Development of State Health Insurance System in Georgia.
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Since 1994, health resources in Georgia have became insufficient. The spending for the health care services per person in 1985 were US$95. 5, US$12.2 in 1989, and US$0.9 in 1994. Currently there are 58.5 physicians per 10,000 inhabitants. The birth rate decreased from 16. 7 in 1989 to 11 in 1997. The mortality rate of pregnant women due to extragenital pathologies, iron deficiency anemias (40% of the total pregnant women), iodine deficiency and complicated abortions are also on the increase. The State Parliament of Georgia decided to reorganize the health care system and, in August 1995, State Health Care Programs and the new system of reimbursement of providers were launched. The monthly contribution rate of medical insurance, which was 4% of the payroll (3% paid by the employer and 1% by the employee), is transferred from the Central Budget directly to the State Medical Insurance Company, which implements nine State Curative Programs. State medical insurance system co-exists with municipal and private health care. Municipal health coverage is closest to the universal coverage (over 80% of the population), and municipal health care services are the closest to a basic package of services satisfying most health care needs of the population. The exceptions are pregnant women and mothers and children under 1 year of age, who are covered by the Federal Programs under State Medical Insurance. (+info)
Health reform and hospital financing in Georgia.
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AIM: To analyze hospital financing and delivery of inpatient services, financial requirements of the hospitals, and their ability to meet these requirements were determined. METHODS: Data on financial performance of 41 hospitals were collected using a standardized questionnaire. Patient survey, group discussions with hospital administrators, and interviews with policy-makers were also used. RESULTS: Thirty-three hospitals were unable to recover full costs, and 29 were unable to recover full costs excluding capital consumption cost. Cost recovery rate (CRR) of full costs for 14 hospitals was less than 70% and CRR of full costs minus capital consumption costs was less than 70% for 8 hospitals. Collected actual revenues comprised 75.2% of hospitals' full costs. Mean CRR for the sample was 78.6+25.2%. General and long-term hospitals recover 64.8% of their costs, but pediatric and specialized hospitals collected revenues to cover full costs excluding the capital consumption costs. Medium-sized hospitals recovered only 63. 5% of full costs. The hospitals operated with low efficiency, low occupancy rates (31%), and excessive staffing (1.5 physicians per occupied bed). They employed salary equalization policies, which increased the share of fixed costs, perpetuated the oversupply of medical personnel, and yielded low pays. Hospitals charged in excess of their officially accounted costs but, and due to the low collection rates, cost recovery rates were below the officially accounted costs (87.6%). CONCLUSIONS: Low official reimbursement rates and patient unawareness of official hospital costs creates conducive environment for shifting major turnover of the real hospital costs to the patients, resulting in illegal patients charging. (+info)
Vascular injuries of the limbs: a fifteen-year Georgian experience.
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OBJECTIVES: to analyse the causes of injury, surgical approaches, outcome and complication of vascular trauma of the upper and lower limbs in patients with vascular injuries operated on over a period between 1981 and 1995. PATIENTS: in 157 patients, the injuries were penetrating in 136 cases and blunt in 21. Isolated vascular trauma was present in 92 (58.6%) patients, 65 cases (41.4%) were aggrevated by concomitant bone fractures, severe nerve and soft tissue damage. The most frequently injured vessels were the superficial femoral (20. 6%) and brachial (19.1%) arteries. RESULTS: saphenous vein interposition grafting was applied with good results in 34 patients, polytetrafluoroethylene grafts were used in three cases, end-to-end anastomoses in 42 cases, venous bypasses in five cases, and venous patches in seven cases. Seventeen patients underwent arterial repair and nine, venous repair. Fasciotomy was used in 18 cases, and vessels were ligated in 14 cases. Blood flow was restored in 91 patients (58.0%), and collaterals compensated in 31 cases (19.7%). Fourteen primary and nine secondary amputations were performed. Twelve patients died. The limb salvage rate was 77.7% (84.1% among surviving patients). CONCLUSIONS: most vascular injuries associated with limb trauma can be managed successfully unless associated by severe concomitant damage to bones, nerves and soft tissues. (+info)
Diphtheria in the Republic of Georgia: use of molecular typing techniques for characterization of Corynebacterium diphtheriae strains.
