demographic condition. The selective approach is more appropriate for a low-income countries to achieve a maximum efficacy. Targeted state program for improving demographic conditions, as a minimum basic package must be a standard for the whole country.Item Food products labeling in Georgia: problems and solutions(Science Publishing Corporation, 2018) Verulava, Tengiz; Gurchiani, Tamuna; Jorbenadze, RevazThe Georgian legislation is a very clear regarding food labeling and completely shares the regulations and fundamental principles of all EU member states at formal level, but there are no effective mechanisms and institutions in place to react to the violation of the established regulations of the law, as well as to be responsible on the increase of public awareness, raising the food purchase and consumption culture. The aim of the thesis is to show problems in the Georgian food market in terms of fulfillment of fundamental norms envisaged under the EU Association Agreement. Qualitative research methodology - Observation method was used for data gathering. Observation was conducted in agricultural hypermarkets of Tbilisi. The situation in Georgia in terms of food labeling norms is quite complicated. The fundamental rules are met in no object of food sales, the information printed on food products creates the obscure presentation for customers regarding its content and suitability, the level of awareness of consumers is very low, consumers are not interested in details about the label information. The consumers focus on the price of products not on the information about its characteristics. Despite regulations that exists on formal level and existence of National Food Agency and also several active projects within partnership with European Union, situation in Georgia is complicated with lack of information from consumers and spurning food safety norms from their side. It is important to increase consumers awareness and actively turning them into those processesItem The Gatekeeper Model: patient’s view on the role of the family physician(Family Medicine & Primary Care Review, 2020) Verulava, Tengiz; Dangadze, Beka; Jorbenadze, Revaz; Lordkipanidze, Ana; Karimi, Leila; Eliava, Ekaterine; Maglakelidze, TamarBackground. An adequate primary healthcare system substantially determines quality of population health and effective spending of healthcare resources. The family physician serving as a ‘gatekeeper’ can make judicious decisions about the appropriate use of medical services. Objectives. The goal of this study was to find out patients’ characteristics, preferences and behavior in regards to the role of the family physician as the gatekeeper in The Republic of Georgia. Materials and Methods. As part of a cross-sectional quantitative study, respondents were interviewed using a structured questionnaire. Results. Majority of the respondents (53.7%, n=245) had a permanent family physician, but were not satisfied with a level of family physician’s professionalism (56.6%, n=258) and preferred self-referral to specialists (55%, n=253). Only 19.5% (n=89) referred to specialists upon family physician’s advice who would coordinate all services and 23% (n=103) have used both family physicians and self-referral. Private health insurance companies were more interested in implementing cost reducing mechanisms rather than the Social Service Agency (which is responsible for Universal Health Care Program). Conclusions. It is appropriate to share private health insurance experiences for developing a model of gatekeeper in the UHCP. In order to improve a family physician institute and increase confidence in it, it is recommended to raise the level of family physicians’ skills of relations with patients as it has a significant effect on the patient preferences. It is advisable to develop a flexible and voluntary gatekeeper model which will better suit the needs of both patients and physicians.Item Health capital – a sustainable development factor in production(Ivane Javakhishvili Tbilisi State University Press, 2019) Verulava, TengizThe health capital implies investments in a human being that are necessary for maintaining his health and capacity. Health influences a person’s wellbeing. It represents the goods that can be consumed as well as invested. Health, as the consumable good, implies that it gives pleasure to a person. Health, as an investment advantage means that a person is able to work and make incomes. The health investment advantage is determined with the value of the benefit received as a result of the advantage. For example, the life expectancy growth means additional years of work through which a human being receives incomes and invests in his own capital. Disabilities, illness, mortality are perceived as the loss in terms of the social health, causing significant economic losses. Naturally, investments in the health capital promote increasing the number of population capable of working, as well as reducing illness and death rate which in turn has a positive impact on a human capital. The following factors influence formation of the health capital