Georgians Fight for Free Healthcare

Georgians have begun taking state hospitals to court for failing to provide basic live-saving treatment. Their cases highlight the broader problems faced by an impoverished population who are still having to pay out for healthcare despite the government's insurance scheme.

"We could write a heartrending tale about each of the four lawsuits which we have at the moment," said Gigi Giorgadze from the non-government Centre for the Defence of Constitutional Rights. "But we are not going to do that. We just want to the court to rule in favour of these unfortunate people, that's enough."

In each of the four cases Giorgadze's centre is handling, hospital managers stand accused of refusing free medical care to a person who subsequently suffered severe ill health or even life- threatening illness as a result.

A fifth case ended in May, with a victory for Tbilisi resident Malkhaz Gobosashvili.

"When I was 15 I had an operation and had an iron structure fitted on my spine," explained Malkhaz. "It was supposed to be removed five years later. Now I am 27 and I am facing complete incapacity but I have no money for the operation."

Finally, Malkhaz, who is himself a lawyer, asked the courts to determine whether he was entitled to state help. He discovered that he was. The court ruled that he was entitled to a free operation in any clinic on presentation of his health insurance.

Georgia has had a paying health service for several years - an innovation which came as a shock to a population used to the free healthcare of Soviet times, and which is now living in poverty.

To shield the worst-off from having to pay for healthcare, the state started a new health programme which guaranteed free medical treatment for 16 categories of people, including children under three and families with many children. People with certain illnesses, such as diabetes and tuberculosis, were also promised free healthcare.

Then in 2001, a system of health insurance was brought in, and this time the whole population was eligible.

"When you bear in mind that other health programmes are being financed out of local budgets, an outsider might get the impression that citizens are fully protected," said Giorgadze. "But not a single one of these programmes actually works."

"Hospitals avoid dealing with patients, who show them health insurance policies, in every way they can as the state money transfers to pay for the treatment either never happen or are made a long time later."

Nana Lezhava is a single mother. Her seven-year-old son Nika was blind at birth and suffers from cerebral palsy. He therefore falls firmly into the category of those entitled to free healthcare. But getting him free treatment proved to be a nightmare.

"In February Nika fell ill with pneumonia," his mother said. "The doctors from the free ambulance which I called did not have the right medicines. The boy was gasping for breath and I had no option but to call a private ambulance."

Nana paid 35 lari (around 15 dollars) to call the ambulance and get her son an injection. Then she tried to get him admitted to hospital. In the city's Clinic No. 2, the staff refused to admit the child when they heard that the state was footing the bill. In the end the same ambulance took Nika, who was by now in a critical condition, to the intensive care ward of the Children's Republican Hospital. But they only let him stay there two days before they checked him out.

And yet, according to Georgian law, any hospital was obliged to admit the sick boy.

In March 2000 the Georgian parliament passed a law entitled "On human rights in the sphere of bio-medicine." "Only ten out of 50 European countries have a law like this and it has been a model piece of legislation in a number of states," said Professor Guram Kiknadze, one of the authors of the law. "But that still does not stop us being at the most primitive level in this sphere."

The current situation is intolerable for doctors, as well as patients. Lyuba Melashivili, a TB specialist and urologist, has worked in Tbilisi's tuberculosis clinic for 23 years. "By law, any treatment, operation or medicine for our patients has to be free," she said. "But they still have to pay fairly large sums. But what can the doctors do when often they don't even have syringes? How many patients can we support on our tiny salaries?"

Questioned about the crisis, government officials generally say that they are mid-way through a programme of health service reform sponsored by the World Health Organisation, and are trying to iron out its faults. It was not possible to speak to a health service official for this article.

To help those suffering the sharp end of the problem, the non-government Society for the Study of Legal Issues in Bioethics and Protection of the Health Service has set up a telephone hotline, and advises citizens who are refused treatment. The organization tries to sort out the problem with the hospital and even with the doctor concerned. Only if that does not work do they advise going to court, explains lawyer Naira Kutateladze.

They try to avoid legal action if at all possible. "Even without it, there's already a trend for doctors and patients to be in confrontation with one another," Kutateladze said.

Her preferred solution is to inform Georgians about their rights under the law. The society has published and distributes booklets explaining who has the right to free treatment, and for what.

"But that is just a drop in the ocean," she complained. "Most of our citizens do not know their own rights to be able to fight for them. The situation is especially difficult in the provinces."

Even getting the new health insurance policies is difficult enough. To do this you need to go around various offices, collecting the right documents and then stand for several days in a queue to get your policy, which is only given out three hours a day on two days a week.

"If everyone who came to us with a complaint did go to court, that's all we would have time to deal with," said Giorgadze. "But few people go that far. They say they prefer to spare their nerves."

Nino Zhvania is a journalist with Akhali Versia newspaper in Tbilisi