jandacvis menejmentis srulyofis meqanizmebi, pirveladi jandacvis

- 1 -

iv.javaxiSvilis sax. Tbilisis saxelmwifo universitetis

ekonomikisa da biznesis fakulteti menejmentisa da

administrirebis mimarTuleba

jayeli irakli vaJas Ze

disertacia

jandacvis menejmentis srulyofis meqanizmebi,

pirveladi jandacvis dawesebulebis momsaxurebis

magaliTze

mosapovebeli xarisxi: biznesis administrirebis doqtori

samecniero xelmZRvanelebi:

oleg ejibaZe, ekonomikis mecnierebaTa doqtori, profesori

oTar gerzmava, medicinis mecnierebaTa doqtori, profesori

Tbilisi

2010 weli

- 2 -

Sinaarsi

Sesavali------------------------------------------------------------------------------------------------------------------3

Tavi I. jandacvis reformis Taviseburebebi zogierT qveynaSi

1.1. janmrTelobis dacvis politikis ganxorcielebis Taviseburebebi

Tanamedrove pirobebSi------------------------------------------------------------------------------------------7

1.2. zogierT qveyanaSi mimdinare pirveladi jandacvis sistemis reformis

Sedegebi-----------------------------------------------------------------------------------------------------------------31

1.3. jandacvis sistemis reformis ganxorcielebasTan dakavSirebili

problemebi ganviTarebad qveynebSi ------------------------------------------------------------------68

1.4. jandacvis sabazro struqturis reforma --------------------------------------------------89

Tavi II. saqarTvelos pirveladi jandacvis ZiriTadi maxasiaTeblebi

2.1. kvlevis masala da meTodika---------------------------------------------------------------------99

2.2. saqarTvelos pirveladi jandacvis sistemaze

moqmedi ZiriTadi socialur-ekonomikuri determinantebi-----------------------------105

2.3. mosaxleobis sociologiuri kvlevis Sedegebi

pirveladi jandacvis sistemiT dakmayofilebis Sesaxeb ------------------------------130

Tavi III. saqarTvelos pirveladi jandacvis sistemis moqmedebis

efeqturobis sistemuri analizis Sedegebi

3.1.saqarTvelos pirveladi jandacvis sistemis

moqmedebis efeqturobis sistemuri analizis Sedegebi ---------------------------------139

3.2. kvlevis procesSi miRebuli Sedegebis ganxilva -----------------------------------154

daskvnebi da rekomendaciebi ----------------------------------------------------------------------------170

gamoyenebuli literaturis sia ---------------------------------------------------------------------181

danarTi --------------------------------------------------------------------------------------------------------------192

- 3 -

Sesavali

K

Temis aqtualuroba: qveyanaSi mimdinare jandacvis sistemis reforma

iTvaliswinebs mravali cvlilebis gatarebas, romelTa Soris umTavresia

regulireba, dafinanseba, saTanado kadrebis mozidva, maTi momzadeba da

gadamzadebaAaxali moTxovnebis Sesabamisad.

dResdReobiT janmrTeloba da misi dacva ar warmoadgens eqimisa da

pacientis martiv urTierTdamokidebulebas. jandacva _ es aris

sazogadoebrivi dinamiur-funqcionaluri rTuli sistema, romelic

ganviTarebiTa da daxvewis yovel safexurze qmnis da nergavs kompleqsur

RonisZiebebs mimarTuls TiToeuli individisa Tu mTeli sazogadoebis

janmrTelobis SenarCunebisa da mudmivi gaumjobesebisken.

am kuTxiT seriozul problemas warmoadgens qveyanaSi mimdinare

pirveladi jandacvis sistemis reformirebaze mimarTuli RonisZiebebis

daxvewis sakiTxebi. miuxedavad mravali mcdelobisa da sakmarisad didi

finansuri mxardaWerisa rogorc saeraSoriso donorebis, aseve

saqarTvelos mTavrobis mxridan reforma ara marto ver xorcieldeba

sakmarisi tempebiT, aramed qmnis damatebiT, zogjer Znelad gamosasworebel

problemebs. amas adasturebs rogorc mosaxleobis da samedicino

personalis sul ufro mzardi negativizmi pirveladi jandacvis sistemaSi

mosalodneli dadebiTi Zvrebis mimarT, aseve im mravalricxovani

alternatiuli samsaxurebis Seqmna, gansakuTrebiT kerZo seqtorSi

(sadiagnostiko centrebi, saojaxo medicinis centrebi, saswrafo da

gadaudebeli daxmarebis centrebi da sxv), romelnic agreTve ver pasuxoben

iseT moTxovnebs, rogoricaa pirveladi jandacvis sistemis

xelmisawvdomoba, pacientTa dakmayofileba (gaweuli samedicino

momsaxureobis adekvaturobisa da xarisxis gaTvaliswinebiT), pacientTa

saWiroebebze aqcentirebuli daxmarebis uzrunvelyfa da sxv.

iqmneba STabeWdileba, rom verc saxelmwifo, verc ucxoeli donorebi

da verc samedicino sazogadoebrioba, miuxedavad mravali mcdelobebisa,

ver axerxebs im uzarmazari faseulebebis mizanmimarTul da swor

- 4 -

gankargvas (Seexeba es materialur bazas Tu sakadro resursebs), romelic

arsebobs Cvens qveyanaSi.

sakmarisia aRiniSnos, rom mxolod arsebuli monacemebiT

saqarTvelos Sromis, janmrTelobisa da socialuri dacvis saministros

sistemaSi moqmedebs 1400-ze meti sxvadasxva dawesebuleba, romelic

axorcielebs sxvadasxva donis ambulatoriul-poliklinikur daxmarebas.

sistemis struqturul-organizaciuli cvlilebebis erT-erT miznad

SesaZloa yofiliyo pirveladi jandacvis dawesebulebis reformireba

saojaxo medicinis centrebad. am kuTxiT saqarTveloSi ucxouri donorebis

daxmarebiT jer kidev 90-ian wlebSi daiwyo sakmarisad farTo muSaoba.

miuxedavad amisa, mTlianad sistemaSi seriozuli Zvrebi ver moxerxda.

dResdReisobiT saojaxo medicinis centrebSi momuSave gadamzadebuli

ojaxis eqimebi ver axdenen miRebuli kvalifikaciis realizabas. marTalia,

Tbilisis masStabiT municipalurma sadazRvevo socialurma programam

daadastura ojaxis eqimebis upiratesoba ubnis Terapevtsa da

pediatrebTan SedarebiT, magram moqmedi qselisa da kadrebis didi nawilis

muSaoba mainc araefeqturia.

aSkaraa, rom esoden savalalo mdgomareobis ZiriTadi mizezia

mosaxleobis dabali gadamxdelunarianoba saxelmwifo da municipaluri

jandacvis dafinansebis simwiris pirobebSi. amas adasturebs msoflios

jandacvis organizaciis monacemebic, romelTa mixedviT saqarTveloSi

qveynis mosaxleobis myidvelobiTi unaris paritetis gaTvaliswinebiT erTi

pacientis mier gaxarjuli sakuTari saxsrebis wili gacilebiT maRalia

evropis da aziis regionis qveynebis umetesobasTan SedarebiT.

zemoaRniSnulis gaTvaliswinebiT kvlevis mizans warmoadgens pirveladi

jandacvis socialur-ekonomikuri efeqturobis kompleqsuri analizi da

miRebuli Sedegebis safuzvelze mecnierulad dasabuTebuli rekomendaciebis

SemuSaveba.

kvlevis procesSi dasmulia da ganxorcielebuli Semdegi amocanebi:

• saqarTveloSi pirveladi jandacvis sistemis ganviTarebis ZiriTadi

strategiebis Taviseburebebis socialur-ekonomikuri efeqturobis Sefaseba.

- 5 -

• pirveladi jandacvis seqtoris reformirebis ZiriTadi etapebis

analizi, am procesis zegavlena rogorc mTlianad sazogadoebaze, aseve

qveynis mosaxleobis janmrTelobis mdgomareobaze;

• sistemuri analizis meTodebis gamoyenebiT imis gansazRvra, Tu

rogor Seesabameba qveyanaSi mimdinare pirveladi jandacvis seqtoris

reformirebis saerTaSoriso standartebs, ra rols asruleben

saerTaSoriso organizaciebi am strategiuli ganviTarebis saqmeSi;

• imis dadgena, Tu ramdenad axdens zegavlenas pirveladi samedicino

momsaxurebis miRebaze ZiriTadi socialur-ekonomikuri determinantebi;

• sociologiuri kvlevis safuZvelze mosaxleobis damokidebulebis

Sefaseba pirveladi jandacvis seqtorSi mimdinare reformebis

mizanSewonilobis Sesaxeb.

kvlevis obieqti da sagani: kvlevis obieqts warmoadgens saqarTvelos

jandacvis sistema, kvlevis sagania pirveladi jandacvis menejmenti

dawesebulebis momsaxureobis magaliTze.

kvlevis mecnieruli siaxle :

• jandacvis sistemaSi gamoikveTa pirveladi jandacvis momsaxureobis

roli da mniSvneloba;

• ganisazRvra pirveladi jandacvis menejmentis suti mxareebi da

daisaxa maTi gadaWris RonisZiebebi;

• pirveladi jandacvis struqturaSi ganisazRvra zogadi praqtikis

eqimis roli da misi adgili jandacvis momsaxurebis sferoSi;

• gamoikveTa problemebi romlebic wlebis ganmavlobaSi xels

uSlidnen jandacvaSi socialuri programebis Sesrulebas da maT jerovan

dafinansebas.

naSromis aprobacia: naSroma aprobacia gaiara iv.javaxiSvilis sax.

Tbilisis saxelmwifo universitetis ekonomikis da biznesis fakultetis

menejmentisa da administrirebis kaTedraze 16.09.09. naSroms mieca dadebiTi

Sefaseba rac aRniSnulia oqmSi.

disertaciis momzadebis procesSi daiwera da gamoqveynda statiebi:

1) ,, saqarTveloSi pirveladi jandacvis sistemis socialur-ekonomikuri

efeqtianobis amaRlebis Tanamedrove problemebi ,,

- 6 -

Jurnali: ekonomika da biznesi #4, 2009 weli.

2) ,, Проблемы менеджмента в деле повышения качества и эффективности деятельности

системы первичного здравоохранения Грузии ,,

Jurnali: saqarTvelos samedicino siaxleebi #7-8 (172-173), 2009 weli.

3) pirveladi jandacvis socialur-ekonomikuri efeqturobis problemebi

saqarTvelos samedicino Jurnali #2, 2009 weli.

4) ,, pirveladi jandacvis programebis menejmentis arasrulyofileba ,,

Jurnali: ekonomika da biznesi #5, 2009 weli

naSromis struqtura da moculoba: naSromi Sedgeba sami Tavisgan, cxra

paragrafisgan, daskvnebisa da rekomendaciebisagan, gamoyenebuli

literaturisa da danarTisagan. naSromis moculoba kompiuterze nabeWdi

195 gverdia.

- 7 -

Tavi I. jandacvis reformis Taviseburebebi zogierT qveynaSi

1.1. janmrTelobis dacvis politikis ganxorcielebis Taviseburebebi

Tanamedrove pirobebSi

janmrTelobis dacvis politika saxelmwifo politikis erT-erT

ZiriTad mimarTulebas warmoadgens. jansaRi sazogadoeba qveynis

socialur mdgomareobis ganmsazRvrelia da swored amitom, sazogadoebis

janmrTelobis xelSewyoba saxelmwifo interesis sagania.

zogadad, saxelmwifo politikis cneba- aris qveynis mTavrobis mier

winaswar gansazRvruli samomavlo moqmedebis gegma, mkafiod gamoxatuli

mimarTuleba sazogadoebisa da qveynis keTildReobis misaRwevad. rodesac

sazogadoeba irCevs qveynis mTavrobas, is mTavroba aseve iRebs

valdebulebas misi xalxis winaSe, igi valdebulia upasuxos da

daakmayofilos sazogadoebis moTxovnebi, rac demokratiis umTavresi

pirobaa.

dRes-dReobiT saqarTveloSi mravali problemaa, romlebic

erTgvarovnad aqtualuria saxelmwifosTvis, iqneba es qveynis sagareo Tu

saSinao politika. yvela ganviTarebuli qveyana Tavisi istoriuli

warsulis gaTvaliswinebiT gadis ganviTarebis garkveul etapebs, rac arc

Tu ise iolia da sakmaod did dros moiTxovs. msoflios yvela

ganviTarebul qveyanas hqonda gardamavali periodi, rodesac saWiro iyo

mTeli rigi radikaluri cvlilebebis ganxorcieleba, axali sistemebis

Camoyalibeba da axali teqnologiebis danergva. dRes-dReobiT

saqarTveloc imyofeba ganviTarebis iseT gardamaval etapze, rodesac

saWiroa sxvadasxva sistemebis reformireba da inovaciebis danergva,

saxelmwifos ganviTarebisTvis saWiroa arsebuli Zveli stereotipebis

dangreva da axlis Seneba, garda amisa aucilebelia mTeli rigi

reformebis gatareba sxva da sxva seqtorSi; iqneba es ganaTlebis,

sasamarTlo Tu janmrTelobis dacvis sfero. swored sajaro politika

warmoadgens mTavrobaSi arsebuli im brZolis Sedegebs romelSic

ganisazRvreba Tu vis ra ergeba. es aris sazogadoebis is dakveTa,

romelsac mTavroba irCevs Seasrulos Tu ar Seasrulos. ufro martivad

- 8 -

rom vTqvaT, sajaro politika aris mTavrobis moqmedebis sarke, radganac

mas pirdapiri gavlena aqvs qveynis sazogadoebaze.

saqarTvelos saxelmwifo politika iseve rogorc sxva qveynebisa

mimarTulia misi sazogadoebis ukeTesi momavlisken, romelsac garkveuli

prioritetebi gansazRvraven, maT Soris SeiZleba aRvniSnoT siRatakisa da

socialuri uTanasworobis daZleva, cxovrebis donis gaumjobeseba da

Zlieri saSualo fenis Camoyalibebis xelSewyoba, umuSevrobis Semcireba

axali samuSao adglebis Seqmnis xelSewyoba, ganaTlebis xarisxis

gaumjobeseba, saerTaSoriso standartebisa da Sromis bazris

moTxovnebisadmi misi misadageba, pensiebisa da socialuri daxmarebis

programebis miznobriobis uzrunvelyofa, sapensio da sxva davalianebis

dafarvis dasruleba, socialuri dazRvevis efeqtiani sistemis

Camoyalibeba, cxovrebis jansaRi wesis da garemos damkvidrebis

xelSewyoba, socialurad saSiS daavadebaTa (tuberkuliozi, Sidsi,

narkomania) prevencia da amaT Soris erT erTi prioritetuli da

aqtualuri jandacvis sistemis reformireba-xelmisawvdomi da xarisxiani

jandacvis uzrunvelyofa da mravali sxva.

saxelmwifo politikis aseve erT-erTi strategiuli mimarTulebaa

sazogadoebrivi jandacvis ganviTareba, romelic orientacias iRebs ara

marto calkeuli adamianebis janmrTelobis mdgomareobis gaumjobesebaze,

aramed mTlianad sazogadoebisaTvis usafrTxo garemos Seqmnaze.

sazogadoebrivi jandacva cdilobs resursebis moZiebasa da

uzrunvelyofs jandacvis samsaxurebis funqcionirebis, cxovrebis jansaRi

wesis damkvidrebas, daavadebaTa profilaqtikas, diagnostikas, mkurnalobas

da fizikur, socialur Tu profesiul reabilitacias. yovelive es

gansazRvravs aramarto sazogadoebrivi jandacvis zogad ganmartebas,

aramed mis funqciebsa da amocanebs saxelmwifo politikaSi.

saxelmwifo politikis principebi jandacvis sferoSi uSualod

mimarTulia samedicino momsaxurebis Tanasworuflebianobis

uzrunvelyofisaken; mosaxleobis samedicino momsaxurebis sayovelTao da

Tanabari xelmisawvdomobisa da jandacvis sferoSi adamianis uflebaTa da

TavisuflebaTa dacvisaken; pacientis uflebebis aRiarebisa da eqimis

damoukideblobis cnobisaken-(kanoniT daSvebul farglebSi); mosaxleobis

- 9 -

sruli informirebisaken, samedicino momsaxurebis yvela arsebuli formisa

da misi miRebis SesaZleblobisaken, saxelmwifos samedicino momsaxurebis

xarisxze pasuxismgeblobisaken.

msoflioSi qveynebi gansxvavdebian erTmaneTisagan ekonomikuri

ganviTarebis mixedviT. am mxriv saxelmwifoebs yofen dabal, saSualo da

maRalSemosavlian qveynebad, aqedan gamomdinare gansxvavebulia maTi

sistemebi, Sesabamisad maTi marTvis strategiebi da problemebic. qveynis

jandacvis resursebis ganawileba mis ekonomikur SesaZleblobebzea

damokidebuli. rac ufro Semosavliania qveynis mosaxleoba, miT metia

jandacvis resursebi. amasTan, rac ufro metia Semosavlebi da Sesabamisad

jandacvis resursebi, miT ufro mcirdeba daavadebebis gavrceleba da

samedicino daxmarebis saWiroeba. maRalSemosavlian qveynebSi mosaxleobis

janmrTelobis mdgomareobis gaumjobesebis ekonomikurad efeqtur

saSualebas warmoadgens cxovrebis jansaRi wesis danergva da

sazogadoebrivi jandacvis sferoSi mimdinare profilaqtikuri

RonisZiebebi. maRalSemosavlian qveynebSi jansaRi konkurenciis sakiTxi da

ekologiuri Tu sazogadoebis jansaRi cxovrebis wesis gaumjobesebis

problemebia ufro mnSivnelovani da yvelaferi xarisixis

gaumjobesebiskenaa mimarTuli, xolo saSualoSemosavlian qveynebSi

ekonomikurad efeqtur saSualebas warmoadgens garemos dabinZurebis

Semcirebisaken mimarTuli programebi. jandacvis dafinansebis sistemas

politikuri mniSvneloba eniWeba.

miuxedavad ganviTarebis donisa, Tu qveyanaSi ar aris Camoyalibebuli

jandacvis Sesabamisi dafinansebis sistema, mosaxleobis siRaribis ZiriTad

mizezad mZime avadmyofoba da mkurnalobaze gaweuli didi xarjebis

aucilebloba xdeba. jandacvis xarjebi ZiriTadad ganixileba mikro da

makro doneze. mikro done moicavs sazogadoebis

wevrebis (individis) janmrTelobis mdgomareobas. sxvadasxva jandacvis

xarjebi ZiriTadad dakavSirebulia TiToeuli individis janmrTelobis

mdgomareobaze, miuxedavad imisa, avad aris Tu ara es piri, xolo makro

done ganixileba mSp-is erT sul mosaxleze biujetidan danaxarjebis

procentuli maCvenebliT. sxvadasxva qveynebSi TiToeul pirze jandacvis

sxvadasxva xarjebi dakavSirebulia Semosavlebis gansxvavebul doneze.

- 10 -

jandacvis mosalodneli xarjebi mkveTrad gansxvavebulia, individualur

xasiaTs atarebs da damokidebulia sxvadasxva faqtorebze, maSin roca

saxelmwifo doneze (makrodoneze) gadawyvetilebis miReba, Tu biujetidan

ramdeni unda daixarjos jandacvis seqtorze, ufro farTo maStabis

xasiaTs atarebs. (cxrili 1)

cxrili 1.

jandacvis xarjebi mikro da makro doneze

mikrodone janmrTelobis

mdgomareoba

individualur doneze sxvadasxva

jandacvis xarjebi ZiriTadad

dakavSirebulia TiToeuli individis

janmrTelobis mdgomareobaze, miuxedavad

imisa, avad aris Tu ara es piri.

makrodone GDP erT sulze sxvadasxva qveynebSi TiToeul pirze

jandacvis sxvadasxva xarjebi

dakavSirebulia Semosavlebis gansxvavebul

doneze

wyaro: http://www.who.int/research/ru/ ( jandacvis msoflio statistika 2009 w.)

1990-ian wlebSi socialisturi wyobis ngrevis Semdeg moxda mTeli

rigi cvlilebebi rogorc yofili sabWoTa kavSiris qveynebSi, aseve

centralur Tu aRmosavleT evropaSi, iqneba es samTavrobo, sakanonmdeblo

Tu dafinansebis, mflobelobis, politikis da jandacvis sistemaSi.

centralur da aRmosavleT evropaSi saxelmwifo jandacvis politika

prioritetad ayenebs saxelmwifo saxsrebis saTanadod gamoyenebis

aucileblobas. prioritetuloba arsebul jandacvis problematikasTan

ganisazRvreba qveyanaSi arsebuli jandacvis saerTo mdgomareobiT.

ukanasknel wlebSi msoflioSi mimdinare ekonomikurma, demografiulma,

socialur-kulturulma da politikurma cvlilebebma mniSvnelovani

gavlena moaxdines jandacvis sistemebzec. 90-iani wlebis dasasruls

msoflio ekonomika radikalurad gansxvavdeboda 80-iani wlebisagan.

centralur da aRmosavleT evropaSi ganviTarebulma politikurma da

ekonomikurma reformebma adre arsebuli centralizebuli da gegmiuri

ekonomikuri sistemebis seriozuli struqturuli gardaqmnebi gamoiwvia.

- 11 -

gaizarda mSp–is %-uli maCveneblebi erT sul mosaxleze, Seicvala

ekonomikis mimarTulebebi da Sesabamisad qveynebmac ganicades

mniSvnelovani cvlilebebi, rac cxadad aisaxa ama Tu im qveynis ekonomikur

maCveneblebze . mgaliTad mSp-is wliuri zrda, yvelaze maRali maCvenebliT

aRsaniSnavia aRmosavleT aziisa da wynari okeanis qveynebSi, ramac

saSualod 6,2% Seadgina, xolo yvelaze naklebi %-uli maCvenebeli

laTinuri amerikisa da axlo aRmosavleTis qveynebSi dafiqsirda.(cxrili 2)

cxrili 2.

mSp-is saSualo wliuri zrda erT sul mosaxleze % (2000-2007ww.)

regioni mSp-is saS. wliuri zrda

aRm. azia da wynari okeanis qveynebi 6.2

samxreT azia 3.2

Evropa 1.4

laTinuri amerika - 0.4

axlo aRmosavleTi da Crd. afrika - 2.5


qveynis mosaxleobis zogadi janmrTelobis mdgomareoba ganisazRveba

am qveynis socialur demografiuli da ekonomikuri mdgomareobiT. mag:

demografiuli mdgomareoba Tavis mxriv - izomeba sikvdilianobisa da

Sobadobis maCvenebliT, rogoria mosaxleobis mateba, misi dabereba

gaaxalgazrdaveba, sqesobrivi Tanafardoba, saSualo sicocxlis

xangrZlivoba da a.S. amis mixedviT qveynebi gansazRvraven jandacis

dafinansebis maStabebs da prioritetebs.

ukanaskneli aTwleulis ganmavlobaSi gamoikiveTa axali tendenciebi

romlebic mkveTrad cvlis qveynis demografiul mdgomareobas. swored es

tendenciebi gaxda msoflio jandacvis organizaciisTvis yuradRebis

sagani. aRniSnulTan dakavSirebiT ganxilul sxva da sxva avtorTa

naSromebSi gamoxatuli azri ZiriTadad emTxveva erTmaneTs, rom:

socioekonomikuri disbalansi, sazogadoebis janmrTelobis saerTo

mdgomareobis gauareseba, arainfeqciuri daavadebebi da maTTan

dakavSirebuli risk-faqtorebi, sikvdilianoba, avadoba da samedicino

- 12 -

momsaxurebis xelmisawvdomobasTan dakavSirebuli problemebi-globaluri

maStabis mwvave realobaa.

miuxedavad imisa, rom ganviTarebul qveynebSi bolo periodSi

mniSvnelovnad Semcirda sikvdilianobisa da avadobis maCvenebeli, dabal

ganviTarebul qveynebSi am mxriv cvlilebebi sapirispirod mimdinareobs.

Seicvala avadobis struqtura, gaizarda qronikul avadmyofTa ricxvi.

xolo ganviTarebuli qveynebis orientacia ZiriTadad daavadebebis

prevenciasa da jansaRi garemoskenaa ufro mimarTuli. maRalganviTarebul

qveynebSi samedicino daxmarebis maRali fasebis kontroli efeqturi

dafinansebis politikis saSualebiT regulirdeba. ase magaliTad, did

britaneTSi, Sveciasa da kanadaSi jandacvis erTi wyarodan dafinansebis

principis SemoRebam jandacvaze xarjebis Semcireba ganapiroba. aSS-Si,

sadac dafinansebis mravali wyaroa (kerZo Tu saxelmwifo seqtori),

jandacvis xarjebis erT doneze SenarCuneba did sirTules warmoadgens.

finansuri politikis ararsebobisas jandacvis xarjebi SeiZleba mZime

tvirTad daawves saxelmwifos biujets. amis magaliTs warmoadgens aSS-is

da samxreT afrikis qveynebis gamocdileba, sadac araefeqturi finansuri

politikis gamo, kerZo sadazRvevo kompaniebi mosaxleobis srul mocvas

ver axorcieleben, ris gamoc umuSevrebi, xandazmulebi da qronikuli

avadmyofebi samedicino dazRvevis gareSe rCebian. mosaxleobis moTxovnisa

da politikuri zewolis Sedegad aSS-is mTavroba uzrunvelyofs

xandazmulTa, umweoTa da invalidTa samedicino daxmarebis dafinansebas.

amave dros, aRsaniSnavia, rom kerZo sadazRvevo kompaniebSi dazRveuli

SedarebiT janmrTeli da SeZlebuli pirebi uaryofiT damokidebulebas

gamoxataven maRali gadasaxadebis gamo da negatiurad aRiqvamen jandacvis

dafinansebis politikaSi saxelmwifos mxridan aqtiur monawileobas.

jandacvis dafinansebis politika gansazRvravs Tu ramdenad

xelmisawvdomia samedicino daxmarebis ZiriTadi saxeebi qveynis mTeli

mosaxleobisaTvis, agreTve samedicino daxmarebis ra saxeebi unda

dafinansdes da.a.S.

ganviTarebul qveynebSi jandacvaze sakmaod didi Tanxebi ixarjeba,

Sesabamisad am qveynebis mosaxleobis janmrTelobis mdgomareoba SedarebiT

- 13 -

maRalia. maRal SemosavlebTan mravali faqtoria dakavSirebuli

magaliTad: ganaTleba, kveba, sanitaruli mdgomareoba.

msoflioSi jandacvaze danaxarjebis saSualo maCvenebeli mTliani

Sida produqtis 8,7 %-s Seadgens. am mxriv, yvelaze ufro maRali

maCvenebeli amerikis regionze modis – 12,8 %, dabali ki - aziis regionze

(3,4%). moyvanil cxrilSi mocemulia danaxarjebi jandacvaze msoflio

regionebis mixedviT, romelic ZiriTadad saxelmwifosa da kerZo seqotrs

Soris nawildeba. msoflioSi jandacvis mTlian xarjebSi saxelmwifo

xarjebis wili Seadgens 57,6 %-s, xolo kerZo wyaroebisa ki 42,4 %-s.

saxelmwifo danaxarjebis yvelaze ufro dabali maCvenebeli aziis

regionSia, sadac igi 33,6 %-s Seadgens. ganviTarebul qveynebSi jandacvaze

saxelmwifo xarjebis wili saSualod 60,7 %-s Seadgens, xolo kerZo

wyaroebis wili 39,3 %-s. (cxrili 3).

cxrili 3. jandacvaze danaxarjebi msoflio regionebis mixedviT 2007 weli

regioni jandacvaze

danaxarjebi

jandacvis xarjebi

wyaroebis mixedviT

(mTlianis %)

jandacvis xarjebi

erT sul

mosaxleze (US$)

erT

sulze

(US$)

mSp % saxelmwifo kerZo saxelmwifo kerZo

afrikis regioni 58 5,5 47,1 52,9 27 31

aziis regioni 31 3,4 33,6 66,4 11 20

Evropis regioni 1756 8,4 75,6 24,4 1350 406

amerikis regioni 2636 12,8 47,7 52,3 1252 1384

ganviTarebadi

qveynebi 412 6,3 55,1 44,9 225 187

ganviTarebuli

qveynebi 4012 11,2 60,7 39,3 2470 1542

saSualo

maCvenebeli

msoflioSi

716 8,7 57,6 42,4 429 287


- 14 -

2007 wlis monacemebiT, saerTo Sida produqtis mixedviT jandacvaze

gaweuli xarjebis wili msoflios maStabiT yvelaze didia aSS-Si (15,3 %),

SveicariaSi (10,8 %), germaniaSi (10,6%). (cxrili 4)

cxrili 4. xarjebi jandacvaze- mTliani Sida produqtis (GDP%) mixedviT.


Qqveyana 1980 1990 1998 2007

avstralia 7 7,9 8,6 8.7

avstria 7,6 7,1 8 10.2

belgia 6,4 7,4 8,6 9.9

kanada 7,1 9 9,3 10

CexeTi 3,8 5 7,3 6.9

dania 9,1 8,5 8,3 10.8

fineTi 6,4 7,9 6,9 8.2

safrangeTi 7,4 8,6 9,4 11

germania 8,8 8,7 10,3 10.6

saberZneTi 6,5 7,5 8,4 9.5

ungreTi 5.2 6..1 6,8 9.1

islandia 6,1 7,9 8,4 9.1

irlandia 8,4 6,7 6,8 7.5

italia 7 8,1 8,2 9

iaponia 6,5 6,1 7,4 8.1

norvegia 7 7,8 9,4 8.7

poloneTi 5,3 6,4 6.2

portugalia 5,6 6,2 7,7 10.2

espaneTi 5,4 6,6 7 8.4

Svecia 9,1 8,5 7,9 9.2

Sveicaria 7,3 8,3 10,4 10.8

TurqeTi 3,3 3,6 4,8 4.8

didi britaneTi 5,6 6 6,8 8.2

aSS 8,7 11,9 12,9 15.3

- 15 -

jandacvis politika da maTi sistemebi centralur, aRmosavleT da

dasavleT evropaSi mkveTrad gansaxvavdeba erTmaneTisagan. mTel rig

qveynebSi jandacva sazogadoebis interessa da ZiriTad sazrunavs

warmoadgens, magram arseboben iseTi qveynebic, sadac es sfero naklebad

prioritetulia saxelmwifosTvis ganviTarebis garkveul etapze.

saxelmwifos mier gamoyofili Tanxebis procentuli maCveneblebiT kargad

Cans saxelmwifosTvis ama Tu im seqtoris prioritetuloba. Tu

gaviTvaliswinebT dasavleTis ekonomikaSi finansur maCveneblebs

resursebis ganawilebis mixedviT sxva da sxva seqtorze saerTo Sida

produqtis (GDP) saxelmwifo danaxarjebis mixedviT, janmrTelobis sfero

mowinave adgilzea, mTavrobis Tu sazogadoebis prioritetTa CamonaTvalSi,

romelsac mosdevs sxva da sxva seqtorebi.

arsebobs jandacvis sistemis ramodenime saxis modelebi, rogoricaa

“bismarkis”, ”semaSkos”, “beverijis” Tu ”amerikuli” modeli, romlebic

TavianTi maxasiaTeblebiT gamoirCevian. zogi maTgani orientirebulia

saxelmwifo dafinansebaze, zogi sadazRveo sistemaze, zogic kerZo

dafinansebaze, rac saxelmwifos Carevas mniSvnelovnad amcirebs. yvela

ganviTarebuli qveynisTvis sadazRevo sistema da Tanadafinanseba

mniSvnelovan rols TamaSobs, xolo ganviTarebad da zog

dabalSemosavlian qveynebSi aqtualuri jer kidev centralizebuli

saxelmwifo dafinansebis modelia ”semaSko”. (cxrili 5).

cxrili 5. jandacvis sistemebis dafinansebis ZiriTadi modelebi.

modelis tipi ZiriTadi maxaiaTeblebi Qveynebi

bismarkis

socialuri dazRvevis

modeli

1883

Semosavlebidan miRebul

gadasaxadebze dafuZnebuli

socialuri dazRvevis

sistema. saxelmwifos roli

minimaluri

germania, belgia,

safrangeTi,

nidrelandebi

semaSkos modeli

1918

jandacvis centralizebuli

sistema saxelmwifo

dafinansebiT

yofili

sabWoTa kavSiris

qveynebi

- 16 -

beverijis modeli

1947

jandacvis centralizebuli

sistema saxelmwifo

dafinansebiT, kerZo

dazRvevisa da momsaxurebis

meti SesaZlebloba

didi britaneTi,

SvedeTi, norvegia,

fineTi

amerikis modeli

1960-iani wlebi

Sereuli forma, saxelmwifos

roli dafinansebaSi

minimaluria

aSS

yvela zemoTCamoTvlili modelidan TioToeli maTgani Tavisi dadebiTi

Tu uaryofiTui TvisebebiT gamoirCeva. rac ufro ganviTrebuli qveynebis

ricxvs miekuTvneba esa Tu is saxelmwifo, miT ufro naklebia saxelmwifo

dafinanseba am seqtorSi. ganvixiloT TiToeuli sistemis modeli qveynebis

ganviTarebis mixedviT da maTi dadebiTi Tu uaryofiTi maxasiaTeblebiT:

msoflios ganviTarebuli qveynebis (dasavleT da centraluri

evropa) maRalSemosavlian (10000 $-ze meti) mosaxleobis nawils, 850

milioni Seadgens. maT ricxvs agreTve miekuTvneba aSS, kanada, iaponia,

avstralia, axali zelandia da sxv. maRalSemosavlian qveynebSi erT sul

mosaxleze, jandacvis sferoSi saSualod 4012 dol. 2007 w. ixarjeba. am

mxriv, yvelaze didi maCvenebliT xasiaTdeba aSS 6096 dol. 2007w. Sveicaria

4179 dol. 2007 w. safrangeTi 3937 dol. 2007w. sicocxlis saSualo

xangrZlivoba Seadgens 76 wels, perinataluri sikvdilianobis maCvenebeli

Seadgens yovel 1000 axalSobilze 9-s, tuberkuloziT daavadebulTa

maCvenebeli – 1000 mosaxleze 0,2 % (1990 w.) 1000 mosaxleze 2,5 eqimia da 8,3

sawoli. ganviTarebul qveynebSi jandacvaze xarjebi erT sul mosaxleze

gaTvliT saSualod 1675 aSS dolars Seadgens. ganviTarebul,

maRalSemosavlian qveynebSi jandacvis sistemaSi aRiniSneba gansxvavebebi

eqimebis raodenobaSi (1,4-dan 4,3-mde 1000 mosaxleze), sawolTa raodenobaSi

(3,9-dan 16,1-mde 1000 mosaxleze), samedicino momsaxurebis organizaciaSi,

jandacvis mTlian xarjebSi ($383-dan $2763-mde TiTo sulze), magram

miuxedavad amisa, janmrTelobis mdgomareobis maCveneblebi am qveynebSi

TiTqmis Tanabaria sicocxlis saSualo xangrZlivoba 74 wlidan 79 wlamde

meryeobs, axalSobilTa sikvdilianoba – 5-dan 9-mde meryeobs yovel 1000

axalSobilze jandacvis statistikuri monacemebi qveynis SigniT,

- 17 -

regionebSi ufro metad gansxvavdeba, vidre qveynebs Soris am qveynebis

sazogadoebis saerTo socio-ekonomikuri mdgomareobis gaTvaliswinebiT,

Znelia daadgino romeli qveynis jandacvis sistema ufro ukeTesia.

jandacvis problemebi ZiriTadad dakavSirebulia mosaxleobis im

nawilTan, romelzec ar vrceldeba socialuri dazRveva, eTnikur

umciresobebTan, an Rarib ubnebSi mcxovreb mosaxleobasTan. agreTve

yuradRebas iqcevs iseTi problemebi, rogoricaa bavSvTa imunizaciis

sruli mocva, mkurnalobis Semdgomi reabilitacia, damatebiTi

eqsperimentuli mkurnaloba. kvlevebi adastureben, rom iseve rogorc

dabalSemosavlian da saSualoSemosavlian qveynebSi, maRalSemosavlian

qveynebSic aRiniSneba resursebis ganawilebasTan dakavSirebuli

problemebi.

amerikis SeerTebuli Statebis janmrTelobis dacvis sistema Sereuli

tipis modeliT xelmZRvanelobs da saxelmwifosTan erTad ZiriTadad

kerZo sadazRvevo sistemebiT muSaobs. saxelmwifo uzrunvelyofs mxolod

pensionerTa da umuSevarTa janmrTelobis dazRvevas. aSS-s mosaxleobis

zogadi demografiuli suraTi aseTia: erT sul mosaxleze jandacvis

danaxarjebi 6096 dolars Seadgens, rac mTliani Sida produqtis (mSp)

15.4%-ia, maT Soris saxelmwifo danaxarji 2682 dolaria (mTlianad

janmrTelobaze daxarjulis (44,7%). dabadebisas sicocxlis mosalodneli

saSualo xangrZlivoba 78 welia (cxrili 6).

cxrili 6. aSS zogierTi demografiuli da ekonomikuri maCvenebeli 2007 w.

qveynis mosaxleoba (mln) 305.8

mosaxleobis saSualo wliuri mateba 1,1%

sicocxlis mosalodneli saSualo

xangrZlivoba (weli)

sul 78,0

Kkaci 75,1

Qqali 80,9

danaxarjebi jandacvaze % mTliani Sida produqtidan 15,4

saxelmwifo danaxarjebis % jandacvis mTlian danaxarjebSi 44,7

kerZo danaxarjebis % jandacvis mTlian danaxarjebSi 55,3

saerTo danaxarjebi 1 sul mosaxleze janrTelobaze (aSS dolari) 6096


- 18 -

miuxedavad imisa, rom qveyana ganviTarebul saxelmwifoTa ricxvs

miekuTvneba, yvelaze did naklovanebad jandacvis sferoSi miCneulia kerZo

dafianasebis modeli, rac garkveul bariers uqmnis sazogadoebis umcires

nawils, romlebzec ukve saxelmwifo iRebs valdebulebas. garda amisa aSS-

s sistema udidesi pozitiuri maxasiaTeblebiT gamoirCeva esenia:

maRalkvalificiuri samedicino daxmareba, socialurad daucveli fenebis

(xanSiSesuli, uZluri da Raribi mosaxleoba) janmrTelobis dacvis

dafinansebis saxelmwifoebrivi sistemis arseboba da mravali sxva rac sxva

saxelmwifoebs naklebad axasiaTebT.

magaliTad did britaneTSi, radikalurad gansxvavebuli (“beverijis”

modeli) sistemaa. did britaneTi jandacvis sistemas saxelmwifo

biujetidan aregulirebs, Tumca arsebobs kerZo sadazRvevo sistemebic. igi

xasiTdeba jandacvis centralizebuli sistemis saxelmwifo dafinansebiT,

kerZo dazRvevisa da momsaxurebis meti SesaZleblobebiT. did britaneTSi

erT sul mosaxleze jandacvis danaxarjebi 2899.7 aSS dolars Seadgens,

rac mTliani Sida produqtis (mSp) 7,6%-ia, maT Soris saxelmwifo

danaxarji 2502 aSS dolaria (mTlianad janmrTelobaze daxarjulis 86,3%).

dabadebisas sicocxlis mosalodneli saSualo xangrZlivoba 77,25 wels

Seadgens (cxrili 7).

cxrili 7.

didi britaneTis zogierTi demografiuli da ekonomikuri maCvenebeli 2007weli.

qveynis mosaxleoba (mln) _ 60,7


sicocxlis mosalodneli

saSualo xangrZlivoba (weli)

sul 77,25

Kkaci 77,0

Qqali 81,0




saerTo danaxarjebi 1 sul mosaxleze (aSS dolari) 2899,7


- 19 -

britanuli jandacvis sistemis organizaciisa da dafinansebis

safuZvels pirveladi samedicino momsaxurebis prioritetuloba

warmoadgens.

ojaxis eqimebis roli am qveyanaSi mniSvnelovania da raodenobrivad

50%-s aRwevs. pirveladi jandacva did britaneTSi kargadaa ganviTarebuli

rac ZiriTadad awesrigebs mosaxleobis mniSvnelovan problemebs. didi

britaneTis jandacvis sistemisaTvis damaxasiaTebelia: Zlieri

sakanonmdeblo baza; dafinansebis saxelmwifoebrivi wyaroebi, stabiluri

fasebi da gansakuTrebuli upiratesoba ki is aris rom sxva ekonomikurad

ganviTarebul qveynebTan SedarebiT didi britaneTis saxelmwifo politika

xasiaTdeba jandacvaze saSualo donis danaxarjebiT. miuxedavad amisa, am

qveynisTvis damaxasiaTebelia kargi xarisxobrivi maCveneblebi, rogorc

samedicino kadrebis kvalificiurobaSi, aseve samedicino servisis

miwodebaSi, Tumca didi britaneTis sistemisTvisac albaT arsebobs

garkveuli naklovanebebi, romelTa problemebsac saxelmwifo uaxloes

momavalSi garkveli strategiebis saSualebiT gadaWris.

