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Georgia Health
The Soviet system of health care, which embraced all the
republics, included extensive networks of state-run hospitals,
clinics, and emergency first aid stations. The huge government
health bureaucracy in Moscow set basic policies for the entire
country, then transmitted them to the health ministries of the
republics. In the republics, programs were set up by regional and
local health authorities. The emphasis was on meeting national
standards and quotas for patient visits, treatments provided, and
hospital beds occupied, with little consideration of regional
differences or requirements.
Under this system, the average Georgian would go first to one
of the polyclinics serving all the residents of a particular
area. In the mid-1980s, polyclinics provided about 90 percent of
medical care, offering very basic diagnostic services. In
addition, most workplaces had their own clinics, which minimized
time lost from work for medical reasons. The hospital system
provided more complex diagnosis and treatment, although
overcrowding often resulted from the admission of patients with
minor complaints. Crowding was exacerbated by official standards
requiring hospital treatment of a certain duration for every type
of complaint.
The Soviet system placed special emphasis on treatment of
women and children; many specialized treatment, diagnostic, and
advanced-study centers offered pediatric, obstetric, and
gynecological care. Maternity services and prenatal care were
readily accessible. Emergency first aid was provided by
specialized ambulance teams, most of which had only very basic
equipment. Severe cases went to special emergency hospitals
because regular hospitals lacked emergency rooms. Although this
system worked efficiently in urban centers such as Tbilisi, it
did not reach remote areas. Most Georgians cared for elderly
family members at home, and nursing care was generally mediocre.
Georgian health spas were a vital part of the Soviet Union's
well-known sanatorium system, access to which was a privilege of
employment in most state enterprises.
When the Soviet Union dissolved, it left a legacy of health
problems to the respective republics, which faced the necessity
of organizating separate health systems under conditions of
scarce resources. By 1990 the Soviet health system had become
drastically underfunded, and the incidence of disease and
accidents was increased by poor living standards and
environmental hazards. Nominally equal availability of medical
treatment and materials was undermined by the privileged status
of elite groups that had access to the country's best medical
facilities. In 1990 the former republics also differed
substantially in health conditions and availability of care (see
table 2, Appendix). Subsequent membership in the Commonwealth
of
Independent States, to which Georgia committed itself in late
1993, did not affect this inequality.
According to most standard indicators, in 1991 the health and
medical care of the Georgian population were among the best in
the Soviet Union. The rate at which tuberculosis was diagnosed,
28.9 cases per 100,000 population in 1990, was third lowest, and
Georgia's 140.9 cancer diagnoses per 100,000 population in 1990
was the lowest rate among the Soviet republics. Georgia also led
in physicians per capita, with 59.2 per 10,000 population, and in
dentists per capita. However, hospital bed availability, 110.7
per 10,000 population in 1990, placed Georgia in the bottom half
among Soviet republics, and infant mortality, 15.9 per 1,000 live
births in 1990, was at the average for republics outside Central
Asia.
Although illegal drugs were available and Georgia
increasingly found itself on the international drug-trading route
in the early 1990s, the drug culture was confined to a small
percentage of the population. The relatively high rate of
delinquency among Georgian youth, however, was frequently
associated with alcohol abuse.
In 1993 the Republic AIDS and Immunodeficiency Center in
Tbilisi reported that sixteen cases of acquired immune deficiency
syndrome (AIDS) had been detected; five victims were nonGeorgians and were deported. Of the remaining eleven, two had
contracted AIDS through drug use and one through a medical
procedure. Despite the small number of cases, the AIDS epidemic
has caused considerable alarm in the Georgian medical community,
which formed a physicians' anti-AIDS association in 1993. The
AIDS center, located in a makeshift facility in Tbilisi, conducts
AIDS research and oversees testing in twenty-nine laboratories
throughout Georgia, stressing efforts among high-risk groups.
Like other former Soviet republics, Georgia began devising
health care reform strategies in 1992. Budget expenditures for
health increased drastically once the Soviet welfare system
collapsed. Theoretical elements of Georgian health reform were
compulsory medical insurance, privatization and foreign
investment in institutions providing health care, and stronger
emphasis on preventive medicine. Little progress was made in the
first two years of the reform process, however. In Georgia
political instability and civil war have destroyed medical
facilities while increasing the need for emergency care and
creating a large-scale refugee problem
(see Threats of
Fragmentation
, this ch.).
Data as of March 1994
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