World Health Organization Assesses Georgian Healthcare System

A new report released on 12 September by the World Health Organization (WHO) and the European Observatory on Health Systems and Policies titled ‘Health Systems in Action: Georgia’ assessed Georgia’s progress in healthcare from 2013 to date.

Access to Healthcare

The report highlighted that since 2013, Georgia has been striving to provide universal health coverage through a package of publicly funded benefits and increased public investment in healthcare.

It noted that while public spending on health remains low by international comparison, (at 2.7% of GDP in 2019) “it has increased as coverage has expanded and out-of-pocket spending on health has fallen considerably.”

It underscored, however, that “coverage policy is extremely complex and there are substantial co-payments,” while the high cost of outpatient medicines remains the “biggest barrier to accessing care for the lowest income households” who are unable to pay out of pocket.

In that context, the report emphasized that “social determinants shape health outcomes significantly,” with poverty being associated with immediate risk factors such as unhealthy diet, smoking, and reduced access to health services, as well as exposure to non-optimal temperatures and both indoor and outdoor air pollution.

Regarding healthcare providers, the report denoted that most are private, including approximately 80% of hospital beds.

Meanwhile, in reference to the number of healthcare workers, the report noted that there is a “very large number” of doctors per capita, but “an acute shortage of nurses.”

Gatekeeping – the practice of primary care physicians authorizing further access to specialty care, hospital care, and diagnostic tests – remains “weak” in Georgia with a “strong patient preference for accessing the system at more specialized levels of care.”

The report positively assessed improvements in access to essential services, especially for the treatment of HIV, multidrug-resistant tuberculosis, and hepatitis C (HepC). In reference to HepC, it remarked that Georgia has a well-developed elimination program with up to 75% of the adult population screened as of May 2022, and active HepC infections having been reduced by 67%.

Life Expectancy and Mortality

Regarding life expectancy and mortality, the report stated that there is a large gap between male and female life expectancy, with women living 8.6 years longer on average according to 2019 data.

Significantly, this trend runs counter to the rest of the WHO European Region, while in Georgia the gap increased from 6.9 years in 2000 to 8.6 years in 2019, in the rest of Europe the gap narrowed from 7.7 years in 2000 to 6.3 years in 2017.

Alluding to the possible causes, the report explained that the male smoking rate was the highest in Europe in 2020, whereas the female smoking rate was among the lowest. On a positive note, it did highlight that tobacco control is a public health priority and that indoor smoking and tobacco advertising bans have been “robust.”

In reference to mortality, noncommunicable diseases account for most of Georgia’s burden of morbidity and mortality with the overall mortality rate remaining “high, with stroke the leading cause of death.”

The report underscored that “excess mortality due to COVID-19 far exceeded the WHO European Region average.”

Looking at the top 10 risk factors as a share of all deaths in 2019, the report highlighted that high systolic blood pressure (38%), dietary risks (24.2%), and high fasting plasma glucose referring to a high risk of diabetes (20.5%) had the three largest shares.

These were followed by high body mass index (17.3%), tobacco (17%), high LDL cholesterol (11.8%), air pollution (9.7%), kidney dysfunction (6.1%), non-optimal temperature (6%), and alcohol use (4.6%).

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