rac Seexeba safrangeTs, rogorc erT erT ganviTarebul qveyanas aq

samedicino dazRveva erTiani socialuri dazRvevis nawils warmoadgens

(bismarkis modeli). qveyanaSi Seqmnilia Semosavlebidan miRebul

gadasaxadebze dafuZnebuli socialuri dazRvevis sistema, romelic

mosaxleobis 80%-s emsaxureba, xolo saxelmwifos roli minimaluria.

safrangeTSi erT sul mosaxleze jandacvis danaxarjebi 2109 aSS

dolars Seadgens, rac mTliani Sida produqtis (mSp) 9,6%-ia, maT Soris

saxelmwifo danaxarji 1603 aSS dolaria (mTlianad janmrTelobaze

daxarjulis 76%). dabadebisas sicocxlis mosalodneli saSualo

xangrZlivoba am qveyanaSi erT-erTi yvelaze maRali maCvenebelia evropaSi

da 79,7 wels Seadgens. safrangeTSi moqmedebs janmrTelobis dacvis

centralizebuli sistema. dakanonebulia samedicino momsaxurebis

safasuris Tanagadaxda mosaxleobis mxridan. amasTan, momsaxurebis

umetesobaze saxelmwifo atarebs fasebis mkacri regulirebis politikas,

rac zRudavs jandacviTi danaxarjebis zrdas.

ganviTarebul qveynebs Soris saintereso iqneba iaponiis modelis

ganxilvac, radgan iaponiis jandacvis dafinansebis modeli gamoirCeva

- 20 -

mosaxleobis sruli mocviT, romlis sadazRvevo sistema socialuri daz-

Rvevis saerTo erovnuli sistemis nawils warmoadgens. igi gamoirCeva

agreTve sicocxlis yvelaze maRali maCvenebliT, sadac sicocxlis

mosalodneli saSualo xangrZlivoba 81,9 wels Seadgens. iaponiis

jandacvis sistema orientirebulia daavadebaTa profilaqtikaze, rac e.w.

janmrTelobis centrebis meSveobiT xorcieldeba, sadac saqmianoben zogadi

praqtikis eqimebi da saSualo samedicino personali. yovelive es misi

ganviTarebis dones mianiSnebs. garkveul sirTules iaponia hospitalur

seqtorSi awydeba, sadac avadmyofis sawolze dayovneba 37.2 dRes Seadgens,

maSin rodesac aSS-Si igi mxolod 9,2 dRes moicavs. amitom iaponiaSi

saavadmyofoebSi sawolTa ricxvi TiTqmis orjer metia sxva ganviTarebul

qveynebTan SedarebiT.

kanadaSi ki kargadaa ganviTarebuli janmrTelobis dazRvevis

saxelmwifo sistema. igi samedicino momsaxurebis donis amaRlebazea

orientirebuli da mis saxelmwifo politikas mosaxleobis jamrTelobis

mdgomareobis gaumjobeseba warmoadgens. erT sul mosaxleze danaxarjebis

gadanawilebis mixedviT kanadaSi ixarjeba 3173 aSS dolari, rac mTliani

Sida produqtis (mSp) 9,8%-ia, maT Soris saxelmwifo danaxarji 2214 aSS

dolaria (mTlianad janmrTelobaze daxarjulis 69,8%). dabadebisas ki

sicocxlis mosalodneli saSualo xangrZlivoba 79,8 wels Seadgens (cxrili 8)

cxrili 8. kanadis zogierTi demografiuli da ekonomikuri maCvenebeli 2007weli.

qveynis mosaxleoba (mln) 32,876


sicocxlis mosalodneli saSualo

xangrZlivoba

sul 79,8

Kkaci 78,0

Qqali 83,0

danaxarjebi jandacvaze mTliani Sida produqtidan 9,8

saxelmwifo danaxarjebis % jandacvis mTlian danaxarjebSi 69.8


saerTo danaxarjebi 1sul mosaxleze (aSS dolari) 3173


kanadaSi funqciebi gadanawilebulia federalur da adgilobriv

doneze, rac imas niSnavs, rom federaluri xelisufleba strategiuli

- 21 -

xasiaTis sakiTxebis gadawyvetaSi monawileobs, xolo jandacvis obieqtebis

mimdinare saqmianoba municipaluri organoebis kompetenciaSi Sedis. kanadis

jandacvis sistemis prioritetebs ganekuTvneba momsaxurebis xarisxi,

samedicino dazRvevis saxelmwifo sistemis arseboba; Tumca qveyanaSi

gaweuli samedicino daxmarebis Rirebuleba sakmaod maRalia da mudmivi

matebis negatiuri tendenciiT xasiaTdeba

msoflios saSualoSemosavliani mosaxleoba (romelTa Semosavali

saSualod erT sul mosaxleze aris 1000 $-dan 7500 $-mde) Seadgens 1,5

miliards da warmodgenilia laTinuri amerikis, aRmosavleT evropis,

samxreT afrikis qveynebiT, agreTve ruseTi, korea, TurqeTi, saudis arabeTi

da Sua aRmosavleTis navTobiT mdidari sxva qveynebi.

saSualoSemosavliani qveynebi ekonomikuri ganviTarebis process

ganicdian. mosaxleobis garkveuli nawili amjobinebs qalaqad migracias.

ekonomikuri aRmavlobis Sedegad zog qveyanaSi mkveTrad izrdeba

jandacvis xarjebSi saxelmwifo dafinansebis wili. yalibdeba socialuri

dazRvevis saxelmwifo sistemebi. zog qveynebSi, mniSvnelovnad ganviTarda

kerZo sadazRvevo sistema. saSualo Semosavlian qveynebSi samedicino

sadazRvevo sistema gardamaval etapze imyofeba. miuxedavad imisa, rom

kanonis mixedviT dagegmili universaluri mocva, realurad samedicino

daxmarebis xelmisawvdomoba araTanabaria. Sedegad, am qveynebSi ufro

metad iseTi daavadebebia gavrcelebuli, romlebic cxovrebis jansaRi

wesis arasakmaris damkvidrebasTanaa dakavSirebuli (gulsisxlZarRvTa

sistemis daavadebebi, simsivne daaS.).

am qveynebisaTvis damaxasiaTebelia resursebis araTanabari

ganawileba, kerZod qalaqad didi klinikuri saavadmyofoebis arseboba,

maSin roca soflad eqimebis naklebobaa, agreTve, viwro specialistebis

didi raodenoba, maSin rodesac pirveladi jandacvis eqimebis naklebobaa.

aseT qveynebs miekuTvneba magaliTad TurqeTi, sadac moqmedebs

janmrTelobis dacvis sistemis dafinansebis Sereuli tipi, romelic

iTvaliswinebs saxelmwifo da kerZo dafinansebas. amasTan, TurqeTSic 1990-

iani wlebidan mimdinareobs janmrTelobis dacvis sistemaSi fundamenturi

cvlilebebi. didi yuradReba eTmoba sadazRveo sistemis ganviTarebas,

Tumca isic unda aRiniSnos rom saxelmwifo danaxarjebis mixedviT

- 22 -

TurqeTi, iseve rogorc sxva ganviTarebadi qveynebi, erT sul mosaxleze

saxelmwifo danaxarjebis mixedviT maRali maCveneblebiT ar gamoirCeva

da mxolod 324.8 aSS dolars Seadgens, rac mTliani Sida produqtis (mSp)

5%-ia, aqedan saxelmwifo danaxarjebi 234 aSS dolaria (mTlianad

janmrTelobaze daxarjulis 72.3%). sicocxlis mosalodneli saSualo

xangrZlivoba am qveyanaSi ki 71,5 welia (cxrili 9).

cxrili 9.

TurqeTis zogierTi demografiuli da ekonomikuri maCvenebeli 2007 weli.

qveynis mosaxleoba (mln) 74,87



saSualo xangrZlivoba

sul 71,5

Kkaci 69,0

Qqali 74,0

danaxarjebi jandacvaze mTliani Sida produqtidan 5%


kerZo danaxarjebis % jandacvis mTlian danaxarjebSi 27.7

saerTo danaxarjebi 1 sul mosaxleze (aSS dolari) 324,8


TurqeTis saxelmwifo politika prioritets janmrTelobis sferoSi

aniWebs mosaxleobis janmrTelobis profilaqtikasa da dedaTa da bavSvTa

jamrTelobis dacvas, Sesabamisad qveyanaSi aqtualuria struqturuli

cvlilebebi am sistemaSi, rorgorc sistemis decentralizaciis mizniT

aseve misi dafinansebis kuTxiTac. TurqeTis magaliTi aRebuli iqna

saSualoSemosavliani, ganviTarebadi qveynebis nimuSad. msgavsi viTarebaa

sxva ganviTarebad qveynebSic.

msoflio mosaxleobis naxevarze meti dabalSemosavlianTa ricxvs

ganekuTvneba. aseTi tipis qveynebisaTvis damaxasiaTebelia infeqciur

daavadebaTa meti gavrceleba, arasrulfasovani kveba, soflad mosaxleobis

meti raodenoba da sxva. qalaqSi mcxovreb, samTavrobo seqtorSi

dasaqmebulebs ufro meti Semosavlebi aqvT da Sesabamisad maTi samedicino

daxmarebis xelmisawvdomobis donec ufro maRalia. aRniSnuli mdgomareoba

resursebis araTanabar ganawilebas ganapirobebs, ase magaliTad, aRiniSneba

- 23 -

dedaqalaqSi Tanamedrove donis, ZviradRirebuli samedicino

teqnologiebis mqone saavadmyofoebis arseboba, maSin roca regionebSi

eqimebis naklebebobaa, xolo saavadmyofoebis xarisxobriv doneze saubaric

zedmetia. jandacvis biujetis TiTqmis naxevarze meti dedaqalaqis

samedicino dawesebulebebisaTvis ixarjeba. dabalSemosavlian qveynebSi

janmrTelobis mdgomareobis dabali done umTavresad gamowveulia

marTvisa da organizaciis dabali xarisxiT, arasrulfasovani kvebiT,

politikuri arastabilurobiT, ganaTlebis dabali doniT da a.S.

yofili sabWoTa kavSiris sivrceSi ganxilvisaTvis mniSnvelovania

tajikeTis magaliTi, romelic msoflios uRaribes qveynebs Soris 20

adgilzea. misi mosaxleobis 80 %- siRaribis zRvars qvemoT cxovobs.

msoflio jandacvis organizaciis statistikuri monacemebis mixedviT

1998 wlisTvis erT sul mosaxleze GDP Seadgenda US $215. sabWoTa

kavSirisTvis igi warmoadgenda mineraluri wylebis mimwodebel qveyanas

romlis ekonomikac sabWoTa kavSiris daSlis Semdeg mniSvnelovnad

dazianda. siRaribis zRvari 90-ian wlebSi kidev ufro gamwvavda –ojaxi

Semosavlis 70% sakvebze xarjavda. yvelaze metad dazaraldnen

mcirewlovan bavSviani ojaxebi da zogierTi geografiuli adgilebi anu

qalaqidan daSorebuli teritoriebi, sadac jandacvis servisi miuwvdomeli

iyo. yovelive es miuTiTebs yveyanaSi arsebul siRaribesa da mzard

araTanabaruflebianobaze, romelic dasavleT evropis qveynebTan SedarebiT

srul winaaRmdegobaSia.

1990-ian wlebSi jandacvis sistemis reforma tajikeTis politikis

dRis wesrigSi naklebad mniSvnelovan adgils iWerda. iseve rogorc dsT-s

sxva qveynebma tajikeTmac ganicada mniSvnelovani politikuri ekonomikuri

da socialuri cvlilebebi. 1995 wlidan qveynis danaxarjebi jandacvaze

mSp-s 2% mde daeca, romlis mizezic tajikeTis gaRatakebamde misuli

mosaxleoba iyo, romelic yofil sabWoTa kavSiris qveynebs Soris yvelaze

naklebad ganviTarebul qveyanas warmoadgenda. am qveyanas igive problemebi

udgas win jandacvis seqtorSi, rogorc sxva dsT-s qveynebs reformasTan

dakavSirebiT. saerTo sazogadoebis janmrTeloba gauaresda, romelic aseve

aisaxa qveynis ekonomikur mdgomareobaze. (Hutton, 2002)

- 24 -

resursebis araTanabari ganawilebis garda aseve mniSnvelovania am

sistemis sxva da sxva seqtorebSi investiciebis araTanabari gadanawilebac,

rac uaryofiT gavlenas axdens Tanasworuflebianobasa da

xelmisawvdomobaze. hatoni (Hutton) Tvlis rom 1990-ian wlebidan ufaso

momsaxurebis Sewyvetis Semdeg da mas Semdeg, rac moimata pirdapirma

gadasaxadebma, Raribi mosaxleoba naklebad mimarTavs samedicino

momsaxurebas da ukve mimarTavs sakuTari biujetis Sesabamisad, rac imas

niSnavs rom maT aRar aqvT SesaZlebloba gascdnen pirveladi

janmrTelobis momsaxurebis dones. miuxedavad amisa sxva da sxva qveynebSi

saxelmwifo danaxarjebi ufro meore donis seqtorzea mimarTuli.

magaliTad tajikeTsa da yazaxeTSi sazogadoebriv jandacvaze

saxelmwifo danaxarjebSi minimaluria pirveladi janmrTelobis dacvis

wili da is orientirebulia stacionarul mkurnalobaze razec

sazogadoebrivi jandacvis biujetis 70 %-ia gaTvaliswinebuli.

1999 wels tajikeTSi cxovrebis donis Sesaxeb Catarebul gamokiTxvis

Sedegebs, araformalur gadasaxdebsa da xelmisawvdomobasTan dakavSirebiT

mivyavarT im daskvnamde, rom mdidrebi orjer ufro metad mimarTaven

saavadmyofoebs, vidre Raribebi (7.8% 3.5%-Tan SedarebiT), igive

mdgomareobaa yirgizeTSi da sxva dsT-s qveynebSi, sadac mimarTvianobis

sixSire mdidrebSi aris 9% xolo RaribebSi 5%. yovelive es dafinansebis

regresiulobis maCvnenebelia. (Falkingham 2001) .

Tanamedrove tajikeTis jandacvis sistemis modeli sabWoTa modelis

msgavsia mcire struqturuli gansxvavebebiT. saxelmwifo rCeba jer kidev

ZiriTad damfinanseblad servisis momwodeblad. respublikis doneze

jandacvis saministro marTavs saxelmwifo–donis jandacvis servisebs,

xolo adgilobrivi sammarTveloebi (raionuli) xelmZRvanelobas uweven

adgilobriv samedicino samsaxurs. politikas da maregulirebel organoebs

aseve marTavs saministro. momsaxurebis xarisxsa da saerTo

xelmisawvdomobaze am qveyanaSic saubari albaT uxerxulia.

adamianis uflebebis dacvis SedarebisTvis evropisa da dsT-s qveynebs

Soris TvalsaCino magaliTad SeiZleba dsT-s sxva qveynebTan erTad

tajikeTi aviRoT sadac naTlaT Cans Tu ramdenad daculia adamiani

sazogadoebaSi da ramdenad SesaZlebelia am sazogadoebis yvela

- 25 -

wevrisaTvis srulyofili samedicino momsaxurebis miReba. ramdenad

xelmisawvdomia jandacvis sistema ubralo adamianebisTvis da ramdenad

efeqturia maTi muSaoba.

tajikeTi inarCunebs jandacvis uzrunvelyofis saxelmwifo

dafinansebis da momsaxurebis sistemas. jandacva kvlav hospitalur

momsaxurebazea orientirebuli da saxsrebi pirveladi daxmarebisTvis

arasakmarisi da uxarisxoa. igi danawevrebulia administraciul erTeulebs

Soris, romlebSic didi Seusabamobebia. Seusabamobaa raionebs Soris

biujetis ganawilebaSi, uTanasworobaa da araefeqturia sistemis menejmenti

da personali, romlebsac aranairi stimuli ar gaaCniaT ukeT imuSaon da

ufro efeqturi gaxadon sistemis muSaoba. arsebobs medikamentebisa da

samedicino maragis deficiti da samedicino personalis anazRaurebac

Zalian dabalia, Tumca mosaxleoba sul ufro mets da mets ixdis

janmrTelobis momsaxurebaSi oficialuri Tu araoficialuri gziT, rac

janmrTelobis dacvis sferoSi seriozul uTanasworobas qmnis da

araTanabar xelmisawvsdomobas iwvevs. reforma damokidebulia qveynis

ekonomikis gaumjobesebaze. amJamad arsebuli sabiujeto garRvevis fonze

unda dadgindes damatebiTi dafinansebis wyaroebi aseve socialuri

dazRvevis sakiTxi, romelic grZelvadiani perspeqtivaa da ekonomikur

winsvlas moiTxovas. reformebi damokidebulia resursebis

gadamisamarTebaze, rogoricaa dafinanseba da kadrebi qveynis farglebSi

aseve araformaluri gadasaxadebis daregulireba.

jandacvis momsaxurebis dafinansebisaTvis damatebiT wyaros tajikeTSi

mxolod araformaluri gadaxdebi axorcieleben. 1994 wlis konstitucia

adamianebs uflebamosilebas aniWebs hqondeT xelmisawvdomi ufaso

samedicino momsaxureba, romelsac ixdis saxelmwifo, iqneba es

stacionaruli Tu ambulatoriuli, Tumca praqtikulad, unda aRiniSnos,

rom samedicino maragi da samedicino momsaxurebisadmi xelmisawvdomoba

ukanasknel wlebSi mkveTrad Semcirda, ramac samedicino sferos didi

ziani miayena, aseve Semcirda jandacvis biujeti da gaizarda formaluri

da araformaluri gadasaxadebi. medikamentebi da sxva saWiro saSualebebi

pacientma unda SeiZinos da avadmyofis kvebac TviTon unda uzrunvelhyos.

- 26 -

pacientebs aseT viTarebaSi iseTi maRali fasebis gadaxda uwevT, rom

maTi dabali xelfasebi amas verafriT ver wvdeba. umetesoba saerTod ver

axerxebs, xolo zog maTgans samomavlod gadaaqvs mkurnaloba. rac Seexeba

gacilebiT rTuli saxis daavadebebsa da sxva stacionaruli mkurnalobis

xarjebs, Raribi mosaxleobisTvis danaxarjebis koeficienti maTi

Semosavlis gacilebiT maRal procentul maCvenebels aRwevs. magaliTad

somxeTSi, mxolod saavdamyofoebis pacientebisaTvis danaxarjebi maTi

Semosavlebis 266.6% Seadgenda, xolo tajikeTSi es maCvenebeli Yyvelaze

maRal niSnuls aRwevs 534.53%-amtkicebs luisi (Lewis, 2000: 22). am cifridan

gamomdinare Tavisuflad SeiZleba vimsjeloT, Tu ramdenad xelmisawvdomia

tajikeTSi samedicino momsaxureba maSin, rodesac adamiani stacionalur

mkurnalobisas ixdis misi yovelTviuri Semosavlis 534.53%-s sakuTari

saxsrebiT.

mosaxleobis socio-ekonomikur jgufebad dayofisas aRmoCnda, rom

tajikeTis Raribi mosaxleobidan maT Soris, vinc mimarTa stacionarul

samedicino momsaxurebas danaxarjma Seadgina maTi yovelTviuri

xelfasis 252%, xolo mdidari mosaxleobisTvis danaxarji stacionaruli

mkurnalobisTvis 54 % -aRmoCnda. gansxvaveba arsebiTad didia. am mizeziT

Raribi mosaxleobis umetesi nawili avadobis SemTxvevaSi ver axerxebs

stacionarul mkurnalobas rac xSirad fataluric ki xdeba. (Sari,

Langenbrunner and Lewis 2000] citireba Lewis, 2000: 23).

evropisa da dsT qveynebis Sedarebisas Cans, rom tajikeTi iseve

rogorc aRmosavleT evropis sxva qveynebi gacilebiT naklebs xarjaven

jandacvaze vidre evropis qveynebi. ufro ganzogadebuli SefasebiT

magaliTad dsTs- amJamindeli danaxarji erT sul mosaxleze aris mSp-is

3%, centraluri da aRmosavleT evropa ki xarjavs 5,3 % s xolo evropis

gaerTianeba saSualod 8,5%. tajikeTis magaliTi yvelaze TvalsaCino

suraTia im naklovanebebisa, romelic dabalSemosavliani da ganviTarebadi

qveynebisTvisaa damaxasiaTebeli, sadac admianis uflebebi irRveva

arasaTanado mmarTvelobisa Tu politikis gamo, sadac janmrTelobis

uzrunvelyofa da misi dacva moqalqisTvis arc Tu ise advilad

xelmisawvdomia da sadac siRaribe da socialuri statusi adamianis

janmrTelobis ganmsazRvreli ZiriTadi faqtoria.

- 27 -

1990 –iani wlebidan, iseve rogorc centraluri, aRmosavleT evropisa

da aziis qveynebma, yofili sabWoTa kavSiris qveynebmac, romlebic TiTqmis

msoflios mosaxleobis meoTxeds warmoadgenen daiwyes gadasvla

centraluri dagegmidan sabazro ekonomikaze. vinaidan es qveynebi

gansxvavdebian rogorc geografiuli, istoriuli, kulturuli bunebrivi

resursebisa Tu mosaxleobis mixedviT, isini amasTanave erTmaneTs

upirispirdebian saerTo problemebiTac, rodesac cvlian sazogadoebriv

seqtorebs da cdiloben jandacvis axali politikis adaptirebas axali

ekonomikuri modelis standartebTan.

rac Seexeba ganviTarebad qveynebSi resursebis gadanawilebasa da

saxelmwifo strategiebs isini dasavleTisagan gansxvavebulia. ZiriTadad

gansxvaveba am qveynebs Soris ekonomikur ganviTarebazea damokidebuli.

rac ufro ganviTrebulia qveyana, miT ufro mniSvnelovnad didia

resursebis alokaciac jandacvaSi. resursebis ganawileba aRmosavleT

evropisa da aziis qveynebSi dasavleTisagan gansxvavebulia. am SemTxvevaSi

jandacvis sfero qveynis erovnul interess ar warmoadgens da iseT

qveynebSi sadac jandacva ar aris prioritetuli sazogadoebriv

dafinansebaTa Soris, romelsac saxelmwifo uzrunvelyofs cxadad Cans

negatiuri Sedegebic. yovelive amis Sedegia sikvdilianobis zrda, rac

arasakmarisi dafinansebisa Tu xelmisawvdomobis problemis indikatoria.

T.verulavam (2008 wels) saqarTvelos magaliTze ganixila ori saxis

midgoma saxelmwifosa da sazogadoebis roli jandacvis sistemis

dafinansebaSi, esenia: pirveli, romelic iTvaliswinebs azrs imis Sesaxeb,

rom yovel moqalaqes Tavisi gansazRvruli uflebebi gaaCnia,

janmrTelobis dacva adamianis keTildReobis ganuyofel nawils

warmoadgens da swavlisa da muSaobis SesaZlebloba damokidebulia

janmrTelobis mdgomareobaze. samarTlian da Tanasworuflebian

sazogadoebaSi maRalxarisxiani samedicino daxmareba yoveli

moqalaqisaTvis unda iyos Tanabrad xelmisawvdomi. am SemTxvevaSi,

saxelmwifos umniSvnelovanesi roli ekisreba sazogadoebis TiToeuli

wevris janmrTelobis dacvis uzrunvelsayofad saWiro resursebis

mozidvis efeqturi meqanizmebis Sesaqmnelad.

- 28 -

meore midgoma, romlis mixedviTac, moqalaqeebs ar aqvT sakuTari

janmrTelobis dacvis upirobo ufleba. am filosofiis mimdevrebi

jandacvas ganixilaven misi rolis TvalsazrisiT mosaxleobis

janmrTelobis mdgomareobis gaumjobesebis saqmeSi (T.verulava Grossman,

1972), agreTve im poziciebidan, Tu rogor zemoqmedebs eris janmrTeloba

qveynis saerTo keTildReobaze.

T.verulavas azriT, janmrTeloba warmoadgens socialur

keTildReobas, romelic unda ganixilebodes adamianis moTxovnilebebis da

ara uflebebis konteqstSi, amitom resursebis ganawilebisaTvis

aucilebelia prioritetebis dadgena. saxelmwifo valdebulia

uzrunvelyos jandacvis dafinanseba im zomiT, rac aucilebelia Sromis

nayofierebis efeqturobis gazrdisaTvis, radganac mosaxleobis Sromis

nayofiereba damokidebulia mis janmrTelobaze. dasaqmebuli adamianis

janmrTelobis arasaxarbielo mdgomareoba amcirebs Sromis nayofierebas,

rac uaryofiTad moqmedebs mosaxleobis saerTo keTildReobaze. am

midgomis mixedviT, saxelmwifom Tavis Tavze unda aiRos samedicino

daxmarebis mxolod im saxeTa dafinanseba, romlebic mosaxleobis

janmrTelobis mdgomareobis gaumjobesebis ufro efeqtur Sedegebs

gamoiwveven. amasTan, maTi azriT, saxelmwifos amocanas ar warmoadgens

samedicino daxmarebis Tanabari xelmisawvdomoba da jandacvaze mTliani

mosaxleobis Tanabari uflebebi.

amgvari midgomis mixedviT, jandacva ar warmoadgens qveynis

prioritetul dargs, radganac mecnierulad ar aris dasabuTebuli is

garemoeba, rom samedicino daxmareba warmoadgens mosaxleobis

janmrTelobis mdgomareobis gaumjobesebis ZiriTad faqtors, Tumca albaT

es sadaoc SeiZleba iyos.

magaliTad aRmosavleT evropis SemTxvevaSi vawydebiT jandacvis

sapirispiro sruliad gansxvavebul kanons. “rac ufro meti fuli sWirdeba

adamians janmrTelobisTvis, miT ufro naklebs iRebs.” aseTi paradoqsi ara

mxolod adamians rogorc pirovnebas exeba aramed misi ganxilva globalur

donezec SeiZleba. komunisturi ideologiis periodSi imdenad, ramdenadac

jandacva ar iyo saxelmwifo strategiebs Soris prioritetuli sfero,

resursebic naklebad nawildeboda. avadmyofoba miCneuli iyo rogorc

- 29 -

klasobrivi urTierTobis Sedegi kapitalizmSi. mTliani sabWoTa

samedicino sistema iyo centralizebuli da iyofoda mxolod samedicino

sistemad, romelic muSaobda janmrTelobis saministros daqvemdebarebaSi.

ruseTi komunistur periodSi aRiarebuli iyo, rogorc erT-erTi

uZlieresi potencialis mqone qveyana, misi uzarmazari sakadro Tu

materialuri resursebiT. es Seexeba, rogorc maRali donis profesionalTa

did raodenobas, aseve samedicino dawesebulebaTa kargad ganviTarebul

qsels dsT-s sxva qveynebTan SedarebiT, ruseTSi, struqturuli cvlilebebi

naklebad SeimCneva. Tumca sabazro ekonomikis damkvidrebasTan erTad

izrdeba kerZo seqtoris ganviTarebac da konkurentunariani garemos

Seqmnac gansakuTrebiT msxvil qalaqebSi. miuxedavad amisa, ruseTSi erT

sul mosaxleze jandacvis danaxarjebi sakmaod mcirea da mxolod 582.7 aSS

dolars Seadgens, rac mTliani Sida produqtis (mSp) 6%-ia, maT Soris

saxelmwifo danaxarji 357 aSS dolaria (mTlianad janmrTelobaze

daxarjulis 61..3%). dabadebisas sicocxlis mosalodneli saSualo

xangrZlivoba ki mxolod 64,8 welia mamakacebSi rac 13,8 wliT naklebia,

qalebTan SedarebiT 72.0 (cxrili 10).

cxrili 10.

ruseTis zogierTi demografiuli da ekonomikuri maCvenebeli 2007 weli.

qveynis mosaxleoba (mln) _ 142,5

mosaxleobis saSualo wliuri mateba -0,4%


saSualo xangrZlivoba

sul 65,5

Kkaci 59,0

Qqali 72,0




saerTo danaxarjebi 1 sul mosaxleze (aSS dolari) 582.7


sabWoTa kavSiris daSlis Sedegad ara marto ruseTi aramed mTeli

misi wevri qveynebic moumzadebeli aRmoCnda jandacvis sistemis marTvaSi,

romelic evropis standartebs uTanabrdeba. sazogadoebis janmrTelobis

- 30 -

gaumjobeseba, amavdroulad myari demokratiuli instituciebis

ganviTarebis mxardaWera, gacilebiT rTuli aRmoCnda, vidre ubralod

jandacvis sistemis gaumjobeseba da gafarToeba. msoflio bankis “msoflio

ganviTarebis 1993 wlis moxsenebaSi aRniSnulia: “jandacvis seqtori

uwyveti da rTuli rgolia. verc mTavroba verc Tavisufali bazari

damoukideblad ver gaanawilebs resursebs janmrTelobis efeqturi

sistemis dasamkvidreblad. maTi pasuxismgebloba vinc ayalibebs jandacvis

politikas gardamaval qveynebSi aris is, rom gaiTvaliswinon

alternatiuli modelebis saxelmwifo jandacvis Zlieri da susti mxareebi

da uzrunvelyon mwiri resursebis ganawileba iseT seqtorebSi, romelic

maqsimalur efeqturobas moutans saxlemwifos”. (WHO). am miznebis

misaRwevad msoflio banki ganviTarebad qveynebs sTavazobs jandacvis

politikis sakiTxebis saTanado ganxilvas da dafinansebis koordinirebas,

rogorc kerZo fondebidan aseve samTavrobo struqturebidan agreTve

saerTo globalur sakiTxebSi TanamSromlobas.

- 31 -

1.2. zogierT qveyanaSi mimdinare pirveladi jandacvis sistemis

reformirebis Sedegebi

sxvadasxva dros Catarebulma kvlevebma aCvenes, rom erTerTi

mniSvnelovani faqtori, romelic moqmedebs mosaxleobis jamrTelobis

mdgomareobaze, aris erovnuli keTildReoba da misi gadanawileba.

socialur fenebsa da jamrTelobas Soris urTierTkavSiri, faqtiurad

kargad aris gamokvleuli evropaSi, sadac jamrTeloba da avadoba

araTanabradaa gadanawilebuli. imisaTvis rom naTeli movfinoT

mdgomareobas. Uunda vaRiaroT, rom jandacvis sistemas ar SeuZlia

,,Seqmnas,, janmrTeloba, magram ZaluZs misi gamosworeba an optimizacia da

a) tanjvis b) avadobis g) sikvdilianobis prevencia. jamrTeloba ar aris

,,adamianuri kanoni” ase rom iyos sikvdilianoba da avadoba iqneboda

,,adamianisaTvis uCveulo da arakanonieri”. jamrTelobis ganmsazRvreli,

meore, Zlileri faqtoria genetikuri struqtura (jamrTelobis sxva

ganmsazRvreli faqtorebi gacnobierebulia Llonde-s moxsenebaSi ojaxis

Sesaxeb, romelic gakeTebuli iqna 1976 w. kanadaSi, es faqtebia: socialuri

da fizikuri garemocva, individualuri qceva da jandacvis momsaxureoba,

isini xels uwyoben genetikuri struqturis gamovlinebas) aseve cnobilia,

rom jandacvis momsaxureoba ar aris ,,xelovnuri” struqtura, romelic

SeiZleba survilis mixedviT, advilad mowesrigdes an demonstirdes

politikis Semqmnelebis mier, radgan igi mWidrodaa gadaxlarTuli

sazogadoebriv politikasa da ekonomikasTan. nebismieri erovnuli

jandacvis sistemis fesvebi sakuTari istoriidan modis, romelic Tavis

mxriv dakavSirebulia politikur da kulturul filosofiasa da

rwmenasTan.

faqtiurad evropaSi, pirveladi jandacvisa da zogadi praqtikis

dRevandeli saxe gansazRvravs misi warmoSobisa da ganviTarebis istoria.

Sua saukuneebidan moyolebuli mSromelebs hyavdaT garkveuli saxis

,,zogadi praqtikosebi”, romlebic zrunavdnen mSromelTa jgufebze

(mSromelebsa da maT daqvemdebarebaze), amisaTvis maT uxdidnen

yovelTviurad, yovel erT sul mosaxleze fiqsirebul Tanxas). amave dros

- 32 -

xelfasi exdeboda qalaqis sabWos, romelic organizebuli iyo, asve zogadi

praktikosebis mier, Raribebze zrunvisa da hospitaluri dacvisaTvis (ufro

metad adgilebi gankuTvnili iyo piligrimebisa da terminaluri

pacientebisaTvis, an specipiuri daavadebebis mag. leprozis, mqone

adamianebisaTvis) XIX saukuneSi mSromelebma daiwyes sazogadoebis Seqmna,

da TavianTi liderebis zegavleniT mixvdnen, rom ,,daavadebaTa fondis”

ganviTareba maTive interesebSi iyo. (mogvianebiT misbarki erTerTi

pirvelTagani iyo, vinc daafuZvna erovnuli daavadebaTa fondi). XIX

saukunis bolosa da XX saukunis dasawyisSi evropaSi ukve aTasobiT

daavadebaTa fondi, klubi da mSromelTa jgufi arsebobda, isini

garkveulwilad waagvanan amerikaSi jandavvis xelSemwyob organizaciebs

(HMO). zogadi praktikosebi popularulebi iyvnen da kvlav arian,

politikis Semqmnelebsa da mosaxleobas Soris. mag. 1860 wlidan zogadi

praqtika, germaniis daavadebaTa fondis bunebrivi maxasiaTebeli gaxda, 1908

wlidan espaneTis ,,lnstituto Nacional de prevision”-is, holandiis daavadebaTa

mandatoruli fondebis sistemis, 1942 wlidan britaneTis erovnuli

jandacvis momsaxureobis. pirvelad jandacvas odiTganve mxars uWerdnen

mTavroba, damzRvevebi da specialistebi.

1920 wlis msoflio jandacvis organizaciis, alma atas deklaraciamde

dausonma (didi britaneTi) Tavis moxsenebaSi warmoadgina ,,pirveladi” da

,,meoredi” jandacva, aseve momavali jandavis centrebisa da pirveladi

jandacvis koncefcia. moxsenebam naTlad warmoaCina poziciebis

radikalurad Secvlis aucilenloba, imisTvis rom mosaxleobis saWiroebis

miuxedavaT jandacvis momxmareblobis organizeba, resursebis ganTavseba,

Canawerebisa da statistikis warmoeba, med-personalis trenireba da

personaluri jandacvis momsaxureoba. dausonis moxsenebam xazi gausva, rom

logikuri sistemis elementebi harmoniulad unda ukavSirdebodnen

erTmaneTs da amave dros yvelasaTvis xelmisawvdomi unda iyos.

jandacvis centrebi SeiZleba yofiliyo saxelmwifo mflobelobaSi

(rogorc saberZneTSi, finetSi ,portugaliaSi, espaneTsa da SveicariaSi) an

zogadi praqtikebis mflobelobaSi (rogorc daniaSi, irlandiSi, italiaSi,

niderlandebsa da did britaneTSi).

- 33 -

aRsaniSnavia, rom jandacvis sistemebi istoriis produqts warmoadgenen

da amitom Zalze gansxvavdebian erTmaneTisagan. magram yvela jandacvis

sistema msgavsi saWiroebisa da moTxovnis winaSe dgas. arsebobs erTgvari

SeTanxmeba, raTa racionalurad iqnas gamoyenebuli sadazRveo resursebi,

amisaTvis gansazRvruli unda iyos dacvis oTxi done, esenia:

- TviT movla (personaluri da Cveulebrivi) ;

- pirveladi profesionaluri movla (zogadi praqtikosebi, eqTnebi da

sxvebi) ;

-specialistebis movla ;

- super specializirebuli movla .

nebismier jandacvis sistemas gadasawyveti aqvs, Tu rogor imuSavebs

TiToeuli done da ra urTierT damokidebuleba iqneba maT Soris,

TiToeul dones Tavisi gasagebi roli unda hqondes da amave dros

mxardaWerili unda iyos resursebiT, organizaciiTa da ganaTlebiT

(saswavlo kursebi da zedamxelvelobiTi funqcia). mag: qveyanaSi

daavadebaTa prevencia SesaZloa erToblivad xorcieldebodes, radgan saqme

imunizacias exeba, SesaZloa maTi organizeba pirvelad jandacvaSic,

rogorc es fineTSi, italiaSi da holandiaSi xdeba. cnobilia, rom im

regionSi sadac arc Tu saxarbielo ekonomikuri da socialuri situaciaa,

jandacvis momsaxureobas gacilebiT meti resursebi esaWiroeba.

evropaSi jandacvis sistema mravali yofiTi problemebis winaSe

aRmoCnda, eseni iyos: demografiuli cvlilebebi (emigracia, mosaxleobis

dabereba), mosaxleobis avadobis zrda, jandacvis araTanabari maCvenebeli,

socialuri uTanasworobis zrda, Rirebulebebis TvalsazrisiT axali

sadiagnostiko da Terapuli saSualebebi da yovelives paralelurad,

mzardi saxelmwifo moTxovnilebebi da molodinebi. Sedegad jandacva

sakmaod Zviri RonisZiebaa, saxelmwifo danaxarjebi mudmivad arasakmarisia,

xolo mosaxleobisaTvis gadaxda savaldebulo aRmoCnda.

dasavvleT evropaSi mTavari iyo qronikuli daavadebebis prevalenturobis

da avadobis zrda, rac garkveul wilad mosaxleobis daberebis Sedegia,

da am procesebTan dakavSirebuli samedicino momsaxureobis moculobisa

da qmediTunarianobis gazrda. daavadebaTa mizezis gamravalferovnebam,

Tanaavadobis dominirebam samedicino Carevebis SesaZlo saxifaTo Sedegebis

- 34 -

winaswar gansazRvram mTlianad Secvala aqamde arsebuli biologiuri

modeli ,,erTi daavadeba drois garkveul monakveTSi”. man moiTxova

Secvliliyo mkurnalobis is modeli, sadac adgili hqonda mwir

koordinacias samedicino momsaxureobis mowodeblebs Soris, agreTve

samedicino momsaxureobis sxvadasxva doneebs Soris (pirveladi, meoreuli,

mesameuli).

gamomdinare aRniSnulidan, jandacvis politikis Semqmnelebma unda

gaakeTon saboloo arCevani saxelmwifo fulis xarjvasTan mimarTebaSi,

rac moicavs jandacvis prioritetebis dadgenas, resursebis Tanasworad

gadanawilebis, momaragebisa da ganviTarebis racionalizacias, jandacvis

instituciebis koordinacias.

makooordinebeli SesaZleblobis gazrdis saSualebebia:

1) koordinebis Zalauflebis gadacema zogadi praqtikosebisaTvis;

2) organizaciul ganyofilebis gafarToeba an gaerTianeba jandacvis

centrebad (an saavadmyofoebad) imisaTvis rom uzrunvelyofili iqnas adre

arsebul ganyofilebebs Soris srulad koordinirebuli muSaoba.

pirvelad jandacvas, romelic SeWidulia zogad praqtikasTan, unari aqvs

gamoasworos jandacvis danaxarjebis efeqturoba, makoordinebeli

qmedebebi da personalis gulilsxmiereba, amave dros Seamciros

arasasurveli efeqtebi dakavSirebuli uTanasworobasTan. miuxedavad am

SesaZleblobis arsebobisa, TiTqmis yvela ganviTarebul qveyanaSi (maT

Soris amarikas wamyvani pozicia ukavia), mosaxleoba specialistebis

momsaxureba ufro intensiuria, vidre pirveladi jandacvis, Tumca amis

aranairi mecnieruli gamarTleba ar gaaCnia. jandacvis momsaxureobis

teqno-struqturebis swrafma zrdam Seuqcevadad Secvala samedicino

praqtikis kusri, hospitaluri da specialistebis momsaxureoba

dominanturi gaxada.

pirveladi jandacva aSkarad iafia, radganac mas naklebad Zviri

teqnologia da iafi muSa xeli hyavs, vidre saavadmyofoebs. rogorc ukve

iqna aRniSnuli dasavleT evropis qveynebSi garkveuli saxiT, yovelTvis

arsebobda pirveladi jandacva, ase rom Cven ar SegviZlia ganviTarebuli

evropuli qveynebis gamocdilebis ganxilva zogadi praqtikis gareSe. ismis

kiTxva, aris Tu ara pirveladi jandacva evropaSi SeRavaTiani (cost-effecitve).

