Posted by: burusi | 27/04/2015

Tengiz Verulava “Health Care System in Georgia”

Tengiz Verulava, Health Care System in Georgia, 2001

Tengiz Verulava, Health Care System in Georgia, 2001

Tengiz Verulava, Temur Kalandadze “Health Care System in Georgia”

State Medical Insurance Company of Georgia. Tbilisi 2001. ISBN 99928-0-219-7

Tengiz Verulava Health Care System in Georgia. PDF VERSION OF BOOK

The book covers a variety of health care issues and topics including history of Georgian health, policy, legislation, human resources, financing, medical insurance, public health, quality, strategy, delivery of care, organization services, education, research and give an overview of the nature of the changes having occurred during transition.
The aim of the book is to provide relevant comparative information to support policy-makers and analysts in the development of health care system and reform in the country. Quantitative data on health services Regional office for Europe health for all databases, OECD Health Data, World Bank, Government of the Republic of Georgia, United Nations Development Programs, Georgian-European Policy and Legal Advice Centre, State department for statistics of Georgian, Center for Medical Statistics and Information of Georgia.

Contents
Foreword
Acknowledgements
1. The Country ……..………………………………………………..……………………… 16
1.1. Geographical Location………………………………………………………………………………..16
1.2. Administrative Division……………………………………………………………………………….18
1.3. State system of Georgia……………………………………………………………………………19
1.4. Religion………………………………………………………………………………………………20
1.5. Climate……………………………………………………………………………………………………….20
1.6. Natural Resources……………………………………………………………………………………..21
1.7. History……………………………………………………………………………………………………….22
1.8. Economy……………………………………………………………………………………………………26
1.9. Education………………………………………………………………………………………………..…34
2. Employment, Incomes and the Social Safety Net …. ..……………….37
2.1. Labor Market………………………………………………………………………………………….37
2.2. Salaries and Wages…………………………………………………………………………………..41
2.3. Minimum Subsistence Level……………………………………………………………………..42
2.4. Social Safety Net……………………………………………………………………………………….43
2.4.1. State Social Allowance……………………………….…………………………………..45
2.4.2. Unemployment Benefit …………………………..……………………………………..45
2.4.3. Pension System……………………………………..……………………………………….45
2.5. Social Policy………………………………………………………………………………………….….47
3. Population Dynamics………………….……………………………………………52
3.1. Population and its Distribution……………………………………………………………….52
3.2. Population by Ethnic Origin………………………………………………………………………53
3.3. Urbanization ………………………………………………………………………………………..….55
3.4. Refugees and Displaced Persons……………………………………………………………..56
3.5. Population Growth………………………………………………………………………………….57
3.6. Structure of the Population by Age Groups………………………………………………61
3.7. Structure of the Population by Sex Groups……………………………………………..65
3.8. Fertility and Family Panning …………………………………………………………………….66

