Healthcare in Georgia is provided by a universal health care system under which the state funds medical treatment in a mainly privatized system of medical facilities. In 2013, the enactment of a universal health care program triggered universal coverage of government-sponsored medical care of the population and improving access to health care services. Responsibility for purchasing publicly financed health services lies with the Social Service Agency (SSA). [1]
The Human Rights Measurement Initiative [2] finds that Georgia is fulfilling 76.3% of what it should be fulfilling for the right to health based on its level of income. [3] When looking at the right to health with respect to children, Georgia achieves 98.1% of what is expected based on its current income. [4] In regards to the right to health amongst the adult population, the country achieves only 86.8% of what is expected based on the nation's level of income. [5] Georgia falls into the "very bad" category when evaluating the right to reproductive health because the nation is fulfilling only 44.0% of what the nation is expected to achieve based on the resources (income) it has available. [6]
From 1921 to 1991, the Georgian health system was part of the Soviet system. Till 1995 health care system in Georgia was based on Soviet Semashko model. The first dramatic change was implemented in 1995, when the budget transfers were complemented with additional sources of the financing: the mandatory health insurance contributions (employer and the employee mandatory contribution - 3% and 1% respectively), funds allocated for Healthcare from the territorial budgets, official co-payment for medical services, which could not be financed by the state programs. [7]
Mandatory social health insurance was abolished after the 2003-2004 Rose Revolution. In 2003, the social insurance tax was replaced by social tax, which was accumulated in the state budget and from 2007 the GoG decided to delegate management of state allocations for health insurance for targeted groups of population (the poor, teachers, law enforcement officers and military personnel (or about 40% of the population), to the private insurance companies, which have become the health service purchaser for the mentioned population groups. This meant that a portion of the population could not access health insurance. The state retained control over a few medical facilities dealing with mental illness and infectious diseases, while all other hospitals and clinics were privatized. [8]
Implementation of universal healthcare was a key priority of the Georgian Dream party, which came to power in the 2012 election. It established the current Georgian healthcare system from 2013. [8]
Since 2013, there has been a radical change of direction in health financing policy as a new government embraced the move towards universal health coverage rather than targeted benefits. [8]
The 2020 average life expectancy in Georgia, estimated by the World Bank Group, was 73.92 years: 69.51 for males and 78.27 for females. [9] [10] [11]
In 2016 the total fertility rate is 2.24 children per woman. Live birth rate is 15.2 per 1000, and mortality rate is 13.7 per 1000. In 2016 infant mortality rate was 9.0 per 1000 live births, and the under-5 mortality rate was 10.7. By 2030, the Maternal mortality rate is expected to drop to 12, and the under-5 mortality rate is expected to drop to 6.0. Maternal mortality is 23.0 per 100,000 live births in 2016. [12] While still high in international comparison, maternal and infant mortality rates have been steadily decreasing.
In Georgia, as with most countries, mortality burden is mostly due to non-communicable diseases. The major causes of death are diseases of the circulatory system, neoplasms, diseases of respiratory system and accidents and injuries. [13] The leading position in the structure of morbidity is associated with Diseases of the respiratory organs, digestive system and circulation system. Infectious diseases are still the source of significant health problems, especially MDR tuberculosis.
