Health in Georgia (country) - Principal Healthcare Reforms

Principal Healthcare Reforms

Planning for healthcare reform began in 1993 and was led by the Ministry of Health and was undertaken during the post-independence shift towards a market economy. Presidential Decree #400, ratified in 1994, provided the basis for the reorganization by expanding healthcare funding sources from government revenues only to include elements of government, payroll tax, and municipal subsidies. The first major changes took place as a result of the 1995 Georgian Health Care Reform Package that introduced new concepts, including social insurance, official user fees, and new provider payment mechanisms like co-payments. In 1999, the Georgian National Health Policy, which outlined objectives to improve the equity, accessibility, and affordability of health services, was developed. The Strategic Health Plan for Georgia 2000-2009, which detailed more strategies for implementing the National Health Policy, was then published. Development of the Primary Health Care Master Plan began in 2003 with support from international aid sources. A plan was outlined to consolidate the 750 existing primary health care facilities outside of Tbilisi into 549 facilities that would serve approximately 30,000 people each. The government was not equipped to regulate such a large number of private practices, though, and the plan was reevaluated in 2007. The consolidated facilities were deemed unrealistic for the mountainous regions of the country and unnecessary in urban areas, and the plan was altered to allow about 900 primary health care facilities in rural areas and an unlimited number in the largest cities. In 2008, the Ministry of Labor, Health, and Social Affairs distributed primary health care "toolkits," which included renovation plans and funds, to rural providers in about 900 rural villages.

The government that came to power after the Rose Revolution was faced with addressing problems that had surfaced during the weak implementation of previous reforms, especially a rise in out-of-pocket payments, an excessive and obsolete health infrastructure, and unequal access to healthcare services. From 2004 to 2006, a major emphasis was placed on transforming the social sector. Previous forms of social assistance created for specific groups were replaced by a new targeted social assistance program, which defined beneficiaries by socioeconomic status, identifying those most in need of economic assistance. In 2006, the State Agency for Social Assistance was created, along with the Governmental Commission for Health and Social Reforms, which was to become the decision-making body for healthcare reforms. The first policy created, entitled Main Directions in Health 2007-2009, outlined four main health objectives for the government to address: affordability of basic health services and protection of the public from serious financial health risks, quality of services, accessibility of services by continued development of infrastructure, and efficiency of the health system. The first reform to be implemented as part of the Main Directions in Health was the Hospital Development Master Plan. Begun in January 2007, the reform resulted in the replacement of the existing hospital infrastructure by transferring ownership rights from the state to the private sector. Hospital locations were chosen based on the principle of 45-minute geographic accessibility, with number of beds based on population size and health needs. Newly reformed hospitals integrated psychology, necrology, oncology, obstetrics, gynecology, pediatrics, and infectious diseases meant to provide comprehensive quality healthcare.

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