ABSTRACT
This study aimed to examine how anxiety related to different styles of coping during the COVID-19 pandemic and how these relationships were moderated by the cultural orientations of individualism/collectivism and a person's sense of meaning in life. A sample of 849 participants from Georgia completed an online survey during the final stage of lockdown. To measure the main variables, we used the State Anxiety Inventory, the Horizontal and Vertical Individualism and Collectivism Scale, the Meaning of Life Questionnaire, the COVID-19 Worry Scale, and the Ways of Coping Scale tailored to COVID-19 pandemic. The latter measured rational coping via the subscales of information accessing/processing and action-planning coping, and affective coping - via the subscales of passive-submissive and avoidant coping. Results suggested that anxiety positively predicted both affective coping styles and negatively predicted the action-planning coping style, while COVID-19 worry predicted all coping styles; presence of meaning in life positively predicted both rational coping styles and negatively predicted the avoidant coping style, while search for meaning positively predicted all coping styles; individualism negatively predicted the passive-submissive style and positively predicted the action-planning style, whereas collectivism predicted all coping styles; furthermore, individualism and collectivism moderated the link between anxiety and the passive-submissive coping style, presence of meaning in life moderated the link between anxiety and avoidant coping style, while search for meaning in life moderated the link between anxiety and the action-planning coping style. Overall, the findings enrich the cultural transactional theory of stress and coping, and generate insights for the culture-sensitive approach to the meaning in life. The results were conceptualized vis-a-vis Georgia's intermediate position between clear-cut individualism and clear-cut collectivism.
ABSTRACT
OBJECTIVE: The objective of this article is to assess the impact of the new health financing reform in Georgia-'medical insurance for the poor (MIP)'-which uses private insurance companies and delivers state-subsidized health benefits to the poorest groups of the Georgian population. METHODS: To evaluate the reform we looked at access to health care services and financial protection against health care costs, which are two key dimensions proposed for the universal coverage plans. The data from two nationally representative Health Utilization and Expenditure Surveys (2007 and 2010) were used, and a difference-in-difference method of evaluation was applied. FINDINGS: The MIP was not found to have a significant impact on service utilization growth nationwide, but in the capital city the MIP insured were 12% more likely to use formal health services and 7.6% more likely to use hospitals as compared with other areas of the country. The MIP impact on out-of-pocket health expenditures was greater in reducing costs of accessing services. The cost reductions were sizable and more pronounced among the poorest. Finally, the MIP significantly increased the odds of obtaining free benefits by insured individuals as compared with the control group. Such an increase was most noticeable for the poorest third of the population. CONCLUSIONS: Marginal changes in access to services and the geographically diverse impact of the MIP on service utilization points to other factors affecting health-seeking behaviour of the insured. These other factors include private insurer behaviour that may have used strategies for reducing claims and managing utilization. Equity impact of the MIP and improved financial protection, especially for the poor, are benefits to be retained by government policies when universal health coverage is rolled out nationwide and all citizens will be covered. The role of private insurance companies as financial intermediaries of the publicly funded programme needs further evaluation before moving forward.