The health care system in Georgia is highly decentralized and was extensively privatized from 2007 to 2012. Regulations are also very liberal and MoLHSA is now working to ensure the quality of care provided is adequate. [8]
In 2013, the enactment of a universal health care program triggered universal coverage of government-sponsored medical care of the population and improving access to health care services. [1]
In the end of 2014 By Government of Georgia was approved Georgian Healthcare System State Concept 2014-2020 “Universal Healthcare and Quality Management for Protection of Patient Rights”, which is a vision of healthcare system development that comprises basics of the sector development in relation to principles and values recognized at international and national levels [14] Ministry of Labour, Health and Social Affairs (MoLHSA) is formally accountable for the health of the population, oversight of the health system, the quality of health services and equity in relation to access to health care throughout the country [15] There are Legal entities under state control of the Ministry: LEPL “Social Service Agency” (SSA), LEPL “National Centre for Disease Control and Public Health” (NCDC), LEPL "State Regulation Agency for Medical Activities (SRAMA) and LEPL Emergency Situations Coordination and Urgent Assistance Center (ESC&UAC). Administration and management of the Health and Social care State Programs including UHC is providing by SSA, which is subordinated institution under the MoLHSA. SSA's territorial offices are located at 68 municipalities and more than 2000 are employed in them [16]
The NCDC is a legal entity of Public Law accountable to the MoLHSA with a dedicated line in the State budget. The NCDC provides national leadership in preventing and controlling communicable and non-communicable diseases through developing national standards and guidelines, health promotion, disease surveillance, immunization, laboratory work, research, providing expert advice, and responding to public health emergencies. [17] SRAMA formally responsible for issuing and control the licenses and permits for health care facilities, regulating medical professionals and pharmaceuticals. [18] ESC&UAC Ensures/coordinates quality emergency medical and referral assistance for improving the state of health of the population during the disaster and martial law situation. ESC&UAC is functioning in all municipalities of the country except in the capital city. By this time 85 medical branches are included. Following extensive privatization and decentralization, most providers in primary and secondary level are private for-profit entities in terms of ownership, governance and management. Many of them are vertically integrated with private health insurance providers and pharmaceutical companies. The development of professional medical associations in Georgia is still at an early stage although there are many of them in existence. Since 2005, the major activity of professional associations has been supporting the MoLHSA in its endeavor to elaborate national clinical practice guidelines and protocols.
Numerous international partners such as WHO, UNICEF, UNFPA, World Bank, USAID, EU, Global Fund, etc. strongly support the health sector in Georgia.
Georgia entered the 1990s with a wholly tax-funded healthcare system, but reforms in 1995 replaced this system with a social insurance model run through the State Medical Insurance Company Under the social insurance model, basic healthcare was paid for by the state insurance company, with additional funds coming from Municipal Health Funds and preventative activities provided by the Ministry of Labor, Health, and Social Affairs [2]. In 2003, after the "Rose Revolution" the social insurance tax was replaced by social tax, which was accumulated in the state budget (social tax has been abolished since 2008). Since 2005, state health programs are financed under the budget assignations only. [8]
2007 can be considered as the new phase of the Reform, as the government of Georgia decided to delegate management of state allocations for health insurance for targeted groups of population (the poor, teachers, law enforcement officers and military personnel), to the private insurance companies, which have become the health service purchaser for the mentioned population groups. Therefore, if till 2007 administration of personal health service purchases was carried out by the single payer state agency, from 2007 health care services are partially purchased by private insurance companies, which provided administration of more than half of state resources allocated for state health care programs by 2012 [8]
In February 2013, the Government of Georgia launched the UHC Program, which marked a significant shift in how health care is financed and health services are purchased in Georgia, as well as the culmination of nearly two decades of health system reforms in Georgia. The UHC Program extended publicly financed entitlement to health care coverage to the entire population. The nature of the program is noncontributory, in the sense that Georgians do not have to contribute for enrollment. Enrollment involves registering with the primary care provider of choice. The benefits package covers a range of primary and secondary care services and limited essential drugs. Administratively, the reform transferred responsibility for purchasing health care services from private insurance companies to the SSA under MoLHSA, thus putting in place a platform to shift from passive to active purchasing [11]. The health financing reforms introduced since 2013, and backed up by significant increases in public health spending, have moved Georgia closer to European