of population: illness of people, disabilities, mortality rate, life expectancy, healthcare expenses and outpatient referral rate. In the period of 1995-2015, in Georgia GDP increased 6.7 mes, that indicates the country’s economic growth. The human development index has increased by 12.2% in this period and hit 0.780 by the year of 2016; According to the rate, Georgia is ranked 70th among 188 countries. The average life expectancy growth has had a positive impact on the country’s economic growth. The same has been done by reduction of maternal and children’s mortality rate and higher state expenses on healthcare. Infant mortality rate decreased from 22 to 9.6 in 19902017 and under-five mortality rate – from 47 to 11.1. For comparison, under-five mortality rate is 11.3 in Europe. Maternal mortality rate dropped from 41 to 13.1. For comparison, maternal mortality rate in Europe is 16. General government expenditure on health has increased and almost doubled in the latest 3 years; that has a positive impact on the population’s health. But, despite these, Georgia is sll significantly lagging behind the threshold set by the WHO recommendations. According to WHO recommendations, state expenditures on health should represent more than 40% in total healthcare expenditures. State expenditures on health care in Georgia represents 37.2% of the total expenses on healthcare, thus Georgia is below the recommendations of the WHO. Due to all above mentioned, Georgian people have to pay by themselves for healthcare issues (up to 63%) [23, 24]. Outpatient referral rate increased from 1.1 to 3.6 per person as the state expenses increased, that positively reflects on the population’s health condition. But this rate is still less than that of European countries (7.5 per person), which is caused by the circumstance that patients are less motivated to go to a doctor for prevention and decide to receive medical service only when they are in critical condition. All this shows that the primary healthcare system cannot fulfill the role of the so-called ‘gatekeeper’. In general, the primary healthcare system has not developed in Georgia. As the health capital fulfils significant role in terms of the country’s economic growth in a long-run perspective, it is highly advisable to promote the development of the primary healthcare system and taking WHO recommendations concerning state healthcare expenses into account.Item Health Capital, Primary Health Care and Economic Growth: Evidence from Georgia(2021) Verulava, TengizIntroduction: Health care system orientation to the primary care has a positive effect on the continuity and coordination of medical services, which improves the health of the population. Investments in healthcare are important in terms of formation of the health capital. The research aims to find out the role of the health capital in economic growth of a Georgia (country). Methods: This study is based on the secondary sources of data. The study data were obtained from Human Development Report, Ministry of Labor, Health and Social Protection of Georgia. As a proxy indicator for measuring the health capital we used the life expectancy, the morbidity prevalence and Incidence rate, maternal and children’s mortality rate, outpatient referral rate, the state expenses on healthcare. Results: The average life expectancy has increased in recent 25 years. The maternal and children’s mortality rate has decreased, healthcare expenses have become higher and outpatient referral rate has also become more constant character. All these have a positive influence on the people’s health and country’s economic growth. However, the state expenses on health and primary healthcare referral rate is far below the European level. Patients are less motivated to go to a primary healthcare for prevention and decide to receive medical service only when they are in critical condition. All this shows that the primary healthcare system cannot fulfill the role of the so called ‘gatekeeper’. In general, the primary healthcare system has not developed in Georgia. Conclusion: As the health capital fulfills significant role in terms of the country’s economic growth in a long-run perspective, it is advisable to promote the development of the primary healthcare system.Item Health Problems of Professional Ballet Dancers(Shota Rustaveli Theater and Film State University of Georgia, 2021) Verulava, Tengiz; Tvalavadze, KetevanBallet is a professional activity that places risky physical and psycho-emotional demands on the human body. The goal of this study was to evaluate health-related problems among ballet dancers. Within the qualitative study, in-depth interviews were conducted with ballet dancers at the State Ballet of Georgia.Item An informed consent of a patient for medical services in Georgia(Ivane Javakhishvili Tbilisi State University Press, 2018) Verulava, TengizPatients' rights issues are becoming increasingly important and is becoming a priority. Legal regulations related to the creation of the fundamental principles of medical ethics, where the main focus is on the "informed