Last week we visited the newly build hospital in Chiatura, one of the many hospitals in Georgia built under the new hospital plan. President Mikheil Saakashvili opened this new multilevel hospital that provides all basic hospital services in December 2011. While the new hospital that has modern equipment made a positive impression at first sight, the story we heard from the staff and a deprived patient gave us a completely different view on the situation. There is a significant lack of beds, leading to a situation where people cannot be treated in a proper room or are sent home, sanitary norms are violated out of the high necessity to provide treatment, and the employees are heavily overworked and underpaid. Due to the high prices that the company that runs the hospital charges the people without insurance, many individuals cannot afford the treatment they need.

In the recent years, the majority of Georgian hospitals were  privatized and many of them were bought by insurance companies. National TV news channels frequently cover new health care policies and the opening and operation of the newly-built hospitals extensively. These new and privatized hospitals replace the older hospitals that often had an outdated infrastructure.

The hospital in Chiatura is owned by the IRAO insurance company and has 25 beds. This is a considerable decrease of the number of beds, as there used to be two polyclinics and one nursery hospital which provided a total of 25 beds. As a result, locals said that there are not enough beds to provide patients with adequate care. Although the hospital’s management says that it is planning to create an additional 15 beds in Chiatura, the medical staff and former staff of the hospitals raised serious doubts if these 15 beds will really be enough to address the shortage.

We talked to several people in Chiatura, including  the facility’s manager, who told us that the lack of beds does not create any problems in practice. However, some employees of the hospital told a different story: On many occasions, patients have to be send home because of there are not enough beds to treat them in. An 80 year-old woman told us that she had to be treated in an ambulance, as there were not enough beds.

As a result of this shortage of beds, basic sanitary norms were violated in order to provide basic treatment to patients. A hospital employee  told TI Georgia that two boys were recently brought in with a serious infection and had to be treated in the surgery room, because there where no other beds available. This leads to the increased risk that patients receiving surgery will become infected. This situation creates difficult choices for the staff, who have to examine and treat patients in the hallway, in an ambulance car, or in a doctor’s office.

The fact that there is only one surgery room and only 25 beds is even more worrisome, as there are mines in Chiatura that employ some 4,000 people. The hospital might thus not be able to handle patients in case of a serious accident because of its limited capacity.

Low salaries are often a reason for bribery and corruption, and it is important to make sure doctors will not be forced to compromise their ethics to make a living. In the Chiatura hospital, medical staff says they are severely underpaid. Several doctors said they didn’t have a written contract or a fixed monthly salary.

The management says  that a surgeon can get up to 1700 Gel for a surgery but the surgeons told us that their salary varies from GEL 160 to GEL 370 a month. Low salaries of doctors are not a problem in Chiatura alone. Recently, a doctor was fired in Zugdidi, after protesting the low salary paid by the Aldagi company which owns the local hospital. Another pressing issue is that, while the hospital in Chiatura is being equipped with modern devices, doctors told us that they had not been provided with some basic equipment.

IRAO, the owner of the hospital, also receives public funds to provide social insurance in Chiatura for the people living under the poverty line. IRAO can make a profit from the social insurance by keeping the prices of hospital services low for the holders of insurance, while maintaining high prices for those who do not have it. We have been told that this is exactly what is happening in practice. For example, the IRAO hospital charges the IRAO insurance company GEL 6 for a general blood test, while uninsured people are charged GEL 12. A doctor told us that uninsured people often cannot afford a treatment because of the high prices IRAO charges them. 

While the new policy enables the construction of modern equipped hospitals, it seems to create major problems in terms of accessibility and quality of health care. The fact that insurance companies need to maximize their profits from hospitals and social insurance in the same region leads to precarious situations.  The stories that we hear from people in other regions suggest that the situation in Chiatura is not an exception.