Healthcare Resource Guide: Georgia

 

Georgia Statistics



Summary

Market Entry

Current Market Trends

Main Competitors

Current Demand

Registration Process

Barriers

Procurement & Tenders

Trade Events

Local Associations

Government Links

Best Prospects

Statistics Snapshot

CS Contacts

 

Capital: Tbilisi

Population: 3,726,400

GDP: $14.74 million

Currency: Lari (GEL)

Language: Georgian

Summary

Over the last 13 years, Georgia’s healthcare system has undergone effective reforms that have improved health indicators and narrowed the gap between Georgian and European standards. After Georgia regained independence in 1991, private spending became the major source of healthcare financing. In 2002, healthcare spending per capita stood at $64 and over 2002-13 it surged to $350. In 2003, the government began liberalizing healthcare policy and boosting competitiveness through major changes including but not limited to easing regulations and letting private companies enter the market. After the hospital development plan was adjusted in 2010 to combine hospital operation and provision of health insurance, the government backed private insurers to become investors and operators. By the end of2014, private companies owned 84.3% of all hospital beds and private health insurance generated $ 74.1 million in gross premiums written, or 43.2% of the total insurance market. In 2013, the Georgian government introduced a universal healthcare (UHC) system for the entire population. The reform diminished the role of insurance companies as government funds flowed directly to healthcare providers. Renewed hospital infrastructure, combined with UHC, improved accessibility of care as well as patient satisfaction, with 96.4% of patients satisfied with UHC. Several rounds of healthcare reform, backed by strong political support, fostered a competitive environment in the healthcare sector by attracting private companies, which made considerable investments in the sector. Private sector spending, combined with the Health Ministry’s (Ministry of Internally Displaced Persons from the Occupied Territories, Labour, Health and Social Affairs of Georgia) liberalization policy and increased government healthcare spending, creates room for sustained growth in Georgia’s healthcare sector.

Market Entry

U.S. medical equipment and products are traditionally well-received in Georgia and are known for their quality and longevity. Public sector healthcare facilities, especially those outside urban areas, lack medical devices, which encourages a market for second-hand medical equipment. During importation, medical devices and pharmaceuticals are free from customs duty and exempt from value added tax (VAT).

Current Market Trends

Georgia is an outstanding destination for healthcare with a multinational, regional environment.

The main current market trends are:

  • Construction of modern hospitals with new technology, particularly Telemedicine (which includes Tele-neuroscience, Tele-psychiatry, and Tele-consultations for hepatitis C and hip and knee replacement surgery).
  • Development of Medical Tourism – the healthcare sector aims to become the healthcare hub of the Caucasus and Central Asia.

Main Competitors

U.S. exporters’ main competitors include companies from Europe; and healthcare providers in Turkey and Israel.

Current Demand

Georgia has approximately 85 general practitioners (GP) per 100,000 people, the third most in Europe and the most among peer countries that average 51.2 per 100,000 people. However, Georgia’s large number of practitioners does not accurately reflect primary care accessibility. In Georgia, a lack of primary infrastructure causes patients to go directly to hospitals, which lowers outpatient numbers at the expense of inpatient facility usage. Georgia has relatively few nurses (0.8 per physician) compared to peers (2.1 average). Moreover, Georgia is the only country among peers with a ratio below 1.0, a negative indicator for the healthcare sector. The WHO, in turn, recommends a 4 to 1 ratio. The undersupply of nurses imposes costs on the healthcare system due to the inefficient use of physicians’ time and skills. The supply of graduating physicians is almost double the peer average of 13.6. In addition, the nurse shortage is widening, as graduating nurses per 100,000 persons is the lowest at 0.5 compared to the peer average of 41.7.

Healthcare quality needs improvement throughout Georgia. Georgia is a healthcare service destination for populations from neighboring countries due to high standards and well-equipped hospitals. However, quality care in rural areas remains poor. To meet the government’s goal of a modern healthcare system capable of providing quality care and attracting medical tourism, the following is needed:

  • Consolidate fragmented healthcare sector;
  • Attract and retain foreign direct investment;
  • Establish complete system of the patient services;
  • Train physicians, nurses, and staff professionals;
  • Achieve hospital accreditation through JCI certification;
  • Establish unified regulatory system for production of pharmaceuticals

Registration Process

According to Georgian legislation, pharmaceutical products must be registered with the Departmental Registry at the Agency of State Regulation of Medical Activities at the Ministry of Internally Displaced Persons from the Occupied Territories, Labour, Health and Social Affairs of Georgia (MoLHSA) before they can be sold in the country. The new laws regulating pharmaceutical products imported and sold in Georgia attempt to simplify the registration process for new kinds of medicine entering the market. The new legislation allows for importers or pharmaceutical manufacturers to register their products based on two types of “recognition:” prior recognition by an accepted international partner or national recognition. Pharmaceuticals in Georgia also benefit from an attractive taxation regime; there is neither value added tax nor customs tax imposed on these products. Georgia is an emerging market and those who choose to open a pharmaceutical company in this country typically seek to enter a growing industry with high growth potential.