- 35 -

am kiTxvaze sruli pasuxis gacema SeuZlebelia, radganc ar arsebobs

sakontrolo jgufi. Tumca saavadmyofoebisa da specialistebis

momsaxureoba udaod Zviria. Tu jandacvis reformam unda gaakeTos aqcenti

pirvelad jandacvaze, rogorc amass msoflio jandacvis organizaciis

lublianis dadgenileba ukeTebs rekomendacias, politikis gegmebi naTlad

unda iqnas artikulirebuli da codnaze dafuZvnebuli, raTa saboloo

jamSi gamoswordes jandacvis miwodebis efeqturoba.

verc erTi qveyana ver gaeqceva konflikts, mzard moTxovnebs, jandacvis

Rirebulebebsa da sazogadoebis SesaZleblobebs Soris. pirvelad

jandacvaze arCevanis gakeTeba ara marto misi nakleb fasTanaa

dakavSirebuli, aramed mis potencialTan koordinireba da xenmZRvanebloba

gauwios, qronikuli mdgomareobebisa (avadobis), ekonomikuri da socialuri

uTanasworobis, mavne zemoqmedebas jandacvis mdgomareobaze.

paradoqsia, magram yvelaze meti samecniero kvleva pirveladi jandacvis

efeqturobis Sesaxeb amerikis iniaciativiT aris Catarebuli, miuxedavad

amisa, rom am qveyanaSi faqtiurad ar arsebobs pirveladi jandacva, xolo

zogadi praqtika safrTxis qveSaa. magaliTisaTvis, zogadi praqtika

amerikaSi ganixileba rogorc saojaxo medicina, da rogorc ,,zodagi

praqtika” aseve, ,,zodagi praqtikosebi” rac maTi dabali samecniero da

socialuri faseulobebis gamoxatulebaa, ar floben MeSH xarisxs.

amerikis komerciuli jandacvis sistemis samecniero kvlevebis Sedegebi,

SesaZloa ar vrceldebodes evropaze. eqimebisa da saavadmyofoebis

moTxovnebis Sesabamisi anazRaureba sadazRveo ogranizaciebis mier, ufro

ioli mosaZiebelia aSS-Si, vidre evropaSi. evropuli jandacvis sistemebis

samecniero kvlevebis nakleboba niSnavs, rom jandacvis politika, didi

Zalisxmevis miuxedavad, Seumecneblad qmedebs. imis kiTxva, pieveladi

jandacva iTvleba Tu ara evropaSi ,,RvTis mier naCuqar? wyalobad”?

1991 wlis pirvel kvlevaSi, romelic moicavda 9 qveyanas, aqedan Svid

evropis qveyanas, (avstralia, kanada, dania, fineTi, germania (yofili

federaciuli respublika), niderlandebi, SvedeTi, didi britaneTi da

amerika (sadac anazRaureba gaweuli momsaxureobis Sesabamisad xdeba, da

qveyanaSi kerZo praqtikis seqtoria), pirveladi jandacvis klasifikaciebSi

mWidro kavSirebi iqna aRmoCenili, kerZod, 12 qveyanaSi saxelmwifo

- 36 -

jandacvis indikatorebis klasifikaciebSi, saxelmwifo kmayofilebasa da

fasebis proporciebSi, (mosaxleobis kmayofilebis maCveneblebi TavianTi

qveynebis jandacvis sistemebis mimarT varireben am qveynebSi erT sul

mosaxleze gadaangariSebuli Rirebulebis Sesabamisad).

2001 wels, pirvelad jandacvaSi zogadi praqtikis saqmianobis

efeqturobis Sefasebisas aRmoCnda rom :

1) gaizarda pirvelad jandacvaSi momuSave eqimebze xelmisawvdomoba,

ramac xeli Seuwyo saxelmwifo jandacvis gaumjobesebas mravali

parametris mixedviT da samedicino momsaxureobis Semcirebas, Tavis mxriv

am ukanasknelma gamoiwvia fasebis Semcireba jandacvis sistemaSi

(ukanasknel SemTxvevaSi Seamcira jandacvis fasebis zrdis tempi);

2) sxva specialistebTan SedarebiT zogad praqtikosebs meti daavadebis

dros SeuZliaT daxmarebis gaweva, xSirad nakleb fasad da igive xarisxiT;

3) gzam, romlis gavliTac pirveladi jandacvis organizeba moxda didi

gavlena iqonia Sedegze da saboloo efeqti gaizarda kompensaciis,

kapitaciis, jgufuri praqtikis, personaluri uwyvetobisa da zogadi

specialistebis wamyvani rolos gamo, pirveladi jandacvaSi. sxvagvarad

rom vTqvaT zogad praqtikosebs unari aqvT miaRwion igive Sedegebs, rasac

aRweven sxva specialistebi, xSiri vizitebisa da Carevis gamo, isini

weliwadSi sakmao raodenobiT pacientebs xvdebian, amitom SesaZlebloba

aqvT daagrovon saWiro gamocdileba da SeinarCunon ukve SeZenili unar-

Cvevebi.

pirveladi jandacvis finansirebam, organizaciam da momsaxureobis

miwodebam didi gavlena iqonia saxelmwifoSi arsebul jamrTelobis

doneze, radgan yvela specifiur-individualuri kategoria mizezia,

naadrevi sikvdilianobisa. amitom pirveladi jandacvis mier yoveli

SemTxveva aRqmulia da reagirebuli (mag: asTma, pnevmonia da

kardiovaskularuli daavadebebi). 2003 wels, Sefasebuli iqna, 12 qveyanaSi

(1970 wlidan 1988 wlamde periodi), Tu ra gavlena iqonia pirveladma

jandacvam saxelmwifoSi arsebul jamrTelobis mdgomareobaze (es

qveynebia: avstria, belgia, kanada, dania, fineTi, safrangeTi, espaneTi,

SvedeTi, holandia, didi britaneTi da aSS) es qveynebi arCeuli iqna

ekonomikuri msgavsebis mixedviT da Sefasebuli iyo drois erTidaigive

- 37 -

periodSi kvlevam aCvena, jandacvis sistemebi romlebic mkacrad

orientirebuli iyvnen pirvelad jandacvaze, axerxebdnen momsaxureobis,

jamrTelobis mdgomareobis gamosworebas. magram yvela evropuli qveyana ar

orientirdeba pirvelad jandacvaze. am qveynebis (yvelaze maRali praqtikis

maCvenebeli iyo 20 da qveynebi 1995 wels ranJirebis TvalsazrisiT

amgvarad ganlagdnen:

- didi britaneTi 19

- dania 18

- espaneTi 16,5

- niderlandebi 15

- italia 14

- fineTi 14

- norvegia 13

- SvedeTi 11

- portugalia 7

- belgia 4

- saberZneTi 4

- germania 3

- Sveicaria 2,5

- safrangeTi 2

aSS-Si maCveneblebi ufro mogvianebiT periodSi iyo 3, rac arc ise

cudia qveynisaTvis romelsac Zalze susti pirveladi jandacva gaaCnia.

qveyanas romelsac didi potenciali aqvs imisTvis, rom gaaumjobesos da

aqedan gamomdinare sakmao mogeba miiRos, ar gaukeTebia araferi pirveladi

jandacvis struqturisa da praqtikis gamosasworeblad. unda aRiniSnos

safrangeTis jandacvis sistema msoflio jandacvis organizaciis 2000

wlis SefasebiT pirvel rangs miekuTvneboda. naTelia, rom an msoflio

jandacvis organizaciis WNR 2000-is kriteriumebi ar afasebda pirvelad

jandacvas, an qronikuli deficitis mier gamowveuli Sedegebi, ar iqna

SemCneuli 2004 wlamde, manam zewolis qveS Seicvala safarangeTis

- 38 -

jandacvis sistema, pirvelad jandacvaze aqcentis gakeTebis, zogadi

praqtikosebisaTvis ,,geiT qiferis” rolis miniWebis mmarTulebiT.

pirveladi jandacva evropaSi ar iTvleba wyalobad, evropaSi cota

qveyanas aqvs mZlavri pirveladi jandacvis sistema (danias, niderlandebis,

espaneTsa da did britaneTSi). mZlavri pirveladi jandacva asocirdeba

dacvis igive xarisxTan, rac qveyanaSi sxva specialistebs gaaCniaT,

mosaxleobis ukeTes jamrTelobis maCvenebelTan da jandacvis sistemis

dabal fasebTan (an ukanasknel SemTxvevaSi jandacvis sistemis fasebis

zrdis SenelebasTan). mraval mdidar qveyanaSi pirveladi jandacva

siRaribisa da dabali xarisxis sinonimad ki ar aRiqmeba (meore xarisxovani

jandacvis momsaxureoba RaribebisaTvis), aramed mosaxleobis saWiroebaze

mopasuxe organizaciad. evropuli kvlevebis Sefasebis mixedviT naTlad

Cans, rom efeqturad organizebuli pirveladi jandacvis magaliTebi Zalze

cotaa, srulyofili modeli TiTqmis ar arsebobs.

miuxedavad imisa, rom evropis yvela qveyanaSi arsebobs jamrTelobis

universaluri dazRveva, pirveladi jandacvis roli da organizeba mainc

gansazRvrulia qveynebis mixedviT. evrogaerTianebaSi jamrTelobis dacva,

kvlav rCeba udides erovnul saqmed. pirveladi jandacvis ara marto

specialistebis qmedebaSi arsebobs gansxvavebebi, aramed qveynebs Sorisac,

mag. maTi specifiuri dafinanseba da regulaciis meTodebi.

rodesac saqme exeba sxva seqtorebs, da rodesac aRmosavleT da

centraluri evropis qveynebi dasavleTisaken ixedebian, raTa ipovon

saukeTeso pirveladi jandacvis modeli, isini arcTu ioli arCevanis win

aRmoCndebian xolme. gadawyvetilia, rom nebismieri modeli, romelic ar

unda airCios qveyanam, unda iyos pirvelad jandacvaze orientirebuli,

moicavdes zogad praqtikosebis met-naklebad wamyvan rols, da

hospitaluri seqtoris momsaxurebis paralelur Semcirebas.

evropis sxva da sxva qveynebis pirveladi jandacvis sistemebis

Sesabamisad, informaciis moZieba gasaocrad rTulia, erTerTi saukeTeso

monacemTa bazis informacia ,,OECD Health data 2003” (ekonomikuri

kooperaciisa da ganviTarebis organizacia) ZiriTadad eyrdnoba 2001 wlis

monacemebs da fokusirdeba danaxarjebze da ara Sedegebze. saerTaSoriso

kvlevebi danaxarjenis Sesaxeb mravladaa, magram kvlevebi efeqturobisa da

- 39 -

mosaxleobisaTvis jandacvis momsaxureobis miwodebis Sesaxeb, mwiri da

ususuria, monacemebis simciris gamo. OECD -s 2003 monacemebis mixedviT:

- jandacvis specialistebis raodenoba 1000 mosaxleze varirebs fineTis-

46,9-dan portugaliis-13,3-mde. (maT Soris arian: didi britaneTi 32,1,

safrangeTi 30.9,germania30,4, niderlandebi 28 da espaneTi 17,1.)

- zogadi praqtikosebis raodenoba varirebs fineTi -1,7-dan Sveicariis-0,5-

mde (maT Soris arian: safrangeTi-1,6. avstria-1,4, germania-1,1.didi

britaneTi-0,6,niderlandebi da portugalia-0,5).

- eqTanTa raodenoba varirevs fineTi-14,9-dan; portigalia 3,8-mde (maT Soris

arian: irlandia-14,8; niderlandebi-12,8; germania-9,7; didi britaneTi 9);

evrogaerTianebis qveynebSi zogadi praktikosebi umciresobaSi arian

moqmed eqimTa Soris, maTi raodenoba bolo xanebSi umniSvnelod gaizarda,

magram mxolod mosaxleobis raodenobis zrdis Sesabamisad. arsebuli

monacemebi saSualebas gvaZlevs vivaraudoT, rom saerTo jamSi arsebulma

med-personalma SesaZloa ver daakmayofilos jandacvis mowodebis, mzardi,

specifiu-teqnikuri moTxovnebi. pirvel rigSi es exebaT eqTnebs, maTi

proporciebi sakmaod sustad icvleba.

evropis jandacvis birTvad SeiZleba CaiTvalos Semdegi: a) zogadi

praktikosebi, b) eqTnebi, g) farmaceftebi, d) xemZRvanelebi, e) damxmare

personali da v) sxva specialistebi. amgvar profesiebs rogorc wesi

efeqturi muSaobisaTvis esaWiroebaT SeTansmebuli makoordinebeli

qmedebebi, reputaciis gazrda da gaziarebul faseulobaTa sistema

(deontologia).

WONGAA-s leqsikonis mixedviT zogadi saojaxo praqtka, zogadi praqtikosi

(ojaxis eqimi) eqimi specialistia momzadebuli tradiciuli an klasikuri

disciplinebis principebis Tanaxmad, piradi eqimi valdebulia pirveladi

amomwuravi daxmareba aRmouCinos pacients (zrunvis maZiebels), sqesis,

asakisa da avadmyofobis xarisxisa da saxeobis miuxedavad. ,,zrunvis

maZiebeli” es termini Semotanilia orselis nimuSis mixedviT zogadai

praqtikosebi zrunaven individze, maTi ojaxis, sazogadoebisa da kulturis

gaTvaliswinebiT. aseve pacientis damoukideblobisadmi didi pativiscemis

gamoxatulebiT. isini acnobiereben profesiul pasuxismgeblobas

sazogadoebis mimarT. zogadi praqtikosebi anxorcieleben TavianT

- 40 -

profesionalur saqmianobas jamrTelobis xelSewyobiT, daavadebaTa

prevenciiT, medikamentebis uzrunvelyofiT, zrunviTa da daavadebis

SemsubuqebiT.

zogad praqtikosebs aqvT unari miiRon, pacientis problemis adekveturi,

personaluri da swori gadawyvetilebebi da aRsaniSnavia, rom problemis

90%-ze meti moculia zogadi praqtikosebis mier. zogadi praqtikosebisa da

specialistebis saqmianoba damatebiT gonebriv aspeqtsac moicavs.

epidemiologiuri koncefciis gamoyenebiT, zogadi praqtikosebi bevr

negatiur winaswar ganWvretebs anxorcieleben (maT kargad ician vin ari

janmrTeli), specialistebi ki bevr pozitiur winaswar ganWvretebs (maT

kargad ician vin aris avad, rodesac mosaxleobasTan muSaoben, sadac

daavadebis didi prevalenturobaa). jandacvis momsaxureobis organizebis

maxasiaTebeels (imisaTvis rom gaizardos efeqturoba da samedicino dacvis

xarisxi) zogadi praqtikosebi iyeneben ,,barierad”, raTa ar dauSvan

jamrTeli xalxis arasaWiro vizitebi specialistebTan da gadaugzavnon

specialistebs daavadebaTa maRali prevalenturoba ,,gafiltruli”

mosaxleoba. specialistebis diagnostikuri saqmianoba moicavs eWvebis

Semcirebas, albaTobebis Seswavlasa da Secdomebis aRnusxvas.zogadi

praktikosebis diagnostikuri saqmianobebi ki moicavs eWvebis daSvebas,

SesaZleblobebis Seswavlasa da saSiSroebis aRnusxvas. pirvelad

xelmisawvdomi unda iyos, mxolod saWiro codnisa da gamocdilebis mqne

zogadi praqtikosi, romelic pasuxs gascems moTxovnebis 95% da saWiroebis

SemTxvevaSi, pacientis daaxloebiT 6% gadaugzavnis specialistebs, iSviaTi

patologiebisa da dawvrilebiTi diagnostirebis saWiroebis SemTxvevaSi, an

Terapiuli procedurebis Casatareblad.

2003 wels, evropaSi analizisas didi gansxvavebebi aRmiCnda post-

socialistur qveynebsa da dasavleT evropis qveynebis zogadi

praqtikosebis valdebulebebs Soris. dasavleTis qveynebis zogadi

praqtikosebis momsaxureoba metad yovlis momcvelia, maT aqvT pacientTan

pirveli kontaqtisa da medikamentur_Terapiuli procedurebiT

uzrunvelyofis SesaZlebloba. yvela qveyanaSi aRiniSneba gabnsxvavebebi

qalaqsa da sofls Soris, soflad mosaxleobis speqtri gacilebiT

farToa. qveynebSi sadac zogadi praqtikosebi TviTdaqiravebulebi arian,

- 41 -

samuSao saaTebi (kviraSi) ufro xangZlivia (mag. avstriaSi, daniaSi,

safrangeTSi, germaniaSi, irlandiaSi, italiaSi, niderlandebSi, did

britaneTsa da sxva qveynebSi). pediatrebs zogadi praqtikosebis funqciebi

gaaCniaT iseT qveynebSi rogoricaa italia da espaneTi, aq isini saxelmwifo

jandacvis sistemaSi muSaobisas zrunaven 14 wlamde asakis mosaxleobaze.

pirveladi jandacvis eqTnebis saqmianoba da movaleobebi sakmaod

mravlis momcvelia. erTi mxriv `praqtikosi eqTanebi~ ganswavlulni arian

rom omiqmedon rogorc praqtikosebma, TavianTi wesebiT, awarmoon mravali

eqimis funqciebSi Semavali saqmianoba (daniSnulebis gacemac ki), rogorc

es espaneTSi, SvedeTsa da did britaneTSi xdeba. damxmare eqTnebi evropaSi

ZiriTadad srulad trenirebul eqTnebs exmarebian teqnikur samuSaoebis

Sesrulebisas, mag. pacientebis binaze, mwoliare mdgomareobaSi movlisas

da sxva manipulaciebis Catarebisas. magram rogorc eqTnis roli Sicvala

eqimTan damokidebulebiT, aseve damxmare eqTnis roli Seicvala eqTanTan

mimarTebaSi (orives funqciebi gaizarda).

eqTnebi jandacvis jgufis wevrebi arian (saxelmwifo jandacvis

centrebSi) iseT qveynebSi, rogoricaa fineTi, portugalia, espaneTi da

SvedeTi. eqTnebis Careva prevenciis sakiTxebSi, evropisaTvis Cveulebrivi

praqtikaa. am procesSi isini janmrTeli vizitorebisagan saxelmwifo

jandacvis eqTnebis funqcias asruleben, amgvarad xdeba daniaSi, did

britaneTsa da italiaSi.

bebia qalebs naTlad gansazRvruli roli aqvT, romelic Sobadobis

procesebTanaa dakavSirebuli. Tumca maTi funqciebi TandaTanobiT

daemsgavsa ante da postnatalur dacvas da patronaJis uzrunvelyofas (mag.

niderlandebSi dRemde binaze mSobiaroba Cveulebrivi praqtikaa amitom

pacientTa umravlesobas bebia qali saxlSi akiTxavs. skandinaviis qveynebSi,

safrangeTsa da italiaSi sazogado eqTnebisa da ubnis eqTnebis praqtikaa

danergili. isini axorcieleben zrunvas axlomaxlo klinikebSi an binaze.

pirveladi jandacvis farmaceftuli praqtika umetes SemTxvevaSi Sedgeba

sazogadoebrivi farmakologiisa da jandacvis centrebisgan (rogorc es

SvedeTSia). pirveladi jandacvis farmacevtebma gadainecvles, eqimebis mier

daniSnuli wamlebis ubralo momwodeblobidan farmacevtuli dacvis

mowodebisaken, farmacevtuli dacva moicavs Sedegebze orientirebul

- 42 -

praqtikas. samomavlod farmacevtebis mier ganixileba oTxi ZiriTadi

sakiTxi, esenia: 1) daniSnuli medikamentebis menejmenti, 2) xangrZlivi

mdgomareobebis menejmenti, 3) avadmyofTa menejmenti, 4) cxovrebis jansaRi

wesis mxardaWera da amaRleba. farmacevtuli dacva gacilebiT Zlieria

niderlandebSi, espaneTsa da did britaneTSi vidre danarCen evropaSi.

pirveladi jandacvis menejerebi profesionalebi arian romlebc

xelmZRvaneloben da axorcieleben pirvelad jandacvis organizebas.

menejerebi umetesad eqimei arian, (mag. espaneTSi) an biznesis

warmomadgenlebi rogorc did britaneTSi.

menejerebi SeiZleba iyvnen finansebis, marketingisa da adamianuri

resursebis specialistebi, magram umetesad mainc zogadi eqimebi arian.

menejerebi upirveles yovlisa fiqroben organizaciasa da saqmeze da aqedan

gamomdinare uxdebaT zrunva: xelmZRvanelobaze, strategiulobaze,

sistemaze, molaparakebaze, gundur muSaobaze, organizaciis ekonomikur da

finansur ganviTarebaze. menejerebs SeuZliaT TavianT dagegmvaSi CarTon

farmacevtebis jgufi, romlebic xels uwyoben medikamentebis racionalu

xarjvas pirvelad jandacvaSi. pirveladi jandacvis menejmenti

ganviTarebis adreul stadiaze inyofeba.

adminstraciuli, mimRebisa da sxva kadrebi Zalze mniSvnelovania

pirveladi jandacvis yoveldRiur saqminobaSi. rameTu isini asruleben

mniSvnelovan funqcias, jandacvis procesSi. sxva specialistebi mag.

dantistebi, socialuri muSakebi, fizio Terapevtebi da profesionali

Terapevtebi, SesaZloa iyvnen pirveladi jandacvis wevrebi, rogorc es aris

espaneTsa da SvedeTSi.

pirveladi jandacvis jgufebis wevrebi mudmivi zewolis qveS imyofebian,

raTa moirgon TavianTi dacvis mowodebis axali roli da funqciebi. axali

roli gulisxmobs pasuxismgeblobis xelaxal gansazRvrebas. mocemulia

sami tipis funqcia, romelic pasuxismgeblobis axali gansazRvrebis qveS

gulisxmobs:

1) Semavsebeli funqciebi (sxva specialistebis efeqturobis gazrga, ufro

kompetentri specialistebis zedamxedvelobis qveS, axali davalebebis

Sesrulebis saSualebiT),

- 43 -

2) CanacvlebiTi funqciebi (im momsaxurebis miwodeba, romelic ZiriTadad

sxva specialistebis mier SeiZleba iyos miwodebuli),

3) damatebiti funqciebi (im saqmianobis Sesruleba rasac sxva

specialistebi arasodes ar akeTeben, an akeTeben cudad an yovelgvari

enTuziazmis gareSe).

dRemde pirvelad jandacvaSi eqTnebi naklebad iyvnen trenirebulebi,

kisrulobdnen nakleb pasuxismgeblobebs, da qmedebdnen naklebi

damajereblobiT, (Sedegad iRebdnen nakleb anazRaurebas) vidre eqimebi.

eqTnebis praqtikis sargeblobianobis gazrda, pacientTa kmayofilebis done,

dabalnsirebuli da saWiro institutis Semdegi ganviTarebis Sedegia.

sakmaod Raribi urTierT damokidebulebebia sazogadoebriv eqTnebsa (ubnis

eqTnebi, janmrTel vizitorTa eqTnebi) da zogad praqtikosebs Soris,

amgvari damokidebulebebi aRiniSneba irlandiaSi, italiasa da did

britaneTSi.

damxmare medpersonali ZiriTadad eqTnebs ki ar exmarebian aramed iReben

gaawyvetilebebs, Tu vis Wirdeba igi da ra SeuZlia gaakeos sakuTari

ZalebiT.

rogorc cnobilia menejmentis Teoriidan, gundi aris im xalxTa jgufi,

romlebic erTad muSaoben sazogado miznebisaTvis. meoce saukunis

dasawyisSi pirvelad jandacvas axasiaTebda solo praqtika. ocdameerTe

saukunis dasawyisSi solo praqtika kvlav aris SenarCunebuli im qveynebSi

sadac zogadi praqtikosebi TviT-daqiravebulebi arian, mag. (avstriaSi,

daniaSi, safrangeTSi, saberZneTSi qalaqad, germaniaSi, irlandiaSi,

italiaSi, niderlandebsa da sxva qveynebSi) magram zogadi praqtikosebi

sul ufro da ufro metad unawileben sxvebs TavianT praqtikasa da

aparaturas (did britaneTSi danergilia jgfuri praqtika) an muSaoben

rogorc saxelmwifo daqiravebulebi jandacvis centrebSi, romelTa

mflobelebi saxelmwifo sadazRveo fondebi an mTavrobaa (mag. saberZneTSi

soflad, fineTSi, portugaliaSi, espaneTSi, SvedeTsa da sxva qveynebSi).

kvlevebma aCvenes rom gundis muSaoba arc imdenad sasiamovnia rodesac igi

12 kacze mets moicavs. yvela gundi aris jgufi, magram yvela jgufi ar

aris gundi. specialistebs Soris kolaboraciis miRweva Zalian rTulia

mxolod ierarqiuli meqanizmebis saSualebebiT. kolaboraciis gareSe

- 44 -

profiluri daavadebebis gafarToveba, mxolod dekretebis saSualebiT ari

aris ioli gansaxorcielebeli.

cotaa ram aris cnobili pirvelad jandacvaSi gundar muSaobaze

dafuZnebuli mecnierebis da xarjTefeqturobis Sesaxeb. gundis wevrebs

sWirdebaT, rom metad iyvnen gaTviTcnibierebulibi menejmentis sakiTxebSi,

rogorc TavianTi uflebebis da efeqturobis kriteriumebis momcvel

specialobaSi, raTa yovelive iyos ganviTarebuli da Seswavlili.

evropis pirveladi jandacvis politikaSi moqmedi pirebis socialuri

kategoriebi ucvleli rCeba, kerZod:

1) pacientebi, (an maTi ojaxebi da asociaciebi) momsaxureobis

momxmareblebi da mosaxleoba (sazogadoeba farTo gagebiT);

2) momsaxurebis momwodeblebi da dawesebulebebi, rogoricaa jandacvis

centrebi da saavadmyofoebi (zogi pirdapir amyarebs kontaqts

pacientebTan, zogs xeli miuwvdeba pirveli kontaqtis momwodebelTan da

sxvebTan, mag. momaval momwodeblebTan) da maTi asociaciebi;

3) saswavlo da samedicino dawesebulebebi;

4) jandacvis industria (konsultaciebis, farmacevtuli da teqnologiuri

industria);

5) jandacvis finansistebi da damzRvevebi;

6) mTavrobis warmomadgenlebi (saerTaSoriso, erovnuli, regionaluri da

adgilobrivi).

araformaluri Zalaufleba, mTavari moqmedi pirebis xelSia: mTavrobis,

damzRvevebisa da specialistebis. araformaluri Zalauflebis ZiriTadi

wyaroa:

1) sakuTreba da finansuri resursebi;

2) codnisa da informaciuli resursebi;

3) socialuri da politikuri mxardaWera.

aseve xelisuflebis xelSia moqceuli formaluri Zalebic. evropaSi,

pirveladi jandacvis sistemebis gansxvavebebi ar aris damokidebuli

moqmedi pirebis tipebze, magram isini moqmedeben erTmaneTze. moqmed pirTa

koleqtivebs gaaCniaT araformaluri politikis Zala da SeuZliaT

ganaxorcielon zemoqmedeba politikur procesebze (mag. kerZo

struqturebis lobireba) da aseve SeuZliaT formalurad imoqmedon

- 45 -

konkretul SemTxvevebSi (mag. gaaerTianon eqimebisa da damzRvevebis

gadawyvetilebebis miRebis procesi) Sedegad, politikis cvlilebebma

SesaZloa moaxdinos:

1) kanonebis urTierTqmedebebis modificireba (mTavrobis mier sxva moqmed

pirze dakisrebuli sagareo kanonebis);

2) resursebis ganTavseba da xelaxali gadawyvetilebis SemuSaveba.

moqmed pirTa Soris dinamiur urTierTqmedebebs kavSiri aqvs:

a) mosaxleobis da pacientebisaTvis momsaxurebis miwodebasTan;

b) TiToeuli donis momwodebelTan gadaadgilebasa da gadagzavnebTan;

g) pacientebis mier damzRvevebis premiebisa da gadasaxadebis gadaxdasTan;

d) momwodeblebis gadaxdis gzebTan;

e) samecniero da politikur ganaTlebasTan (mag. moxsenebebi da

gaidlainebi);

v) mTavrobis regulaciasTan.

Zalze cotaa cnobili pirveladi jandacvis wesebis urTierTqmedebebis

Sesaxeb. qveynisa da erovnebaTaSorisi urTierTobebis, sxvadasxva doneze,

warmatebebi, SeiZleba gavzomoT miRweuli Sedegebis saSualebiT,

rogoricaa jandacvis sistemis xarjebi da janmrTelobis mdgomareobis

srulyofis gamosavlebi.

evropis saxelmwifoebis jandacvis politikis miznebis (rom yvelas

aucileblad eqneboda jandacvaze xelmisawvdomoba da jandacvis

danaxarjebi erTnairi iqneboda momxmareblis nebismieri Semosavlis

miuxedavad) sisruleSi moyvana, Zalze rTuli aRmoCnda. warmodgenili

eqsperimentebis gamo mTavrobas kvlav Sexvda winaaRmdegobebi, rac imaSi

mdgomareobs, rom jandacvaze moTxovna gasaocrad, umowyalod gaizarda da

jandacvis miwodeba an SeTavazeba kidev ufro amwvavebs arsebul

problemebs. yvelaze cudi is aris rom moTxovna ar aris saWiroebis

Sesabamisi. aseve cudia, rom organizaciebma TavianTi arseboba realobaSi,

ar daiwyes sufTa furclidan, rac saukeTeso arCevani iqnebida. jandacvis

sistema ar aris advili Sesacvleli, igi mxolod viTardeba garkveuli

CarCos farglebSi, romelic mas STamomavlobiT gadmoeca. xSirad

organizaciebi Zveli problemebis, institucionaluri STamomavlobis,

- 46 -

memorials warmoadgenen, amitom maT dRevandelobaze asaxulia istoriuli

procesebi da xSirad problemebi swored iqidan iRebs saTaves.

istoriulad, dominanturi dainteresebuli jgufi moicavda

monopolist specialistebsa da eqimebs, visi CarTulobac xsnis da

aZlierebs avadobaze dafuZnebuli, SemoTavazebuli modelis dominirebas.

Sedarebulad Tu ganvixilavT eqTnebis magaliTs, maTi avadobisa da

janmrTelobis ganmsazRvrelebi, jandacvis politikisa da momsaxureobis

mowodebis dominirebas efuZvneba. faqtia, rom moqmed pirebs, ukeTesi

reputaciiT (saavaduyofoebi-jandacvis centrebis winaaRmdeg, viwro

specialobis eqimebi-zogadi praqtikosebis winaaRmdeg) da organizebuli

interesebiT (mag. specialistebi romelTac mxars uWeren farmacevtebi da

teqnologiuri industria) meti araformaluri Zalaufleba gaaCniaT

romelsac yovelTvis ar moaqvs efeqturi makoordinebeli gadawyvetilebebi.

dinamiuri, politikuri procesebis dasasruli, jandacvis momsaxureobis

struqTuriTa da funqciebiT, romelic asaxavs Tu rogor aris kanoni

dafuZnebuli da modificirebuli da rogor aris resursebi ganTavsebuli

da gadanawilebuli politikis Seqmna yovleTvis iyo dinamiuri procesi,

mas ar aqvs dasasruli da formaluri da araformaluri Zalauflebis

cvlilebebi, (unda moxdes cvlilebebi resursebis gadanawilebisa da

socialuri da politikuri mxardaWeris TvalsazrisiT) reformis miznebma

ufleba unda misces pirvelad jandacvas:

1) gazardos zogadi praqtikosebis Zalaufleba TavianTi donis da

statusis farglebSi (makoordinebeli reforma, romelic warmoadgens `geiT

qiferobasa~ da myidvelobiT kanonebs);

2) zogadi praqtikosebisa (momsaxureobis paketis) da sxva pirveladi

jandacvis momwodeblebis profilis gafarToeba;

3) moaxdinos pirveladi jandacvis organizaciuli resursebis

cvlilebebisa da sistemis kontrolis stimulireba (romelic aucilebelia

pirveladi jandacvis mTavari rolis gasaZliereblad).

zogadi praqtika kagrgad cnobili samedicino specialobaa evropaSi

universitetis Semdgomi savaldebulo swavlebiT (evrogaerTianebis

qveynebSi), romelic grZeldeba 3 wlidan (espaneTSi), 6 wlamde (fineTSi).

magram naTelia, rom pirveladi jandacvis pozicia zog qveyanaSi ufro

- 47 -

mZlavria, Qqveynebis pirveladi jandacvis Zala damokidebulia mis wevrebsa

da maT urTierTqmedebaze. zog qveyanaSi arsebobs negatiuri rgoli,

dabali socialuri pativiscemis, Raribi ganaTlebisa, dabali sakuTari

pativiscemisa, dabali xelfasisa, mwiri kvlevebisa da rTuli

urTierTobebis specialistebsa da saavadmyofoze dafuZvnebul medicinas

Soris . qveymebs, romelmac daamsxvries es rgoli, iseTebma rogoricaa

dania, niderlandebi da didi britaneTi (da SeiZleba espaneTic CaiTvalos

maT rocxvSi) mZlavri profesionaluri organizaciebi aqvs, romlebmac

TavianTi gza gaikvlies universitetebSi da bolos miaRwies universitetis

Semdgom saswavlo kursebs, romelic Tavis mxriv gaxda zogadi

praqtikosebis profesiis damkanonebeli (ra dromdec evrogaerTianeba

gamoaqveynebda Sesabamis kanonmdeblobas) .SesaZloa yvelaze saintereso

SemTxveva niderlandebis iyos, misi warmateba ukavSirdeba belgias,

safrangeTsa da germanias, aseve mdidar qeynebs, romelTa bismarkis

jandacvis sistemis modeli aqvT (socialuri uzrunvelyofis sistema,

romelic dafuZvnebulia proporciuli premiebidan da gankuTvnilia

jandacvis sistemisaTvis) zogadad rom vTqvaT, im qveynebis mTavroba, sadac

bismarkis sistemaa ufro metad reaqtiul rols asrulebs or sxva ZiriTad

moqmed pirTn erTad (specialistebi da damzRvevebi), romelic dominirebs

politikis procesze . faqtiurad, mTavrobas gamoyofili aqvs misi

formaluri Zalaufleba daavadebaTa fondebisaTvis (saxelmwifo dazRveva).

am qveynebSi organizaciuli qseli mihyveba neo-korporaciul sqemas,

romelic dafuZvnebulia, saxelmwifo dazRvevebisa da specialistebis

gadawyvetilebebis miRebis dakavSirebaze (aqedan specialistebs wayvani

roli aqvT), maSin roca maT susti (niderlandebis gamoklebiT) zogadi

praqtika.

zogadi praqtikis statusi ufro maRalia im qveynebSi, sadac erovnuli

jandacvis momsaxureobaa warmodgenilia bevrijis sistemiT, rogorebic

arian dania, espaneTi da didi britaneTi. evropuli jandacvis

momsaxureobis fondireba xdeba gadasaxadebis akrefis saSualebiT da am

dros saxelmwifos mier mowodebuli momsaxureoba ufro farToa, magram

zogadi praqtikosebi SesaZloa muSaobdnen kerZo praqtikiTac, rogorc es

daniaSi da did britaneTSi xdeba. am qveynebSi saxelmwifo xelisuflebas

- 48 -

formaluri politikis erTpirovnuli Zalaufleba gaaCniaT da isini

moqmedebis momxreni arian, akanoneben Carevebis gegmebs, garekanonebis da

resursebis gaTvaliswinebisa da ganviTarebis saSualebiT. damzRvevebi

aranair rols ar asruleben (finansireba saxelmwifosia, Tumca kerZo

dazRveva momgebiani biznesia) da specialistebi Zalauflebiani moqmedi

pirebi arian. am kuTxiT espaneTis magaliTi sakmaod sainteresoa, aris ra

bevrijis sistemis mqone qveyana, mxolod 1980 wlidan, man miaRwia

mniSvnelovan warmatebas xmelTaSua zRvis sxva qveynebTan mag. saberZneTTan

da portugaliasTan SedarebiT.

zogadi praqtika myarad aris dafuZnebuli zemoT naxsenebi, oTxi

evropis qveynis jandacvis sistemaSi, mas daxmareba gauwia damcavma

sazomebma:

1) specialistebis dacvaze xelmisawvdomobis limitireba da zogadi

praqtikosebiT uzrunvelyofa, romelTac `geiT qiferis~ roli gaaCniaT

(gare kanoni SemoRebuli mTavrobis mier);

2) sakmao finansuri da materialuri resursebis ganTavseba. (jandacvis

centrebis kerZo sakuTrebisac ki daniaSi, niderlandebsa da did

britaneTSi).

holandiaSi, meoce saukunis dasawyisSi zogadi praqtikosebis pozicia

sakmaod rTuli iyo. isini ierarqiulad yvelaze dabla imyofebodnen da

saerTo samedicino saqmes Zalze mcired mxardaWeras uwevdnen, is

gaerTianebebic ki romlebic gascemdnen samuSaodan ganTavisuflebis

nebarTvas. meore msoflio omis situacias arTulebda ori faqtori:

1) 1942 wlis mTavrobam gadawyvita waredgina axali daavadebaTa fondis

sistema, romelic ukve iyo cnobili omamde. Sedegad mosaxleobis 70% (is

vinc, xelfasis saSualebiT SezRudul Semosavals gamoimuSavebda)

savaldebulo sistemis wevri gaxda da yvelas surda moxvedriliyo zogadi

praqtikosebis pacientTa siebSi, romelTac `geiT qiferis~, rolic hqondaT.

manamde, cota xanSi, yovelgvari finansuri barierebis gareSe, sayovelTao

samedicino momsaxureobam aiwia ufro maRal doneze.

2) faqtori romelmac imoqmeda zogadi praqtikosebis poziciaze iyo

specialistebis momsaxureobis swrafi ganviTareba. rac samecniero da

teqnikuri progresis brali iyo, magram holandiaSi daavadebaTa fondebis

- 49 -

sistema hospitalur medicinas warmarTavda araswori mimarTulebiT, rameTu

specialistebis dacvis fasebi ar iyo limitirebuli. specialistebis

anazRaureba iyo momsaxurebis Sesabamisi, maSin roca zogadi praqtikosebis

anazRaureba iyo kapitaciis meTodiT gamoTvlili.

daZabuloba, romelic Seiqmna, gamowveuli iyo, zogadi praqtikosebis

damatebiTi funqciis gamo, rac specialistebTan pacientebis gadagzavnaSi

gamoixateboda, isini Tavis mxriv didi siamovnebiT iRebdnen pacientebs,

radgan momsaxurebisaTvis maT honorari exdebodaT. universitetebSi

studentTa miReba ar iyo limitirebuli. mraval eqims surda gamxdariyo

specialisti, da specializaciaze TiTqmis ar arsebobda SezRudvebi. 1956

wels gaixsna holandiis zogad praqtikosTa koleji, da 1965 wels zogad

praqtikosTa erovnuli instituti. zogadi praqtikebis pirveli kaTedra

daarsda 1966 wels Utrecht-is universitetSi. amave wells maTi anazRaureba

gaizarda 50%-iT, es moxda profkavSirebisa (zogadi praqtikosebis

erovnuli asociacia) da profesionalTa asociaciis, mTavrobasTan

xangrZlivi konfliqtis Semdeg, mTavrobam gamoaqveyna (`White Paper~)

oficialuri ganacxadi jandacvis organizaciebis Sesaxeb, sadac zogad

praqtikosebs mniSvnelovani roli mieniWa.

holandiis zogadi praqtikis Semdgomi ganviTareba, Zalze nela

mimdinareobda da sruli transformirebisa da ganviTarebisaTvis mas ori

aTwleuri dasWirda. pirveladi jandacvisa da hospitaluri dacvis

sazRvrebis gadakveTis momentebi Zalzed rTuli aRmoCnda. am momsaxureobis

gaerTianeba jandacvis politikis saqme iyo holandiaSi, 1990 wlidan ukve

naxsenebi `transmunaluri dacva~ Biesheuvel-is moxsenebis Semdgom aRmocenda.

zogadi praqtikosebisaTvis navaraudebi damatebiTi honorari, damatebiTi

samuSausaTvis, arasodes ganxorcielebula, 2004 wlis `transmunaluri

dacva~ kvleviTi moqmedebebi da yoveldRiuri realobaa, romelic moicavs

ufro met hospitalur da binaze dacvis miwodebas, vidre zogadi praqtika.

mTavrobas jandacvaze ZiriTadi pasuxismgeblobebi awevs, marTva

ganpirobebulia saxelmwifoebrivad orientirebuli jandacvis sistemebiT,

romelic gansazRvrulia da eZebs mocvisa da momsaxureobis gafarTovebis

gzebs, socialur samarTlianobisa da moralur valdebulebebze

dayrdnobiT.