norms. These include: (i) near universal population entitlement to publicly financed health care; (ii) free visits to family doctors; (iii) referral and prescribing systems; (iv) a single purchasing agency; and (v) higher public spending on health. Sustaining the coverage achieved to date and deepening coverage through better financial protection against OOP costs are the policy priorities for the Government of Georgia. Total health spending in Georgia–at 8.5 percent of GDP in 2015 is much higher than the average for upper-middle-income countries (7.0 percent) and approaching the EU average (10 percent). From 2012 to 2015, the health budget more than doubled, increasing from 5.3 percent to 8.6 percent of total government spending, and as a percentage of GDP from 1.7 percent to 2.9 percent. In this respect, Georgia is experiencing a steep increase in its health sector spending, which is consistent with other middle-income countries’ experience at the time of UHC introduction. Public spending on health in Georgia is mainly drawn from general tax revenues and allocated to the UHC Program and vertical programs, all of which are administered by the SSA. [19] Despite rising public spending on health, OOP remains the dominant source of financing for health in Georgia, filling the void of health spending that is not covered through public sources. OOP spending in Georgia is decreased and estimated to be 57 percent of all health spending (73% in 2012). [19]
There is an extremely high number of doctors per capita in Georgia compared with other European countries, and it had 573.3 physicians per every 100,000 people in 2015. Number of nurses per 100000 population since 1998 is going down and is much less, than in countries mentioned above (419 per 100000 population). A ratio of the number of nurses to the number of physicians was equal 0.7 in 2015. [12]
The number of hospitals was large during the Soviet era. In 1999, there were 246 hospitals in Georgia (or 287 specialized, including specialized institutes) provided 22,491 hospital beds. [7] By 2015, there were 12,830 hospital beds (2014 - 11,675) in the country. The number of beds per 100,000 population was 345.1 (2014 - 313.3), with an occupancy rate of occupancy rate 193.1 (2014 - 188.3), ALOS of 5.3 (2014 - 5.2), and a turnover rate of 36.4 (2014 - 36.3). Following the introduction of the universal health care program, a rapid growth of the admissions was observed in both outpatient and inpatient institutions. Compared to 2012, the hospital service provision for 100,000 population increased by 50%. In 2015 the numbers of encounters of the population with outpatient facilities grows to 4.0 per 1 person (2.1 in 2012) [20]
Notable hospitals in Georgia include the following:
Hospitals in Abkhazia:
Hospitals in South Ossetia
Major health care reforms and policy measures till 2013 see in the box.[ citation needed ]
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Since 2013, the Universal health Care program has been launched, which was commencement of universal access to medical services funded by state for all citizens of Georgia. The Universal health Care program covers the planned outpatient, urgent outpatient-in-patient and planned surgical services, as well as the treatment of oncological diseases and delivery. [1]
The research carried out by the World Bank, the World Health Organization and the US Agency for International Development revealed the main achievements of the Universal health Care Program: increased access to medical services, increased use of medical services, and reduction of financial barriers and expansion of coverage. In the publication of European Health Report 2015 of World Health Organization's European Bureau, Universal Health Care Program in Georgia has been recognized as the successful project. From May 2017 to further reform of the program, it was expedient to elaborate new criteria for differentiation of beneficiaries. The basic object of reform is to provide services more oriented on need and to develop the approach -"social equity". The services package is connected to the income of the population.
From July 1, 2017, for people with chronic illnesses who are registered in the unified database of "socially unprotected families" and their rating score is not exceeding 100 000, have been enacted state program for providing medicines for chronic diseases. The program envisages providing patients with number of medicines for cardiovascular chronic illnesses, lung chronic diseases, diabetes (type 2) and thyroid gland diseases.
On April 21, 2015, Memorandum of Understanding was signed between the company "Gilead" and the Government of Georgia, which laid foundation for the elimination of hepatitis C in Georgia. The services are provided for persons with hepatitis C certifying citizenship of Georgia and persons with neutral travel documents, as well as for accused/convicts placed in penitentiary establishments. [12]
Increased government funding for maternal and child health and ease of access to the high quality health care services played an important role in the reduction of the number of deaths of mothers and children. Georgia has been able to reach the Millennium Development Goal No.4, since in 2015 the mortality rate of children under five was 10.2 per 1000 live birth. [12]
The initiative of starting the perinatal care regionalization process from May 2015 is a significant step forward in strengthening the maternal and newborn health care system, which considers defining the levels of perinatal service providers and their role and responsibilities in order to provide the correct timing of the correct patient to a correct medical institution and, if necessary, effective referral.