Reimbursement

Healthcare service providers (both state and private) generate revenue from out-of-pocket payments (including fee-for-service and the UHC co-payments), transfers from state healthcare programs, and payments from private medical insurance companies. Out-of-pocket expenditure on healthcare in Georgia exceeds public financing and private insurance payments. While the Georgian Government is the main source of hospital service financing in the country, the total Government expenditure on health is low at 0.3% of GDP, compared to the 5% benchmark set by peer countries, which leaves significant room for growth. The actual prices charged to patients are not regulated by the state. However, the reimbursement paid by the Social Service Agency (SSA) to healthcare providers under the UHC differs depending on the type of service provided and the location of the facility (in some cases reimbursement rates are higher in Tbilisi than in the regions).

Barriers

There are no significant barriers or limitations on imports of U.S. goods. The only customs requirement is the inclusion of shipment documentation, with a thorough description of the product. Medical devices and pharmaceuticals are free from customs duty and exempt from value added tax.

Procurement & Tenders

Government tenders, domestic tenders, global tenders, tender notices, procurement news, project information, business opportunities, international competitive bids, request for proposal (RFPs), and expression of interest (EOI) from Georgia can be found on the following link: http://www.globaltenders.com/government-tenders-georgia.php

Trade Events

Tbilisi Health Forum: https://10times.com/caucasus-healthcare

Caucasus Healthcare (25-27 October, Tbilisi): https://ilikevents.com/event/483-tbilisi-caucasus-healthcare

Healthcare Expo (25-27 Oct 2018, Tbilisi): https://10times.com/caucasus-healthcare

ExpoGeorgia: http://www.expogeorgia.ge/calendar/

Government Links

Ministry of Internally Displaced Persons from the Occupied Territories, Labour, Health and Social Affairs of Georgia: http://www.moh.gov.ge

Drug Regulation Authority of Georgia: http://ehealth.moh.gov.ge/Hmis/Portal/Default.aspx

FAQs

  • Are there special prohibitions or import regulations covering the importation of U.S.-made medical equipment?

The importation of any kind of medical equipment to Georgia is free from regulation and does not need registration or permissions of any kind.

The only exception is equipment which already contains medicines in any form (for instance ointments, powders, liquids for applying to/in the body). Otherwise medical devices, machinery, equipment etc. do not need registration for crossing the border or being used on the territory of Georgia.

  • What laws and restrictions regulate the importation of U.S.-made vitamins and food supplements into Georgia?

Georgian pharmaceutical regulators differentiate vitamins based on the dosage of the active ingredient. Vitamins with lower concentrations are considered as being biologically active supplements or nutrition supplements. The importer decides whether or not to register the vitamins and there are no special rules for importation. Vitamins with high concentrations of the active ingredient are considered as having a therapeutic effect and are considered a drug. In this case, importers must follow all standard rules for drug registration and importation. If the pill is a combination of several vitamins (such as in multivitamins) then it is classified as a drug even if the components are at therapeutic dosage levels.

  • How can companies export FDA-approved medical products to Georgia?

Brand name or generic pharmaceutical products can be registered in Georgia based on their acceptance by a pre-approved intergovernmental pharmaceutical regulatory body or the regulatory body of foreign country.

U.S. Commercial Service Contact Information

Name: Mackenzie Rowe

Position: Economic Officer

Email: RoweML2@state.gov  

Best Prospects

  • Universal Healthcare Coverage: Since 2013, the Georgian government has laid the foundation for public health policy by enacting a state-funded, universal healthcare program. More than 90% of the population used the universal healthcare program as beneficiaries; the rest had private medical insurance. The Universal Health Care (UHC) reform has increased access to health services and reduced financial barriers and out of pocket costs, and according to the World Health Organization (WHO), the World Bank, and USAID, has increased the overall financial security of UHC recipients. Georgia now has a foundation of universal entitlements within its health system, representing a major step towards improving access to health services for the entire population. Second phase of the reform launched in July 1, 2013, extended the services covered and include planned ambulatory care, urgent outpatient and inpatient care, elective surgery, chemo-, hormone and radiotherapy treatment, obstetrics and cesarean sections, basic drugs for target groups of the population. In May 2017, to further reform the program, elaboration of new criteria for differentiation of beneficiaries (according to beneficiaries' revenue) has been implemented for provision of more needs oriented services and development of "social justice" approach. From July 1, 2017, persons suffering from chronic conditions, who are registered in the unified database of "socially vulnerable families" are eligible for the state program providing drugs for chronic conditions. The program provides patients with selected drugs for chronic cardiovascular diseases, chronic obstructive pulmonary disease, diabetes (type 2) and thyroid conditions.
  • Viral Hepatitis C: Georgia is among the countries with high hepatitis C (HCV) prevalence. According to the latest population-based seroprevalence survey, conducted by the National Center for Disease Control and Public Health (NCDC) and U.S. Centers for Disease Control and Prevention (CDC) in 2015, estimated national seroprevalence of hepatitis C is 7.7% and the prevalence of active disease is 5.4%.