- 50 -

mTavrobis mier warmoebuli, jandacvis sistemis mocvis mimarTulebebi

SesaZloa mravalferovani iyos. ori ukiduresi strategia, ganviTarebis

TiTqmis erTi da igive stadiazea, sayovelTao fondireba da

saxelmwifoebrivi momarageba (ssrk) da minimaluri saxelmwifoebrivi

Carevis politika (amerikis SemTxveva). Sualeduri strategiaa:

a) erovnuli jandacvis sistema an bevrijis sistema, sadac fondireba

gadasaxadebis akrefvis gziT xorcieldeba da saxelmwifo realurad aris

CarTuli mimdinare procesebSi.

b) saxelmwifo dagegmvis harmonizacia sazogadoebis garkveul,

dainteresebul jgufebs Soris viTardeba (yalibdeba profesiuli

gaerTianebebi), rogorc es bismarkis sistemis dros xdeba (safrangeTis,

germaniis, italiis, holandiis, Sveicariasa da sxvaTa SemTxvevaSi).

zogadad, rogorc ukve iqna naxsenebi bismarkis sistema saxelmwifo

mTavrobis mocvis sapirispirod moqmedebs, maSin roca bevrijis sistema

avaldebulebs mTavrobas, rom aqtiurad CareTos. arsebobs sqemis mravali

varianti. zogierT qveyanas, erovnuli jandacvis sistemebiT, rogorebic

arian portugalia da espaneTi, yavs xelfasiani praqtikosebi da pacientTa

siebi. maSin roca sxva qveyanas danias, italiisa da didi britaneTis

msgavsad yavs kerZo, TviT-daqiravebuli zogadi praqtikosebi, romlebic

sistemasTan kontraqtebis saSualebebiT arian dakavSirebulebi da maTi

anazRaureba xdeba kapitaciis meTodiTa da premiebiT.

droTa ganmavlobaSi jandacvis sistemebis orientacia SeiZleba

Seicvalos, rogorc es moxda safrangeTSi, kerZod meoce saukuneSi

mTavrobis Careva Sualedurs poziciebs flobda, situacia Seicvala mZlavr

samTavrobo Carevamde, radgan 2004 wels jandacvis sistema miuaxlovda

gakotrebas. espaneTi aseve ganviTarebis erT-erTi magaliTia, aq poziciebi

Secvala 1980 wels arsebuli centraluri samTavrobo Carevebi, 2003 wels

Seicvala regionaluriT, TiTqmis federalur donemde. yvela SemTxvevaSi

mTavrobas uwevs mravali kritikuli gadawyvetilebis miReba. arsebul

jandacvis problemebze pasuxi, SesaZlebelia mxolod, jandacvis sistemis

momsaxurebis momwodeblebis gazomviT, an SesaZlebelia pasuxis Zebna

jandacvis sistemis gareT. Tu pasuxi formulirebulia, saxelisuflebo

politikas SeuZlia miznad daisaxos:

- 51 -

1) kanonebisa da SeTanxmebis modificireba sistemis SigniT;

2) wevrTa Soris resursebis ganTavseba da xelaxali gadawyvetileba

saavadmyofoebsa da pirvelad jandacvas Soris, agreTve jandacvis

sistemasa da socialur momsaxureobas Soris (binaze momsaxureba kargi

magaliTia), sazRvrebis gadakveTa da mowesrigeba Zalze mniSvnelovania

(cotaa cnobili, sxvadasxva wyobis dros mowodebul momsaxureobis

SeRavaTianobaze da Tu ra kavSiria specialistebis ganaTlebis tipebsa da

xarjefeqturobas Soris).

mTavroba SeiZleba xels uwyobdes pirveladi jandacvis siZlieres

sxvadasxva kuTxiT mag. makoordinebeli eqsperimentis gafarTovebis gziT

(fondebis mflobeloba did britaneTSi, transmunaluri dacva holandiaSi)

an daavadebaTa profilis gafarTovebis gziT (mcire qirurgiuli Carevebi

espaneTSi) magram saboloo warmateba mainc damokidebulia,

profesionalebis mxardaWeraze. `geiT qiferoba~ reogorc makoordinebeli

saSualeba, safrangeTSi da germaniaSi, meoce saukuneSi, dablokili iyo

Zlieri, opoziciuri, specialistTa asociaciis mier (da damzRvevTa

asociaciis mier, industriis mxardaWeriT), romelsac win aRudga, mxolod

zogad praqtikosTa susti asociacia. msgavsi ram belgiaSi 2004 wels

warmatebiT da nebayoflobiT iqna dafuZnebuli. sqema saSualebas aZlevs

pacientebs amoirCion `privilegirebuli~ zogadi praqtikosebi, visac

pacientTa siebis eleqtronuli samedicino Canawerebi aqvT da visac

SeuZlia xelmZRvanelobas daukveTos specialisti, visac Rirebulebis

pacientisaTvis gadasaxdeli wili naklebi aqvs (gaaCnia ukeTesi

anazRaureba specialistisaTvis).

qveynebs, romelTac susti zogadi praqtika aqvT, gauWirdebaT gaiTavison

saerTaSoriso saukeTeso gamocdileba radgan formaluri da

araformaluri politikis Zalauflebis xelaxali gadawyvetileba,

socialur-politikur winaaRmdegobebs Sexvdeba. yovelive Seamcirebs kargi

momavlis Sansebs an institucionaluri cvlilebebis arials. amgvari

gamocdileba gaaCniaT germanias, saberZneTsa da safrangeTs, politikosebs

SeuZliaT ubiZgon, aseve xeli SeuSalon cvlilebebs, imitom rom isini

iReben gansxvavebul gadawyvetilebebs:

- 52 -

1) gansxvavebul politikur xedvaze damokidebulebiT (imis mixedviT

Zalaufleba memarcxeneebs ekuTvnis Tu memarjveneebs);

2) sxvadasxva Sexedulebebis arsebobis gamo, centralur, regionalur da

adgilobriv mmarTvelobebSi;

3) sxvadasxva moqmedebebisa da jgufebis, lobirebis survilis arsebobis

gamo (damzRvevebi, specialistebi, industria, pacientTa asociacia,

saerTaSoriso saagentoebi da sxva).

ar arsebobs evropuli jandacvis politika. mxolod axali, 2004 wlis,

evropuli konstitucia arsebobs, romelic arafers ambobs mocemul

TemasTan dakavSirebiT. dasavleT evropaSi pirveladi jandacvis

xelmZRvanelobis oTxi dominanturi sqema, romlebSic asaxulia, centrsa da

regions Soris, Zalauflebis dabalansirebis sxvadasxva SemTxvevebi:

1) centralizebuli mTavroba, bevrijis sistemis farglebSi (dania, fineTi,

italia, norvegia, espaneTi da SvedeTi);

2) decentralizebuli mTavroba bevrijis sistemis farglebSi (saberZneTi,

islandia, portugalia, didi britaneTi);

3) decentralizebuli mTavroba bismarkis sistemis farglebSi (avstria,

belgia, germania, holandia da Sveicaria);

4) centralizebuli mTavriba bismarkis sistemis farglebSi (safrangeTi da

luqsemburgi).

instituciebis arsia socio-politikuri Zala gardaqmnan formalur

Zalad. instituciebi moicaven:

1) saxelmwifoebrivi CarCoebis modificirebas (regulacias,

kanonmdeblobas);

2) resursebis ganTavsebisa da xelaxali gadanawilebis (finansebis,

aRWurvilobis, codnisa da muSa Zalis).

rodesac im qveynebis mTavrobebis mier, romelTac erTiani qselli aqvT

(dania, holandia, didi britaneTi) xdeba gadawyvetilebis miReba, (rom

saboloo miznad daisaxn, zogad praqtikosTa avtonomiuri jgufuri

praqtika) ,,pozitiuri rgoli” sruldeba. saxelmwifoebriv Zalas SeuZlia

mniSvnelovani roli iTamaSos, qselis ganviTarebis xelSewyobaSi, miaRwios

sistemis efqtur koordinacias, daxvewos finansuri meqanizmebi,

gadawyvetilebis miRebasTan dakavSirebuli kanonebis da codnis warmoebisa

- 53 -

da gavrcelebis saSualebiT. unda aRiniSnos, rom konkurencia garkveul

wilad SesaZloa iyoss xelis SemSleli faqtori, radgan igi abrkolebs

TanamSromlobas.

arCeuli mTavrobisaTvis SeiZleba oficialurad iqnas miniWebuli

gadawyvetilebis miRebis ufleba, erovnul doneze (safrangeTi,

portugalia, didi britaneTi), regionaler doneze (dania, norvegia,

espaneTi, SvedeTi) an erovnul da municipalur doneze (fineTi). politikis

Semqmnelebi axdenen yoveldRiuri qmedebis ganxorcielebaze

pasuxismgeblobis delegirebas zemoaRniSnul doneebze.

1998 wlamde erovnul mTavrobasa da damzRvevebs ejeraT rom, maT

hqondaT ufleba gadaewyvitaT, gadaixdidnen Tu ara sazRvargareT ara

urgentuli mkurnalobis safasurs. am wels evropis iusticiis umaRlesma

sasamarTlom miiRo ori dadgenileba, msgavsi precendentebis dros farTo

Carevis Sesaxeb. faqtiurad, mocemul SemTxvevaSi, evropis jandacvis

politika ganviTarda evropis sasamarTlos zegavlenis mier.

damzRvevebsa da finansistebs SedarebiT viwro Sexedulebebi aqvT,

radgan isini ar ganixilaven moqmedebebs jandacvis sistemis miRma.

damzRvevebi Sualeduri rgolis warmomadgenlebi arian, gadamxdelebisa da

potencialur pacientebs Soris. isini didad arian dainteresebulebi

kvlevebisa politikis ganviTarebis xelSewyobaSi (axali teqnologiis

danergvaSi, mtkicebulebebze dafuZnebul medicinisa da gaidlaienbis

danergvaSi, organizaciis dagegmvaSi, stimulebis efeqturobasa da sxva

amgvar qmedebebSi) rogorc ukve iyo aRniSnuli, saxelmwifo dazRvevas

(daavadebaTa fondebi) Zalze mniSvnelobani politikuri roli aqvs

bismarkis sistemis mqone qveynebSi, sadac mZlavri formaluri da

araformaluri politikuri Zalebi arseboben. kerZo dazRveva ar

sargeblobs didi formaluri da araformaluri politikuri ZalauflebiT,

magram evropaSi igi sul ufro da ufro Zlierdeba, rac demonstrirebulia

didi britaneTis SemTxvevaSi. mxolod Sveicariis SemTxvevaSi, kerZo

dazRvevis premiebi da ara oficialuri gadasaxadebi, jandacvis mTeli

Rirebulebis 50%-ze metia. kerZo dazRvevis roli gansxvavebulia evropis

sxva da sxva qveyanaSi. zog qveyanaSi (irlandiasa da holandiaSi) kerZo

dazRveva uzrunvelyofs individebis (ZiriTdad mdidrebis) mocvas,

- 54 -

savaldebulo saxelmwifo mocvis gaerSe.sxva qveyanaSi (italiaSi,

portugaliaSi, espaneTSi da did britaneTSi) kerZo dazRveva anxorcielebs

damatebiT mocvas (ormagi mocva, pacientis meti komfortis survilis da

siebis lodinis survilis arqonis SemTxvevaSi im individebis, romelTa

savaldebulo saxelmwifo mocvac gaaCniaT). zog qveyanaSi (dania,

safrangeTi) kerZo dazRveva awarmoebs Tanagadaxdis daniSnulebis gacemis,

stomatologiuri momsaxureobis da sxva SemTxvevebSi .evropaSi saxelmwifo

da kerZo dazRvevisa da momsaxureobis, rogorc momgebianis aseve

aramomgebianis mowodebis organizeba tradiciuli praqtikaa. kerZo

dazRvevisa da momsaxureobis miwodebis Sereulma formam, rogorica

amerikaSi ganviTarebuli (HMO), evropaSi ver daimkvidra adgili.

damzRvevebis yvela urTierTqmedeba specialistebTan ukavSirdeba

gansazRvrebas:

1) Tu romel pacients an momsaxureobas unda mieniWos prioriteti;

2) Tu ramdenad farToa erTi pacientisaTvis gadaxdili Tanxa meore

pacientis Tanxaze, Cadebuli resursebis xarjebTan mimarTebaSi.

damzRvevebs gaaCniaT SeTanxmeba dazRveulebTan (ZiriTad muSakebTan) da

gansazRvraven maTi praqtikis profils, met-naklebad zusti SeTanxmebis

SeTavazebis gziT. garkveuli kritikuli kiTxvebi yovelTvis arsebobs

maTsa da momsaxureobis momwodeblebs Soris. pacientebis dajgufeba,

romelic ar ukavSirdeba diagnozebs (mag. avadobas), maTi moqmedeba

Rirebulebebsa da Sedegebze, da saWiro koordnacia warmatebis sawindaria,

pirveladi jandacvis da meoradi jandacvas Soris urTierT kavSirebis.

amitom sazRvrebis gansazRvra pirvelad da meorad jandacvas Soris

xangrZlivi procesia, im mizniT rom gadainacvlos tradiciul

momsaxureobis arCevam mwvave da qronikuli saavadmyofoebidan, naklebi

resursebiT datvirTul pirveladsa da sazogadoebrivze dafuZvnebul

alternativaze.

arsebobs, warmatebuli pirveladi da meoradis Canacvlebis magaliTi,

gadaudebeli dacvis sferoSi. Svedi adleris reformam 1990 wels moicva

saavadmyofoebis makoordinebeli Zalauflebis decentralizacia,

municipalur sazogadoebriv seqtorze (hospitaluri dacvidan, eqTnis

- 55 -

binaze momsaxureobaze), ramac Seamcira mwvaveTa raodenoba saavadmyofoebSi

gazarda eqTnis binaze momsaxureoba, qronikul SemTxvevebSi.

nebismier qveyanaSi jandacvis industria, yvelaze metad moqmedebs

organizaciisa da jandacvis miwodebaze. jandacvis industria msoflio

ekonomikis nawilia. mas rogorc qvemodan zemoT aRmavali aseve sapirispiro

moqmedeba gaaCnia, mTavrobidan mosaxleobisken da pacientebidan

profesionalebisa da politikosebze. erT-erTi magaliTi zemodan qvemoT

moqmedi jandacvis sistemisa mdgomareobs SemdegSi: evropisaTvis HMO-s

msgavsi gadawyvetilebis SeTavazebis procesi, romelic mTavrobis mier

aris stimulirebuli (mag. Sveicariasa da did britaneTSi).

HMO nebismieri alternativis warmodgena axal problemaTa miTiTebiT. mag.

arasasurveli amorCeva, RaribTa da qronikuli daavadebis mqone pacientebis

mkurnaloba, saxifaTo pasuxismgeblobis dakisreba moxucebsa da sxva. unda

iTqvas rom HMO-s jer-jerobiT Tavisi warmoSobis qveyanaSic, amerikaSi, ar

gadauwyvetiaT problemebi, da dazRvevisa da momsaxureobis miwodebis didi

nawili, am qveyanaSi, moklebulia saTanado bazas. medicinis muSakTa

garkveuli jgufebis mier, mTavrobis winaSe xdeba saWiro uaxlesi

teqnologiebis wardgena, vidre Sesabamisi teqnologiebi Sefasdeba,

aucilebel efeqtur da produqtiulad. pacientebis mxridan moTxovnebi

aseve aCqarebs im teqnologiebis wardginebas, romelic jer ar aris

Sefasebuli. imitom rom ar aris gansazRvruli kvlevis strategia da

kvlevisaTvis gankuTnili saxelmwifo fondebi limitirebulia, industria

(konsultaciebi, samedicino da farmacevtuli aRWurviloba)kvlevis

mimarTulebebze, ganviTarebaze da gavrcelebaze moqmedi Zala gaxda,

rogorc mtkicebulebebze dafuZvnebuli medicines SemTxveveSia. amgvarad

eqimebma, farmacevtebma da eqTnebma myari urTierTobebi unda daamyaron

jandacvvis industriasTan, samedicino saganmanaTeblo moqmedebis

uwyvwtobisa da winsvlisaTvis. axlaxan industriam aCvena, rom eZebs

jandacvis sistemis struquris Sesaxeb, politikur gadacyvetilebebis

miRebaSi Carevis gzebs, sakuTari interesebis dacvisTvis.

1963 wels edingburgSi (Sotlandia, didi britaneTi) daarsda praqtikis

pirveli kaTedra. meore kaTedra ki 1966w. Utrech-Si (holandia). pirveladi

jandacvis ganviTarebisaTvis, universitetebs, zogadad, did mniSvneloba

- 56 -

hqondaT, magram xmelTaSua zRvis qveynes Soris didi gansxvavebebia am

kuTxiT (kerZod portugaliiszogadi praqtikis kaTedra 1980 wlidan aqvs,

espaneTs ki 2002 wlidan barselonaSi- ,,Novartis” kaTedra), Tumca

portugalias Zalze susti pirveladi jandacva aqvs da espaneTs piriqiT.

profesorebi ZiriTadad zogadi praqtikosebi arian, vinc CamoSorda

klinikur saqmianobas.

Nuerus claus (samedicvino skolebSi misaRebi kontigrentis raodenobis

SezRudva) mniSvnelovan faqtorad iTvleba, radgan igi saSualebas iZleva

mTavrobis mier koordinirebuli iqnas swavleba kadrebis dagegmasTan

mimarTebiT. rogorc axlaxans iyo miniSnebuli, ganviTarebul qveynebSi,

meti eqimebi da meti saavadmyofoebi srulebiT ar niSnavs met jamrTelobas

(arc ise iSiaTad, sawinaaRmdegoa marTali) mniSvneloba ar aqvs

raodenobas, mniSvneloba aqvs xarisxs (zogadi praqtikosebi

specialistebisa da maTi geografiuli gadawilebis winaaRmdeg). Cven kvlav

ganvicdiT samecniero codnis naklebobas zogad praqtikosebisa da

specialistebis optimalur proporciebis Sesaxeb, magram empiruli

monacemebi gviCveneben, rom pozitiuri damokidebuleba arsebobs, zogad

praqtikosebis xelmisawvdomobasa da mosaxleobis janmrTelobis dones

Soris. ramdeni zogadi praqtikosia saWiro? Cven ar viciT swori pasuxi.

mtkicebulebebi gviCvenebs rom savaraudod 500-dan (Zalze izolirebul

adgilebSi soflad) 3000-mde.

zogoerT universitetSi daniaSi, fineTSi, holandiaSi, portugaliaSi,

did britaneTsa da sxva qveynebSi, xels uwyoben pirvelad jandacvaze

orientirebas TavianT samedicino skolebSi. msoflio moZraoba zogadad

moqmedebs lozungis ,,msofliodan ofisebisaken, mwvavedan qronikulisaken,

daavadebebidan problemebis gadaWris orientirebisaken” gavleniT. rac

niSnavs: studentebis adreul da permanentul CarTvas pirvelad jandacvaSi,

qronikuli pacientebis, avadobi menejmentze orientacias, klinikur da ara

daavadebebze aRweriTi warmodgenis saSualebiT swavlebas. saeqTno

saswaleblebi metad arian orientirebulni pirvelad jandacveze vidre

umaRlesi saswavleblebi. zogierTi farmacevtuli saswavlebelicaa

pirveladi jandacvis orientaciis, mag. espaneTSi. 1985 wels didi

britaneTis, zogad praqtikosebis kolejis wevrebma gamoavlines, rom

- 57 -

naxevarze meti problemebi zogad praqtikosebs moutana iman, rom maT ar

SeeZloT ,, diagnozebi”-s dadgena da daavadebebis, diagnozebisa da

sikvdilis mizezebis Sefaseba saerTaSoriso klasifikaciis mixedviT.

WONGA saerTaSoriso klasifikaciebis komiteti (WICC) asrulebs amgvar

iniciatorul samuSaos. 1998 wels mis mier Seqmnilli ukanaskneli

produqti, romelic daexmara pirveladi jandacvisa da kvlevebis aRqmas da

2003 wels gamocemuli WONCA-s leqsikoni zogadi saojaxo praqtikisaTvis.

saxelmwifo jandacvis skolebis CarTvas pirveladi jandacvis

ganviTarebaSi, SasaZloa gadamwyveti mniSvneloba hqondes. Aamgvari praqtika

arsebobs portugaliis (lisabonis saxelmwifo jandacvis skolis) da

espaneTis (granadisa da madridis saxelmwifo jandacvis skolebis)

SemTxvevebSi. ra Tqma unda xelmZRvanelobas danamdvilebiT didi

mniSvneloba aqvs. sul ramdenime moxsenebam ganapiroba jandacvis

momsaxurebisa da zogadi praqtikosebis realuri xedva. mag. Ees

moxsenebebia : inglisSi kolingis zogad praqtikaSi da bleqis jandacvis

miwodebis uTanasworebis Sesaxeb, kanadaSi ,,Lalonde Report,, . mTeli msoflios

maSstabiT almaatis deklaracia, SvedeTSi_,,the Crossroad Project,,

espaneTSi_,,socialogia de los ambulatorios,, da ambrilis moxseneba

holandiaSi_,,biesheuvel deeker and Dunning,,.

mtkicebulebebze dafuZnebul medicinas mZlavri biologiuri safuZveli

aqvs, misi moqmedeba pirvelad jandacvaze ar aris cnobili, radganac igi

fokusirdeba ,,erTi daavadebis,, modelze da arafers ambobs avadobis

Sesaxeb da farmaceptul produqtebze. gaidlainebs SeuZliaT mravali

specifiuri problemis dros daxmarebis gaweva. qveynebi, romlebsac ar

aqvT SemoRebuli ,,geiT qiferoba” mag. germania da avstria, cdiloben

Seamciron pacientebis yidvis procesi, erTi eqimidan meoreze, jamrTelobis

dazRvevis vauCeruli sistemis saSualebiT ( yovel dazRveuls ufleba aqvs

erTi vauCeriT, sami Tvis ganmavlobaSi isargeblos da am periodSi ufleba

aqvs mxolod erT zogad praqtikosTan hqondes viziti). mtkicebulebebi, rom

,,geiT qiferoba” ukeTesia efeqturobisa da koordinaciisaTvis vidre sxva

saSualebebi, Zalze cotaa. ,,geiT qiferoba” xSirad monopolias amyarebs

pacientebis mier dacvis miRebis nebarTvis gacemis dros da xSirad

- 58 -

asocirdeba pacientTa siebTan, mag. daniaSi, irlandiaSi (dabali

Semosavlis mqone pacientebisaTvis), italiaSi, holandiaSi, portugaliaSi,

espaneTsa da didbritaneTSi. specialistebi xSirad filtris funqcias

asruleben da ara mxolod fasebis kontrolSi xedaven Tavis funqcias.

xandaxan mxardaWerasac imsaxureben amgvari fiqrisaTvis, mag. safrangeTSi

da germaniaSi.

,,geiT qiferoba” da pacientTa siebi gamarTlebulia Teoriulad, im

sazogadoebaSi romelic pirvelad jandacvazea orientirebuli . zogadi

praqtikosebi SeiZleba ekontaqtebodnen bolo gadamwyvet periodSi im

pacientebs visac ar aRmouCines qirurgiuli daxmareba, raTa janrTelobis

sisustisa da riskis gamo maT namdvilad esaWiroebaT amgavari Careva. es

principulad gaadvilebs dacvis kanonis sawinaaRmdego qmedebis aRmofxvras

(xalxi visac jamrtelobis meti dacva esaWiroeba iRebs nakleb

momsaxureobas), pirvelad es formulireba iyo 1970 wels did britaneTSi

julian tiudor hartis mier da umetesad bazarze orientirebul

jandacvis sistemebSi. arsebobs literatura, romelic adasturebs, rom

eqTnisa da zogadi praqtikosis erToblivi CanacvlebiTi moqmedebis

SemTxvevebs absoliturad Tanaswori da xSir SemTxvevaSi ukeTesi Sedegebi,

pacientTa kmayofilebis maRali done da momsaxureobis maRali xarisxi

moaqvs, gunduri muSaoba SeiZleba daexmaros urTierT gagebasa da axali

kompromisebis aRmocenebas.

pacientebi sul ufro da ufro aqtiuri momxmareblebi xdebian. isini

moiTxoven da mxars uWeren momsaxureobis xarisxis amaRlebas, romelic

saaTobiT gagrZelebadi mocdis nacvlad, swrafad xelmisawvdomi iqneba.

Tanamedrove cxovrebam moitana moTxovna jamrTelobisa da cxovrebis

jansaR nirze. mosaxleobas surs, avadmyofobisa da daavadebebis gareSe

cxovreba.

kvlevebma Zalze saintereso ram daamtkices, kerZod ukeTesi jandacvis

momsaxureba yovelTvis ar niSnavs ukeTes jamrTelobas (es SeiZleba

paradoqsad CaiTvalos, magram mdidari qveynebisa da mosaxleobisaTvis

metad Cveulia avadoba, vidre ganviTarebadi qveynebis Raribi

mosaxleobisaTvis) simarTlea, rom pacientebi ar zrunaven jandacvis

momsaxureobis zust organizebaze, aramed maT surT TavianTi problemebis

- 59 -

saswrafo da dauyonebliv gadaWra, aRsaniSnavia, rom jandacvis

problemebis gadaWra xSirad SefasebaSi mdgomareobs da ara

diagnostirebasa da mkurnalobaSi.

evropis jandacvis sistemebSi, pirveladi jandacvis wverebi yvelgan

erTnairi arian, magram maTi urTierTqmedebebi Zalze gansxvavebulia.

pacientebi, momwodeblebi, saswavlo dawesebulebebi, jandacvis industria,

finansistebi, damzRvevebi da mTavroba erToblivad cdilobs xeli Seuwyos

jamrTelobas da aRmofxvras avadoba da sikvdilianoba (sxva sityvebiT

aRmofxvras tanjva da gaaxangrZlivos cxovrebis Sualedi) evropaSi

maravali magaliTia jandacvis wevrebis warmatebuli urTierT

TanamSromlobis, mag. pacientebTa siebi da ,,geiT qiferoba”. eqsperimentis

gatareba, garkveuli gzaa gamoswordes jandacvis saerTo mdgomareoba,

gafarTovdes zogad praqtikosTa profiluri datvirTva da gatardes

makoordinebeli moqmedebebi specialistTa momsaxurebasTan mimarTebiT.

magram, mraval ZiriTad kiTxvaze jer-jerobiT ar arsebobs mecnieruli

pasuxi, amitom gadawyvetilebis miReba xdeba codnis vakumis pirobebSi.

evropuli mosaxleoba fiqrobs, rom garkveuli saxis erovnul

damzRvevebs SeuZliaT gadaanawilon daavadebebis, invalidobisa da

jamrTelobis sxva problemebis finansuri riski da xeli Seuwyon

nebadarTul xarjebze, romelic ar aris damokidebuli pirovnebis

Semosavalze, xelmisawvdomobas. Evropul jandacvis momsaxureobas, iseve

rogorc zogad praqtikaSi, pirveladi jandacvis aspeqtSi didi istoria

aqvs. WONCA da msoflio jandacvis organizacia xazs usvams pirvelad

jandacvas, radgan Tvlian rom igi yvelaze ukeT ergeba mosaxleobis,

damzRvevebis, momwodebelTa jgufebisa da politikis SemqmnelTa

interesebs. a) roca saqme exeba jandacvis dagegmis procesebs pirveladi

jandacvis samecniero bazas xarjefeqturobis Sesaxem Zalze mwiria;

b) mravali rCeva zogadi praqtikosebis dRiur saqmianobaSi moklebulia

samecniero safuZvels; g) pirveladi jandacvis arsi ufro farToa, vidre

jandacvis saWiroebaze pasuxi; d) zogadi praqtikosebi kvlav ganagrZoben

ganaTlebas, mihyvebian orsulebis paradigmas, maTi ZiriTadi davalebaa

upasuxon individualuri pacientebis Civilebs.

- 60 -

cnobilia, rom jandacvis specialistTa Sromis anazRaurebis meTodebi

unda ganirCeodes meTodebisagan romliTac xdeba, jandacvis momsaxurebis

danaxarjebis gansazRvra. orive finansirebis nawilia, magram gadaxdis

meTodebi miekuTvneba egreT wodebul ,,resursebis ganTavsebas” maSin roca

bolo miekuTvneba ,, Semosavlebis gazrdis,, funqciebs, orive elementi

efuZvneba erTsa da imaves, avtonomiis, xarisxis, solidarobis poziciebis

da efeqturobis faseulobebis gaTvaliswinebiT gadaxdas, iseve rogorc

profesionaluri momsaxurebis sxva atributebis gaTvaliswinebas. eqimebis

gadaxdis meTodebs uzarmazari mniSvneloba aqvs pirvelad jandacvaSi, igi

emsaxureba instituciebis erTmaneTTan dakavSirebas.

jandacvais organizaciebSi wlebis ganmavlobaSi, sul ramodenime

kiTxvam gamoiwvia iseTi mxurvale kamaTi, rogorc gamoiwvia

momsaxureobisaTvis profesionalebze gadaxdis meTodebis gansazRvram.

zogadi praqtikosebi anazRaurebis ZiriTadi meTodebia, kapitaciis meTodi,

xelfasebi da gaweuli momsaxureobis Sesabamsi anazRaureba.

bevrijis sistemis mqone evropis qveynebSi, gadaxda ZiriTadad

xelfasebisa da kapitaciis saSualebiT xdeba, maSin roca bismarkis

sistemis mqone qveynebSi, Warbobs gaweuli momsaxureobis anazRaurebis

meTodi (irlandiisa da holandiis gamoklebiT, sadac zogadi praqtikosebis

anazRaureba kapitaciis meTodiT xdeba). qveynebis umravlesobas gadaxdis

Sereuli meTodi aqvT, magram is qveynebi, sadac dominanturi gadaxdis

saSualebaa gaweuli momsaxurebis Sesabamisi anazRaureba, TiTqmis arasodes

iyeneben gadaxdis meTodebs. Zalze mcire empiruli mtkicebulebebi

arsebobs imis Sesaxeb, Tu sxva da sxva saxis cvlilebebi, romlebic

ukanaskneli dekadis ganmavlobaSi xdeboda zogadipraqtikosebis

anazRaurebis sferoSi, rogor moqmedeben zogadi praqtikosebis qcevebze,

jandacvis fasebze da pacientis keTildReobaze. unda iTqvas, rom

mtkicebulebebis gareSe cvlilebebis morgeba evropuli jandacvis sistemis

miznebTan, efeqturobisa da Tanasworobis Sesaxeb arc Tu saxarbielod

xdeba. zogierT qveyanaSi (mag. espaneTa da did britaneTSi) zogadi

praqtikosebis anazRaureba ukeTesia vidre sxva eqimebis. norvegiaSi adre

gaweuli sistemuri mcdelobebis Sedagad, zogad praqtikosTa da sxva

eqimTa xelfasebs Soris mciredi gansxvavebaa. evropul qveynebSi, ufro

- 61 -

eqimebis, saSualo saerTo Semosavali Zalze meryevia da 2001 wels, 120000

evrodan (did britaneTSi), 36000 evromde meryeobda ( espaneTSi).

Suasaukuneebis droidan sazogadoebebi da gildiebi da mSromelTa

jamrTelobis klubebi eqimebs uxdidnen kapitaciis meTodiT (yovel

wliurad, yvela wevrisaTvis, vinc eqimebs unda moenaxulebinaT Tu

gaxdebodnen avad).

kapitaciis sistema ganapirobebda, rom pirovnebas anazRaureba hqonoda

erT sul mosaxleze gaweuli samedicino moqmedebisaTvis. 1910 wels

inglisSi, britaneTis erovnul janmrTelobis damzRvevebs, adgilobriv

gaerTianebebs daevalaT gadaewyvitaT gadaxdis romeli meTodi jobda.

umravlesoba momxre iyo gaweuli momsaxureobis Seasabamisi anazRaureba

Secvliliyo kapitaciis meTdiT, radgan bolo dros aRmoCnda, rom igi

naklebi usiamovnebis momtani iyo. kapitaciis meTodis Teoriuli

SesaZleblobebia:

1) eqimebma SeiZleba gaakeTon Warbi referalebi;

2) meTodi moicavs zogad praqtikosebSi prevencialur Sexedulebis

Camoyalibebas, rom igi gamoimuSavebs mets Tu mis praqtikaSi meti avadobis

aRricxvasa da mkurnalobas eqneba adgili;

3) administraciuli procesebi ufro martivia;

4) ganxorcielebuli momsaxureobis faseuloba umniSvneloa da zogad

praqtikosebis Semosavali damokidebulia imaze, Tu ramdenma adamianma

moisurva mis pacientTa siebSi Cawera (mosaxleoba eqimebze metad did

rols TamaSobs specialistebis Semosavlis gansazRvraSi);

5) kapitacias buferuli moqmedeba aqvs eqimebs Soris mZlavri konkurenciis

winaaRmdeg;

6) pacientTa siebi gaurkvevel urTierTobebs afuZvneben, ara marto

momxmarebelTan, aramed sxvebTanac (rac saSualebas iZleva, saWiroebis

SemTxvevaSi dacvis kanonis Semobrunebis SesaZleblobas, anu

specialistebis im kontaqtebis SesaZleblobas, romelic ar aris pacientTa

siebSi);

7) imis gamo rom pacientTa siebi dakavSierebulia meti pacientis mocvasTan,

igi asocirdeba zogadi praqtikosebis geografiul gadalagebasTan;

- 62 -

kapitacia asocirdeba mZlavr pirvelad jandacvasTn da mosaxleobis

jamrTelobis mdgomareobis gamosworebasTn. zemoT xsenebuli 18 OECD-s

qveynidan, did britaneTs, danias, espaneTsa da holandias am kuTxiT

yvelaze kargi maCvenebeli aqvT.

xelfasis gadaxdis sistema iTvaliswinebs eqimTa anazRaurebas drois

mixedviT da aranairi mniSvneloba ar aqvs TuU ra qmedebebs Seicavda

Catarebuli momsaxureba da pacientTa ra raodenobas gaewia daxmareba.

xelfasis saSualebiT anazRaurebis meTodi asocirdeba, samedicino

praqtikis struqturis organizebis formasTan, mag. pirvelad jandacvaSi,

jandacvis centrebis arsebobasTan, garkveuli saxis jgufebi disciplinebis

ganviTarebasa da avtonomiis kontrolTan. xelfasiani zogadi

praqtikosebis umetesobas, damatebiTi sazogadoebrivi valdebulebebic

gaaCniaT, an SemosazRvruli geografiuli areali aqvT. Teoriulad

selfasebiT anazRaurebis dros, optimaluri moqmedebebis stimulireba,

eqimTa garemomcvel organizebul samuSao ZalaSi mdgomareobs vidre

finansur meqanizmebSi per se. Sedgenilia wyvilebi maTi umravlesoba

pacientebi arian romlebic anxorcieleben daTvlas. amave dros, eqimebs

SeuZliaT personaluri Rirebulebis minimumamde dayvana:

1) dabali riskis pacientebis SerCevis;

2) receptebis gamoweris;

3) gadagzavnebis warmoebis;

4) konsultaciis dros Semcirebis saSualebiT.

Teoriuliad xelfasis SemTxvevaSi optimaluri samedicino momsaxureobis

miwodeba damokidebulia samedicino personalze da ar regulirdeba

anazRaurebis meqanizmebiT. im SemTxvevaSi Sefaseba xdeba kolegialuri

msjelobiT da ara pacientis kmayofilebiT. SesaZlebelia adgili hqondes

pacientTa zedapirul damokidebulebasa da ara adekvaturi momsaxurebis

SemTxvevebs, radgan finansuri stimuli, maqsimaluri momsaxurebis

miwodebis ar arsebobs. saxelfaso sistema, roca xeslfasebi dabalia

araformaluri anazRaurebis damkvidrebas ubiZgebs (,,Savi fuli” ,,magidis

qvemodan gadaxda”) damatebiTi gadaxda aCqarebs uzrunvelyofis procesebs

da zrdis sasurvel momsaxureobaze xelmisawvdomobas. mniSvnelovania

aRiniSnos, rom xelfasiani pirveladi jandacva saSualebas aZlevs

- 63 -

specialistebs periodulad aiyvanon institutis Semdgomi ganaTlebisaTvis

studentebi. amave dros ufro axalgazrda specialistebis meTvalyureobas

uweven da xels uwyoben maTi kvalifikaciis zrdas, ufro metad gamocdili

kolegebi. es faqtori ganapirobebs dacvis xarisxis zrdas.

saxelfaso sistema administraciuli CarTulobis TvalsazrisiT, ufro

martivia, vidre sxva sistemebi. specialistebis geografiuli gadanawileba

yovelTvis metyvelebs dagegmarebis xarisxze.

zogad praqtikosebs xelfasis saSualebiT uxdian, evropis im qveynebSi,

sadac saxelmwifo dominantur da yovlismomcvel rols TamaSobs

jandacvis sistemaSi, rogorc fineTi, saberZneTi (soflis jandacvis

zogadi praqtikosebi) islandia, norvegia (qalaqebSi daqiravebuli)

portugalia, espaneTi da SvedeTi. xelfasiT anazRaurebis sistema

Tanxvedria pacientTa siberisa da ,,geiT qiferobis” islandiaSi,

portugaliasa espaneTSi.

xelfasebis anazRaurebis sistema, danarCenebTan SedarebiT yvelaze

gavrcelebuli sakamaTo Temaa. mravali profesionali mas socialistur

medicinis da semaSkos sistemis nawilad aRiqvams, romelsac hqonda

komunisturi orientaciis qveynebSi, dekadebis ganmavlobaSi da dabali

dacvis xarisxiTa da cudi samuSao pirobebiT xasiaTdeboda. Tumca eqimebs

uxdian xelfass, dasavleT evropasa da TiTqmis yvela qveyanaSi,

samedicino skolebSi, saavadmyofoebSi, saswavlo samedicino centrebSi da

maT aqvT samedicino dacvis SesaniSnavi maCvenebeli. es gviCvenebs rom

saxelfaso sistema ar aris ,,per se,, magram eqimebis regulaciisa da

stimulirebaSi igi wamyvan rols ver TamaSobs.

momsaxurebis Sesabamisi anazRaurebis dros, Teoriulad arsebobs

SesaZlebloba, pacientebs miewodos saWiroze meti momsaxureoba, raTa

gaizardos anazRaureba. amas mivyavarT momwodeblis mier provocirebul

moTxovnebamde (zedmet da arasaWiro diagnostikasa da mkurnalobisaken).

romlis drosac pacienti iRebs imaze met momsaxureobas, vidre is

moiTxovda, rom hqonda Sesabamisi ganaTleba. eqimebi SesaZlebelia

axdendnen moTxovnebis provocirebas, roca:

1) arsebobs mecnieruli eWvebi;

2) eqimebs aqvT mcire datvirTva;

- 64 -

3) izrdeba konkurencia;

4) gadasaxadebis piradi Rirebuleba mcirdeba.

moTxovnebis provocirebas SeuZlia migviyvanos moWarbebul referalebamde

da ,,trefikingamde pacientebSi”, roca nawili honorarisa eqimisaTvis

ikargeba, magram problema imaSi mdgomareobs, rom referalebis ricxvi

Zalze mcirea radgan eqimebs ar surT pacientis dakargva.

momsaxurebis Sesabamisi anazRaurebis sistema asocirdeba zogadi

praqtikosebis sust politikur ZalauflebasTan, dabal pirveladi

jandacvis maCveneblebTan. am mimarTebaSi, 18 mdidari OEOCED-s qveynebidan

yvelaze cudi maCvenebeli germaniaSi, SveicariaSi da safrangeTSi

aRiniSneba. aseve problemebia momsaxureobis ganxorcielebisaTvis

dakavsSirebul gadaxdasTan (prefomance-related) mimarTebaSi, romelmac

farTod daikava adgili britanul jandacvaSi (anu saxelmwifo seqtorSi)

bolo 15-20 wlis ganmavlobaSi, xolo irlandiis, espaneTisa da sxva

jandacvaSi seqtorebSi ukanaskneli dekadis ganmavlobaSi. momsaxureobis

ganxorcielebasTan dakavSirebuli gadaxda SemoRebuli iyo mTeli rigi

mizezebis gamo, rogoricaa:

1)zogadi praqtikosebis stimulireba (protokolebisa da gaidlainebis

gamoyeneba, damtkicebuli Carevis xelSewyoba, zogadi daniSnulebebi,

fasebis kontroli farmacevtul saSualebebze, vizitebis gazrda da sxva).