A health system, health care system or healthcare system is an organization of people, institutions, and resources that delivers health care services to meet the health needs of target populations.
Health care, or healthcare, is the improvement of health via the prevention, diagnosis, treatment, amelioration or cure of disease, illness, injury, and other physical and mental impairments in people. Health care is delivered by health professionals and allied health fields. Medicine, dentistry, pharmacy, midwifery, nursing, optometry, audiology, psychology, occupational therapy, physical therapy, athletic training, and other health professions all constitute health care. The term includes work done in providing primary care, secondary care, tertiary care, and public health.
Publicly funded healthcare is a form of health care financing designed to meet the cost of all or most healthcare needs from a publicly managed fund. Usually this is under some form of democratic accountability, the right of access to which are set down in rules applying to the whole population contributing to the fund or receiving benefits from it.
Universal health care is a health care system in which all residents of a particular country or region are assured access to health care. It is generally organized around providing either all residents or only those who cannot afford on their own, with either health services or the means to acquire them, with the end goal of improving health outcomes.
A public hospital, or government hospital, is a hospital which is government owned and is fully funded by the government and operates solely off the money that is collected from taxpayers to fund healthcare initiatives. In almost all the developed countries but the United States of America, and in most of the developing countries, this type of hospital provides medical care free of charge to patients, covering expenses and wages by government reimbursement.
Healthcare in Mexico is a multifaceted system comprising public institutions overseen by government departments, private hospitals and clinics, and private physicians. It is distinguished by a unique amalgamation of coverage predominantly contingent upon individuals' employment statuses. Rooted in the Mexican constitution's principles, every Mexican citizen is entitled to cost-free access to healthcare and medication. This constitutional mandate is translated into reality through the auspices of the "Institute of Health for Well-being," abbreviated as INSABI. INSABI does not exist anymore.
The Ministry of Health is the ministry of the Government of Turkey responsible for proposing and executing the government policy on health, planning and providing healthcare and protecting consumers. Likewise, it is responsible for proposing and executing the government policy on social cohesion and inclusion, family, protection of minors, youth and of care for dependent or disabled persons. The Ministry is headquartered in the Bakanlıklar in Ankara.
The healthcare reform in China refers to the previous and ongoing healthcare system transition in modern China. China's government, specifically the National Health and Family Planning Commission, plays a leading role in these reforms. Reforms focus on establishing public medical insurance systems and enhancing public healthcare providers, the main component in China's healthcare system. In urban and rural areas, three government medical insurance systems—Urban Residents Basic Medical Insurance, Urban Employee Basic Medical Insurance, and the New Rural Co-operative Medical Scheme—cover almost everyone. Various public healthcare facilities, including county or city hospitals, community health centers, and township health centers, were founded to serve diverse needs. Current and future reforms are outlined in Healthy China 2030.
Healthcare in Malaysia is under the purview of the Ministry of Health of the Government of Malaysia. Malaysia generally has an efficient and widespread system of health care, operating a two-tier health care system consisting of both a government-run public universal healthcare system along with private healthcare providers. Within the chronically underfunded public universal healthcare system, specialist services are either free or have low user fees for procedures ; as such the public healthcare system suffers from high demand, routine congestion, long wait lists, chronic widespread delays along with persistent shortages in healthcare personnel, medical equipment and healthcare supplies. Therefore, private healthcare providers play a pivotal role in providing specialist consultants and general practitioner (GP) services to the Malaysian population; the private healthcare providers complements or supplants the public healthcare system in terms of availability, types of treatments provided and types of materials used.