4. Environmental and Behavioral Determinants of Health ……….72
4.1. Environment……………………………………………………………………………………….72
4.1.1. Air pollution……………………………………………………………………………….72
4.1.2. Soil……………………………………………………………………………………………..74
4.1.3. Water Supply……………………………………………………………………………..75
4.2. Social-economical Determinants………………………………………………………….79
4.3. Determinants Related to Personal Behavior………………………………………..81
4.3.1. Life Style……………………………………………………………………………………..81
4.3.2. Nutrition……………………………………………………………………………………..82
4.3.3. Tobacco Consumption………………………………………………………………..85
4.3.4. Alcohol Consumption………………………………………………………………….88
4.3.5. Drug abuse………………………………………………………………………………….90
5. Health status …………………………………………………….…………..……. 95
5.1. Life expectancy at Birth……………………………………………………………………….95
5.2. Birth Rate…………………………………………………………………………………………….98
5.3. General Mortality……..………………………………………………………………………101
5.4. Infant Mortality………………………………………………………………………………..107
5.5. Maternal Mortality……………………………………………………………………………114
6. Specific epidemiological background …………………………………. 119
6.1. Communicable Diseases…………………………………………………………………..120
6.1.1. Tuberculosis……………………………………………………………………………124
6.1.2. Malaria……………………………………………………………………………………130
6.1.3. Diarrheal Diseases…………………………………………………………………..132
6.1.4. Food Poisoning, Botulism’s …………………………………..…………………133
6.1.5. Anthrax ………………………………………………………………..………………. 133
6.1.6. Hepatitis ………………………………………………………….……………………..134
6.1.7. Typhoid, Brucellosis, Rabies…………………………………………………….135
6.1.8. Diphtheria ……………………………………………………………………………….136
6.1.9. Acute Flaccid Paralysis……………………………………………………………..138
6.1.10. Sexually Transmitted Diseases……………………………………………….139
6.1.11. HIV/AIDS………………………………………………………………………………..142
6.2. Non-communicable Diseases ……………………………………….. 144
6.2.1. Cardiovascular Diseases……………………………………………………………144
6.2.2. Cancer………………………………………………………………………………………148
6.2.3. Accidents and Poisoning…………………………………………………………..153
6.2.4. Diabetes Mellitus………………………………………………………………………………154
6.2.5. Iodine Deficiency Disorders……………………………………………..……………….155
6.2.6. Psychosocial and Mental Health……………………………………….………………156
6.2.7. Digestive System Diseases……………………………………………….……………….158
6.2.8. Respiratory System Diseases…………………………………………….………………159
6.2.9. Nervous System and Sense Organs Diseases…………………….………………161
6.2.10. Genitourinary System Diseases…………………………………….………………..161
6.2.11. Blood and Blood Forming Organ Diseases……………………………………..161
7. History of Georgian Medicine…………………………………………..……….162
7.1. The Pre-Christian Period……………………………………………………..………….……….162
7.2. The Christian Period……………………………………………………………………….………..162
7.3. The Russian Conquest Period……………………………………………………….………….164
7.4. The Period of Independence of Georgia (1918-1920)………………..……………..165
7.5. The Soviet Period…………………………………………………………………..………………….167
8. Health Care Reform…………………………………………………………..……….181
8.1. Determinants and Objectives …………………………………………………………….……….181
8.2. Legislation………………………………………………………………………………………..…………186
8.3. Decentralization of Health Care System Management……………….……………….195
8.4. Privatization………………………………………………………………………………….……………..199
8.5. Contracting…………………………………………………………………………………..……………….200
8.6. The impact of changes in health care system………………………………………….……….202
8.6.1. Quality of health care…………………………………………………………………………..202
8.6.2. Solidarity and competition ………………………………………………………..……….. 202
8.6.3. Efficiency………………………………………………………………………….……..………….. 203
8.6.4. Cost containment………………………………………………………………………….…….. 204
9. Organizational Structure and Management…………………………………..…206
9.1. Introduction …………………………………………………………………………………………..………… 206
9.2. Ministry of Labor, Social Affairs and Health………………………………………….………..…. 206
9.3. Regional Health Authorities………………………………………………………………….…………. 209
9.4. District Health Authorities……………………………………………………………………………….. 211
9.5. Department of Public Health…………………………………………………………………………… 212
9.6. Department of Sanitary Surveillance and Hygienic Rationing (DSSHR) ……………… 214
9.7. State Medical Insurance Company………………………………………………………………………215
9.7.1. Internal organization of SMIC……………………………………..…………………………….216
9.7.2. Insured Population………………………………………………………………..218
9.7.3. Benefits Package……………………………………………………………………220