consent" issue. The study is designed to determine by how much the patient is aware of the surgery performed by a doctor provided informed consent. The quantitative part of the study, semi questionnaire survey was carried out with surgical patients. The majority of patients are properly informed about the diagnosis and treatment of disease, surgical treatment alternatives. It is recommended to conduct training with the medical staff, who are directly responsible for the patients' awareness.Item Introduction of Mandatory Vehicle Inspection and its impact on Health: Case of Georgia(Taylor & Francis Group, 2019) Lordkipanidze, Ana; Bigvava, Nana; Verulava, TengizTo fight atmospheric air pollution, the Georgian government has implemented a law about vehicle inspection. The aim of this survey is to determine under which conditions are owners of technically faulty vehicles ready to give up using technically faulty cars. Within the qualitative study the in-depth interviews were conducted. Taxi drivers think that this law is harmful to them though they appreciate the efficacy of vehicle inspections. Controls should be placed on the quality of fuel as part of the development of public transport while increasing awareness about the harmful effects of atmospheric air pollution.Item Left Ventricular Systolic Dysfunction After Myocardial Infarction(Gazi Medical Journal, 2021-01) Verulava, Tengiz; Shakinov, Giorgi; Jorbenadze, Revaz; Bakashvili, Naniko; Beka, DangadzeThe left ventricular systolic dysfunction is one of the most common complications after myocardial infarction. The damage of the large area of the cardiac muscle leads to a significant decrease in cardiac contractility. Our study presents a very unusual case of the left ventricular systolic dysfunction after myocardial infarction. A 76-year-old female was hospitalized at Chapidze Emergency Cardiology Center (Tbilisi, Georgia) with the diagnoses of ischemic heart disease and acute subendocardial myocardial infarction. Due to cardiac muscle ischemia, sinus bradycardia and diastole prolongation was revealed, which increased left ventricular end-diastolic volume and eventually caused left ventricular overload. It seemed to be a main predictor of developing compensatory ventricular premature contractions, followed by ventricular fibrillations. This argument was later supported by the stable medical condition reached by transcutaneous cardiac pacing. According to this result, the decision was made to implant a dual-chamber cardioverter - defibrillator as a non-standard treatment option, which turned out to be very successful. According to recent data, implanting permanent dual-chamber cardioverter-defibrillators as a preventive step for ventricular fibrillation has not been reported yet.Item Obstacles in the Development of Nonprofit Hospitals in Georgia(Taylor & Francis Group, 2019) Verulava, Tengiz; Lordkipanidze, Ana; Besiashvili, Nino; Todria, Mirian; Lobjanidze, Zviad; Jorbenadze, Revaz; Eliava, EkaterineThe most common form of ownership of medical establishments worldwide is a nonprofit organization. In contrast, the number of nonprofit medical institutions in Georgia is very scarce, while private profit organizations hold about 90% of the medical market. The goal of the research is to study the factors that affect the development of nonprofit hospitals in Georgia. Since there are very few nonprofit medial institutions in Georgia, we hypothesize that there is not enough motivation for functioning of such institutions. For the purposes of this research, six in-depth interviews were conducted with managers and experts of nonprofit organizations. As the research demonstrated, there is no sufficient motivation for functioning of the nonprofit form of medical organizations. Although the Tax Code provides tax benefits, they exist only in a token way and do not support the development of nonprofit medical organizations. It is necessary to improve the tax benefits provided for nonprofit hospitals in the Tax Code and share the world experience in order to increase number of nonprofit organizations in Georgia. It is recommended for Government to give more support to nonprofit organizations, in order to increase their functioning efficiency and bring incentive for development of new nonprofit medical institutions.Item Patients’ perceptions about access to health care and referrals to family physicians in Georgia(Balkan Medical Union, 2020) Verulava, Tengiz; Jorbenadze, Revaz; Karimi, LeilaIntroduction: Adequate utilization of primary health care directly reflects the health status of a population. In the Republic of Georgia many patients seek care without a referral by a primary-care provider; as a result, patient’s referral rate to a family physician is low. The tendency of patient’s self-referral behavior may reduce the effectiveness of the healthcare system. The objective of the study. The research aims to study the cause of low referral rate to a family physician in Georgia. Material and methods. An analytic cross-sectional study was conducted. Within the quantitative survey 300 patients and within the qualitative research 20 family physicians from different cities and regions of Georgia were interviewed. Results: Patient’s referral rate to a family physician was low. 55% of family physicians revealed that patients had often addressed them only for the referral to specialists. 