Health care system in Georgia
The State Commission for Regulating Social Policy was set up as part of the 2000–2009 strategic health plan of Georgia. It reported directly to the president and provided guidance to the MoLHSA, the National Health Management Center, Regional Health Departments and other health-related sectors. The role of the National Health Management Center was determined to provide scientific and technical input into the process of health sector reform, and it worked directly with both international and local non-governmental organisations The MoLHSA manages the public health services, and the role of government in regulating health care and financial transactions has been greatly reduced since 2003.
According to the financial records, Georgia also receives substantial external health financing from sources such as the United Nations, the World Bank, non-governmental organisations and other countries, including Germany, Japan, the United Kingdom, and the United States.
The Governmental Commission for Health and Social Reforms, the State Minister of Public Reforms, and MoLHSA developed ‘Mein Directions in Health 2007–2009’, which outlined the 3-year health sector transformation. It focused on ensuring affordability, quality, accessibility and efficiency on health services. It also introduced market-based principles to health care management about 80% of the hospitals were sold to the private sector for redevelopment as modern and most of them as multi-profile hospitals. Nearly all health care providers are private actors, independent of the state.
Currently, the National Healthcare Policy is still under development in Georgia The official data of 2009 shows that health care and health insurance are privatised, and organisational structure of health care system can be depicted in Figure.
Three principal fields can be classified within the Georgian health care system:
- Public health
- Primary care setting
- Hospital sector
Transformation of soviet sanitary-epidemiologic surveillance into public health system, which started in 1996 — is still lingering on the level of undefined logical framework, unable to make development perspectives for the field more or less predictive. Conceptual scheme for structuring Georgian public health field, bordering the competences, objectives, legal rights and obligations are defined in the Georgian law ‘on Public Health’ adopted in 2007.
According to the law, public health is defined as the complex of measures directed towards health improvement, disease prevention and control in the population, which aims at supporting the general welfare and healthy lifestyle of the population, providing healthy and safe environment for living, bolster the reproductive health and preventing from both contagious and non-contagious disease outspread. The above mentioned shows that predictive, preventive and personalised medicine (PPPM) elements are increasingly becoming a recognised concept and should be gradually integrated into health care systems.
The literature described that according to the law, the subjects pertaining to the public health field competence involve the following: prevention of transmittable diseases, identification of transmittable diseases, isolation and putting a person to quarantine, provision of biological safety, setting norms of air, water and earth composition, sound, vibration and EM radiation limits and surveillance, chemical, radiation, technology and production safety, defining healthy lifestyle, maternal, child and adult health policy, control on tobacco consumption, drug addiction, toxicomania and alcoholism and taking respective measures against the above listed.
Launching the law on Public Health implicates the delegation of competences on different ministries and local governances within the public health field (including Ministry of Agriculture, Fisheries and Food, Ministry of Environmental Safety and Natural Resources, Ministry of Education and Science, Ministry of Internal Affairs, Ministry of Defense, and Ministry of Justice) and coordination of public health policy making and implementation assigned to the MoLHSA.
The deemed structure of public health can be formulated like the following:
- Policy and strategy in defining the structure in the central apparatus of the Ministry
- Strategy in implementing, coordinating, monitoring and analysing the structure in the capital and local regions (National Center of Disease Control and its office)
- Financial means needed for the implementation of educational, expert and research activities, implying state programmes
Primary care setting and hospital sector
Data shows that the course of training doctors (especially therapeutic field physicians) into general practitioners and remaking polyclinic system into family medicine centres was initiated by the end of the twentieth century in Georgia. This process has been progressing slowly with some hindrances due to different reasons, resulting in simultaneous activity of both systems in today’s health care system, with more or less similar competences. Polyclinics and family medicine centres coexist both in the cities (including the capital) and regional centres as well. The system of rural doctor and nurse also remains the main health care provision in the villages, composing the primary care setting for the village-dwelling population. The rural medical personnel refers to the village outpatient setting and is related to regional family medicine centre or polyclinic under agreement, which provides the specific monitoring for their professional activity and assists in the management of complex cases. For the past several years, up to 50 modernly equipped hospitals have started functioning.