Morocco became an independent country in 1956. At that time there were only 400 private practitioners and 300 public health physicians in the entire country. By 1992, the government had thoroughly improved their health care service and quality. Health care was made available to over 70% of the population. Programs and courses to teach health and hygiene have been introduced to inform parents and children on how to correctly care for their own and their families' health.
Healthcare in Taiwan is administered by the Ministry of Health and Welfare of the Executive Yuan. As with other developed economies, Taiwanese people are well-nourished but face such health problems as chronic obesity and heart disease. In 2002 Taiwan had nearly 1.6 physicians and 5.9 hospital beds per 1,000 population. In 2002, there were 36 hospitals and 2,601 clinics in the country. Per capita health expenditures totaled US$752 in 2000. Health expenditures constituted 5.8 percent of the gross domestic product (GDP) in 2001 ; 64.9 percent of the expenditures were from public funds. Overall life expectancy in 2019 was averaged at 81 years.
Healthcare in Turkey consists of a mix of public and private health services. Turkey introduced universal health care in 2003. Known as Universal Health Insurance Genel Sağlık Sigortası, it is funded by a tax surcharge on employers, currently at 5%. Public-sector funding covers approximately 75.2% of health expenditures.
Healthcare in Finland consists of a highly decentralized three-level publicly funded healthcare system and a much smaller private sector. Although the Ministry of Social Affairs and Health has the highest decision-making authority, specific healthcare precincts are responsible for providing healthcare to their residents as of 2023.
The French health care system is one of universal health care largely financed by government national health insurance. In its 2000 assessment of world health care systems, the World Health Organization found that France provided the "best overall health care" in the world. In 2017, France spent 11.3% of GDP on health care, or US$5,370 per capita, a figure higher than the average spent by rich countries, though similar to Germany (10.6%) and Canada (10%), but much less than in the US. Approximately 77% of health expenditures are covered by government funded agencies.
Healthcare in Ghana is mostly provided by the national government, and less than 5% of GDP is spent on healthcare. The healthcare system still has challenges with access, especially in rural areas not near hospitals.
Tanzania has a hierarchical health system which is in tandem with the political-administrative hierarchy. At the bottom, there are the dispensaries found in every village where the village leaders have a direct influence on its running. The health centers are found at ward level and the health center in charge is answerable to the ward leaders. At the district, there is a district hospital and at the regional level a regional referral hospital. The tertiary level is usually the zone hospitals and at a national level, there is the national hospital. There are also some specialized hospitals that do not fit directly into this hierarchy and therefore are directly linked to the ministry of health.
Healthcare in the United States is largely provided by private sector healthcare facilities, and paid for by a combination of public programs, private insurance, and out-of-pocket payments. The U.S. is the only developed country without a system of universal healthcare, and a significant proportion of its population lacks health insurance. The United States spends more on healthcare than any other country, both in absolute terms and as a percentage of GDP; however, this expenditure does not necessarily translate into better overall health outcomes compared to other developed nations. Coverage varies widely across the population, with certain groups, such as the elderly and low-income individuals, receiving more comprehensive care through government programs such as Medicaid and Medicare.
Examples of health care systems of the world, sorted by continent, are as follows.
Healthcare in Luxembourg is based on three fundamental principles: compulsory health insurance, free choice of healthcare provider for patients and compulsory compliance of providers in the set fixed costs for the services rendered. Citizens are covered by a healthcare system that provides medical, maternity and illness benefits and, for the elderly, attendance benefits. The extent of the coverage varies depending on the occupation of the individual. Those employed or receiving social security have full insurance coverage, and the self-employed and tradesmen are provided with both medical benefits and attendance benefits. That is all funded by taxes on citizens' incomes, payrolls and wages. However, the government covers the funding for maternity benefits as well as any other sector that needs additional funding. About 75% of the population purchases a complementary healthcare plan. About 99% of the people are covered under the state healthcare system.