2)xelmisawvdomobis gaumjobeseba;

3) kadrebis motivireba;

4) kadrebis ayvanisa da SenarCunebis procesebis gamtkiceba;

5) organizaciul kulturaSi cvlilebebis mniSvneloba;

6) kadrebis anazRaurebis kontroli;

7) profkavSirebis Zalauflebis Semcireba;

8) kadrebis ganviTarebis politikis gaZliereba.

magram mtkicebulebebis umravlesoba, romelic momsaxureobis Seeabamisad

gadaxdis Sesaxeb arsebobs, miuTiTebs mxolod sasargeblo moqmedebebze.

warmatebis misaRwevad saWiroa Zalisxmva, raTa miRweuli iqnas

yovelwliuri miznebis Sesaxeb SeTanxmembebi mTel jgufTan aseve miznebis

xelaxali Sexsenebebi da garemoebebi, raTa miRebuli iqnas Sedegebi.

ganvlili gza momavalSi, garkveulwilad gansazRvravs ,,gamosavlebs”

- 65 -

rogoricaa, klinikuri moqmedebebis xelSewyoba, romelic Tavs aridebs

,,jamrTelobis iseT gamovlinebas, romelsac SesaZlebelia gverdi auaroT”,

magaliTad:

1) ambulatoriuli dacvis saTuTi mdgomareobebi (hospitalizaciis

SesaZlebeli gverdis avla);

2) sikvdili, romelic ar iyo gardauvali (mag. sikvdili tetanosiT an

pnevmoniiT).

zogierT stimuls SesaZloa Sereuli efeqti hqondes, 1993 wels,

irlandiaSi warmodgenili, zogadi praqtikosebis stimulirebis sqema

iTvaliswinebda, rom saxelmwifo dazRveulebisaTvis gacemuli daniSnuleba

yofiliyo fasiani (dabali klasisaTvis, anazRaureba kapitaciis meTodiT).

zogad praqtikosebs saSualeba miecaT SeenaxaT Tanxis naxevari, romelsac

proeqtis farglebSi iyeneben TavianTi pacientebisaTvis da darCenili Tanxa

egzavneboda jandacvis xelmZRvanelobas pirveladi jandacvis

ganviTarebisaTvis. seqma ar iTvaliswinebda jarimebs, biujetidan

gansazRvrulze meti Tanxis daxarjvisaTvis. 1990 wlis gamokiTxvam cxadyo,

rom zogadi praqtikosebi mxars uWerdnen sqemas, farmaceptebi

ewinaaRmdegebodnen mas, pacientebma ki araferi icodnen sqemis Sesaxeb,

mosaxleobis saWiroebibi da gaWirvebebi ki kvlav ucvleli rCeboda. es

aspeqti arasodes ar yofla, srulad ganxiluli kvlevaSi. mtkicebulebebi

cxadyofen, rom finansebze fokusirebulma stimulebma SeiZleba cudi

gavlena iqonios pacientTa momsaxureobaze. stimulebis warmatebul

gamoyenebaze, arsebobs saTuo mtkicebulebebi. 1964 wels didi britaneTSi,

dawesda specialuri anazRaureba, jgufuri muSaobisaTvis, sakuTrebis

gaumjobesebisTvis da damxmare kadrisTvis, ramac dramatul cvlilebebamde

miiyvana zogadi praqtika, man warmoSva pirveladi jandacvis struqtura,

romelic dReisTvis warsuls bardeba. norvegiaSi zogadi praqtikosebi

visac binaze vizitisaTvis uxdian 30 evros, metad rutinulad misdeven

binaze vizitebis praqtikas, vidre is eqimebi, romelTac igive saqmianobaSi 6

evros uxdian. Tumca am magaliTidan ar Cans pacientebma Tu moiges, binaze

vizitebis ricxvis gazrdiT.

dakvirvebam gamoaaSkarava anazRaurebisa da stimulebis gansxvavebuli

SemTxvevebis dros, magaliTad xelfasiT anazRaurebad eqimebs urCevniaT

- 66 -

mokle samuSao da naklebad datvirTuli dRe hqondeT. eqimTa anazRaurebis

meTodebi garkveulwilad moqmedeben Tavisufali da samuSao drois

monacvleobaze. ojaxis eqimebi da axalgazrda zogadi praqtikosebi sxvebze

metad afaseben Tavisufal drosa da ojaxur cxovrebas. amgvari

damokidebuleba aRiniSneboda norvegiaSi, ris gamoc 1990 wlisaTvis zogadi

praqtikosebis ori ZiriTadi tipi Camoyalibda: adgilobrivi mTavrobis

mier, xelfasis saSvalebiT anazRaurebuli daqiravebulebi da

damoukidebeli kontraqtebis mqoneebi, romelTac ZiriTadad momsaxurebis

Sesabamisi anazRaureba hqondaT. am SemTxvevaSi momsaxurebis Sesabamisi

anazRaurebis mqone eqimebis momsaxurebis produqti 20-40%-iT meti iyo,

magram is, rom xelfasian eqimebs meti Tavisufali dro hqondaT, zogierTi

zogadi praqtikosisaTvis stimuls warmoadgenda (rom emuSava xelfasiT

anazRaurebad eqimad) jgufuri stimulireba SesaZlebelia mxilod maSin

roca, saqme jandacvis centrebs an jgufur muSaobas exeba. espaneTSi,

jandacvis centrebSi, mTeli jgufis stimulireba xdeba, kerZod fasebis

kontrolisa (daniSnulebis fasebis CaTvliT) da eqTnebsa da eqimebs Soris

zogadi monitoringis warmoebis saSualebiT. msgavsi sistemis dros

monitoringi efeqturia radgan, medpersonals erTmaneTis praqtikis Sesaxeb

meti informacia aqvT vidre menejers. xorvatiaSi pirveladi jandacvis

privatizacia (zogadi praqtikosebis xelfasebiT anazRaurebis meTodis

kapitaciis meTodiT Secvla da kerZo kontraqtebis SemoReba) asocirebuli

iyo gaumjobesebasTan (vizitis zusti drois daniSvnebi, vizitebis

telefoniT daniSvnebi, telefonis saSualebiT konsultaciebis gacema

arasamuSao dros). Cven araferi ar viciT amgvari cvlilebebi, rogor

moqmedeben momsaxurebis xelmisawvdomobaze da janmrTelobis

mdgomareobaze. stimulebma aseve SesaZloa gansazRveron profesionalTa

kariera. portugaliaSi, sadac uamravi ,,winaaRmdegobebia” da cota jildoa

qvemodan zemoT mimavali kibis (karieris) dasaZlevad, arsebobs sqema,

romelic sxva da sxva saxis stimulebs Tavazobs eqimebs, mag. menejerebi

Tavazoben eqimebs, mniSvnelovani gadawyvetilebebis miRebis da jandacvis

momsaxurebis dagegmvis dros miiRon monawileoba.

garkveuli gamocdileba dagrovda stimulebis uaryofiTi moqmedebaze

(negatiuri stimulebi). magalliTad germaniaSi sqema sjida eqimebs,

- 67 -

erovnuli wamlebis biujetis dasaSvebze meti xarjisaTvis, ramac gamoiwvia

wamlebis fasebis 25%-iT gazrda, SesaZloa am procesma gazarda

saavadmyofoebSi mimarTvisa da gadagzavnis procesebi. safrangeTSi

aRiniSneboda, rekomendirebuli gaidlainebis garda sxva daniSnulebebis

gacemis faqtebi. mravali kvlevaa Catarebuli gaidlainebis Sesatyvisobasa

da klinikuri efeqtis qonebasTan dakavSirebiT, magram Sefasebebi da

moxsenebebi amis Sesaxeb jer ar gakeTebula. stimulebi aseve gamoyenebuli

unda iyos TviT-movlis xelSewyobisaTvis, radgan igi (personaluri da

ijaxis) dacvis umniSvnelovanesi, bazisuri safexuria. germaniaSi xdeba

qronikuli pacientebis, binaze movlis finansuri mxardaWera.

Zalze cotaa cnobili, Tu rogor moqmedeben zogadi praqtikosebis

anazRaurebis sxva da sxva sistemebi fasebsa da jandacvis SesaZleblobaze.

- 68 -

1.3. jandacvis sistemis reformis ganxorcielebasTan dakavSirebili

problemebi ganviTarebad qveynebSi

1993 wlis seqtemberSi Catarda saerTaSoriso konferencia Temaze

`jandacvis seqtoris reforma ganviTarebad qveynebSi: 1990-iani wlebis

sakiTxebi~ konferenciis Catarebis periodSi, didi daintereseba iyo am

sakiTxisadmi. amerikis SeerTebul StatebSi ixilavdnen klintonis gegmas,

ukanaskneli ramdenime aTwleulis yvelaze mniSvnelovan winadadebas

jandacvis reformis irgvliv. didi britaneTi, niderlandebi, SvedeTi da

evropis sxva qveynebi nergavdnen finansur da miwodebis axlebur

meqanizmebs. saSualo Semosavlebis mqone qveynebi, magaliTad taivani,

nergavda jandacvis dazRvevis axal sistemas. msoflio banks axali

gamoqveynebuli hqonda 1993 wlis ganviTarebis angariSi ìnvesticia

jandacvaSi~, sadac SemoTavazebuli iyo jandacvis strategiebis

gansxvavebuli xedva dabali da saSualo Semosavlebis mqone qveynebSi.

ganviTarebad qveynebSi jandacvis mniSvnelovan miRwevad iTvleboda bavSvTa

universaluri imunizacia, oraluri rehidrataciis Terapia da amerikis

kontinentze poliomelitis praqtikulad sruliad aRmofxvra. amave

periodSi axleburi midgoma Camoyalibda reproduqciuli janmrTelobis,

daavadebuli bavSvebis, imunodeficitis/Sidsis mimarT. Sedegi gamoiRo

vertikalurma da kategoriirebulma programebma. Tumca, ufro da ufro

aSkara xdeboda, rom warmatebis SesanarCuneblad jandacvis sistemebs

bevrad meti mxardaWera esaWiroebodaT, rogorc es seqtoris sxvadasxva

angariSebidan da jandacvis seqtoris Sefasebebidan gamoikveTa, mTel rig

ganviTarebad qveynebSi, jandacvis sistemebi realurad funqcionirebda

araefeqturi da araTanabari resursebis ganawilebis, uxarisxo

momsaxurebis da demoralizebuli personalis pirobebSi. pacientebi

saxelmwifo samedicino sistemidan kerZo sistemaSi gadadian, riTac

gamoxataven TavianT damokidebulebas. jandacvis aseT dangreul sistemebSi

ismoda SekiTxva imis Sesaxeb, SenarCundeba ki aseT viTarebaSi miRweuli

Sedegebi donorebis mxardaWeris dasrulebis Semdeg, meti fondebis moZieba

ufro gonivruli iqneba Tu ara, SeiZleba Tu ara ukiduresad Rarib

qveynebSi miRwevebze saubari da sxva. konferenciaze `jandacvis seqtoris

- 69 -

reforma~ gamoikveTa azri, rom jandacvis sistemebis axleburi xedva da

inovaciebi aRmofxvris am uTanasworobas. iseTi koncefciebi, rogorebicaa

àxali sazogadoebrivi marTva~ an `kerZo sazogadoebrivi partnioroba~

gvpirdeboda sazogadoebrivi miznebisa da antreprenioruli kreatiulobis

potenciur sinTezs, ramac SeiZleba moitanos jandacvis miRwevebis axali

era. bevr ganviTarebul qveyanaSi, inovaciebi jandacvis dafinansebis da

miwodebis sakiTxebSi, TiTqos ufro amtkicebda am sistemebis

biurokratiulobas. SeeZlo ki am siaxleebs axali energia STaebera

ganviTarebadi qveynebis jandacvis sistemebisaTvis? didi cvlilebebi

ganicada samedicino sazogadoebam am periodis mere. aTwleulis bolos,

sxva saerTaSoriso konferenciaze, jandacvis sistemis wamyvani

mkvlevarebisgan movismineT, rom `jandacvis seqtoris reforma~

ganviTarebad qveynebSi jandacvis sistemebis yvelaze didi damangrevelia.

auditoriis didi nawili am azrs daeTenxma. mTeli rigi problemebis

gamomwvev mizezad dasaxelda `jandacvis reformis Cavardna~; maT Soris

gazrdili samedicino gadasaxadebi, vertikaluri imunizaciis mier

miyenebuli ziani da decentralizaciis Semdegi ojaxuri dagegmvis

programebi. aseve RaribTa xarisxian samedicino momsaxurebaze

xelmisawvdomobis Semcireba, rac gamowveulia araTanaswori sadazRvevo

sistemebiT.

ra moxda am wlebSi? ra doziT moxda sawyisi optimizmis realizeba (an

pesimizmis)? DDM proeqtis dasrulebam mogvca saSualeba gamovikvlioT es

sakiTxebi. modiT gavarkvioT Tu ra codna dagrovda ganviTarebad qveynebSi

jandacvis seqtoris reformaze aTwleulis ganmavlobaSi (ra periodSic

mimdinareobda es proeqti) da davusvaT sakuTar Tavs SekiTxva, ra

SegviZlia viswavloT aqedan?

reforma gulisxmobs dadebiT cvlilebebs. magram jandacvis seqtoris

reforma moicavs ufro mets, vidre mxolod janmrTelobis an

janmrTelobis dacvis gaumjobesebaa. 1995 wels, DDM Camoayaliba jandacvis

seqtoris reformis gansazRvreba, rogorc: `xangrZlivi, mizanmimarTuli da

fundamentaluri cvlileba~; sadac `xangrZlivi~ niSnavs araerTjerad da

droebiTs, aramed xangrZlivmoqmed gavlenas; `mizanmimarTuli~ niSnavs

racionalurs, gegmiurs da faqtebze dafuZnebuls; da `fundamentaluri~

- 70 -

niSnavs jandacvis sistemis mniSvnelovan strategiul siRrmeebs (bermani

1995 weli). gamokvleulia jandacvis sistemis cvlilebis specifiuri

ganzomilebebi, romlebic reformis strategiebis nawili iyo (kaselsi 1995).

calsaxaa, rom jandacvis seqtoris reformam SeiZleba moicvas jandacvis

sistemebis farTo speqtri.

jandacvis seqtoris reforma ar aris koncefcia, romelsac unda

hqondes mxolod erTi gansazRvreba. ar unda davideT mcire detalebamde

da gavarkvioT ra Sedis da ra ar Sedis reformis farglebSi (kaselsi da

janovski 1996 weli). Tumca am mosazrebis kritikosebi gvTavazoben ufro

naTlad CamovayaliboT is, Tu ra igulisxmeboda (ivaraudeboda) da raze

gamovxatavT kritikul azrs. imisaTvis, rom SevafasoT reformis

efeqturoba, unda ufro naTlad vicodeT ra igulisxmeba reformis qveS.

pirveladi gansazRvrebis mixedviT umjobesia davakonkretoT, Tu ras

vgulisxmobT `fundamentaluri cvlilebebis~ qveS. uiliam hsiaos (2000

weli) statiaSi mohyavs `makontrolebeli niSnulebi~ CamonaTvali (`Control

knobs”) romliTac isazRvreba jandacvis sistemebis ZiriTadi procesebi da

Sedegebi. hsiaos azriT, jandacvis seqtoris ZiriTadi aqcenti unda

gakeTdes: dafinansebis, gadasaxadebis, organizebis, regulirebis da

momxmarebelTa qcevis Camoyalibebisa da morgebisaTvis.

jandacvis sistemis aseTi meqanizmebis naTlad Camoyalibeba dagvexmareba

jandacvis seqtoris reformis ufro frTxil daxasiaTebaSi. SeiZleba ufro

gamosadegi iyos sistemuri cvlilebebis strategiuli da fundamentaluri

programebis gamoyofa SezRuduli, nawilobrvivi an mzardi programebisgan.

pirvel nawils SeiZleba vuwodoT reformebi didi asoTi (R), meores ki

reformebi patara asoTi (r). gTavazobT, didi R-iT movixsenioT is

reformebi, romlebic Tavis TavSi moicavs hsiaos mier CamoTvlil minimum

or elements, xolo patara r-iT ki is programebi, sadac SedarebiT

SezRuduli masStabiT mxolod erTi aseTi elementi, Sedis.

magaliTisaTvis, axali an farTomasStabiani erovnuli jandacvis

sadazRvevo sistemis Camoyalibeba iTvaliswinebs, dafinansebis,

regulirebis da miwodebis saqmeSi mniSvnelovani cvlilebebis

ganxorcielebas. imis mixedviT, Tu rogor aris igi struqturirebuli is

aseve gavlenas moaxdens jandacvis miwodebis sakiTxebzec. aqedan

- 71 -

gamomdinare, igi CaiTvleba reformad `didi asoTi~ da piriqiT reformebi

`patara asoTi~ iqneba magaliTad momsaxurebis safasuris SemoReba

sazogadiebriv klinikebSi an, erovnuli saswavlo saavadmyofoebisaTvis

avtonomiis miniWeba. aseT qmedebebs, eWvgareSea rom didi sargeblis motana

SeuZliaT, Tumca isini calke aRebuli ar aris igive masStabis da

sirTulis, rac e.w. `reformebi didi asoTi~. `R” tipis reformebi Tavis

TavSi SeiZleba bevri `r” tips reformis ganxorcielebas moicavdes:

1) sistemuri paketi cvlilebebisa;

2) reforma unda iyos ~mizanmimarTuli~ es niSnavs, rom reformis

elementebi da komponentebi unda Camoyalibdes racionalurad: naTlad

gamoikveTos jandacvis sistemebis problemebi, faqtebze dafuZnebulad,

moiZebnos sistemis cvlilebebisa da am problemis gadaWris

damakavSirebeli meqanizmi. aucilebelia SemuSavdes jandacvis reformis

naTlad formulirebuli politika, imgvarad, rom masSi monawile

pasuxismgebelma pirebma, romlebic axorcielebn cvlilebebs, SeZlon

konkretulad gansazRvron miznebi da amocanebi, kavSiri, maT saqmianobasa

da reformis mizans Soris aseve sistemis sxvadasxva komponentebTan;

3) reforma unda iyos `xangrZlivmoqmedi~ yvelaze fundamentaluri

cvlilebebi iqneba xangrZlivmoqmedi xasiaTis, radgan isini iTvaliwinebs

sistemebis mniSvnelovan transformacias da axali moqmedi pirebis Seqmnas,

romlebic daicaven TavianT axal interesebs politikur procesebSi. Tumca,

aseTad ar CaiTvleba is reformebi, romlebic SemoTavazebulia

kanonmdeblobiT da romelTa ganxorcielebac ar moxda; arc isini,

romlebis ganxorcielebac daiwyo da Sewyda, mag, niderlandebSi ar

ganxorcielda ambiciuri reforma saxelwodebiT `marTuli konkurencia~,

bolomde ar gatarda Sesabamisi RonisZiebebi da mogvianebiT damatebebi

Sevida reformis kanonmdeblobaSi, riTac mTlianad gabaTilda gatarebuli

sistemuri cvlilebebi. bunebrvia, Cven SeiZleba garkveuli codna miviRoT

Seumdgari an ganuxorcielebeli reformebidan, magram isini ver

warmoadgens srul suraTs.

dayofis mizani sulac ar aris utyuari maCveneblis gamokveTa, romelsac

gamoviyenebT imis gansasazRvravad, ganxorcielda msxvil Tu mcire

- 72 -

masStabiani reforma; aramed Cven gvinda ganvixiloT bolo aTwleulSi

dagrovili gamocdileba jandacvis reformis irgvliv.

mniSvnelovania miznobrivi jandacvis reforma ganvasxvavoT sistemaSi

ganxorcielebuli garedan nakarnaxevi cvlilebebisagan. aseTi gansxvavebebi

saSualebas gvaZlevs SevafasoT reformebi maTi Zireuli mniSvnelobiT.

terminis `jandacvis seqtoris reforma~ gamoyeneba misi sxvadasxva

mniSvnelobiT da gansxvavebuli motivaciis mqone mxaris mier gamoyeneba

SeiZleba aixsnas jandacvis sistemis cvlilebis mravlad arsebuli

negatiuri gamocdilebiT. cvlilebebi, romlebic, Tavs moxveulia

samTavrobo iniciativiT, xSirad saerTaSoriso donorebis mxardaWeriT, ar

isaxavs miznad jandacvis sistemis gaumjobesebas. aseTi proeqtebi ufro

xSirad makroekonomikuri stabilurobis miRwevas an ufro demokratiuli

politikuri sistemebis Camoyalibebas emsaxurebian da isaxaven samedicino

miznebis miRwevas. msgavsma cvlilebebma, SeiZleba gamoiwvios jandacvis

sistemebis an janmrTelobis gaumjobeseba, magram SeiZleba arc gamoiwvios.

xSirad maT SemuSavebisas, aseTi mizani arc aris. frTxilad unda viyoT

cvlilebebis `jandacvis seqtoris reformad~ moxseniebisas, radgan maT

cota mcire informacia SeiZleba mogvawodon jandacvis sistemis

mizanmimarTuli cvlilebebis Sesaxeb, Tumca, maT SeiZleba didi gavlenac

moaxdinon sistemaze.

garedan Tavsmoxveuli cvlilebebi, SeiZleba ramdenime wyarodan

modiodes, magaliTad:

1. jandacvis sistemis zogierTi cvlileba SeiZleba gamomdinareobdes

politikuri, socialuri an ekonomikuri reformidan, davuSvaT qveynis

komunisturi wyobidan gamosvlis periodSi;

2. sxva tipis jandacvis sistemis cvlilebebi gamowveuli iyo mTlianad

saxelmwifos reformidan (mag. laTinuri amerika);

3. jandacvis sistemis gansxvavebuli cvlilebebi gamoiwvia mwvave

finansuri krizisis dasaZlevad SemuSavebulma erovnulma programebma

(rogorc wesi `struqturulis Sesabamisobis miRwevis~ formiT); Tavidan

ganxorcielda laTinur amerikaSi 1980-ian wlebSi da ufro mogvianebiT

CrdiloeT afrikis qveynebSi.

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`reforma SeiZleba xasiaTdebodes reformad didi (strategiuli da

mizanmimarTuli) da patara (inkrementaluri da miznobrivi) asoebiT~ da

gansxvavebuli SeiZleba iyos am ori formis Sefasebis meTodebic. Tumca

imis sawinaaRmdegod, rac iTqva, Cven davakvirdiT, rom yvelaze ufro

mizanmimarTuli jandacvis reforma aris e.w. `r” reformis. mxolod mcire

raodenobis ganviTarebadma qveyanam Caatara jandacvis sistemis

momcvelobiTi analizi, gegmiuri strategiuli cvlilebebis

ganxorcielebis Semdgom. Zalian mcirea im qveynebis raodenoba, sadac

Catarda `R” tipis reformebi da SeiZleba aqedan daskvnebis gamotana. ufro

xSiria `r tipis reformebis ganxorcielebis praqtika. aseTi mcire

masStabiani cvlilebebi fundamentalurad ver Secvlian jandacvis

sistemas, magram maT aqvT rogorc dadebiTi, ise uaryofiTi gavlena.

mimovixiloT, xsenebuli reformebis ramdenime tipi. pirvelad SevexoT

jandacvis cvlilebebs, romlebic Tavs moxveulia seqtoris garedan.

magaliTebia qveynebi, romlebic gamodian komunisturi weswyobilebidan –

yofili sabWoTa kavSiris, aRmosavleT evropis qveynebi da qveynebi sadac

kvlav mmarTvelobaSia komunisturi partia, Tumca romlebmac gaxsnes

ekonomika (mag. CineTis saxalxo respublika da vietnami). aRmoCnda, rom

sabazro principebiT gamowveulma struqturulma da ekonomikurma

cvlilebebma, umetes SemTxvevaSi uaryofiTi gavlena iqonia jandacvis

seqtorze. CineTSi, 1978 wels dawyebulma ekonomikurma cvlilebebma (gu da

tang, 1995 w.) daSala jandacvis dafinansebis socialuri meqanizmi. Amis

Sedegad, moxda saxelmwifo sistemaSi sabazro Zalebis uecari SeWra.

pirveladi donis momsaxurebam dakarga Tavisi koleqtiuri dafinansebis

safuZveli CineTis umravles soflebSi. saxelmwifo biujeti ara

adekvaturad afinansebda saavadmyofoebs qalaqSi. Aman moitana iseTi

mniSvnelovani cvlilebebi, rogoricaa soflis eqimis praqtikis

privatizacia, saavadmyofoebis finansuri avtonomiebis SemoReba da fasebis

eskalacia (moxda fasebis liberalizacia da provaiderebi Tavisufalni

iyvnen, Semosavlis gazrdaSi). jandacvis seqtoris cvlilebebi CineTSi,

ekonomikis am reformis sapasuxo iyo (uei da reni, 1999l; liu da al, 1995).

iTvleba, rom saxelwifos prioriteti ar iyo jandacvis seqtoris reforma,

magram arsebobs niSnebi imisa, rom zogierT provinciaSi da qalaqSi

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ganviTarda, cvlilebebisa da eqsperimentebis am periodis ufro

momcvelobiTi erovnuli politikis SemuSavebis interesi.

jandacvis sistemis garedan Tavsmoxveuli reformis ZiriTadi tipi aris

mTlianad saxelmwifos reformis da decentralizaciis Sedegi, rogorc es

moxda laTinuri amerikis qveynebSi. gvian 1980-ian da 90-ian wlebSi, laTinur

amerikaSi gaCnda reformebiT dainteresebis talRa, romelic gamowveuli

iyo 80-iani wlebis finansuri “valebis” krizisiT da samxedro wyobilebis

aTwleulis Semdgom, demokratiis aRdgenis surviliT (grindeli, 1996

weli). magaliTad bolivia, 1993 wels sanCes lozadas xelisuflebaSi

mosvlis Semdeg. saxelmwofoebrivi reforma ganxorcielda qveynis

biujetis SemcirebiT da saxelisuflebo funqciebis municipalitetebze

decentralizaciis gziT. samTavrobo funqciebi jandacvasTan mimarTebaSi

zeviT xsenebuli procesis Sesabamisad gadaeca municipalitetebs. Tumca,

amas ar hqonia jandacvis seqtoris reformis saxe. am cvlilebam pirvel

etapze moitana samedicino dawesebulebebisaTvis dafinansebis Semcireba da

es gagrZelda manam, sanam jandacvis `r” tipis reformis mixedviT, ar

daevala municipalitetebs maTi dafinansebis asignirebuli Tanxis

jandacvaze mimarTva (ruizi da giusani, 1998; dimertiCenko, 1990).

decentralizaciis reformis magaliTebi sxva kontinetzec arsebobs da

maT Soris senegali erT-erTi gamorCeulia. senegalSi, jandacvis seqtoris

adgilobriv warmomadgenlobebze decentralizaciis didi xnis mcdelobis

Semdeg, mTavrobam ganaxorciela radikaluri nabiji da moaxdina seqtoris

sruli decentralizacia adgilobriv municipalitetebze da amasTan,

jandacvis sistemis dafinansebis da funqcionirebis aranairi samoqmedo

wesebi ar miuwodebia maTTvis. aseTma nabijma qveyana miiyvana sistemis

srul daSlamde, ar arsebobda praqtikulad aranairi komunikacia dargis

xelmZRvanelebsa da merebs Soris (gridmani, 2000 w). boliviasa da

senegalSi, jandacvis sistemis menejerebi da saerTaSoriso organizaciebi

decentralizebuli jandacvis sistemebSi investiciis Cadebis gziT,

cdilobdnen raime sargebeli enaxaT Seqmnili mdgomareobidan, magram

yovelive es Zalian Sorsaa da araferi aqvs saerTo mizanmimarTuli,

jandacvis sistemisaTvis specialurad SemuSavebuli da misi

gaumjobesebisaken mimarTuli decentralizaciisagan.

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reformis garedan Tavze moxveva kidev moxda afrikis qveynebze, rac

gamoiwvia 1980-iani da 90-iani wlebis finansurma krizisma. saerTaSoriso

safinanso institutebis (msoflio banki da saerTaSoriso savaluto fondi)

mier inicirebuli struqturuli gardaqmnis programebi, gulisxmobda

adgilobrivi valutis devalvacias, samTavrobo danaxarjebis (xSir

SemTxvevaSi, socialuri danaxarjebis CaTvliT) da valebis Semcirebas da

saxelmwifo momsaxurebebis SezRudvas. xSirad es procesebi did gavlenas

axdenda jandacvis sistemaze, xdeboda ra danaxarjebis Semcireba da

fasebis momateba importirebul saqonelze. arsebuli gamocdilebis

gaanalizebis Semdeg, sanma da berniem (1995) aRniSnes, rom `struqturuli

gardaqmnebi, fiskaluri gamkacrebis da biujetis SemcirebiT, ar uqmnis

safrTxes jandacvis seqtoris funqcionirebas~. magram maT aseve aRniSnes,

rom, `struqturuli gardaqmnebi ar ganapirobebs SezRuduli resursebis

mniSvnelovan intra-seqtoralur xelaxal gadanawilebas~ da ìSviaTia

mniSvnelovani cvlilebebi, reformebi Tavisi bunebiT ar aris mzardi~. sxva

sityvebiT rom iTqvas, am makro-ekonomikur reformebze, jandacvis seqtori

yvelaze xSirad pasuxobda `r~ tipis jandacvis dafinansebas aqtivobebiT,

magaliTad keniasa da ganaSi momsaxurebis safasuris SemoReba, bamakos

iniciativa Temis xelSewyoba wamlebis dafinansebiT.

iSviaTia qveynebi, sadac jandacvis reforma ganxorcielda

mizanmimarTulad, fundamentalurad da xangrZlivmoqmedad (rogorc es

DDM-is mier Camoyalibda 1993 wels). 1980 wlis Semdeg, msgavsi reforma

ganxorcielda: CileSi, kolumbiaSi, zambiaSi, CexeTis respublikaSi,

ungreTSi, poloneTSi (1990-is Semdeg), CineTSi (qveynis pilotur regionebSi)

da samxreT afrikaSi, CamoTvlilTagan mxolod zambia da CineTia dabal

Semosavliani qveyana. piriqiT, Zalian didi iqneba sia, Tu CamovTvliT

qveynebs, sadac ganxorcielda `r~ tipis reformebi jandacviT sferoSi. maT

Soris davuSvaT dafinansebis axali meqanizmis – momxmareblis safasuris

SemoReba da adgilobrivi winaswari gadaxdis sqemebi marTvisa da

organizebis axali formebi – decentralizacia da saavadmyofoebis

avtonomia. CileSi jandacvis reforma 80-iani wlebis dasawyisSi daiwyo da

reformebis talRis erT-erTi pirveli iyo. (talRis pirveladi etapi iyo

1950, 60-ian wlebSi erovnuli jandacvis sistemis Camoyalibeba). Ciles

- 76 -

reforma iTvaliswinebda kerZo sadazRvevo gegmebis, saxelad ISAPRE

SemoRebas da pirveladi sistemis decentralizacias (kastaneda, 1992). igi

moicavda hsiaos TiTqmis yvela sakontrolo niSnuls:

• Zireuli cvlilebebi dafinansebaSi – kerZo sadazRvevo sistemis

SemoRebas, romelic mniSvnelovnad finansdeboda socialuri

dazRvevis SenatanebiT;

• pirveladi jandacvis dawesebulebebis decentralizaciis

municipalitetebze;

• gadaxdis meqanizmis cvlilebas da masSi momsaxurebis safasuris da

Semdeg erT mosaxleze (per kapita) gaangariSebis SemoRebas;

• axali maregulirebeli reJimis, maT Soris sadazRvevo kontrolis

Camoyalibeba;

• jandacviTi qcevis Secvlis axali programebi (prevenciisaken

mimarTuli).

1993 wels dawyebuli reforma kolumbiaSi aseve moicavda yvela

`sakontrolo niSnuls~; inovaciuri socialuri dazRvevis farglebSi, misi

saSualebiT SesaZlebeli gaxda `konkurenciis marTva~ sazogadoebrivi da

kerZo samedicino dazRvevis gegmebisa da sazogadoebrivi _ kerZo

provaiderebTan kontraqtis dadebis gziT (kolumbiis jandacvis seqtoris

reformis proeqti, 1996).

zambiuri modeli (dawyebuli 1991-1992 wlebSi) iTvaliswinebda

saxelmwifo jandacvis sistemis inovaciurad restruqtuirebas

institucionalur doneze. reformis farglebSi Seiqmna jandacvis

centraluri sabWo, romelic zedamxedvelobas uwevda samedicino

momsaxurebis miwodebis saqmeebs da ar Sedioda jandacvis saministros

SemadgenlobaSi. es modeli aseve gulisxmobda decentralizacias

mniSvnelovani masStabiT (regionis jandacvis menejmentis gundze da

sabWoebze), momsaxurebis safasuris SemoRebas da sargeblis paketebis

Seqmnas (msoflio savaWro organizacia, 1997).

centraluri da aRmosavleT evropis qveynebSi sabWoTa sistemis

Sesacvlelad aseve ganxorcielda mTeli rigi fundamentaluri reformebi.

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1990-ian wlebis dasawyisSi dawyebuli reforma CexeTis respublikaSi

gulisxmobda saxelwifo momsaxurebis swrafi tempiT privatizacias,

saxelmwifosTan dakavSirebul da kerZo sadazRvevo fondebis Seqmnas,

anazRaurebis axali sistemis SemoRebas.

ungreTSi Catarda pirveladi jandacvis sistemis nakleb ambiciuri

privatizacia, SemoiRes centralizebuli socialuri dazRvevis sistema da

moxda municipalur doneze sakuTrebis decentralizacia. poloneTSic

ganxorcilda decentralizacia, avtonomia mieniWa saavadmyofoebs da

klinikebs da moxda ramdenime pirveladi jandacvis sistemaSi politikuri

privatizacia SerCeul regionebSi; Tumca es yvelaferi moxda mxolod 1997

wels jandacvis dazRvevis Sesaxeb sakanonmdeblo aqtis miRebis Semdeg,

riTac fundamentaluri cvlileba ganxorcielda (bermani, 1998).

srulmasStabiani `R~ tipis reformebis gamocdilebis mqone qveynebs

saerTo maxasiaTeblebi aqvs; pirvel rigSi xandaxan (magram ara yovelTvis)

aseTad SeiZleba CaiTvalos mwvave krizisi (politikuri da/an ekonomikuri),

kolumbiaSi jandacvis reformis kanonmdebloba Seicvala erovnuli

sapensio sistemis reformis paralelurad, am ukanasknelis krizisis gamo.

kolumbiaSi pirvelad didi xnis ganmavlobaSi, demokratiuli wesiT airCies

xelisufleba. qveyanaSi aRmoCnda navTobis maragi, ramac saSualeba misca

mTavrobas ganexorcielebina ZviradRirebuli da popularuli politikuri

cvlilebebi. Tumca es yovelTvis ase ver xdeba, magram savaraudoa, rom

jandacvis sistemis mniSvnelovani cvlilebebi ganxorcielda farTo

saxelwifoebrivi garemosdacviTi strategiis Secvlis gamo. aseTi

ganacxadis arseboba, saWiroebis aRiareba da cvlilebebis ganxorcielebis

SesaZlebloba, yovelTvis ar aris sakmarisi piroba `R~ tipis reformis

gansaxorcieleblad. magaliTad CileSi msgavsi reformebi Catarda

ekonomikuri krizisisa da gardamtexi politikuri cvlilebebis gareSec.

marTali `R~ reformis dawyebas win unda uZRodes analitikuri samuSao da

dadegmva, magram CamoTvlili qveynebis umravlesobaSi es ar momxdara.

ufro xSirad, analizi Catarda, magram iSviaTi iyo misi, reformebis

dawyebamde Catareba. sxva qveynebma, analizis Catarebis saWiroeba aRmoaCines

mxolod reformis dawyebis Semdeg.

- 78 -

Ciles reforma SemuSavda teqnokratTa mcire jgufis mier, romlebmac

SeiZines samxedro reJimis uaryofiTi mimarTeba, imis gamo, rom maT hqondaT

saukeTeso monacemebi da analizi.

zimbabvesa da kolumbiaSi reformebi daiwyo mniSvnelovani analizis

Catarebis Semdeg. maT Soris Sefasda momsaxurebis utilizacia,

daavadebebis tvirTi, Catarda xarjebis efeqturobis analizi. kolumbiaSi

Sefasda arsebuli da SeTavazebuli sadazRvevo sistemebi, Tumca, mTeli es

samuSao sakmarisi ar iyo da didi damatebiTi samuSao ganxorcielda

reformis mimdinareobis procesSic.

sapirispiro magaliTia poloneTi, sadac axali samedicino dazRvevis

programa daiwyo Zalian SezRuduli informaciisa da gamocdilebis

pirobebSi (bermani 1998), reformis mimdinareobis meore wels, xelisufleba

agrovebda faqtebs axali sistemis marTvisTvis.

efeqturad ganxorcielebisa da sicocxlisunarianobisaTvis, R tipis

reformas esaWiroeba sakmaod didi raodenobis kvalificiuri adamianuri

resursebi, institucionaruli mxardaWera da stabiluroba. praqtikulad

yvela xsenebul qveyanaSi, moxda am saWiroebis arasaTanado doneze

Sefaseba. poloneTSi xelisufleba Svid welze mets bWobda SeTavazebuli

samedicino dazRvevis sistemis struqturaze. miuxedavad amisa, 1999 wlis

ianvarSi, am sistemis realurad ganxorcielebis Semdeg, Seiqmna

momzadebuli kadrebis simcire, romlebsac xelmZRvaneloba unda gaewiaT 17

regionaluri daavadebebis fondsTvis, aseve SezRuduli iuo adamianuri

resursebi centraluri monitoringisa da maregulirebel organoSi

samuSaod.

kolumbiaSi `marTuli konkurenciis~ proeqti moiTxovda axali

unarCvevebis mqone kadrebis yolas sazogadoebriv saavadmyofoebSi da

jandacvis xelmZRvanelobaSi, romelsac Secvlili, maregulirebeli

funqciebi daekisra (boserti 1998).

gansakuTrebiT problematuria institucionaluri stabilurobis

sakiTxi ganviTarebul qveynebSi, romlebic xasiaTdeba politikuri garemos

cvlilebebiT. reformis dawyebidan pirveli 6 wlis ganmavlobaSi,

kolumbiaSi gamoicvala jandacvis 5 ministri. TiToeulma maTganma Tan

moiyvana Tavisi gundi (boserti 1998).

- 79 -

zambiaSi jandacvis saministros xelmZRvaneloba ufro stabiluri,

xolo jandacvis reformisadmi politikuri mxardaWera ki cvalebadi iyo

(boserti 2000).