9.7.4. Contracts……………………………………………………………………………….225
9.7.5. Public Relations Framework………………………………………………….227
9.7.6. Future Challenges………………………………………………………………….230
9.8. Regional Municipal Fund……………………………………………………………….231
10. Health Care Delivery System…………….………………………….232
10.1. Introduction……………………………………………………………………………….232
10.2. Structure of the Soviet Health Care System………………………………….233
10.3. Organization of Services after Reforms……………………………………..235
10.4. Primary health care service…………………………………………………………..236
10.4.1. Feldsher-Midwife Posts……………………………………………………..238
10.4.2. Rural ambulatory and health centers………………………………….239
10.4.3. Urban and district polyclinics……………………………………………….240
10.4.4. Regional Outpatient Services……………………………………………….241
10.4.5. Republican Facilities……………………………………………………………..241
10.4.6. Special Focus polyclinics……………………………………………………….241
10.4.7. Enterprise Polyclinics…………………………………………………………….241
10.4.8. Patient lists and Referral restrictions…………………………………….248
10.5. Hospital services…………………………………………………………………………..249
10.6.1. Rural hospitals………………………………………………………………………251
10.6.2. District hospitals…………………………………………………………………..251
10.6.3. Regional hospitals………………………………………………………………..252
10.6.4. Special focus hospitals………………………………………………………….252
10.6.5. Republican hospitals…………………………………………………………….253
10.6.6. Physical Infrastructure…………………………………………………………254
10.6.7. Hospital Beds……………………………………………………………………….255
10.6.8. Bed occupancy in hospitals……………………………………………………262
10.6.9. Length of stay……………………………………………………………………….263
10.6.10. Bed rotation rate………………………………………………………………..265
10.6.11. Admissions ……………………………………………………………………….266
10.7. Maternal and Child Health……………………………………………………………267
10.7.1. Health of Children………………………………………………………………….267
10.7.2. Immunization Coverage……………………………………………………….270
10.7.3. Adolescence…………………………………………………………………………271
10.7.4. Physical Developments of Children and adolescents…………..272
10.7.5. Women’s Health………………………………………………………………….272
10.8. Community Care………………………………………………………………….278
10.9. Mental Health Services………………………..………………….………….279
10.10. Anti-tuberculosis Care……………………………………………………….281
10.11. Endocrinology Care……………………………………………………………281
10.12. Other Special Care…………………………………………………………….281
10.13. Pharmaceuticals ………………………………………………………………282
10.14. Health Technology…………………………………………………………….284
11. Human resources for health…………………………………………285
11.1. Introduction…………………………………………………………………………………285
11.2. Physicians…………………………………………………………………………………..288
11.3. Nurses………………………………………………………………………………………..291
11.4. Medical education……………………………………………………………………..294
11.5. Health Research…………………………………………………………………………298
11.6. Professional Groups…………………………………………………………………..300
12. Health Care Finance…………………………………………………..301
12.1. Introduction…………………………………………………………………………………301
12.2. Health Care Benefits………………………………………………………………….303
12.3. Health Care Expenditure……………………………………………………………308
12.4. Levels for Financing……………………………………………………………………315
12.5. Sources of Financing………………………..……………………………….……….317
12.6. Transfers from the State Budget………………………………………………320
12.7. Insurance Compulsory Premiums……………………………………………..321
12.8. Local Government (Municipalities)…………………………………………………..326
12.9. Out-of-Pocket Payments………………………………………………….…………………328
12.9.1. Co-payments…………………………………………………………………..……….330
12.9.2. Informal Payment …………………………………………………………..………. 332
12.10. Voluntary Medical Insurance Premiums…………………………………..……….334
12.11. Humanitarian Aid …………………………………………………………………………..…. 334
12.12. State Medical Insurance Company Revenues and Expenditures ………….335
12.13. Department of Public Health Revenues and Expenditures …….. 341
12.14. Ministry of Health Programs Revenues and Expenditures …….. 342
13. Payment Systems for Provider ………………………………… 343
13.1. Introduction……………………………………………………………………………….343
13.2. Financing of Ambulatory Care…………………………………………………….345
13.3. Financing of Hospital Care………………………………………………………….348

14. International Cooperation………………………………………..353

15. Strategic Health Plan for Georgia………………………………360

Figures and Tables…………………………………………………….368
Bibliography………………………………………………………………….….379

***
Tengiz Verulava Health Care System in Georgia. PDF VERSION OF BOOK


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