42% of patients visited the family physician once or did not visit at all and 57% did not consult with a family physician for preventive purpose. Conclusion: The result suggested that patient’s low referral rate was due to distrust towards family physicians, which was related to the lack of qualification of physicians and the low public awareness of the family doctor’s competence. Due to an inadequate reimbursement, family physicians do not have enough motivation to provide adequate service and lack of continuous education negatively affects their professional development. It is recommended to raise public awareness about the primary care, to introduce effective methods for payment of family doctors, to increase the role and affordability of continuous professional education.Item Primary care gatekeeping and referrals: patient’s view on the family physician role(Ivane Javakhishvili Tbilisi State University Press, 2020) Verulava, Tengiz; Jorbenadze, RevazAn adequate primary healthcare system substantially determines quality of population health and effective spending of healthcare resources. The family physician serving as a ‘gatekeeper’ can make judicious decisions about the appropriate use of medical services. The goal of this study was to find out patients’ characteristics, preferences and behavior in regards to the role of the family physician as the gatekeeper in The Republic of Georgia. As part of a cross-sectional quantitative study, respondents were interviewed using a structured questionnaire. Majority of the respondents (53.7%, n=245) had a permanent family physician, but were not satisfied with a level of family physician’s professionalism (56.6%, n=258) and preferred self-referral to specialists (55%, n=253). Only 19.5% (n=89) referred to specialists upon family physician’s advice who would coordinate all services and 23% (n=103) have used both family physicians and self-referral. Private health insurance companies were more interested in implementing cost reducing mechanisms rather than the Social Service Agency (which is responsible for Universal Health Care Program). Study results demonstrated that attitudes of different demographic groups of population towards the ways of referral to specialists differ from each other. A certain part of patients preferred referring to family physicians who would coordinate all required medical services and be a sole agent protecting their interests. The study demonstrated that beneficiaries of the private health insurance prefer referring to specialists through their family physicians. It is due to the fact that private health insurance companies were more concerned with establishing cost reduction mechanisms rather than the beneficiaries of UHCP. Such a mechanism implies increasing a role of family physicians, i.e. the gatekeepers of the healthcare system. The model of gatekeeper has more benefits in regards to response to the patient’s needs, improvement of the medical service coordination and cost reduction. Such approach fits the key primary health values more, it accentuates the key role of family physicians in the process of treatment and the importance of confidence in the patient- physician relationship as well as responsiveness to the individual patient needs. In order to widely implement the gatekeeper model within the UHCP, each beneficiary should have a permanent family physician who would ensure continuous and comprehensive medical service provision. It is advisable to raise the level of skills of family physicians, to develop a continuous medical education, as the highly skilled physicians will enjoy more confidence among patients that in turn will increase the rate of referral to them. According to our study some beneficiaries preferred their family physician to co-ordinate their care and referral to specialists when needed, while others preferred self-referral. Therefore, implementing a flexible voluntary model of gatekeepers may be a recommended policy. The flexible voluntary model of gatekeepers means that the UHCP should explicitly offer all options and encourage their members to choose the option which fits their preferences: self-referral, gatekeeping or coordinated care with self-referral. A voluntary choice of the gatekeeper model is acceptable both for physicians and for patients since it has no negative effect on the relations between physicians and patients, plus it is responsive to patients’ needs. It can be assumed that implementing gatekeeping voluntarily will be acceptable to physicians, because a possible detrimental effect on patient relations, will not exist in a voluntary model. Furthermore, a voluntary choice increases even more a responsibility of the family physician as he/she ensures provision of comprehensive medical services, including having control over the course of treatment.