Prevalence and Estimated Number of HCV RNA+ Individuals by Regions and Cities

The Government of Georgia declared strong intention to eliminate hepatitis C in Georgia. In February 2014, the Ministry of Health (Dr. David Sergeenko) initiated discussion regarding strengthening Hepatitis C response in the country with US partners after the successful negotiations of the Memorandum of Understanding between the Government of Georgia and U.S. pharmaceutical company Gilead was signed on April 21, 2015. As a result, Georgia started an unprecedented National Hepatitis C Elimination Program. National Screening Protocol was developed and subsequently approved by the Government. More than 600 sites, including inpatient and outpatient facilities, prisons, Georgian Harm Reduction Network (GHRN) centers, pharmacies, etc., provide HCV screening across the country. A unified electronic screening registry was created which captures data from all national and local HCV screening programs across the country. Data from the screening and treatment programs are linked by a unique identifier. As of January 2018, more than 1.4 million screenings were registered in the database, among which ~896,000 were unique individuals with positivity rate 11.1%. Starting with 4 sites in 2014, currently 32 service centers in different cities, including 1 center in penitentiary system, are providing diagnostic and treatment services to the elimination program beneficiaries. Since the launch of the program in 2015 through December 2017, 38506 patients completed the treatment. Cure rate reached 98.2%.

  • Richard Lugar Center for Public Health Research: R. Lugar Center for Public Health Research is a brand new state-of-the-art laboratory facility under the NCDC, which serves as the National Public Health Reference Laboratory for Georgia as well as for the region for specific diseases. Operational since August 2013, the Lugar Center took start in 2004, after USA – Georgia Agreements were signed (in 1997 and in 2002) on cooperation in the area of prevention of proliferation of technology, pathogens and expertise related to the development of biological weapons. The Lugar Center consists of modern Biosafety Level 2 (BSL-2) and Biosafety Level 3 (BSL-3) laboratories, with emphasis to timely detect and identify human and animal pathogens based on the One Health concept. This BSL-3 facility houses bacteriology and virology laboratories, and the National Repository of human and animal especially dangerous pathogens (EDPs). The BSL-3 facility is unique not only in Georgia but also in the entire Caucasus and Central Asia Region. The Center also includes the well-equipped genomic center, which makes the center a unique sequencing facility in the region. The reference laboratory activities of NCDC’s Polio, Influenza and Measles/Rubella Laboratories are accredited by the WHO. Four Labs are connected to WHO Lab Network: Rotavirus, Invasive Meningitis, Malaria, and Salmonellosis. The center participates in WHO Laboratory Networks: Central Asia and Eastern Europe Surveillance on Antimicrobial Resistance (CAESAR), Global Antimicrobial Resistance Surveillance system (GLASS); antimicrobial resistance determination is based on European Committee on antimicrobial Susceptibility Testing (EUCAST) guidelines. The Lugar Center Laboratory manages and implements two National Quality Assurance Programs for bacterial antimicrobial susceptibility testing and for hepatitis C diagnostics.

At present NCDC/Lugar Center has implemented more than 160 international scientific and public health projects within ~ 36,000,000 USD.

On the basis of the Lugar Center, the following scientific achievements were made the first time in the World:

(1) new species of Orthopox virus discovered (so called Akhmeta virus

(2) brucellosis and leptospirosis pathogens were found in bats

(3) bartonella taylorii was detected as a human pathogen in patients with HIV / AIDSJanibacter hoylei PVAS-1 was separated from endocarditis clinical sample

The Lugar Center has been assessed by ANAB according to the requirements of international standard ISO 15189:2012 while demonstrating technical competence in the field of Medical and Clinical Laboratories and received the Certificate of Accreditation in Clinical Bacteriology and Serology.

  • Environment and Health: Burden of disease caused by adverse environmental impacts is quite high (17%) in Georgia. In order to reduce and prevent the environmentally-related diseases’ burden and reduce people's exposure to ecological risks, the National Environmental and Health Action Plan (NEHAP) has been developed based on requirements set by the Association Agreement between Georgia and the EU. The country has initiated the implementation of the commitments set in the NEHAP through utilization of the twinning mechanism supported by the EU. The project Twining-GE22-"Strengthening Environmental Health System in Georgia” carried out by a consortium of Italy, Poland and the UK, was supported by EU and started in 2017. The project’s purpose is to strengthen the legal framework on environmental health in Georgia through harmonization with European requirements, improving environmental health management, ensuring long-lasting environmental policy development and strengthening inter-sectorial collaboration.

Statistics Snapshot

Market Size

Healthcare spending (including investment)

 

... as percent of GDP

8.5%

Number of hospitals

15,084

Physicians

27,362

…of which surgeons

2,220

...of which pediatricians

1,428

Demographics

Population

3,720,400

Life expectancy men/women

69.2/77.8

Infant mortality

9.6/1000 live births

Percent of population older than 65

14.6

Annual deaths

12.8/1000 people


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