`reformis mcire asoTi~ gamocdileba ra Tqma unda Zalian

gansxvavebuli da mravalnairia. igi SeiZleba SemuSavdes, rogorc hsias

mier CamoTvlili erT-erTi romelime sakontrolo niSnulis Sesacvlelad,

an jandacvis sistemis erTi samizne nawilis (mag. saavadmyofoebis an

jandacvis centrebis), mosaxleobis erTi jgufis (mag: soflis an qalaqis,

an saxelmwifo seqtoris TanamSromlebis) an momsaxurebis erTi romelime

momsaxurebis tipis (imunizacia an mSobiaroba) reformirebisaTvis.

afrikaSi, SemoiRes momsaxurebis safasuri, qveyanaSi aseTi cvlilebebi

ganxorcielda sxva Tanmdevi sistemuri cvlilebebis gareSe da naklebi

yuradReba mieniWa sistemis sxva nawilebze mis gavlenas (qrizi 1990). am

tipis reformis kidev erTi magaliTi, jandacvis sistemis decentralizacia,

rac centraluri amerikis umravles qveyanaSi ganxorcielda da

iTvaliswinebs jandacvis saministros adgilobrivi ofisebisaTvis

funqciebis nawilis gadacemas (boserti 1998 weli).

indoeTSi, keniaSi da zimbabveSi, Seiqmna avtonomiuri (damoukidebeli)

saavadmyofoebi (sistemis dafinansebis da anazRaurebaSi mniSvnelovani

cvlilebebis gareSe) – (govivndaraji da Cavala, 1995). amasTan didi

Zalisxmeva moxmarda kerZo seqtoris promocias, gansakuTrebiT

arasamTavrobo organizaciebis meSveobiT da donorebis dafinansebiT

(makpeiki 1997). `r~ tipis reformis kerZo SemTxvevaa piloturi programebi,

romlebic emsaxureba `R~ tipis strategiebis SemuSavebas aRebul regionSi,

axali midgomis gamocdisaTvis. gamomdinare `R~ modelis politikuri da

teqnikuri sirTulidan, SeiZleba CaiTvalos, rom xsenebuli modeli

miRebulia; Tumca dakvirvebam cxadyo, rom es ufro gamonaklisi, vidre

wesia.

yirgizeTSi isi-kulSi didi warmatebiT ganxorcielda jandacvis

darRvevebis piloturi programa; analogiuri Camoyalibebis procesSia

egvipteSi, aleqsandriaSi. adrea mtkiceba, rom es piloturi programebi `R~

modelebad gadaiqceva am qveynebSi. idealur SemTxvevaSi (akademiuri

muSakebis yvelaze sayvareli sakiTxi), pilotireba, `R~ modelis SemuSavebis

- 80 -

yvelaze misaRebi gzaa. Tumca, praqtika gviCvenebs, rom ganviTarebad

qveynebSi politikosebi upiratesobas cvlilebebis swrafad

ganxorcielebas aniWeben; miuxedavad garkveuli riskisa, rac Tan sdevs

pilotirebis meTodis gamoyenebas, xSirad es aris gza, Tavidan aicilo `R~

reformis ganxorcieleba.

ra Tqma unda mniSvnelovania, rom bevri `r~ tipis qmedebebi inergeba `R~

modelSi. pacientis mier gadaxdeli momsaxurebis safasuri Ciles,

kolumbiis, zambiis da evropis qveynebis reformis axali mastimulirebeli

meqanizmia.

decentralizacia, romelic zambiis jandacvis saministros farglebSi

ganxorcielda, Ciles, kolumbiis, CineTis da centraluri evropis qveynebis

farTomasStabiani reformebis mniSvnelovani nawilia. jandacvis seqtoris

`R~ tipis Semadgeneli nawilia aseve saavadmyofoebis avtonomia. mravali

aseTi inovacia Sedis im konkretuli miznebis CamonaTvalSi, romelic

farTo reformis programas ayalibebs. Tumca, TiToeuli konkretuli `r~

komponentis efeqturobaze moqmedebs sistemis sxva aspeqtebis cvlileba. `R~

reforma ufro metia, vidre mcire reformebis nawilebis erToblioba.

mTavari kiTxva, romelic jer kidev ar aris sakmaod gaanalizebuli aris

is, Tu ra garemoebebis SemTxvevaSi da ramdenad aris savaraudo, rom

sistemuri cvlileba gaaumjobesebs konkretuli `r~ reformis efeqturobas.

sxva sityvebiT rom iTqvas, ivaraudeba Tu ara, rom `R~ reforma ufro met

efeqts moutanos qveyanas, vidre `r~ reformis erToblioba da rogoria

riskebi?

viTardeba da icvleba reformis iniciativebic, rogorc ki Tavs iCens

problemebi gegmaSi da ganxorcielebaSi, politikosebi cdiloben Secvalon

isini.

boliviaSi, roca adgilobrivma mTavrobam veRar daafinansa samedicino

xarjebi, centralurma mTavrobam Secvala decentralizaciis politika am

problemis gadasaWrelad. qveynebi swavloben, rom arCevani mdgomareobs ara

marto imaSi, ganaxorcielo reforma Tu ara; arsebobs aseve reformis

metad da naklebad efeqturi tipebi. hsiaos sakontrolo niSnulebi aris

politikis arCevanis mamoZravebeli da zogierTi arCevani ukeTesia, vidre

sxvebi.

- 81 -

yvelaze serozuli kritika, rac jandacvis seqtoris reformis

winaaRmdeg ismis, aris is, rom man ziani miayena sazogadoebriv jandacvas,

bazisuri momsaxurebis miwodebas. es mosazreba Zalian yuradsaRebia.

SeiZleba daviwyoT reformis misi zogadi amocanebis mixedviT Sefasebia.

jandacvis reforma SemuSavdeba imisaTvis, rom miRweul iqnas xarjis

Tanabari ganawileba, moicvas jandacvis seqtoris resursebis gamoyenebis

efqturobis amaRleba, samedicino momsaxurebis xarisxis gaumjobeseba da

finansuri stabiluroba. jandacvis seqtoris im cvlilebebTan mimarTebaSi,

romlebic Tavs iqna moxveuli gareSe Zalebis mier, SegviZlia vTqvaT, rom

isini didad efeqturi ar iyo xsenebuli amocanebis miRwevis mimarTebiT da

piriqiT, Seqmnes problemebi.

CineTis ekonomikurma reformam soflis samedicino sistemis kolafsi

gamoiwvia da mniSvnelovnad gazarda danaxarjis araTanabrad ganawileba

(liu 1995). senegalis SemTxvevaSi, decentralizaciam aseve Zalian didi

ziani moutana adgilobriv samedicino momsaxurebebs. poloneTSi da sxva

gardamavali ekonomikis qveynebSi, gaizarda àralegaluri anazRaurebis~

wili, rac Tavis Tavad amcirebs xarjis araTanabrad ganawilebas (Cavla

1998).

Camoyalibebuli azri jer ar aris, umravles SemTxvevaSi, Zalian cota

droa gasuli da ar Catarebula momcvelobiTi monitoringi, ar arsebobs

SefasebiTi monacenebi maTi realuri gavlenis dasadgenad. mcire

raodenobis qveynebi Seecadnen `R~ reformis ganxorcielebas, Cans, rom aseT

reformebs Tan sdevs sirTuleebi dasaxuli amocanebis SesrulebaSi.

umravles `R~ modelis mimdevar qveyanaSi Zalian didia xarjis

araTanabari ganawilebis problema. kolumbiam es monacemi gazarda

socialuri dazRvevis sistemis meSveobiT, Tumca jer Zalian Sorsaa

srulyofilebamde (kolumbiis jandacvis seqtoris reformis proeqti 1996).

Ciles samedicino dazRvevis sistema iTvaliswinebs orsafexurian

sistemas, kerZo danaxarjebis gegmis CaTvliT, sadac xarji daaxloebiT

aRemateba sazogadoebrivi momsaxurebis xarjs (birtani da almarza 1997).

zambiis raionebi iReben nakleb dafinansebas, vidre reformamde da

momxmareblis mier gadasaxdeli safasuri SeiZleba zRudavdes

xelmisawvdomobas (Cita 2000). umravles qveyanaSi, sadazRvevo reforma

- 82 -

dakavSirebulia resursebis `soliduridan~ kerZo sadazRvevo da kerZo

provaiderebis (sadac midian ufro mdidari pacientebi) yulabaSi

gasasvlelTan ar aris calsaxad dadgenili is, rom msgavsma araTanabarma

ganawilebam gamoiwvia RaribTaTvis miwodebuli momsaxurebis odenobis

Semcireba (vidre miewodebodaT reformamde), an ra moxdeboda reformis

gareSe.

zambiis gamoklebiT, sadac dafinanseba stabiluria, ar Semcirda

qveynebSi sadac `R~ modelis reforma midis, mniSvnelovnad gaizarda

jandacvis danaxarjebi. aqedan gamomdinareobs, rom ganviTarebad qveynebSi

reformebiT ar mcirdeba xarjebi. gaurkvevelia, rogor unda Sefasdes

efeqti. Tu danaxarjis zrdas mosdevs proporciuli an meti zrda

efeqturobisa an janmrTelobis xarisxis, an xelmisawvdomobis, maSin es

dadebiTi Sedegia.

praqtikulad ar gvaqvs efeturobis da xarisxis sazomi, jandacvis

reformis ZiriTad amocanebTan mimarTebaSi gavlenis saCveneblad. dauSvaT

viciT, rom kolumbiaSi da aRmosavleT eropaSo saavadmyofoebi

araefeqturia, aris zedmeti sawolebi, TanamSromlebi. Tumca jer ar viciT,

moaxdina Tu ara gavlena reformebma am sazomebze Zneli gasazomia xarisxi

ganviTarebul qveynebSic ki, iq sadac arsebobs xarisxis kvlevis da

xarisxis erTiani Sefasebis sistemebi (lourens da rozanski 1998). Aase|T

SemTxvevebSic ki Znelia dadebiTi tendenciebis Sefaseba.

`r~ tipis modelebisaTvis erTmaneTis gamomricxavi monacemebi arsebobs.

reformis elementi, gansakuTrebiT momsaxurebis safasuris SemoReba

(afrikis qveynebSi magaliTad) farTod iqna gakritikebli. aseTi qmedebebis

Semdeg faqtebi cxadyofs, rom danaxarjis araTanabrad ganawileba

namdvilad Semcirda da misi gauqmeba realurad am problemas principSi

ver Svelis (krizi 190; redid vandemurteli 1996) magram Znelia sapirispiro

sakiTxze pasuxis gacemac – ramdenad SeeZleboda fiskaluri problemebis

pirobebSi samedicino momsaxurebas saerTod arseboba am anazRaurebis

gareSe, maSin roca sabiujeto dafinanseba Semcirda an gaiyina?

momxmareblis anazRaurebis SemoRebam keniaSi, pirvel periodSi aseve

problemebi Seqmna (sxva qveynebis analogiuri) magram, USAID-is da sxva

organizaciebis daxmarebis wyalobiT, maT SeZles gaeumjobesebinaT

- 83 -

viTareba da CamoeyalibebinaT danaxarjis Tanabrad ganawilebis sistema

Zlian rTul garemoSi (kolinsi 1996) decentralizacia xSirad xdeba

kritikis sagani, Tanxis araTanabrad ganawilebis problebis kidev ufro

gaRrmavebis gamo. kvlevebma araerTgvarovani Sedegebi aCvena. xSir

SemTxvevaSi, dafiqsirda xelmisawvdomobis igive done rac reformamde iyo

(boserti 2000).

Ciles magaliTis mixedviT, municipalitetze decentralizaciis Semdgom,

jandacvis danaxarji erT sulze araTanabari ganawilebis done Semcirda,

rac imaze metyvelebs, rom decentralizaciis pirobebSic arsebobs gza am

problemis dasaZlevad. decentralizaciis oponentebi aseve yuradRebas

amaxvileben vertikaluri imunizaciis da ojaxis dagegmvis ganadgurebul

programebze da mainc kvlevebiT dadginda, rom ugandaSi xsenebuli

programebis Semcireba SeiZleba gamowveuli iyos sxvadasxva faqtorebiT,

magaliTad biujetis Semcireba (hatCinsoni 1999).

boliviaSi centralurma xelisuflebam SeZlo aRedgina prioritetuli

saqmianobebis dafinansebis praqtika samoqmedo wesebis Seccvlis gziT da

decentralizaciis Tavidan acilebiT (ruiz mier 2000).

am mimoxilvidan Cveni mTavari daskvna imaSi mdgomareobs, rom

ganviTerebad qveynebSi jandacvis reformis irgvliv sabolood

Camoyalibebuli azri ar arsebobs. ukanaskneli aTwleulis gamocdileba ar

aris sakmarisi momcvelobiTi SefasebisaTvis, jandacvis seqtoris reformis

gansazRvrebis mixedviT.

ufro meti droa saWiro imisaTvis, rom viswavloT Tu rogor gavakeToT

ukeT da rogor efeqturad SevafasoT miRebuli Sedegebi. jandacvis

seqtors jer ar Seuqmnia naTeli Canawerebi mniSvnelovani miRwevebisa.

sistemebi, romelTa reformirebac moxda rTul mdgomareobaSi iyo da ufro

Rrmavdeboda krizisi, aSkara iyo, rom Zveli modeli aRar muSaobda.

ganviTarebad qveynebze modis msoflio daavadebaTa tvirTis Zalian didi

wili da aqedan miyenebuli ziani uzarmazaria. miuxedavad imisa, rom

garkveuli gaumjobeseba miRweulia vertikaluri programebis wyalobiT.

janmrTelobis statusi da epidemiologiuri tranzicia kvlav viTardeba da

axal moTxovnebs wauyenebs jandacvis sistemas, miuxedavad qveynis

ganviTarebis donisa es moTxovnebi SeiZleba ufro mwvave iyos saSualo

- 84 -

ganviTarebis qveynebSi, magram Rarib qveynebSi isini aseve did gavlenas

moaxdenen reformaze. sazogadoebrivi jandacva da mosaxleoba momavalSi

kidev ufro didi problemebis winaSe aRmoCndebian. aseTi SeiZleba iyos

qalebisa da mamakacebis, reproduqciuli janmrTelobis klinikuri da

socialuri, daavadebuli bavSvebis saWiroebebis da imunodeficiti (Sidsis)

prevenciisa da movlis mzardi moTxovnebis dakmayofileba. jandacvis

sistema umravles ganviTarebad qveyanaSi dgams dafinansebis, efeqtianobis,

danaxarjebis Tanabrad ganawilebis da xarisxis problemis winaSe. dabalia

am gamowvevebis Sesabamisi momzadebis done.

ukanaskneli aTwleulis manZilze ganxorcielebuli reformis

gamocdilebam ramdenime gakveTili gvaCvena. maT Soris:

1) `R~ tipis reformebi Zneli gansaxorcielebelia da cotaa

ganviTarebad qveyanaSi misi warmatebuli magaliTebi. jandacvis seqtoris

reformisaTvis aucilebelia ramdenime pirobis dacva, romelTa

erTianobaSi Tavmoyra Znelia dabali Semosavlebis mqone qveyanaSi. aseTi

pirobeia, magaliTad cvlilebebis SesaZlebloba, liderobis maRali done,

samTavrobo stabiluroba garkveuli periodis manZilze, rac iZleva

reformis Sesabamisi strategiis mixedviT ganxorcielebis saSualebas; aseve

mniSvnelovania maRali kvalifikaciis mqone adamianuri resursebi,

informacia da organizaciis arseboba. laTinuri amerikis da poloneTis

magaliTze gavigeT, rom Znelia reformebis ganxorcielebisaTvis

mxardaWeris mopoveba. konkretuli strategiebi, magaliTad, politikuri

momxreebis jgufis yola (jandacvis da sxva sakvanZo saministroSi),

aucilebelia. aseve rTulia aseTi politikuri mxardaWeris SenarCuneba.

kolumbiaSi reformis ganxorcielebis susti mxare iyo mTavrobis Secvla

reformis kanonis miRebis Semdeg. axali mTavroba aRar iyo ZveliviT

enTuziazmiT aRvsili reformis Catarebaze. am momentisaTvis, SesaZloa, rom

`R~ tipis reforma yvela qyeynisaTvis ar aris, saTanado politikuri

mxardaWeris gareSe, farTomasStabiani reformis ganxorcieleba albaT ar

moitans Sedegad jandacvis sistemis miznebis Sesrulebas mokle vadaSi.

2) `R~ modelis reformebis pirobebSi, aucilebelia Zveli institutebis

reformirebis da axlebis Seqmnis didi yuradReba unda mieniWos. xSirad

reformatorebi fiqroben, rom dafinansebis da gadaxdis meqanizmis Secvla

- 85 -

sakmarisia xarisxiani da efeqturi jandacvis reformisaTvis, Tumca, xSirad

vxedavT, rom organizaciuli mouqneloba da biurokratiuloba xSirad

xels uSlian organizaciebis efeqturad saqmianobas. reformebisaTvis

saWiroa TanamSromlebis SerCevis axali gzebi, axali unar-Cvevebis mqone

Statebi da ufro adaptireba. organizaciuli kultura mraval sxvadasxva

organizaciaSi, magaliTad sazogadoebriv saavadmyofoebSi, sadazRvevo

gegmebSi, adgilobriv mTavrobebSi, jandacvis saministroSi da sxva

sakvanZo saxelisuflebo organoebSi. bevrad meti yuradReba unda daeTmos

organizaciul ganviTarebas da momzadebas reformis Catarebisas.

3) `r~ tipis reformebi, miuxedavad imisa, rom naklebad iTxovs sistemuri

xasiaTis cvlilebebis ganxorcielebas, mainc gansxvavebulia misi Sedegebi.

zogjer es imitom xdeba, rom, is pirobebi, romlebic aucilebelia `R~

modelis reformis warmatebisaTvis, - magaliTad axali da gadamzadebuli

adamianuri resursebis, ukeTesi informacia problemis gamosakveTad da

politikis cvlilebebis dasagegmad, organizaciuli gaZliereba da

stabiluroba – aseve arasakmarisad aris ganviTarebuli mcire masStabiani

reformebis pirobebSic. Tumca, xSirad ar xdeba `r~ tipis reformebis

sworad SerCeva konkretuli marTebulad SerCeuli problemis

gadasaWrelad. aseTi meTodis arCeva ar niSnavs, rom ar aris saWiro

sistemuri analizi da rom yuradReba ar unda mieniWos imas, Tu sistemaSi

ganxorcielebuli cvlilebebi rogor gavlenas moaxdenen reformis

efeqturobaze.

4) aqilevsis qusli detalebSia. maSin, roca ar arsebobs naTeli da

martivi modeli jandacvis reformisa, iqneba es farTo Tu

mciremasStabiani, SegviZlia gamovkveToT ramdenime mniSvnelovani gza,

romlis saSualebiTac dauSvaT finansuri meqanizmebi, decentralizacia,

hospitaluri avtonomia da sxva saqianoba ufro efeqturi iqneba. arsebobs

dafinansebis meqanizmi, rac gulisxmobs SezRudul samTavrobaTSoriso

transferebs da aqciaTa fonds, rac ganapirobebs decentralizebuli

jandacvis sistemis pirobebSi ganxorcielebuli danaxarjebis met

Tanasworobas. arsebobs gamocdileba, romelic dagvexmareba momsaxurebis

safasuris meqanizmis gamoyenebisas, rac gviCvenebs, rom momsaxurebis

zogierT doneze umjobesia erT sulze anazRaurebis meqanizmis gamoyeneba.

- 86 -

gamocdileba gviCvenebs, rom SeiZleba Temis monawileobam aamaRlos

efeqturoba RaribebisaTvis momsaxurebis anazRaurebis programebis ganxor-

cielebisas. metad mniSvnelovania aseTi saxis gamocdilebis gafarToeba,

anu imis swavla, Tu rogor gavxadoT reformebi ufro efeqturi (da ara is,

ganvaxorcieloT cvlilebebi Tu ara).

5) jandacvis seqtoris reforma, iqneba es mcire Tu farTomasStabiani,

ar SeiZleba Camoyalibdes erTi globaluri an Tundac regionaluri

formuliT. gamomdinare iqidan, rom ar gvaqvs erTiani mosazreba imis

Sesaxeb, Tu ras unda niSnavdes efeqturi jandacvis reforma, unda

gaviTvaliswinoT qveynis istoria, Rirebulebebi da kultura imisaTvis, rom

SevimuSaoT misaRebi midgoma. damatebiT, mniSvnelovania sakmarisi

informacia da Zlieri analitikuri instrumentis qona, imisaTvis, rom

gamoikveTos yvelaze saWirboroto problema da monitoringi Cautardes

gadawyvetilebis ganxorcielebas. sakiTxi gulisxmobs didi yuradRebis

daTmobas rogorc jandacvis seqtoris reformis Camoyalibebis

analitikuri sawyisisaTvis, aseve reformis ganxorcielebis ZiriTad

qvakuTxedebSi investorebisadmi.

reformatorebi arasaTanado yuradRebas uTmoben reformis Sedegebs –

jandacvis, Tanabari gadanawilebis. finansuri dacvis da pacientis

dakmayofilebis sakiTxebs, imaT, romlebis gadasaWreladac SemuSavda

reforma. yuradReba eqceva gegmis teqnikur mxareebs da finansirebas,

miwodebas da menejments. imisaTvis rom SevZloT da SevafasoT

grZelvadiani Sedegebi `R~ tipis reformis rTuli kompleqsuri

cvlilebebis, gvWirdeba informaciis Seqmna, romelic am Sefasebis

saSualebas mogvcems. `r~ tipis reformis SemTxvevaSi, aseve gvWirdeba

frTxili analizi imisa, Tu ra gamoasworebs mdgomareobas da ra sistemuri

pirobebi aris saWiro imisaTvis, rom reformebis irgvliv SemuSavebuli

rekomendaciebi, realuri gaxdes. arsebobs garkveuli Sedegebi, magaliTad

kvlevebi momsaxurebis safasurisa da decentralizaciis irgvliv, romelic

gviCvenebs reformis ZiriTad Sedegs. momsaxurebis safasuris garSemo

gamovlinda ukuefeqtebic; xolo decentralizaciasTan mimarTebaSi,

mniSvnelovani gavlena cvlilebebisa ver gamoikveTa (arc dadebiTi da arc

uaryofiTi). aseTia pirveladi Sedegebi.

- 87 -

DDM proeqtis saqmianobis mTeli aTwleulis ganmavlobaSi (1991-2000),

Seicvala gaizarda jandacvis sistemis gagebis da iseTi strategiis

SemuSavebis survili, romlis saSualebiTac sistemebis xarisxi amaRldeba.

msoflio jandacvis angariSSi, rac warmoadgens msoflio jandacvis

organizaciis da msoflio bankis erToblivi saqmianobis Sedegs, ZiriTadi

aqcenti keTdeba jandacvis sistemebze. masSi mocemulia ufro sruli da

ukeTesi xarisxis faqtebi, jandacvis sistemis mier Sesrulebuli

saqmianobis irgvliv. angariSSi naCvenebi iqneba jandacvis sistemis

amocanebi da Sedegebi, mosaxleobis janmrTelobasTan, dafinansebasTan da

mosaxleobis moTxovnebisa da saWiroebis dakmayofilebis kuTxiT.

USAID-is gareSe, janmrTelobisa da jandacvis sistemebis mtkicebulebebis

umravlesoba ar iarsebebda. USAID-is strategia gulisxmobs mosaxleobis,

jandacvis da kvebis sakiTxebze, xuT strategiul amocanaze fokusirebas.

esenia:

1) daugegmavi da aradrouli orsulobis SemTxvevebis Semcireba;

2) fexmZimobisa da mSobiarobis Sedegad qalebis sikvdilianobis da

janmrTelobis gauaresebis faqtebis raodenobis Semcireba;

3) bavSvebisa da mcirewlovanebis janmrTelobisa da kvebis gaumjobeseba

da bavSvTa sikvdilianobis Semcireba;

4) Sidsis gadacemis faqtebis da imunodeficitis uaryofiTi gavlenis

Semcireba;

5) infeqciuri daavadebebis riskis Semcireba.

jandacvis sistemebis mtkicebulebebi da jandacvis reforma zeviT

CamoTvlili prioritetebis ganxorcielebas exmareba. magram, aseve

SegviZlia gamovkveToT iseTi kritikuli sakiTxebi, romlebic yvela

strategiul amocanas exmianeba; aqedan gamomdinare, resursebis flangva

iqneba, erTi da imave sakiTxze sxvadasxva kategoriaSi cal-calke

gadawyvetilebis Zieba.

sami yvelaze mniSvnelovani sakiTxi, romelic saerToa yvela

mimarTulebisaTvis:

1) dabali Semosavlebis mqone qveynebisaTvis (gansakuTrebiT afrikis)

grZelvadiani finansuri strategiis SemuSaveba. Ggamomdinare iqidan, rom

ganviTarebis daxmareba TandaTan gadadis seqtoris farTomasStabian

- 88 -

midgomaze da xdeba davalianebis Camoweris dakavSireba jandacvaze da

ganaTlebaze finansebis uzrunvelyofasTan, arsebobs ufro prioriteuli

programebisaTvis xangrZlivi da kolaboratiuli programebis

Camoyalibebis, gamocdis da Sefasebis SesaZlebloba. USAID-is SemTxvevaSi.

es saqmianoba xorcieldeba mravali sxvadasxva programisa da proeqtis

farglebSi, magram Znelia am qmedebebis efeqtianad gaerTianeba.

2) saxelmwifo midgomebis gaZliereba ara saxelmwifo samedicino

momsaxurebebis provaiderebisadmi. DHS da bevri sxva wyaro xazs usvavs

arasaxelmwifo pirveladi jandacvis provaiderebis mniSvnelobas

samedicino momsaxurebebis miwodebis saqmeSi (bermani 2000-weli). USAID aris

msoflio lideri kerZo saxelmwifo urTierTobebis gaZlierebaSi, iseT

sakiTxebTan mimarTebaSi, rogoric aris imunizacia, diareiT mimdinare

davadebebis kontroli, ojaxis dagegmva da reproduqciuli janmrTeloba.

magram bevri aseTi saqmianoba Semoifargla specifikuri kategorizirebuli

programebiT. aseve saWiroa daxmareba sistemur doneze. kerZo saxelmwifo

urTierTobis momcvelobiT strategiis SemuSavebisa da marTvisaTvis

(momzadebis, dafinansebis da regulirebis saSualebiT). Aaucilebelia, rom

ufro meti sistemuri xasiaTis yuradReba daeTmos ara-saxelisuflebo

provaiderebis mTlianad jandacvis seqtoris reformis saqmeebSi Cabmas.

3) jandacvis saministroebSi, adgilobriv jandacvis departamentebSi da

samedicino momsaxurebis provaiderebSi mmarTvelobis donis amaRleba.

cudi sazogadoebrivi mmarTvelobidan Tavis daRwevis gza xSirad aris

xolme arsebuli struqturebidan gamosvla, an axali vertikaluri

programebis Seqmna, an arasamTavrobo seqtorTan muSaoba. es SeiZleba

misaRebi iyos, Tumca igi ar Wris arsebul problemas. SegviZlia ki ufro

meti gavakeToT da vcadoT SevimuSaoT axali strategiebi, ganvaxorcieloT

momzadebis procesi da amiT gavaumjobesoT mmarTveloba.

- 89 -

1.4. jandacvis sabazro struqturis reforma

sabazro urTierToba gamoxatavs gansazRvrul ekonomikur

gancalkevebas mwarmoeblebsa da produqtebisa da momsaxurebis

momxmarebelTa Soris. Tavisi SinaarsiT masSi CarTulia mravali elementis

nakrebi, sabazro meqanizmi aris procesi, ris Sedegadac myidveli da

gamyidveli urTierTTanamSromloben imisaTvis, rom gansazRvron

warmoebuli saqonlis an momsaxurebis fasi da raodenoba, amgvarad

moTxovnileba, SeTavazeba da fasi warmoadgenen mis mTavar elementebs.

ZiriTadi cneba, romelic gamoxatavs sabazro urTierTobis arss,

warmoadgens konkurencia, romelic SeiZleba ganisazRvros, rogorc

mwarmoeblebs Soris urTierTobis tipi saqonlis da momsaxurebis fasis

dadgenisa da SeTavazebis moculobis mizeziT, aseve momxmarebelTa Soris

fasebis formirebisa da moTxovnis moculobis mizeziT. bazris

struqturuli organizaciis poziciiT arsebiTi mniSvneloba aqvs

mwarmoeblis raodenobas (gamyidvelebis) da momxmareblis raodenobas

(myidvelis).

A ase rom bazari srulyofili konkurenciiT badebs didi raodenobiT

erTi saxis saqonlis damoukidebel mwarmoebels erTis mxriv, da am

saqonlis momxmarebelebis masas meores mxriv. kavSiris struqtura aseTia:

rom principSi yvela momxmarebels SeuZlia SeiZinos saqoneli nebismieri

mwarmoeblisgan, Tavisi sasurveli SefasebiT da momgebianobiT. aseve yvela

mwarmoebels SeuZlia nebismier momxmarebels mihyodos Tavisi saqoneli,

verc erTi momxmarebeli ver SeiZens arsebiT nawils saerTo SemoTavazebis

moculobisgan da verc erTi mwarmoebeli ver daakmayofilebs

moTxovnilebis arsebiT wils. bazari srulyofili konkurenciiT-ufro

efeqturi struqturaa, romelic gvaZlevs resursebis saukeTeso gziT

ganawilebis saSualebas.

Tu warmoiqmneba raime obieqturi SezRudvebi gamyidve-lebisaTvis da

aseve myidvelebisaTvis, maSin saqme gvaqvs arasrulyofili konkurenciis

struqturebTan, romlebic saWiroeben damatebiT koreqtirebas

saxelmwifosagan.

- 90 -

bevr ganviTarebul qveyanaSi janmrTelobis sferos am poziciidan

gaanalizebisas saWiroa aRiniSnos aseTi SezRudvebis arseboba, isini

vlindebian sxvadasxva formiT. ase magaliTad, aSS-Si samedicino

momsaxurebis SemoTavazebis xelovnuri damabrkoleblis rols TamaSobs

amerikuli samedicino asociacia, romelic aerTianebs yvela kerZo

praqtikis mqone eqimTa raodenobis daaxloebiT naxevars. asociaciis mier

izRudeba samedicino fakultetebze miReba, swavlis safasuri izrdeba,

kontrolirdeba eqim-emigrantTa nakadi da maTi samedicini praqtikiT

dakaveba. asociaciisTvis Setyobinebis gareSe ar SeiZleba mowonebuli

iqnes raime mniSvnelovani iniciativebi. Aaucilebelia avRniSnoT, rom

arsebobs damatebiTi xelovnuri barierebi samedicino momsaxurebis

mwarmoeblebisaTvis maTi bazarze gasvlisas. es dakavSirebulia imasTan,

rom sufTa ekonomikuri TvalsazrisiT ukve formirebuli specialistisTvis

advilia samedicino momsaxurebis bazarze Sesvla an gamosvla, radganac

samedicino daxmarebis bevri saxeoba ar aris dakavSirebuli mniSvnelovan

sastarto kapitalTan. Mmeores mxriv, dinamiuri moTxovnileba, axali

moxmarebebis gaCena da samedicino momsaxurebisa da Tanmxlebi saqonlis

bazarze iwvevs am sferoSi axali specialistebisa da

fsevdospecialistebis mizidvas, amitom sruliad gasagebia mwarmoeblebis

ukve Semdgari kontigentis swrafva imisaken, rom yvela SesaZlebeli da, ara

marto ekonomikuri saSualebebiT, Seamciron bazarze potenciuri

konkurentebis Semosvla, SezRudon SemoTavazebebi, maqsimizireba gaukeTon

fasebsa da Semosavlebs.

konkurenciis da informaciis zemoT aRniSnuli SezRudvebi niSnavs,

rom samedicino momsaxurebis bazari mniSvnelovnad iqneba gansxvavebuli

srulyofili konkurenciis bazrisagan. srulyofili konkurenciis

pirobebSi, roca firmas gauCndeba raime saqonlis warmoebis ukeTesi xerxi,

is ubralod daagdebs fasebs da am gziT waarTmevs myidvelebs sxva

mwarmoeblebs. warmoeba yovelTvis efeqturia, xolo fasebi asaxaven

yvelaze ufro moxerxebuli mwarmoeblebis sawarmoo danaxarjebs. Tu es

pirobebi ar sruldeba, maSin SeiZleba gadarCnen is mwarmoeblebic,

romelTa fasebi mniSvnelovnad aWarbeben mwarmoeblebis danaxarjebs.

- 91 -

roca saqoneli araerTgvarovania da myidveli cudadaa

informirebuli, maSin misTvis rTulia gansazRvros ras niSnavs ufro

dabali fasi, signali SesaZlo ufro momgebian SeZenaze Tu saqonelis

dabal xarisxze, xolo, roca myidveli informirebulia fasebis Sesaxeb,

maSin firmas SeuZlia wonasworobis fasebis doneze ufro maRla aswios

is mxolod gamyidvelebis raodenobis SezRudviT.

SeiZleba sqematurad iqnas naCvenebi (cxril 11) srulyofili bazris

gansxvaveba im sabazro struqturisagan, romelic damaxasiaTebelia

samedicini momsaxurebis bazrisaTvis.

cxrili 11. bazris struqtura.

Ksrulyofili konkurenciis bazari

samedicino momsaxurebis bazari

Ggamyidvelebis didi raodenoba

gamyidvelebis raodenoba

SezRudulia, arsebobs bazarSi

Sesvlis SezRudva,

SesaZloa situaciebi, romlebic

axlosaa bunebriv monopo-

lizaciasTan.

saqonlis erTgvarovneba

samedicino momsaxurebis ara-

erTgvarovnoba, misi indivi-

dualuroba da unikaluroba.

Kkargad informirebuli myidveli Aarasrulyofili informacia

SesaZlebelia saqonlis, fasisa da

xarisxis urTierTdapi-rispireba

SeuZlebeli an garTulebuli fasisa

da xarisxis urTierT-dapirispireba.

Mmwarmoeblebi iRwvian mogebis

maqsimizaciaze

saxelmwifos an kerZo “uSemosavlo”

organizaciebis didi raodenobis

arseboba

produqciis realizacia sruldeba

rogorc wesi da rigia, pirdapiri

gziT .

xSirad saWiroebs mesame piris anu

kompetenturi Suamavlis Carevas,

romelic afinansebs samedicino

momsaxurebis ZiriTad nawils.

- 92 -

zemoT aRniSnul Sedarebas Tu davakvirdebiT, SeiZleba davrwmundeT, rom

samedicino momsaxurebis bazari, organizaciuli struqturebis

TvalsazrisiT gvevlineba, rogorc arasrulyifili konkurenciis bazari.

amasTan erTad Tavisi ZiriTadi maxasiaTeblebiT igi uaxlovdeba

struqturebs, romlebic ekonomikur TeoriaSi klasificirdeba rogorc

monopoliuri konkurenciisa da monopoliis bazari.

A aucilebelia mivaqcioT yuradReba im faqtorebs, romlebic

gansazRvraven samedicino momsaxurebis moTxovnilebebsa da winadadebebs.

mTavar rols aq TamaSobs fasi, romelsac erTi mxriv gansazRvravs

moTxovnilebebi da winadadebebi, meores mxriv ki misi Tavisufali

cvlilebebis pirobebSi axdens mis balansirebas. imisaTvis, rom gakeTdes

prognozebi moTxovnebisa an winadadebis SedarebiTi cvlilebis Sesaxeb

fasis cvlilebisas, saWiroa am cvlilebebis raodenobrivi parametrebis

codna. moTxovnilebis raodenobrivi daxasiaTebis yvelaze gavrcelebuli

formaa moTxovnilebis elastiuroba, arsebobs misi 3 forma: es aris fasis

elastiuroba, Semosavlis elastiuroba, sxvadasxva saqonlis jvaredini

elastiuroba.

fasis elastiuroba izomeba rogorc saqonelze moTxovnilebis

moculobis procentuli gazrdis fardoba mocemuli saqonlis fasis

procentul SemcirebasTan Tanabar pirobebSi. is gviCvenebs, Tu ramdeni

procentiT gaizrdeba moTxovnilebis moculoba saqonlis fasis 1

procentiT Semcirebisas. samedicino moTxovnolebis umravlesoba flobs

dabal elastiurobas, es niSnavs imas, rom elastiurobis koeficienti

erTze dabalia. amerikis specialistebis SefasebiT fasis moTxovnilebis

elastiuroba stacionalur samedicino momsaxurebaze udris saSualod 0.7

(kosmetikuri qirurgiis garda), bevr SemTxvevebSi ki is varirebs 0.2 dan 0.7.-

mde. es niSnavs imas, rom fasis momatebasTan erTad samedicino

momsaxurebaze moTxovna iklebs yvelaze ufro naklebad fasis zrdasTan

SedarebiT (fasis momatebisas 10%-iT moTxovna Semcirdeba 2-7% procentiT)

moTxovnis elastiurobis raodenobrivi gamoxatva asaxavs swored

mocemuli qveynis samomxmareblo qcevis Taviseburebebs, radganac is

isazRvreba samomxmareblo upiratesobebis erTobliobiT, mosaxleobis

Semosavlebis doniT, nacionaluri xasiaTis TvisebebiT, ekonomikis saerTo

- 93 -

ganviTarebiT. amitom erTi qveynis monacemebiT miRebuli elastiurobis

daxasiaTebis gadatana meore qveynis pirobebze arasworia, magram saerTo

wesi mdgomareobs imaSi, rom rac ufro kategoriulia is moTxovna,

romelsac akmayofilebs mocemuli momsaxureba da rac ufro naklebad hyavs

mas Semcvlelebi, imdenad naklebi iqneba fasis elastiuroba. ruseTSi

jerjerobiT ar arsebobs am koeficientis gaTvla, rac dakavSirebulia

mosaxleobis cxovrebis cvlad pirobebTan, magram SeiZleba vivaraudoT

Semdegi: pirvel rigSi, mosaxleobis udidesi nawilis cxovrebis dabali

saSualo done ar aZlevs mas saSualebas gamoyos mniSvnelovani saxsrebi

samedicino momsaxurebis anazRaurebisaTvis, meore, cxovrebis janmrTeli

wesis imijis ararseboba ar iwvevs mosaxleobis SemosavlebSi Tavisi

janmrTelobis dacvisa da SenarCunebaze danaxarjebis xvedriTi wilis

gazrdas.

F amgvarad janmrTelobis ganviTarebis strategiis gansazRvrisas

Znelia gamoiyeno samedicino momsaxurebaze fasebis cvalebadoba, rogorc

moTxovnilebisa da SeTavazebis balansirebis meTodi. winadadebebze da

moTxovnilebebze gavlenas axdens aseve arasafaso faqtorebi. moTxovnileba

ganisazRvreba myidvelebis (mosaxleobis) raodenobiT, erTi adamianis,

ojaxis saSualo SemosavliT, Canacvlebadi samedicino momsaxurebis fasiT.

TviTon pacientebis raodenobas gansazRvravs mosaxleobis daavadebis done

da maTi janmrTelobis xarisxi.

amerikaSi moTxovnilebis elastiuroba eqimebis momsaxurebaze

gaweuli SemosavliT warmoadgens 0.75%-s, ruseTSi ki es koeficienti

mosaxleobis umravlesobisTvis iqneba ufro dabali. unda aRiniSnos, rom

zemoT aRniSnuli elastiurobis koeficientebis gamoTvla rTulia, yvela

isini gamoxataven ganviTarebis ama Tu im etapisaTvis damaxasiaTebel

ZiriTad kanonzomierebebs. bevri soliduri firmis biznes-gegmis

SemadgenlobaSi, samuSao garemos miuxedavad, arsebobs aucilebeli

ganyofileba, romelic Seicavs mTeli nacionaluri produqtis zrdis

tendeciis analizs, demografiul prognozs da monacemebs elastiur

moTxovnaze. es informacia gamoiyeneba warmoebis moculobis zrdis

dagegmvisaTvis da aseve Sesabamisi saxsrebis mozidvisaTvis.

- 94 -

samedicino momsaxurebis winadadeba damokidebuli iqneba ara marto

fasebze, aramed zogierT sxva faqtorze: gamosayenebeli resursebis fasi,

dotacia da gadasaxadebi, mocemuli momsaxurebis mwarmoeblebis raodenoba,

bolo garemoebas aqvs arsebiTi mniSvneloba. ar aris SemTxveviTi is, rom

amerikeli ekonomistebi jandacvisaTvis Cveuli informaciis asimetriis

gaTvaliswinebiT, miuTiTeben Tavisebur kanonze. am kanonis dedaazri aris

Semdegi: rac metia qirurgi, miT ufro meti operacia warmoebs, anu

medicinis muSakebi ukve Tavisi arsebobiT badeben damatebiT

moTxovnilebebs.

moTxovnilebis da winadadebis formireba samedicino momsaxurebaze,

aseve fasebis warmoqmna arian gansazRvrul damokidebulebaSi bevr

faqtorTan. amasTan erTad mosaxleobis janmrTelobis dacva

damokidebulia ara mxolod samedicino momsaxurebis bazris

funqcionirebis efeqturobaze, aramed mTel rig sxva bazrebze, romlebic

mWidro kavSirSi arian erTmaneTTan, Tu ganvixilavT mxolod samedicino

dawesebulebebis funqciebs, maSin isini upirveles yovlisa gamodian or

ZiriTan bazarze: resursebisa da samedicino momsaxurebis bazarze.

resursebis bazarSi Sedis SromiTi resursebisa da da materialuri

resursebis bazari. es bazari uzrunvelyofs samedicino dawesebulebebs

samedicino aparaturiT, wamlebiT da xelsawyoebiT. am bazarze

moqmedebisas, samedicino ganyofilebebi yiduloben saWiro resursebs da

awarmoeben gadaxdas, romlebic gamodian, rogorc resursebis mflobelTa

xelfasebi da Semosavlebi. resursebis bazarze samedicino ganyofilebebi

gamodian myidvelebis rolSi, samedicino momsaxurebis bazarze ki-

gamyidvelebis.

samedicino dazRvevis farTod gamoyenebis pirobebSi momsaxurebis

bazari SeiZleba warmodgenili iyos Semdegi saxeobebiT: dazRvevis bazriT,

samedicino momsaxurebis bazris dazRvevis sistemiT da samedicino

momsaxurebis Tavisufali bazriT. rac Seexeba resursebis bazars, is

SeiZleba iyos gansazRvruli saxiT iyos klasificirebuli. es aris

samedicino mowyobilobebis bazari, wamlebisa da Sromis bazari.

samedicino momsaxurebisa da resursebis bazari mWidro kavSirSi

arian erTmaneTTan, erTis mxriv moTxovnileba resursebis bazarze

- 95 -

warmoadgens warmoebis moTxovnilebas samedicino momsaxurebaze, meores

mxriv ki fasebis done da mTlianad koniuqturas resursebis bazarze

gansazRvravs samedicino dawesebulebebis ganviTarebis potenciuri

SesaZleblobebi da sazRvrebi. amitom ar aris SemTxveviTi, rom samedicino

momsaxure personalis momzadebis done, wamlebis preparatebis arseboba,

jandacvis materialuri-teqnikuri bazis dabali done gaxda Cvens qveyanaSi

arsebuli jandacvis krizisis mwvave problema. Mmravali wlis manZilze am

sferos gankargavda saxelmwifo monopolizmi, saxsrebis umniSvnelo Tanxa,

romelsac gamoyofda saxelmwifos biujeti, ganviTarebis eqstensiuri

meTodebis siWarbe aris warmoqmnili sirTuleebis ZiriTadi mizezi.

am pirobebSi warmoqmnili pirvel samedicino kooperativebs, patara

sawarmoebs bevr rameSi hqondaT warmateba, radganac maTTvis

xelmisawvdomo iyo Tanamedrove aRWurviloba, deficituri wamlebi,

yvelaze ufro kvalificiuri specialistebi. aman miiyvana samedicino

momsaxurebis xarisxi ufro met diferencirebamde, gaaZliera socialuri

daZabuloba, amitom saxelmwifo iyo iZulebuli daewesebina gaZlierebuli

kontroli wamlebisa da samedicino teqnikis warmoebaze, kerZod, es

gamoixata ruseTis jandacvis saministros reorganizaciaSi, romelic

gardaiqmna ruseTis federaciis jandacvis da samedicino mrewvelobis

saministrod, aseve 1994 wlis zafxulis ruseTis federaciis mTavrobis

dadgenilebis gamocema “saxelmwifo mxardaWera samedicino mrewvelobis

ganviTarebisTvis da mosaxleobisa da jandacvis ganyofilebebis wamlebiTa

da samedicino daniSnulebis nakeTobebiT uzrunvelyofa”

nebismier SemTxvevaSi am problemebis umravlesobis warmatebiT

gadawyveta SeiZleba mxolod qveynis mTeli janmrTelobis sistemis

finansuri bazebis gafarToebiT. dRes-dReobiT sabazro ganviTarebis

urTierToba realurs xdis am SesaZleblobas. finansuri saSualebebis

iseTi tradiciul wyaroebTan erTad, rogoric aris saxelmwifo biujeti,

warmoiSoba axali saSualebebic. rogorc aRwerilia kanonSi “ruseTis

federaciis moqalaqeebis samedicino dazRveva” es saxsrebi SeiZleba iyos

saxelmwifosi da sazogadoebrivi organizaciebis, sawarmoebis, faseuli

qaRaldebis Semosavlis da bankisa da sxva kreditorebis kreditebi.