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Sixty-six Corynebacterium diphtheriae strains (62 of the gravis biotype and 4 of the mitis biotype) isolated during the Georgian diphtheria epidemic of 1993 to 1998 and 13 non-Georgian C. diphtheriae strains (10 Russian and 3 reference isolates) were characterized by (i) biotyping, (ii) toxigenicity testing with the Elek assay and PCR, (iii) the randomly amplified polymorphic DNA (RAPD) technique, and (iv) pulsed-field gel electrophoresis (PFGE). Fifteen selected strains were ribotyped. Six RAPD types and 15 PFGE patterns were identified among all strains examined, and 12 ribotypes were found among the 15 strains that were ribotyped. The Georgian epidemic apparently was caused by one major clonal group of C. diphtheriae (PFGE type A, ribotype R1), which was identical to the predominant epidemic strain(s) isolated during the concurrent diphtheria epidemic in Russia. A dendrogram based on the PFGE patterns revealed profound differences between the minor (nonpredominant) epidemic strains found in Georgia and Russia. The methodologies for RAPD typing, ribotyping, and PFGE typing of C. diphtheriae strains were improved to enable rapid and convenient molecular typing of the strains. The RAPD technique was adequate for biotype differentiation; however, PFGE and ribotyping were better (and equal to each other) at discriminating between epidemiologically related and unrelated isolates. (+info)
Salmonellosis in the Republic of Georgia: using molecular typing to identify the outbreak-causing strain.
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In May 1998, three large outbreaks of salmonellosis, affecting 91 persons, were identified in the Republic of Georgia. Eighteen Salmonella Typhimurium strains were characterized by arbitrary primed polymerase chain reaction and pulsed-field gel electrophoresis; the results suggested that all cases were part of a single outbreak caused by a distinct clonal strain. (+info)
Risk factors for diphtheria: a prospective case-control study in the Republic of Georgia, 1995-1996.
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The large-scale resurgence of diphtheria in the former Soviet Union offered a unique opportunity to evaluate risk factors for the transmission of respiratory diphtheria; therefore, a prospective case-control study was done in the republic of Georgia. In total, 218 diphtheria cases (hospitalized between October 1995 and March 1996) and 408 matched controls participated. One hundred cases (45%) were /=15 years of age (range: <1 to 75 years). In the multivariate analyses, the following risk factors were found to be significant: lack of vaccination (matched odds ratio [mOR]=19.2), household exposure to diphtheria (mOR=7.4), exposure to skin lesions (mOR=5.8), history of eczema (mOR=3.4), fever with myalgia prior to illness (mOR=2.6), having tonsils (mOR=4.4), sharing a bed (mOR=1.9), sharing cups and glasses (mOR=2.7), and taking a bath less than once a week (mOR=2.6). These findings emphasize primary prevention through immunizations, secondary prevention following exposure to diphtheria (and to suspicious skin lesions), and adherence to strict standards of personal hygiene. (+info)
Epidemic diphtheria in the Republic of Georgia, 1993-1996: risk factors for fatal outcome among hospitalized patients.
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Epidemic diphtheria reemerged in the republic of Georgia in November 1993. To identify risk factors for fatal outcomes, clinical and epidemiologic data on all hospitalized diphtheria patients were examined. Medical charts of patients from 1993-1995 were reviewed. A total of 659 cases and 68 deaths were identified (case fatality rate [CFR] = 10.3%). Fifty-two percent of all cases and 68% of deaths were in children 3 days) between onset of symptoms to antitoxin treatment were significantly associated with fatal outcomes. Immunization of children and 40- to 49-year-old adults was required to rapidly control the epidemic. (+info)
Direct polymerase chain reaction for detection of toxigenic Corynebacterium diphtheriae strains from the Republic of Georgia after prolonged storage.
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A total of 226 paired nose and throat swab specimens from 113 clinical diphtheria cases from the republic of Georgia were analyzed by direct polymerase chain reaction targeting both A and B subunits of the diphtheria toxin gene, tox. Even after prolonged transport and extensive storage (7-14 months) of the clinical specimens in silica gel packages, direct polymerase chain reaction detected the diphtheria tox gene in 54% of the specimens. Specimens obtained by throat swab were three times more likely than those obtained by nose swab to be positive for Corynebacterium diphtheriae. (+info)