Medical Personel in Georgia - Surgery room

When the Soviet Union collapsed in 1991, many Eurasian countries, including Georgia, quickly realized they could no longer support a “cradle-to-grave” universal health care system. Since then, devising and implementing an effective medical infrastructure-public or private- has proved extremely difficult. When the Georgian Dream coalition came to power following the 2012 parliamentary elections, expanding state-funded care was emphasized as a central priority moving forward. Today, the country’s Ministry of Labor, Health and Social Welfare accounts for the largest share of the country’s roughly $3.3 billion budget, which amounts to over a third of total spending and a 54% increase since 2012. Furthermore, as of September this year, the Health Ministry had spent about 90% of its universal health care budget for the year.^[1] In light of these figures, some argue that a universal healthcare system is not fiscally feasible for the country at this time. History, however, demonstrates why a government-run infrastructure should not be so quickly abandoned.

According to Akaki Zoidze, a lead researcher at the Curatio Foundation (an NGO that focuses on public health care policy) and former minister of health, “lessons from other countries show that when you have a private provider and a public payer, [the former] would maximize the profit and try to [play] the system and escalate the cost of healthcare.” Indeed, time and time again the private medical industry in former Soviet regions has sought to maximize profits at the expense of public welfare. Often times, the health insurance market in these countries is either insufficiently regulated or too costly for many individuals. Therefore, according to a report by the European Observatory on Health Systems and Policies on trends in health systems among former Soviet countries, “among the major cross-cutting themes are the various ways in which the high share of private OOP [out-of-pocket] expenditure in many countries undermines key health system goals, including financial protection, equity (in terms of both financing and accessing health services), efficiency and quality.”^[2] In order to combat the incentive for private industry to raise costs, Zoidze recommends “effective regulation [and] good control [of spending and facility services] through electronic databases.”

For Georgia, a public system is not the problem, costs are. Of course, promoting a high quality of care is a central priority for any health care system. However, in order to do that, resources must first be managed in a way that reduces expenses so funds can be allocated to accomplish that goal.

Implementation of large-scale public systems are bound to face hiccups (take the Affordable Care Act, for example). Thus, unexpected costs are inevitable. Georgia’s health care system undoubtedly faces a wide range of challenges moving forward, but the aspiration for a public system shouldn’t be abandoned until management and administrative concerns are given sufficient time to be addressed.

^[1] http://www.eurasianet.org/node/75446

^[2]http://www.euro.who.int/__data/assets/pdf_file/0019/261271/Trends-in-health-systems-in-the-former-Soviet-countries.pdf?ua=1

Eric Millman