- 96 -

imisaTvis, rom zemoT CamoTvlili wyaroebi realurad

funqcionirebdnen, aucilebelia pirobebi, romelic qmnis finansur

investicias mosaxleobis janmrTelobis dacvaSi sakmarisad momxibvlel

mimarTulebad. Cveni SexedulebiT, am mizniT aucilebelia finansuri bazris

instrumentebis diferencireba da maTTvis saxelmwifos Sesabamisi

mxardaWeris uzrunvelyofa. magram miuxedavaT imisa, rom am procesSi

mTavar rols iTamaSebs saxelmwifo da dazRvevis kerZo organizaciebi,

samedicino ganyofilebebs da jandacvis Sesabamiss organoebs SeuZliaT

moizidon damatebiTi Tavisufali fuladi saxsrebi. es SeiZleba miRweuli

iqnas sxvadasxva gzebiT.

rogorc cnobilia, fasiani qaRaldebis mimzidveloba ganisazRvreba

misi sami parametriT: likvidobiT, SemosavlianobiT da riskiT. aucilebeli

samedicino dazRvevis sistemis formireba, aseve saxelmwifo biujetis

mniSvnelovani monawileoba jandacvis sferoSi iZleva imis varaudis

saSualebas, rom 2-3 weliwadSi samedicino dawesebulebis finansuri bazebi

gamyardeba da Cveni TvalsazrisiT, es fasian qaRaldebs mianiWebs ufro met

mimzidvelobas, upirveles yovlisa usafrTxoebisa da likvidobis aspeqtSi,

naklebad-Semosavlianobis. garda amisa, saTanado propagandiT SeiZleba

sazogadoebaSi keTilganwyobili damokidebulebis formireba iseTi

mniSvnelovani socialuri sferosadmi, rogoricaa jandacva da amiT am

fasiani qaRaldebisTvis damatebiTi mimzidvelobis miniWeba.

komerciul bankebTan urTierTobebSi kreditebis dabrunebis

uzrunvelyofis damatebiT garantias SeiZleba warmoadgendes uZravi

qonebis dagiraveba, gansakuTrebiT miwis im nakveTebis, romelic gaaCniaT

raionul centrebsa da patara qalaqebSi ganlagebul samedicino

dawesebulebebs. finansirebis aseTi tradiciuli saSualebebis garda

SeiZleba gamoyenebul iqnes jandacviTi saqmianobis finansirebis sxva

saSualebebi, romlebic SeiZleba gamodgnen mniSvnelovnad ufro

xelsayreli, vidre bankis krediti. aseTi finansirebis erT-erT saSualebas

warmoadgens lizingi _ es aris uZravi da moZravi qonebis ganTavsebis

operacia, rodesac am qonebas specialurad yidulobs. lizinguri firma.

igi rCeba mis sakuTrebaSi, magram ijariT gaicema mewarmeebze. Cveulebriv,

lizings ganmartaven, rogorc manqanebisa da aRWurvilobis xangrZliv

- 97 -

ijaras. amJamad lizingiT SesaZlebelia warmoebis yvelaze ufro

gansxvavebuli faqtorebisa da sxvadasxva qonebis miReba _ yvelaze

rTulidan dawyebuli saofise aRWurvilobiT damTavrebuli. lizinguri

firma gamodis Tavisebur Suamavlad Sesabamisi aRWurvilobis

mwarmoeblebsa da maT momxmareblebs Soris.

cnobilia, rom lizingi yvelaze ufro mimzidvelia aRWurvilobis

droebiTi saWiroebisas. sawarmoebi mimarTaven mas, rodesac maT ara aqvT

kreditis gamoyenebis saSualeba aucilebeli aRWurvilobis SesaZenad.

xolo imis gaTvaliswinebiT, rom lizinguri garigeba ar iTvaliswinebs

sagarantio da saavanso giraos, sawarmoebs erTi da igive kapitalis

gamoyenebiT moZraobaSi mohyavT resursebis didi raodenoba. lizingiT

miRebuli aRWurviloba ar fiqsirdeba sawarmos balansSi da aqedan

gamomdinare ar zrdis mis davalianebas, ar auaresebs mis finansur

mdgomareobas.

amJamad, rodesac jandacvaSi midis mravalmowyobis formirebis procesi

da arsebobs finansuri saSualebebis mwvave ukmarisoba, lizinguri

firmebis Seqmna, Cveni SexedulebiT, mniSvnelovnad gaumjobesdeba

samedicino dawesebulebebis materialur-teqnikur bazas. pirvel etapze es

SeiZleba iyos saxelmwifo lizinguri firmebi, romlebic SeZlebdnen

Tanamedrove samedicino aRWurvilobis mwiri moculobebis gamnawileblis

Taviseburi rolis Sesrulebas da imis miRwevas, rom isini moxvdnen karg

xelSi. amasTan, rogorc msoflio gamocdileba aCvenebs, lizingis

gamoyeneba ukeTesia iq, sadac aqvT gansakuTrebiT rTuli da iSviaTi

aRWurviloba, romelsac momsaxurebas ukeT uweven lizingis gamcemlebi,

vidre amas SeZlebs misi gamomyenebeli samedicino dawesebuleba.

ekonomikur literaturaSi gvxvdeba momsaxurebis sferoSi iseTi

specifikuri formis gamoyenebis SeTavazeba, rogoricaa feqtoringi. es aris

Cveulebriv saxelSekrulebo safuZvelze ganxorcielebuli sasaqonlo

miwodebebis moTxovnebis Sesyidva feqtoring-firmis mier. amgvari operaciis

Sedegad mewarme, romelic yidis moTxovnebs, 2-3 dReSi Rebulobs

moTxovnili Tanxis 70-90%-s avansis saxiT. darCenili 10-30% feqtoring

firmisTvis garkveul wilad warmoadgens sagarantio Tanxas. feqtoring-

firma axdevinebs mewarmes garkveul procentebs savalo moTxovnebis

- 98 -

eqvivalentis dauyovneblivi gacemis, riskis premiisa da administraciuli

mmarTvelobiTi xarjebis anazRaurebisTvis. feqtoringi, upirveles yovlisa,

efeqturia sawarmoo dawesebulebebsa da sabiTumo firmebSi, romlebic

Sesabamisad awarmoeben da yidian samomxmareblo saqonels, magram Cven

migvaCnia SesaZleblad, rom aucilebeli samedicino dazRvevis pirobebSi,

rodesac bevri sawarmo droulad ar awarmoebs gadaxdebs aucilebeli

samedicino dazRvevis teritoriul fondebSi, xolo bevri maTgani imyofeba

gakotrebis zRvarze, sawarmoebis fondisadmi da sadazRvevo

organizaciebisadmi savalo movaleobebi SeiZleba mieyidos feqtoring-

firmebs. es uzrunvelyofda samedicino dawesebulebebis Tanabar

dafinansebas.

amgvarad, bazris konkretuli struqtura formirdeba mravali faqtoris

gavleniT, romlebic asaxaven qveynis ekonomikis mdgomareobas mTlianobaSi,

regionalur Taviseburebebs, Sesabamisi infrastruqturis ganviTarebis

dones da rac ufro zustad ecodinebaT es faqtorebi sakanonmdeblo da

aRmasrulebel xelisuflebas, miT ufro efeqturad da civilurad iqneba

gamoyenebuli sabazro meqanizmebi mosaxleobis janmrTelobis dacvaSi.

- 99 -

Tavi II. saqarTvelos pirveladi jandacvis ZiriTadi maxasiaTeblebi

2.1. kvlevis masala da meTodika

dasmuli miznebidan da amocanebidan gamomdinare, kvlevis procesSi

gamoyenebuli iyo Semdegi meTodebi: sociologiuri, istoriuli,

eqspertuli Sefasebis, SemTxveva-kontrolis, samedicino-statistikuri (maT

Soris korelaciuri da raodenobrivi analizi).

gamokvlevaSi gamoyenebulia msoflio bankis, saqarTvelos Sromis,

janmrTelobisa da socialuri dacvis saministros mier SemuSavebuli

“saqarTvelos janmrTelobis mdgomareobis Sesaxeb” 2006 wlis monacemebi,

saqarTvelos statistikis saxelmwifo departamentis, samedicino

statistikisa da informaciis centris, samedicino dazRvevis saxelmwifo

kompaniis saorganizacio-normatiuli masalebi.

sainformacio Ziebis procesSi gamoyenebul iqna rogorc internetiT

moZiebuli masalebi, aseve sxvadasxva qveyanaSi gamocemuli literatura,

romlis safuZvelzec gakeTda informaciuli mimoxilva. damuSavda

sxvadasxva qveynebis monacemebi, romlebic Seexeboda rogorc mosaxleobis,

avadobisa da sikvdilianobis TaviseburebaTa analizs. kvlevis procesSi

ganxorcielda saqarTvelos mosaxleobis janmrTelobis mdgomareobis

amsaxveli maCveneblebis SedarebiTi analizi, sxva da sxva daavadebebis

gavrcelebis ZiriTadi demografiuli tendenciebis Seswavla dinamikaSi

(1990-2007 ww.).

agreTve calke Segrovda da damuSavda statistikuri masala,

romelic Seexeba saqarTvelos sxvadasxva regionSi arsebul sazogadoebis

janmrTelobis mdgomareobas. ganxilul iqna rogorc zogadad

saqarTvelos, aseve sxva qveynebis mosaxleobis janmrTelobis

mdgomareobis amsaxveli maCvenebeli qveynis socialur-ekonomikuri

mdgomareobasTan kavSirSi.

kvleva Catarda qveynis geografiuli Taviseburebebis, pacientTa

yofiTi tradiciebis, mavne Cvevebis, profesiuli faqtorebisa da cxovrebis

higienuri pirobebis dacvis gaTvaliswinebiT. gaanalizebulia aRniSnuli

- 100 -

faqtorebis SesaZlo gavlena adamianis janmrTelobis saerTo

mdgomareobaze.

amis garda, specialuri programiT gamokvleulia 200 respodenti.

Catarebul gamokvlevaSi gamoyenebul iqna “SemTxveva-kontrolis” meTodi,

romelic xangrZlivi kvlevis meTodebs miekuTvneba. am tipis gamokvleva

dafuZnebulia avadmyofebsa da janmrTel pirebze gamosakvlevi faqtoris

zemoqmedebis Sesaxeb miRebuli informaciis Sejerebaze. gamokvlevis

damajereblobas mTlianad gansazRvravs Sesadarebeli jgufebis SerCeva.

jgufebi gamosakvlevi niSnis garda yvela sxva damaxasiaTebeli niSniT

sakmarisad msgavsi iyo. “SemTxveva-kontrolis” meTodis gamoyenebisas

kavSirebis magnitudis gamoTvlebs warmoadgens SefardebiTi riski (relative

risk RR), romelic aseve cnobilia rogorc riskis koeficienti (risk ratio).

SefardebiTi riski gamoiTvleboda faqtoris zemoqmedebis mqone jgufSi

daavadebis insidensis maCveneblis SefardebiT am faqtoris gavlenis qveS

naklebad myof jgufSi daavadebis insidensis maCvenebelTan. SemTxveva-

kontrolis kvlevis SefardebiTi riskis ganmsazRvrelia odds ratio (OR). igi

gamoiangariSeba SemTxveviT jgufSi zemoqmedebis prevalensis SefardebiT

sakontrolo jgufSi zemoqmedebis prevalensTan damajereblobis

intervali warmoadgens (CI) ricxvTa wyvils, romelic gansazRvravs zRvars,

romlis SigniT arsebobs 95%-iani albaToba imisa, rom mosalodnelia

WeSmariti riskis dacema; igi damyarebulia p-s 0.05 mniSvnelobaze. roca

SefardebiTi riski 1.0-is tolia, maSin ar arsebobs aranairi kavSiri,

amitom Tu CI Seicavs 1.0-s riski ar aris.

samuSao Catarda specialurad SemuSavebuli programis mixedviT,

romelic emyareba msoflios jandacvis organizaciis moTxovnilebebs,

kvlevis am dargSi sxvadasxva qveynis gamocdilebas.

programa Seicavs kiTxvebs, romlebic dakavSirebulia rogorc

pirovnebis demografiul mdgomareobasTan, cxovrebis wesTan, aseve

daavadebis simptomebTan, risk-faqtorebTan, mavne CvevebTan da a. S. daculi

iyo informaciis sruli konfidencialoba, ramac saSualeba mogvca migveRo

gulaxdili pasuxebi. gaanalizda saqarTvelos jandacvis da sadazRvevo

sistemis moqmedebis adekvaturoba mosaxleobis samedicino moTxovnilebebis

uzrunvelyofis kuTxiT.

- 101 -

pirveladi sociologiuri informaciis misarebad gamoiyeneboda

rogorc anketireba, aseve pirdapiri interviu, romelic respondentebs

damatebiTi konsultaciis saSualebas aZlevda. kiTxvari Sedgeba ZiriTadi

nawilisa da miznobrivi kiTxvebisagan. mTlianad Catarebul kvlevaSi

CarTuli iyo 200 respodenti, romelTa asakobrivi jgufi 20 dan 70 wlamde

meryeobda. kiTxvarebi darigda TbilisSi. 20 dan 65 wlis mosaxleobas

Soris. respodentTa raodenobam mTlianobaSi Seadgina 200 adamiani.

gamokiTxva Catarda rogorc samedicino dawesebulebebSi, aseve mis

gareTac, pacientTa da janmrTel mosaxleobis Soris. respodentebi

SeirCnen SemTxveviTi ( random sampling) SerCevis meTodiT, yovelgvari raime

miznobrivi damaxasiaTebeli niSnis gareSe. (simple sampling) kiTxvaris

saboloo versia Seicavs 30 sxva da sxva tipis SekiTxvas. gamokiTxvaSi

monawileoba savaldebulo ar yofila da amasTanave yvela maTgani

anonimuri iyo. respodentebma miiRes ganmarteba kvlevis miznebis Sesaxeb.

monacemebis Segrovebis instrumentad gamoviyeneT kiTxvarebi da

Sesabamisad miviReT raodenobrivi monacemebi (quantitative data). imisaTvis, rom

zogadi warmodgena gvqonoda gamokiTxul kontingentze, respondentebi

kiTxvaris SablonSi (sample ) ganawilebuli iyvnen Semdegi maxasiaTeblebis

mixedviT: sqesi, asaki profesia sacxovrebeli adgili, samuSao statusi,

ojaxuri mdgomareobi da sxva kategoriebis mixedviT.

kiTxvaris meore nawili moicavda Semdeg sakiTxebs: respodentTa

socialur-ekonomiur mdgomareoba, saSualo Tviuri Semosavali,

janmrTelobis mdgomareoba da masTan dakavSirebul problemebi,

saxelmwifo samedicino dazRvevis sistemis Sesaxeb gaTviTcnobierebis

done da samedicino dazRvevis polisis gamoyenebis SesaZlebloba. aseve

SeviswavleT respodentTa dakmayofilebis done miRebuli samedicino

momsaxurebiT.

kvlevisaTvis kiTxvaris masala Segrovda ganxiluli literaturuli

masalis Sedegad, saidanac SeirCa kvlevisaTvis sayuradRebo sakiTxebi,

romlebic aRniSnul problemas exeboda. gamokiTxvis mTavar sirTules

regionebis macxovrebelTa gamokiTxva warmoadgenda, amisaTvis mivmarTeT

”saqarTvelos mosaxleobis janmrTelobis Sesaxeb” jandacvis saministros

mier Catarebuli gamokvlevebis Sedegebs. analizisaTvis gamoyenebuli iqna

- 102 -

sxva da sxva meTodebi (frequencies, cross-tabs, Chi-square,) , romlebic statistikuri

programis SPSS 11. saSualebiT gakeTda.

ZiriTadi sakiTxebi, romelsac kiTxvari moicavs aris

socioekonomikuri statusis ganmsazRvreli, am jgufebis cxovrebis wesi da

maTi damokidebuleba janmrTelobis xelmisawvdomobasTan dakavSirebiT da

sxva, romelic cal calke da erTmaneTTan kavSirSi iqna ganxiluli.

(cxrili 12).

cxrili 12. kiTxvaris Tematika.

ZiriTadi determinantebi statusi qmedebebi

socio demogr.

maxasiaTeblebi;

ganaTleba;

migracia;

risk faqtorebi;

samomavlo rwmena da

imedebi

janmrTelobisaTvis

aucilebebli pirobebi,

fizikuri mdgomareoba,

socialuri dgomareoba,

cxovrebis wesi

kveba,

garToba,

sportuli aqtivoba,

medikamentebis gamoyeneba.

sqesi, asakobrivi jgufi, ojaxuri mdgomareoba, finansuri

mdgomareoba, ganaTleba da sxva determinantebi gamoyenebuli iqna maTi

samedicno servisis xelmisawvdomobaSi zegavlenis xarisxis Sefasebis

mizniT.

janmrTelobis servisisadmi Tanabar xelmisawvdomobis tendenciebis

gamosavlenad garkveul socialur jgufebs Soris gamoyenebuli iqna

standartuli, kategoriebs Soris distribuciis meTodi. aseve gaanalizda

urTierTkavSiri calkeul cnebebsa da cvladebs (concept/variables) Soris,

asociacia korelacia (association/ correlation) garkveul socialur faqtorebsa

da janmrTelobas Soris. respodentTa distribucia, arsebul gansxvavebebSi

Sefasda Chi squire testis analiziT. gansxvaveba mniSvnelovnad CaiTvala,

rodesac P < 0.05.-ze iyo.

asakis, ganaTlebis, sacxovrebeli adgilisa da socialuri statusis

gavlena jandacvis servisisadmi xelmisawvdomobaSi Sefasda jvaredini

analizis (crosstabs )xerxiT, rogorc mamakacTa jgufSi aseve qalTa

kategoriaSi cal calke. respodentebi Semdegi kategoriebis mixedviT

- 103 -

dajgufdnen: sqesis, ojaxuri mdgomareobis, asakobrivi jgufis;

ganaTlebis, sacxovrebeli adgilisa da finansuri mdgomareobis mixedviT,

rac mniSvnelovani kategoriebia socio-ekonomikuri statusis

gansazRvrisaTvis. kiTxvari Seicavda iseTi xasiaTis SekiTxvebs,

rogoricaa magaliTad saSualod ojaxis Semosavali, janmrTelobis

saerTo mdgomareoba, mowevis, alkoholis moxmarebis, kvebis, fizikuri

aqtivobisa da jansaRi cxovrebis wesis Sesaxeb.

kvlevis meTodologias Semdegi Zlieri mxareebi aqvs: masSi Sedis iseTi

socioekonomikuri indikatorebi, romlebic mniSvnelovania adamianis

janmrTelobis mdgomareobis Sesaxeb msjelobisas. kiTxvaris saSualebiT

warmodgenili iyo mosaxleobis ara romelime konkretuli miznobrivi

jgufi, aramed mcire raodenobis, saqarTveloSi arsebuli sazogadoebis

nimuSi, sqesis, asakis, ganaTlebis, ekonomiuri mdgomareobisa Tu sxva

kategoriebis gaTvaliswinebiT. Sefaseba standartulad Catarda da

Seicavda mraval kategoriebs.

kvlevas hqonda aseve ramodenime SezRudvac. magaliTad mosaxleobis

moculoba. vinaidan sirTules warmoadgenda mTeli saqarTvelos mocva

aRniSnuli kvleviT damxmare saSualebebad avirCieT standartuli

saqarTvelos statistikis departamentis mier gamokvleuli saqarTvelos

mosaxleoba.

sirTules vawydebiT aseve socioekonomikuri determinantebis ufro

Rrma Seswavlisas. xSir SemTxvevaSi aseTi tipis kiTxvebze pasuxebi Tavidan

iqna acilebuli da garda amisa amomwuravad pasuxis gacemac SeuZlebeli

aRmoCnda, Tumca mocemuli kiTxvebi socioekonomikuri statusis

gansazRvrisTvis vfiqrobT sakmarisi unda iyos.

jandacvis sistemis moqmedebis gaumjobeseba, xarisxis gazrda da

saboloo jamSi momxmarebelTa moTxovnilebebis maqsimaluri

dakmayofileba, konkretul specifikasa da pirobebzea damokidebuli.

kvlevis safuZvelze SeiZleba davaskvnaT, rom saqarTvelos jandacvis

sistemaSi arsebuli socialuri uTanasworoba da araTanabari

xelmisawvdomoba ufro Rrmad unda iqnas Seswavlili da unda moxdes misi

swori mimarTulebiT warmarTva, rac upirveles yovlisa daabalansebs im

araTanabar xelmisawvdomobis problemas, romelic dResdReobiT

- 104 -

saqarTvelos sazogadoebaSi maRal da dabal Semosavlis mqone socialur

jgufebs Soris arsebobs. jandacvis sistemis dafinansebisas umjobesi

iqneba Tu prioiritetad Raribi fenis xelSewyoba dadgeba dRis wesrigSi,

raTa gardamaval periodSi mkafiod gamoikveTa am ori radikalurad

gansxvavebuli mdidrebisa da Raribebis fena rac saxelmwifos mxridan

saTanado xelSewyobas udaod saWiroebs. saxelmwifo politikaSi

namdvilad SeiniSneba am strategiis ganviTarebis tendenciebi, rac aseve

warmatebuli nabiji iqneba siRaribis daZlevisa da qveynis ekonomikuri

ganviTarebisaken.

- 105 -

2.2 saqarTvelos pirveladi jandacvis sistemaze moqmedi ZiriTadi

socialur-ekonomikuri determinantebi

yofili dsT-s qveynebis sivrceSi sainteresoa saqarTveloSi arsebuli

viTarebis ganxilvac. 2008 wlis monacemebiT saqarTvelos mosaxleoba dRes-

dReobiT 4.38 mln mosaxles Seadgens, romelTagan ZiriTad mosaxleobas

qarTvelebi warmoadgenen, Tumca aq cxovroben aseve umciresobis

warmomadgenlebi, romlebsac TavianTi sasaubro enebi gaaCniaT. maTgan

yvelaze mniSvnelovan raodenobas rusebi, somxebi, azerbajanelebi, somxebi,

berZnebi da osebi warmoadgenen. (grafiki 1)

grafiki 1.

saqarTvelos mosaxleobis ganawileba nacionalobs mixedviT (2008 w)

wyaro: http://www.statistics.ge (საქართველოს სტატისტიკური წელიწდეული 2008 w.)

saqarTvelos mosaxleobis ZiriTadi demografiuli mdgomareoba arc

Tu ise saxarbieloa. Sobadoba 1990-ian wlebTan SedarebiT TandaTanobiT

klebis tendencias gviCvenebs. Tu 1990 wels yovel 1000 mosaxleze

maCvenebeli 17 iyo 2007 wlisaTvis es maCvenebeli 9,4-mde Camovida.

miuxedavad imisa rom sikvdilianobis maCvenebelSi didi cvlileba ar

aRiniSneba, saerTo demografiul mdgomareobas amiT ver ganvsazRvravT,

xolo rac Seexeba bunebriv matebas am SemTxvevaSi mkveTri cvlilebaa.

bunebrivi mateba yoveli aTasi bavSvidan 7,7-dan 1,8 mde Semcirda, rac

saerTo demografiuli mdgomareobisTvis dasafiqrebel sakiTxs

warmoadgens. (cxrili 13)

- 106 -

cxrili 13.

saqarTvelos mosaxleobis ZiriTad demografiuli maCveneblebi (1990-2007 ww).


Tu 1979 wels saqarTvelos mosaxleobis aRweris monacemebiT yoveli 1000

qalidan 231 iyo erTSviliani, 240 - orSviliani, 329-s ki hyavda sami da meti

Svili. 2008 wlis aRweram daafiqsira sami da meti bavSvis myoli qalebis

Semcirebis tendencia (300 yovel 1000 gaTxovil qalze), dResdReobiT ki

samSviliani ojaxebis ricxvi (16%) TiTqmis erTi-orjer Semcirda, rac aSkara

safrTxes warmoadgens. dResdReobiT umetesoba ojaxebisa (51%) erTSviliania.

(grafiki 2)

grafiki 2.

cocxalSobilTa ganawileba dabadebis rigiTobis mixedviT (2008 w.)


1990 1991 1995 1996 2000 2001 2005 2006 2007

Sobadoba (yovel

1000 mosaxleze) 17,0 16,6 11,9 11,9 11 10,9 10,7 10,9 11.2

sikvdilianoba

(yovel 1000

mosaxleze)

9,3 9,6 10,4 10,4 10,7 10,5 9,3 9,6 9,4

bunebrivi

mateba (yovel 1000

mosaxleze)

7,7 7 1,5 1,5 0.3 0,4 1,4 1,3

1.8

51%

33%

16%

pirveli

bavSvi meore

bavSvi

mesame da

meti bavSvi

- 107 -

qvemoT moyvanili cxrilidan Cans saqarTvelos mdgomareoba

Sobadobisa da bavSvTa mokvdaobis mixedviT calkeul regionebSi 2008

wlis saqrTvelos statistikis departamentis monacemebis mixedviT.

mokvdaobis yvelaze maRali maCvenebeli TbilisSi aRiniSneba, Tumca aq unda

gaviTvaliswinoT aseve mosaxleobis proporciuli gadanawilebac sxva

regionebTan SedarebiT. (cxrili 14).

cxrili 14.

Sobadoba da bavSvTa mokvdaoba, samedicino dawesebulebebis 2008 wlis

monacemebi

regioni

cocxal-

SobilTa

raodenoba

maCvenebeli

1000

dabadebulze

0–1 wlamde

gardacv-

lilTa

raodenoba

maCvenebeli

1000cocxal-

Sobilze

perinata

luri

mokvdaoba

aWara 4402 16,8 91 14,5 31,0

Tbilisi 20055 19,7 554 16,9 36,2

kaxeTi 3081 7,7 26 5,8 13,5

imereTi 6494 19,0 122 16,8 35,5

samegrelo 3706 8,0 24 5,9 13,9

Sida qarTli 2549 15,1 18 6,3 21,3

qvemo qarTli 4053 15,8 21 4,2 19,9

guria 890 14,4 9 10,1 24,4

samc-javaxeTi 2069 17,1 13 3,4 20,4

mcxeTa-

mTianeTi 440 13,5 4 9,1 22,4

raWa-leCxumi 117 8,5 0 0,0 8,5

saqarTvelo 47856 16,8 882 12,6 29,2


ukanaskneli 75 wlis manzilze sicocxlis saSualo xangrZlivoba 29

wliT gaizarda da 2005 wles 73.0 weliwads miaRwia. mamakacis saSualo

xangrZlivobaa 68.8 weliwads, xolo qalebisa 76.9 weliwads utoldeba.

(grafiki 3)

- 108 -

grafiki 3. saqarTvelos mosaxleobis sicocxlis saSualo xangrZlivoba

1930, 1970,1991da 2008 wlebi.


siRaribe socioekonomikuri mdgomareobis erT erTi umniSvnelovanesi

determinantia. saqarTvelos mosaxleobis umetesi nawili siRaribis zRvars

miRma imyofeba sabazro ekonomikaze gadasvlasTan dakavSirebulma

politikurma da ekonomikurma krizisma saqarTvelos umetesi mosaxleobis

nawilis gaRaribeba gamoiwvia. 1999 wels mosaxleobis 51.8 % siRaribis

oficialurad aRiarebul zRvars miRma cxovrobda. bolo oTxi wlis

statistikuri monacemebi cxadyofs, rom siRaribis miRma myofi adamianebis

ricxvi gaizarda qveynis ekonomikuri aRmavlobis procesSic ki. gaizarda

agreTve ukidures gaWirvebaSi mcxovreb adamianTa raodenobac (romelTa

yovelTviuri moxmareba saarsebo minimumze dabalia. (grafiki 4).

grafiki 4. siRaribe done saqarTveloSi 1997-2008 ww


4247

64

71

65

7268

76

0

10

20

30

40

50

60

70

80

1930

19701991 2008

- 109 -

siRaribis koeficienti gviCvenebs rom ekonomikur zrdas didi gavlena

aqvs siRaribeze, romelic Semosavlis Tanabari ganawilebis pirobebSi unda

moxdes. siRaribis aspeqtebs Soris aRsaniSnavia 2 ZiriTadi mizezi: esenia

umuSevroba da kapitalis arqona. qveynis saerTo umuSevrobis maCvenebeli

2000 wels SedarebiT naklebi iyo, xolo 2007 wels moimata 16.2 % Tumca

arsebobs uzarmazari gansxvaveba qalaqSi 27.8% da soflad 5.1 %

mcxovrebTa umuSevrobas Soris. am gansxvavebis ZiriTadi mizezia soflad

dasaqmebis farTo gagebiT gansazRvra, aqedan gamomdinare statistikuri

monacemebi umuSevrobis bevrad ufro maRal dones da siRaribes ufro

qalaqSi aCvenebs vidre soflad, rac vfiqrob absoluturad Seusabamoa

arsebul realobasTan, radgan realurad soflad amJamad gacilebiT

rTuli mdgomareobaa umuSevrobisa da siRaribis TvalsazrisiT, vidre

qalaqSi. (grafiki 5.)

grafiki 5. umuSevroba da siRaribe qalaqsa da soflad 2000-2007ww

umuSevroba

0

10

20

30

40

50

60

70

80

qalaqSi soflad

2000

2007


garda qalaqisa da soflis mdgomareobas Soris arsebuli

gansxvavebisa uzarmazari sxvaobaa saqarTvelos regionebs Soris siRaribis

maCveneblebSi: uRaribes regionSi siRaribis maCvenebeli yvelaze mdidar

regionTan SefardebiT TiTqmis orjer maRalia (grafiki 7) siRaribis maRal

maCvenebelSi Sedis SedarebiT mTiani raionebi. miuxedavad imisa rom

TbilisSi siRaribis done arc Tu ise gansxvavdeba sxva raionebTan

SedarebiT, yvelaze metad mainc siRaribis maStabiT samcxe-javaxeTi da

kaxeTi gamoirCeva (grafiki 6).

- 110 -

grafiki 6. siRaribe regionebis mixedviT 2008 weli.


siRaribis problemebTan dakavSirebiT Seiqmna siRaribis daZlevis

porgrama romelic moicavs Raribi mosaxleobis socialuri dacvis

uzrunvelyofas, romelic dResdReobiT arc Tu ise saxarbielo

mdgomareobaSia. siRaribis Semsubuqebas xels uwyobs ara ekonomikuri

zrdis moculoba, aramed resursebisa da Semosavlebis Tanabrad

gadanawileba. msoflio bankTan da saerTaSoriso savaluto fondTan

erTad gaero mxars uWers da mTavrobas daxmarebas uwevs siRaribis

daZlevis erovnuli strategiis SemuSavebaSi, rac miznad isaxavs axali

samuSao adgilebis Seqmnas da saxelmwifo mmarTvelobis efeqtur

ganxorcielebas.

mosaxleobis siRaribis donem mkveTrad imata da 1998 wels saSualod

50,2% Seadgina. qalaqad es maCvenebeli 11,6 procentuli punqtiT gaizarda

da 67,5%-s miaRwia, xolo soflad 3,0 procentuli punqtiT gaizarda da

48,3% iyo. (grafiki 7)

- 111 -

grafiki 7. siRaribis done saqarTveloSi

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

sul qalaqSi soflad

19982000


gaizarda siRaribis simwvave, romelic zedmiwevniT maRal dones

martoxela adamianebSi aRwevs imis gaTvaliswinebiTac, rom am kategorias

ZiriTadad asakovani mosaxleoba miekuTvneba.

Catarebulma gamokvlevam cxadhyo, rom uRaribesi mosaxleobis

xarjebis struqturaSi wina planze wamoweuli iyo sursaT-sanovagis SeZena.

qveyanaSi swrafi tempiT mimdinareobs mosaxleobis sxvadasxva

socialur fenebad dayofa, rac ganapirobebs am fenebs Soris ara marto

ekonomikuri, aramed socialur-kulturuli Taviseburebebis gansxvavebasac.

1998 wels 400-1000 laris Semosavlis mqone ojaxebis raodenoba gaizarda

7,4%-mde, wina wlis 6,9%-Tan SedarebiT. xolo SedarebiT mdidari, anu 1500

larze meti Semosavlis mqone ojaxebis raodenoba 1,2%-s gautolda.

sakmarisad mkveTrad gamoixata janmrTelobis mdgomareobis ZiriTadi

maxasiaTeblebis gansxvavebac, gansakuTrebiT ukiduresad Rarib, da

SedarebiT SeZlebul fenebs Soris. amis damadasturebelia is faqtic, rom

uRaribes mosaxleobasTan SedarebiT SeZlebuli mosaxleoba saSualod 20-

30%-iT naklebs xarjavda mkurnalobasa da medikamentebis SeZenaze. es

gasagebicaa, vinaidan siRaribes Tan sdevs mosaxleobis maRali dasnebovneba

da Sesabamisad samedicino xarjebis zrdac.

arsebuli situacia cxadyofs, rom saqarTvelos mosaxleobis didi

nawilisaTvis aucilebeli sasicocxlo minimumis SesanarCuneblad saWiro

- 112 -

saxsrebis mopoveba sul ufro gaZnelebulia. umwvavesi saWiroebis

miuxedavad es kategoria Tavs aridebs miakiTxos saTanado samedicino

daxmarebis mizniT jandacvis dawesebulebebs, rac TavisTavad maTi

dasnebovnebisa da saboloo jamSi naadrevi sikvdilis sawindaria.

mimdinare wels janmrTelobis dacvis saministros davalebiT Catarda

specialuri kvleva, romelic moicavda q.TbilisSi mcxovrebi dabali da

maRali Semosavlis mqone mosaxleobis janmrTelobis mdgomareobis

Sedarebas.

dadginda, rom mosaxleobis Raribi fenebis janmrTelobis

mdgomareobis amsaxveli maCveneblebi gacilebiT uaresia, rac Tavis mxriv

unda ganapirobebdes maT maRal moTxovnas saTanado samedicino

momsaxurebis gawevaze. miuxedavad amisa am kontingentis eqimTan

mimarTvianoba zedmiwevniT dabalia. imavdroulad, SeZlebuli fenebis

warmomadgenlebi ara marto gamoirCeodnen ukeTesi janmrTelobis

maCveneblebiT, aramed gacilebiT maRali samedicino aqtiurobiT.

sayuradReboa isic, rom maTi didi nawili pirveli jgufis

warmomadgenlebisagan gansxvavebiT mimarTavs eqims ara mxolod daavadebis

SemTxvevaSi, aramed profilaqtikuri Semowmebis mizniTac, sakmaris dros

uTmobs janmrTelobis gakaJebas. ukanasknel wlebSi siRaribis zrdasTan

erTad saxlemwifos mier jandacvis subsidireba ar aRmoCnda sakmarisi

Tanabari xelmisawvdomobisTvis. amis Sedegad Raribebs faqtiurad waerTvaT

samedicino daxmarebisadmi xelmisawvdomobis SesaZlebloba.

jandacvis samsaxuris Tanabar xelmisawvdomobaze gavlenas ori

ZiriTadi faqtori axdens:

1. Rarib mosaxleobas ar SeuZlia samedicino momsaxurebis sul ufro

maRali fasebis gamo safasuris gadaxda;

2. centridan daSorebul regionebSi mcxovreb mosaxleobas uWirs

samedicino dawesebulebamde misvla.

samedicino momsaxurebis Rirebuleba, gaxda gadaulaxavi barieria

Raribi mosaxleobisTvis. saxelmwifos mier jandacvis seqtorze

danaxarjebis SemcirebasTan erTad aRniSnul sferos dafinansebis tvirTi

mTavrobidan individze gadavida. 1991 wlamde, mTeli samedicino

momsaxurebis xarjebis 85 % saxelmwifo biujeti faravda 1994 wlisTvis

- 113 -

mTavrobis wili 25% mde daeca, xolo dRes igi 15 %-s Seadgens. darCenili

xarjebi dRes ifareba pacientis mier an sadazRevo programiT, rogorc

oficialuri dafinanseba mTavrobis mier an subsididrebuli momsaxurebis

safasuri, an kidev–rogorc ukananono gadasaxadebi, romlebsac jandacvis

muSakebi iTxoven iseTi momsaxurebisTvisac ki romelsac saxelmwifo

anazRaurebs. mkurnalobis da medikamentebis Rirebuleba saavadmyofoebSi

miRebul araoficialur tarifebTan erTad mosaxleobis 30%-sTvis

mkurnalobas xelmiuwvdomels xdis. aqedan gamomdinare aRniSnuli

mosaxleobis umetesoba ver axerxebs samedicino momsaxurebiT sargeblobas.

mosaxleobis mxolod 8% SeuZlia misTvis aucilebeli samedicino

momsaxurebis safasuris gadaxda. aseTi araTanabari ganawileba ara mxolod

samedicino momsaxurebis araerTgvarovan xelmisawvdomobaze miuTiTebs,

aramed asaxavs saavadmyofos adgilebze dabali moTxovnis (28%) mizezs,

rom Rarib mosaxleobas ar SeuZlia saavadmyofoSi yofnisa da mkurnalobis

safasuris gadaxda.

centridan daSorebul raionebSi jandacvis xarisxiani momsaxurebis

naklebad uzrunvelyofa, nawilobriv aixsneba medicinis muSakTa dabali

kvalifikaciiTa da samedicino aparaturis naklebobiTac. daSoreba xSirad

amcirebs profesionaluri momsaxurebisa da ukeTesad aRWurvili

resursebis xelmisawvdomobas.

jandacvis sistemis analizma gviCvena Tu ramdenad did problemas

warmoadgens pirveladi samedicino daxmarebis seqtori. unda

gaviTvaliswinoT, rom saqarTveloSi Warbadaa iseTi pirveladi samedicino

daxmarebis dawesebulebebi, rogoricaa ambulatoriebi, poliklinikebi,

qalTa konsultaciebi, dispanserebi, sxva da sxva punqtebi qalaqebsa Tu

soflebSi, Tumca xSir SemTxvevaSi isini problemas ver wyveten.

dResdReobiT mosaxleobas 2059 samedicino momsaxurebis saSualebebi

awvdis momsaxurebas. maT Soris yvelaze metad ambulatoriuli klinikebi

da diagnostikuri centrebi (1180) da saavadmyofoebia 229. samedicino

dawesebulebebis struqtura gamosaxulia (grafikSi 8).

- 114 -

grafikSi 8. samedicino dawesebulebebi 2008weli.

1180

500

229

150

0 200 400 600 800 1000 1200 1400

ambul. klinikebi

stomat. klinikebi

saavadmyofoebi

sxva sam dawes.


am dawesebulebaTa personalis simravle sakmarisad aferxebs axali

sistemis Camoyalibebis process. pirveladi samedicino daxmarebis

dawesebulebaTa materialuri baza, gansakuTrebiT raionebSi da soflad,

arc wina periodSi da arc amJamad metwilad ar pasuxobs dadgenil

standartebs da mouvlelobis gamo naklebad asrulebs Tavis funqciur

daniSnulebas, garda amisa aparatura, mowyobilobebi da inventari

moZvelebulia da xSirad uvargisic.

gansakuTrebiT problemuria mravalricxovani da xSirad naklebad

kvalificirebuli kadrebis sakiTxis mogvareba.

2000 wels registrirebuli iyo 21,100 eqimi, 47.4 yovel 10.000

mosaxleze. yvelaze did jgufs pediatrebi da Terapevtebi warmoadgenen.

samedicino personalis saxelfaso Semosavlebi warmatebul klinikebSi

meryeobs 30 dan 400 aSS dolaramde. saSualod eqimis Semosavali TveSi 130

aSS dolars Seadgens rac mniSnvelovnad dabalia.

mosaxleobis damokidebulebac samedicino daxmarebis mimarT

saTanadoa umetesoba Tavs aridebs eqimTan vizits. amasTan, mosaxleobis

avadobis struqturis, da saTanadod samedicino daxmarebis sxvadasxva

saxeebze misi moTxovnis Secvlam ganapiroba poliklinikebis da

gansakuTrebiT ambulatoriebis personalis dausaqmebloba.

- 115 -

mosaxleobis mimarTvianobis tendenciebi samedicino dawesebulebebSi

naTlad asaxavs yvela zemodCamoTvlili faqtoris aSkara gavlenas.

(grafikSi 9)

grafikSi 9. saqarTvelos mosaxleobis mimarTvianoba samedicino

dawesebulebebSi 1990-2008 ww.


rogorc moyvanili sqemidan Cans, qveyanaSi mkveTrad iklo

mosaxleobis mimarTvianobam rogorc ambulatoriul-poliklinikur, aseve

stacionarul dawesebulebebSi. mimarTvianobis amgvari cvlilebis ZiriTad

mizezad SeiZleba CaiTvalos, Warbi raodenobis samedicino personalis

Semcireba agreTve, mosaxleobis gadamxdelunarianobis kleba.

yvela zemoT moyvanili faqtorebi iZleva niSans imis Sesaxeb rom

qveyanaSi sadac ar aris mowesrigebuli esa Tu is sistema aucilebelia

misi reformireba da ganaxleba. swored aseTma viTarebam, aseve msoflios

donori organizaciebis mxardaWeram saqarTvelos stimuli misca daewyo

janmrTelobis dacvis seqtoris reformireba, romelmac garkveuli etapebi

gaiara da mniSvnelovani cvlilebebic ganicada.

ekonomikuri ngrevis, samoqalaqo omis, afxazeTis da samxreT oseTis

konfliqtebi. Sedegad 1991-1994 wlebSi saqarTvelos mSp 70-75%-iT daeca.

dagrovda mniSvnelovani sagareo vali, Sida davalianebebi, xolo sustma

fiskalurma politikam didi sabiujeto deficiti gamoiwvia. saqarTvelos

ekonomikuri krizisi erT erTi yvelaze mwvaveTagani iyo yofili sabWoTa

kavSiris respublikebs Soris. amis gamo umZimesi aRmoCnda gardamavali

periodi, romlisTvisac damaxasiaTebeli iyo ekonomikuri da socialuri

mdgomareobis mkveTri gauareseba. cxrilSi mocemulia saqarTvelos

0

2 0

4 0

6 0

8 0

1 0 0

1 2 0

- 116 -

ekonomikuri ganviTarebis maCveneblebi 1996 wlidan 2008 wlis CaTvliT

sadac mkafiod Cans ekonomikuri vardnis procesi, romelic saqarTvelom

ganicada aRniSnul periodSi. (cxrili 15).

cxrili 15.

saqarTvelos ekonomikuri ganviTareba

1996 1997 1998 1999 2008

mSp-s (%) 10.5 10.8 2.9 3.0 1.8

samomxmareblo

fasebis indeqsi

39.4 7.1 3.6 19.1 4.3

gacvlis

kursi(lari aSS

dolarze)

1.263 1.3 1.391 2.021 1.67

sagadasaxado

Semosavlebi (mSp-s %)

10.6 12.7 12.8 13.8 11.5


1990-iani wlebis Sua periodidan usafrTxoebis mizniT samxreT

oseTTan da afxazeTTan cecxlis Sewyvetis Sesaxeb SeTanxmebis dadebis

Semdeg msoflio bankisa da saerTaSoriso savaluto fondis daxmarebiT

saqarTvelos mTavrobam daiwyo kompleqsuri reformebis programis

ganxorcieleba ekonomikis aRsadgenad, rac sakmaod warmatebuli aRmoCnda.

1990-iani wlebis bolos aSkara gaxda, rom saxelmwifo resursebis marTva

efeqturad ar xorcieldeboda ekonomikuri aRmavlobis Sedegi Tanabrad ar

nawildeboda. gaizarda siRaribisa da Semosavlebis uTanasworobis

maCveneblebi. ekonomikuri aRmavlobac arastabiluri aRmoCnda. 2000 wels

mSp erT sul mosaxleze 678 aSS dolari Seadgina. 1990-iani wlebis Sua

periodSi ekonomikis reformirebis programis garda wamowyebuli iqna bevri

seqtoruli reforma 1995 wels miRebuli iqna axali konstitucia, romelic

adamianis uflebebaTa, demokratiul mmarTvelobasa da sabazro ekonomikis

sayovelTaod aRiarebul principebs emyareba.

ukanaskneli 12 wlis ganmavlobaSi, iseve rogorc sxva danarCeni

yofili sabWoTa kavSiris wevri qveynebi da saqarTvelo ganicdis

- 117 -

gardamaval periods gegmiur (planned) ekonomikidan sabazro ekonomikaze

gadasvlas sadac jer ar gadawyvetila eTnikuri konfliqtebi da mravali

sxva ekonomikuri Tu politikuri sakiTxebi. qveynis mosaxleobis 20%

emigraciaSi imyofeba an iZulebiT gadaadgilebulia zemoTxsenebuli

eTnikuri konfliktebis gamo, bevrma ki qveyana ekonomiuri da sxva saxis

usafrTxoebis gamo datova. aseT viTarebaSi eWvi momavlis

keTildReobisaTvis da sazogadoebis janmrTelobis ukeTesi

mdgomareobisaTvis sakmaod didi iyo. jandacvis reforma 1995 wels daiwyo

maSin rodesac saqarTvelos umZimesi ekonomikuri periodi hqonda reformis

mizani pirvel rigSi iyo ukiduresad mZime mdgomareobaSi myofi jandacvis

sistemis reabilitacia da axal demokratiul faseulbebis

gaTvaliswinebiT axlebur midgomebTan adaptacia. saerTo jamSi igi

gulisxmobda cxovrebis donis amaRlebas moxda sistemis deregulacia da

decentralizacia funqciebis gadanawileba qveynis saxelmwifo da

adgilobriv doneze. centralizebuli erTiani sistema, romelic adre

ruseTisagan imarTeboda gadavida TviT dafinansebaze da daiwyo

socialuri programa saxelmwifo dazRvevis fondis saxiT. rasac

amavdroulad Tanxebis aramiznobrivi xarjvac mohyva. amas mohyva

samedicino dazRvevis saxelmwifo kompaniisa da socialuri dacvis erTiani

fondis gaerTianeba da erTiani saxelmwifo fondis Seqmna romelic mTel

socialur sferos afinansebda. amiT saxelmwifo iRebs valdebulebas

sazogadoebis socialur uzrunvelyofaze. Semdgomi etapi SeiZleba iTqvas

bazisuri paketis Seqmnaa, romlis mixedviTac xdeba programuli

dafinanseba problemaTa prioritetulobis mixedviT romelsac saxelmwifo

centraluri da municipaluri programiT afinansebs.

2006-2010 wlisiTvis saqarTvelos jandacvis sistemaSi gamiznulia 400

milioni laris investicia, risi saTanadod ganxorcielebisaTvis saWiroa

mkveTri, kargad Camoyalibebuli gegma axali modelis sistemis Sesaqmnelad,

romelic saqarTvelos ekonomikuri ganviTarebis gegmis Sesabamisi iqneba.

jandacvis sferoSi saqarTvelos mTavrobam SeimuSava erovnuli politika

da Camoayaliba saxelmwifo komiisia, romelic uSualod prezidents

eqvemdebareba. politikis umTavresi elementebia jandacvis dafinansebis

gazrda, raTa sami mxaris saxelmwifos, damqirevebelTa da daqiravebulTa

- 118 -

monawileobiT mosaxleobisTvis uzrunvelyofili iqnes jandacvis ZiriTadi

paketi. gamiznulia mosaxleobisa socialuri dazRveviT dazRveulTa sul

ufro meti raodenoba, romelmac 2010 wlisaTvis saqarTvelos mTliani

mosaxleoba unda moicvas.

aseve dagegmilia pirveladi jandacvis gaumjobeseba. yuradReba ufro

mimarTulia pirveladi da profilaqtikuri momsaxurebisken da ara

mkurnalobisken. dagegmilia aseve adaminauri resursebis ganviTarebis

xelSewyoba, Warbi samedicino personalis Semcireba personalis

gadamzadeba, infrastruqturis ganaxleba 100 axali saavadmyofo da

sainformacio sistemebis SemuSaveba. sazogadoebriv jandacvaze mimdinare

saxelmwifo xarjebi dabalia da Seadgens mTavrobis mTeli xarjebis (2003

wlis monacemebiT) 6%-s da erToblivi Sida produqciis mxolod

daaxloebiT 1%-s. es jer kidev bevrad naklebia vidre gansazRvrulia

ekonomikuri ganviTarebisa da siRaribis daZlevis programis amocanebiT.

1997 wlis samedicino dazRvevis Sesaxeb kanonis Sesabamisad

SemoRebuli socialuri dazRvevis sistema, romelsac marTavs

sazogadoebriv sakuTrebaSi myofi erTiani saxelmwifo socialuri

dazRvevis fondi (SUSIF), ZiriTadad finansdeba xelfasidan savaldebulo

gadasaxdebidan, romelis farglebSi damqiraveblebi ixdian gadasaxads

xelfasis 3%-is odenobiT, xolo daqiravebulebi xelfasis 1%-s. vinaidan

gadasaxdis amoRebis moculoba dabalia, maTi saSualebiT mopovebuli

Tanxebi Sesabamisi biujetis mxolod 70% faravs, darCenili nawili

damokidebulia gadaricxvebze centraluri (20%) da adgilobrivi

biujetebidan (10%). mTavroba uzrunvelyofs Senatanebs umuSevarTa,

pensionerebisa da bavSvebis nacvlad. erTiani saxelmwifo socialuri

dazRvevis fondi afinansebs sxvadasxva programebs jandacvis sferoSi da

sakontraqto safuZvelze dasaqmebuli hyavs asobiT jandacvis

momsaxurebasTan dakavSirebuli specialisti ,,momsaxure personali,, (1999

wlis monacemebiT TiTqmis 700 adamiani), vinaidan jandacvasTan

dakavSirebuli momsaxurebis yvela saxe 1999 wlidan aRar eqvemdebareba

uSualod jandacvis saministros. radganac individualuri dazRvevis

programebi iSviaTia, Sesabamisad es imas niSnavs rom samedicino

momsaxureba sazogadoebis daucvel fenisTvis xelmisawvdomi namdvilad

- 119 -

unda iyos, rac gamoixateba saxelmwifos mier aRebul valdebulebaze

romelsac igi ixdis bavSvebis Tu socialurad daucveli adamianebis

nacvlad magram realurad es ase ar aris.

jandacvis reformis strategiebis ganxorcielebis mniSvnelovani

Tavisebureba, misi samarTlebrivi bazis Seqmnacaa. yovelgvari

samarTlebrivi baza ki iqmneba rogorc saerTaSoriso aqtebze aseve qveynis

konstituciaze dayrdnobiT. vinaidan arsebuli kanomdebloba ar

iTvaliswinebda mTel rig mniSvnelovan sakiTxebs ara marto saqarTvelos

aramed dsT-s qveynebis konstituciebSic Sevida rigi mniSvnelovani

cvlilebebi, upirveles yvlisa es Seexeba adamianis uflebebsa da

Tavisuflebebs.

saqarTveloSi janmrTelobis seqtorSi dawyebuli reformirebis

fonze saqarTvelos sakanonmdeblo seqtorSic mTeli rigi cvlilebebi

ganxorcielda da calkeuli kanonebic ki daiwera admianis da maTi

uflebebisa Tu Tanasworuflebianobis Sesaxeb, aseve eqimebsa da pacientTa

Soris sakuTari uflebebis Sesaxeb kargad ganisazRvra maTi uflebebi.

Seiqmna saqarTvelos kanoni `saeqimo saqmianobis Sesaxeb~ sadac

gansazRvrulia samedicino saqmianobis standartebi da eTikuri normebi

Sesabamisi profesiuli ganaTlebisa da praqtikuli swavlebis

uzrunvelyofis sakiTxebi, damoukidebeli samedicino saqmianobis

sertificirebisa da resertificirebis sakiTxi, eqimTa valdebulebebsa da

socialur uflebebis sakiTxi.

adamianis uflebebis dacvasTan dakavSirebiT daemata kanoni

`pacientis uflebebis Sesaxeb~ romelic aregulirebs janmrTelobis dacvis

sferoSi pacientTa srul informirebas, pacientis Sesaxeb informaciis

konfidencialobas da sxva samarTlebriv uflebebs.

garda zemoaRniSnulisa, saqarTvelos parlamentma miiRo Semdegi

kanonebi, romlebic exeba samedicino dazRvevis, wamlisa da farmacevtuli

saqmianobis, organoTa gadanergvisa Tu sxva mniSvnelovani sakiTxebs.

am kanonebSi srulad aris asaxuli samedicino momsasaxurebis

sferoSi aRiarebuli da danergili Nnormebi, romlebic xels uwyoben

saqarTveloSi jandacvis sistemis sxvadasxva mimarTulebis samarTlebriv

CarCoSi funqcionirebas. aRsaniSnavia rom am samarTlebrivi normebis

- 120 -

Camoyalibebas safuZvlad udevs is saerTaSoriso strategiebi da

globaluri miznebi, romlebsac emsaxurebian iseTi saerTaSoriso

organizaciebi rogorebicaa WHO, UNICEF, EU Tu sxvebi.

samarTlebrivi cvlileba aseve iTvaliswinebs cvlilebebs

samedicino saqmianobis Sesrulebisas, “samedicino personals unda

amoZravebdes eTikuri faseulobebi – pativi sces xalxis Tavmoyvareobas,

samarTlianobas da sxva principebs da aseve misdevdes profesiul eTikur

normebs”

rodesac saubaria Tanasworuflebianobasa da xelmisawvdomobaze

unda gaviTvaliswinoT saqarTvelos konstituciis Semdegi muxlebi,

romlis mixedviTac saxelmwifom unda uzrunvelyos xelmisawvdomi da

gansazRvrul pirobebSi ufaso samedicino daxmareba.

37-e muxli: “yvelas aqvs ufleba isargeblos janmrTelobis

dazRveviT, rogorc xelmisawvdomi samedicino daxmarebis saSualebiT.

kanoniT dadgenili wesiT gansazRvrul pirobebSi uzrunvelyofilia ufaso

samedicino daxmareba“ – yovelive es gulisxmobs imas rom miuxedavad

socialuri mdgomareobisa da SesaZleblobebisa cxovrebis xarisxis

nebismier doneze myofma adamianma realurad unda SeZlos saWiroebis

SemTxvevaSi miiRos saTanado samedicino daxmareba, magram samwuxarod amas

dResdReobiT sazogadoebis farTo fenebSi siRaribis faqtori aferxebs.

bolo dros ganxorcielebuli jandacis seqtoris reformebze dakvirvebiT

vcdilobT ganvsazRvroT ekonomikuri, politikuri da institucionaluri

faqtorebi romlebmac xeli Seuwyo an SeuSala politikis danergvas,

romelic pirvel rigSi yvelaze Rarib mosaxleobas janmrTelobaze aisaxa.

sainteresoa aseve dakvirveba jandacvis dafinansebis meqanizmebis

kombinirebaze, romelic RaribTa sasargeblod unda iqnas mimarTuli.

saqarTvelos ekonomikuri ganviTarebisa da siRaribis Semcirebis

strategia moiTxovs myari ganviTarebis erovnuli strategiis SemuSavebas.

1996 wels Seiqmna amgvari ganviTarebis erovnuli komisia, magram winsvla am

kuTxiT naklebad SesamCnevia.

siRaribis daZlevisa da ekonomikuri zrdis erovnul programaSi

naTqvamia, rom saavadmyofoebs maTi restruqturizaciis mizniT eniWebaT

avtonomia, romlis mixedviTac valdebulebas ixsnian jandacvis

- 121 -

saministros winaSe da Tavisufalni arian kadrebisa da dawesebulebis

marTvaSi. am mizniT Seiqmna saxelmwifo fondi, romelic moaxdens

resursebis reinvesticias hospitaluri seqtoris reabilitaciaSi. yovelive

amas unda mohyves, rogorc hospitalebis aseve kadrebis optimizacia da

personalis gadamzadeba da maTTvis axali teqnologiebis gacnoba. am

programis ganxorcielebis Sedegad gaTvaliswinebulia 5 wlis

ganmavlobaSi saavadmyofo sawolebis raodenobis Semcireba 50%-iT da

stacionarSi dasaqmebuli Warbi samedicino personalis xarisxobrivi da

raodenobrivi optimizacia 40%-is odenobiT. siRaribis daZlevis programaSi

mocemuli saavadmyofoebis dagegmvisa da optimizaciis strategia Zalian

zogad saxes atarebs da igi konkretuli risk-faqtorebis gaTvlis gareSe

ar iqneba efeqturi. saqarTvelos makroekonomikuri maCveneblebi yvela

dargis da maT Soris jandacvis sistemaSi dResdReobiT arsebul

mdgomareobas gansazRvravs. sainteresoa ra viTarebaSi imyofeba dReisaTvis

saqarTvelos jandacvis sistema?

arsebuli viTareba cxadyofs, rom sistema Zalze mZime mdgomareobaSia

da jer kidev bevria gasakeTebeli misi gaumjobesebisaTvis. am sakiTxTan

dakavSirebiT didi wvlili Seitana msoflio jandacvis organizaciam da

SeimuSava sruliad axali Sexeduleba janmrTelobis dacvis sistemis

SefasebisaTvis. SemuSavda sruliad axali, unificirebuli indeqsebi.

aRniSnul indeqsSi msoflio jandacvis organizaciis mier sxva

faqtorebTan erTad Setanilia siaxle DALY-s koncefciis saxiT. igi

mimarTulia sicocxlis xanrZlivobis Sefasebisaken. aqamde sicocxlis

xanrZlivobis Teoria eyrdnoboda sicocxlis mTlian xangrZlivobas,

mokvdavobis monacemebze dayrdnobiT. 2000 wels Seiqmna pirveli precedenti

imisa, rom msoflio jandacvis organizaciam sicocxlis xangrZlivobis

gamoTvlisas Seitanos Sesworebebi, rac iTvaliswinebs janmrTeli

sicocxlis xangrZlivobis periods. am ukanasknelze yuradReba

gamaxvilebulia imis gamo, rom SeiZleba or qveyanaSi sicocxlis

xangrZlivoba erTnairi iyos, magram mTavaria Tu ramdenia swored

janmrTeli sicocxlis xangrZlivoba. DALY-s indeqsi am ukanasknelis

xangrZlivobazea orientirebuli. SeiZleba or qveyanaSi sicocxlis

xangrZlivoba 75 weli iyos, magram aqedan ramdeni weli adamiani imyofeba

- 122 -

avadmyof mdgomareobaSi, swored am ukanasknelis gamoklebiT sicocxlis

saerTo xangrZlivobaze gvaZlevs warmodgenas qveyanaSi mcxovrebTa

janmrTeli sicocxlis xangrZlivobaze.

saqarTveloSi reformis efeqturi gatarebis mizniT saxelmwifos

gverdiT daudga mTeli rigi saerTaSoriso donori organizaciebi. 1992

wlidan saqarTveloSi daiwyo saxelmwifo instituciebis Camoyalibeba da

qveynis saerTaSoriso sazogadoebaSi gaerTianeba. saqarTvelo 1992 wels

SeurTda evropis uSiSroebisa da TanamSromlobis organizacias da gaxda

gaerTianebuli erebis organizaciis, saeraSoriso savaluto fondisa da

msoflio bankis wevri; 1993 wels qveyana SeuerTda damoukidebel

saxelmwifoTa Tanamegobrobas. politikurad arastabilurma mdgomareobam

da qveyanaSi gamefebulma areulobam xeli SeuSala mTavrobasa da

saerTaSoriso organizaciebs grZelvadiani ganviTarebisTvis mimarTuli

zomebi mieRoT. gaeros misiis mizani Tavdapirvelad saqarTveloSi

arsebuli mdgomareobis Sefaseba iyo, romlis moRvaweoba daiwyo

konfliqtis Sedegad dazaralebuli mosaxleobis yvelaze daucveli fenis

kompleqsuri daxmarebiT, romelsac mohyva grZelvadiani ganviTarebisaken

mimarTuli strategiebis mxardaWera. am periodidan gaeros daxmarebis

strategiac Seicvala rac humanitaruli daxmarebidan strategiul

ganviTarebisaken mimarTul iseT programebzea orientirebuli romelic

infrastruqturisa da socialuri seqtoris saqmianobas iTavliswinebs. am

mxriv msoflio jandacvis organizaciis roli udidesia.

arsebuli problemebis gadaWrisaTvis msoflio jandacvis

organizaciam SeimuSava peroeqti “janmrTeloba yvelasTvis" 21-e saukuneSi

romlis ZiriTadi mizania sazogadoebis janmrTelobis miRweva rac

pirveladi, meoreuli da mesameuli profilaqtikis saSualebiTaa

SesaZlebeli. aqedan Cans, rom janmrTelobis dacvis reformireba

SesaZlebelia rogorc normatiul-samarTlebrivi uzrunvelyofiT, aseve

ekonomikuri da organizaciuli saqmianobis safuZvelze. amitomac

sazogadoebrivi jandacvis politika - aucileblad unda gaxdes erTiani

saxelmwifoebrivi politikis nawili, rom es strategiebi efeqturad

ganxorcieldes. misi ZiriTadi orientacia aris kontroli danaxarjebze Tu

ramdenad mizanmimarTulad xdeba saxelmwifo fondebis gamoyeneba da

- 123 -

Sedegebis miRweva anu produqtiulobisa da Sedegianobis amaRleba,

Tanasworoba, miukerZoebloba da samarTlianoba jandacvis sakiTxebSi.

msoflio jandacvis organizacia ikvlevs msoflioSi arsebul problemebsa

da tendenciebs, rogorc mosaxleobis janmrTelobis sferoSi aseve mis

socialur Tu demografiul viTarebaSi da saxavs miznebs Semdgomi

aTwleulisaTvis. am tendeciebis mixedviT qvemoT moyvanil cxrilSi

(cxrili 16) aRwerilia msoflioSi arsebuli ZiriTadi demografiuli da

ekonomikuri maCveneblebis saerTo mdgomareoba uaxloes aTwleulis

periodSi.

cxrili 16. ZiriTadi demografiuli da ekonomikuri maCveneblebi msoflioSi


msoflio jandacvis organizacia axorcielebs daavadebebTan brZolas

maTi gavrcelebis speqtris mixedviT, rac ukanasknel periodSi garkveul

cvlilebebs ganicdis da Sesabamisad daavadebaTa prioritetulobac maTi

gavrcelebis mixedviT icvleba. (cxrili 20). cxrilSi mocemulia msoflio

mosaxleoba 6,394,491,481,(8 mlrd.-2025)

matebis tempi: 1.14% (0,85% - 2025)

Sobadoba: 20.24 dabadeba/ 1,000mosaxleze(17.2-2025

mokvdaoba: 8.86 gardacvaleba/1,000 mosaxleze

(8.8 – 2025)

sqesobrivi Tanafardoba 1.06 mamakaci/ qali (1.05-2025)

0-1asakis bavSTa mokvdaoba: 50.31 1,000 cocxlad Sobilze (29 –

2025)


xangrZlivoba

mTliani mosaxleoba:

mamakaci

qali

64.05 weli (72,3 – 2025)

62.48 weli

65.7 weli

fertilobis maCvenebeli: 2.62 dabadebuli bavSvi/qali (2,31 –

2025)

GDP erT sul mosaxleze aSS $6418

- 124 -

jandacvis organizaciis mier Catarebuli kvlevis Sedegebis mixedviT

msoflioSi yvelaze metad gavrcelebul daavadebaTa monacemebis dinamika

1990-iani wlebidan 2020 wlamde maTi prioritetulobis cvalebadobis

mixedviT. magaliTad Tu 1990-ian wlebSi, msoflioSi yvelaze ufro

gavrcelebul daavadebaTa Soris, pirvel adgils ikavebda respiratoruli

daavadebebi, uaxloesi aTwleulis mosalodnleli cvlilebidan

gamomdinare, prioritetuli adgili SeiZleba Seicvalos gulis iSemiuri

daavadebebiT, depresiiT Tu sagzao SemTxvevebiT.( cxrili 17)

cxrili 17. msoflioSi yvelaze ufro gavrcelebuli daavadebebis

mosalodneli cvlilebebi prioritetuli rigis mixedviT 1990-2020ww.

# daavadebebis dasaxeleba,

1990 w.

daavadebebis dasaxeleba, 2020 w.

1 respitaruli daavadebebi gulis iSemiuri daavadeba

2 diarea depresia

3 perinataluri mizeziT

gamowveuli daavadebebi

sagzao-satransporto travmebi

4 depresia Tavis tvinSi sisxlis mimoqcevis

moSla

5 gulis iSemiuri daavadeba filtvis qronikuli daavadebebi

6 Tavis tvinSi sisxlis

mimoqcevis moSla

qveda sasunTqi gzebis

respitaruli daavadebebi

7 tuberkulozi diarea

8 wiTela Sidsi

9 sagzao-satransporto

travmebi

perinataluri mizeziT

gamowveuli daavadebebi

10 malaria

11 filtvis qronikuli

daavadebebi


am indikatorebze dayrdnobiT msoflio jandacvis organizaciam

Camoayaliba aTaswleulis ganviTarebis gegmebi, sadac globaluri maStabis

miznebi da strategiebia ganxiluli. ZiriTadad jandacvis sferoSi

msoflio miznebsa da strategiebs msoflios sxva da sxva wamyvani

- 125 -

saerTaSoriso organizaciebi warmarTaven, Tumca yvelaze mniSvnelovani

roli msoflio jandacvis organizaciasa da mis evropis regionalur

warmomadgenlobebs akisriaT. “aTaswleulis ganviTarebis miznebi da

janmrTeloba” mravali miznidan, amocanebidan da indikatoridan - 6

maTgani exeba uSualod janmrTelobas da moicavs msoflio maStabiT

siRaribis aRmofxvras, sikvdilianobis Semcirebas, dedaTa da bavSvTa

janmrTelobis gaumjobesebas, garemos dacviTi RonisZiebebis

stabilurobas, da ganviTarebisaTvis msoflio TanamSromlobis

Camoyalibebas.

globaluri janmrTelobis problemebi moicavs iseTi daavadebebis

gavrcelebis SeCerebas, rogoricaa aiv/Sidsi malariis aRmofxvra

tuberkulozis SeCereba sxva gadamdebi daavadebebis winaaRmdeg brZola,

aseve Tambaqos winaaRmdeg brZola, imunizacia da vaqcinacia bavSvTa

janmrTeloba, usafrTxo orsuloba da sxva. (cxrili 18)

cxrili 18. msoflio jandacvis organizaciis miznebi da amocanebi.

miznebi amocanebi

siRaribis

aRmofxvra

amocana 1 : moSimSileTa ricxvis ganaxevreba 1990

da -2015 wlebs Soris

bavSvaTa

sikvdilianobis

Semcireba

amocana 2: 1990-2015 w.w. periodSi xuTwlamde

asakis bavSvTa sikvdilianobis ori mesamediT

Semcireba

dedaTa

janmrTelobis

gaumjobeseba

amocana 3: 1990-2015 periodSi mSobiareTa

sikvdilianobis maCveneblis Semcireba sami

meoTxediT

aiv/Sidsis,

malariasTan da

sxva daavadebeTan

brZola

amocana 4: aidv/Sidsis gavrcelebis SeCereba da

ukuprocesis dawyeba 2015 wlisaTvis

- 126 -

garemos dacviTi

RonisZiebebis

stabilurobis

uzrunvelyofa

amocana 5: sasmelad vargisi wylis momaragebas

moklebuli mosaxleobis raodenobis ganaxevreba 2015

wlisaTvis

farmacevtul

ganviTarebisaTvis

msoflio

TanamSromlobis

Camoyalibeba

amocana 6: farmacevtul kompaniebTan

TanamSromlobiT ganviTarebadi qveynebis ZiriTadi

medikamentebiT xelmisawvdom fasebSi uzrunvelyofa


globaluri janmrTelobis problemebs Soris aRsaniSnavia riskebi

axalSobilebisa da mozardebisaTvis, riskebi qalTa janmrTelobisaTvis da

reproduqciuli janmrTeloba.

sakvebze damokidebuli risk-faqtorebi da gadamdebi daavadebebi

aqtiuri sibere, wamalTdamokidebuleba, mdgradi ganviTareba da garemo

riskebis Semcireba, jansaRi sakvebi, travmebi da dazianebebi.

garkveuli strategiebis formirebisaTvis kvlevisaTvis saintereso

indikatorad aRiarebulia sami ZiriTadi erTeuli, romelTa mixedviTac

msoflio jandacvis organizacia sargeblobs, esenia: LE; HALE; DALY, rac

qveynis sociodemografiul viTarebas asaxavs. am mizniT msoflio

jandacvis organizaciis mier Camoyalibebuli ”globaluri janmrTelobis

gaumjobesebis samoqmedo gegma” (janmos meTerTmete samoqmedo programa

2006-2015) gulisxmobs investiciebs janmrTelobaSi siRaribis masStabebis

Semcirebis mizniT, individualuri da globaluri janmrTelobis

usafrTxoebis uzrunvelyofas, universaluri mocvis, genderuli

Tanasworobis da janmrTelobasTan dakavSirebiT adamianis uflebebis

dacvis xelSewyobas, janmrTelobis determinantebis gaumjobesebas,

jandacvis sistemebis gaZlierebasa da Tanabari xelmisawvdomobis

uzrunvelyofas.

evropis regionuli ofisis mier ganviTarebis programis mixedviT

2005-2010-wlebisaTvis dasaxulia Semdegi strategiebi: jandacvis sistemis

gaZliereba; informaciul/inteleqtualuri funqciis gaZliereba; qveynis

- 127 -

qmedebebis koordinacia; partniorobis ganviTareba; miRwevebis Sefaseba da

aRwera; ”janmrTeloba yvelasaTvis” gegmis ganaxleba; sazogadoebrivi

jandacvis ZiriTadi problemebis SerCeva da wamoweva, mxardaWeris da

ganviTarebis unari da Tanxebis Segroveba.

“jansaRi cxovrebis garemo” da sicocxlis ufleba yvela adamianisTvis

Tanasworad erTnair uflebas warmoadgens”. gaerTianebulma erebis

asambleam 1948 wlis 10 dekembers adamianTa uflebebis dacvis Sesaxeb

daamtkica ‘universaluri deklaracia”, sadac aRniSnulia:

“yvela adamians aqvs ufleba sicocxlis, Tavisuflebis da piradi

usafrTxoebis”-am dokumentSi agreTve saubaria adamianTa Tansaworufle-

bianobaze, mSvidobian garemoze, maT uflebebze, iqneba es genderuli

Tansaworoba Tu sxva socialuri Tu ekonomikuri saxis

Tansaworuflebianoba da aseve socialuri progresis xelSewyobaze da

cxovrebis ukeTesi standartebis Seqmnis pirobebze msoflios mSvidobian

garemoSi. am dokumentSi aseve saubaria gaeros sxva wevr qveynebTan

TanamSromlobaze saerTo miznebis misaRwevad. deklaraciaSi mkafiodaa

Camoyalibebuli mTavrobisa da misi xalxis urTierdamokidebuleba, rom

maTTvis funqciebis safuZvels-konkretuli politikis CamoyalibebaSi

xalxis survili unda warmoadgendes, rac Tavisufal Tanaswor arCevnebSi

gamoixateba. aseve yvela adamians ufleba aqvs mis qveyanaSi iyos

Sesaferisi cxovrebis done adekvaturi misi ojaxis, janmrTelobisa da

keTildReobisTvis, aseve sursaTis, sacxovrebeli pirobebis Sesabamisi,

ufleba-hqondes aucilebeli socialuri servisebi da aseve ufleba

usafrTxoebis umuSevrobis, avadmyofobis, uunarobis, daqvrivebis, asakis Tu

sicocxlis sxva naklovanebebis SemTxvevaSi, im pirobebSi rac adamianis

kontrols ar eqvemdebareba da ufleba saxelmwifom daicvas igi aseT

viTarebaSi. deklaracia yvela adamians avaldebulebs sazogadoebis

mimarT romelSic isini cxovroben.

1948 wlis 10 dekembris “adamianis uflebebis dacvis universalur

deklaracias” evro sabWom mxari dauWira da sayovelTaod aRiara rom

evropis sabWos saerTo mizani, rac misi wevri qveynebis erTobas

gulisxmobs da erT-erTi meTodi romliTac es mizani miiRweva, swored

admianis uflebebis da ZiriTadi Tavisuflebebis gaazreba da dacvaa,

- 128 -

rasac isini aseve mTels msoflios mouwodebdnen. am deklaraciis

safuZvelze evro sabWos sxdomaze, romSi 1950 wlis 4 noembers Camiyalibda

iseTi instituciebi rogoricaa evropis sasamarTlo da mSvidoba

msoflioSi, romelic saukeTeso SemTxvevaSi SenarCunebulia maSin, rodesac

qveyanaSi arsebobs erTis mxriv efeqturi politikuri demokratia da

meores mxriv yvelasaTvis saerTo cneba adamianis uflebebis dacvis

Sesaxeb, romelzec qveynis mTavrobaa damokidebuli. aqedan gamomdinare

ZalaSi Sevida adamianis uflebebis dacvis universaluri deklaracia,

romelic adamians da saxelmwifos urTierTdamokidebulebas

urTierTkavSirs mkveTrad aZlierebs da erTmaneTze damokidebuls xdis.

swored es saerTaSoriso aqti gaxda saxelmZRvanelo msoflios sxva

da sxva qveynebisaTvis ramac agreTve Tavisi wvlili Seitana mTeli rigi

qveynebis konstituciebSi. konstituciaTa umetesobaSi adamianTa uflebebi

da Tavisuflebebi calke muxlis saxiTaa Sesuli iqneba es dsT qveynebi

evropa Tu aSS-s konstituciebi, Tumca rodesac saubaria konstituciurad

adamianis uflebesa da Tavisuflebebze albaT garkveuli sifrTxilea

saWiro radgan xSir SemTxvevebSi es uflebebi darRveulia da kanonsa da

mis farglebs garkveulwilad scildeba.

saqarTveloSi moRvawe saerTaSoriso organizaciebis roli

mniSvnelovania misi, rogorc ekonomikuri aseve politikuri da socialuri

ganviTarebisaTvis, Sesabamisad saqarTveloSi maTi moRvaweoba sxva da sxva

sferoebs moicavs. maT Soris konfliqtebis mogvareba, humanitaruli

daxmareba, jandacvis seqtoris daxmareba, ekonomikuri ganviTareba, garemos

dacva da sxva romlebic TanamSromlobis princips emyareba.

gaeros ganviTarebis programa (UNDP)–mimarTulia sami

prioritetuli sferosadmi. ekonomikuri, politikuri da socialuri

marTvis gaumjobeseba, meore siRaribesTan brZola ekonomikuri aRmavlobis

xelSewyoba da mesame bunebrivi resursebis ukeTesi marTva. gaeros

ganviTarebis programa yvela Tavis farglebSi aseve mudmivad agrZelebs

genderuli Tansaworobis damkvidrebis xelSewyobas.

gaeros bavSvTa fondi- (UNICEF)-saqarTvelos mTavrobas mniSvnelovan

daxmarebas uwevs jandacvis seqtorSi rac dedaTa da bavSvTa

- 129 -

janmrTelobas moicavs upirvele yovlisa. aseve did rols TamaSobs Cvil

bavSTa imunizaciisa da daavadebaTa kontrolis sakiTxSi.

gaeros mosaxleobis fondis (UNFPA)- daxmareba gulisxmobs

reproduqciuli janmrTelobis momsaxurebis gaumjobesebas da samedicino

aparaturis miwodebis, profesiuli momzadebisa da saganmanaTlebo

saqmianobis saSualebiT xelSewyobas. garda amisa fondi daxmarebas uwevs

saqarTvelos mTavrobas mosaxleobis aRweris CatarebaSi.

jandacvis msoflio organizacia (WHO) saqarTvelos mTavrobas

daxmarebas uwevs Semdeg sakiTxebSi: dedaTa da bavSvTa da axalgazrdebis

janmrTeloba; gadamdebi daavadebebi, (tuberkuliozi, malaria, Sidsi)

fsiqikuri janmrTeloba (narkomania, da TviTmkvleloba). arainfeqciuri

daavadebidan yuradReba gamaxvilebulia avTvisebian simsivneebze da maT

winaswar profilaqtikaze. jandacvis msoflio organizacia zemoxsenebul

sferoebSi daxmarebas uzrunvelyofs arsebuli politikis propagandis,

infrastruqturisa da sistemis ganviTarebisa da teqnikuri xelSewyobis

saSualebiT.

axali modelis mixedviT saxelmwifo valdebulebas iRebs iseT

mniSvnelovan problemebze rogoricaa prevencia, usafrTxo garemos Seqmna

da umweo mosaxleobaze zrunva.

jandacvis dafinanseba saqarTveloSi efuZneba sami mxaris

urTierTobebs: esenia: saxelmwifo, damqiravebeli da adamiani. saxelmwifom

Tavis Tavze aiRo umniSvnelovanesi amocanebis gadawyveta: prevencia,

usafrTxo garemos Seqmna da umweo mosaxleobaze zrunva. damqiravebelma

itvirTa daqiravebulTa samedicino dazRvevis dafinanseba. amave dros axal

pirobebSi TiToeuli pirovnebis funqciac Seicvala – adamianma

daiwyo Tavis janmrTelobaze fiqri da masze zrunva mkurnalobisaTvis

saWiro xarjebis Tavidan asacileblad.

- 130 -

2.3. mosaxleobis sociologiuri kvlevis Sedegebi pirveladi jandacvis

sistemiT dakmayofilebis Sesaxeb

sociologiuri kvlevis Sedegad gamokiTxulTa saerTo raodenobam 200

respodenti Seadgina, aqedan pasuxebis raodenoba meryeobda (61.7% dan 74.4%)

Soris, romlebic miRebulad CaiTvala. gamokiTxul respodentTa Soris

umravlesoba qalTa jgufiT iqna warmodgenili (51%), xolo danarCeni

mamakacTa jgufma Seadgina (49%). aRniSnuli gviCvenebs respodentTa

rodenobas romlebmac miiRes monawileoba aRniSnul gamokiTxvaSi.

asaki – respodentebi gamokiTxvis mixedviT daiyo Semdeg asakobriv

jgufebad 20-29; 30-39; 40-49; 50-59; 60-69 da 70 da mis zeviT. amaTgan yvelaze

did raodenobas 40-49 (19%) da 50-59 (23%) asakobrivi jgufebi Seadgenda.

ojaxuri mdgomareobis mixedviT respodentTa umetesoba (44.5%)

daojaxebulia, xolo 20% ara, 13 %-ma ki pasuxs Tavi aarida.

qvemoT mocemuli cxrili gviCvenebs repodentTa yovelTviur saSualo

Semosavals, romelic meryeobs 200–dan 1000 laramde. respodentebi

Semosavlebis mixedviT dayofilia dabali, saSualo da maRal Semosavlebis

mqone adamianebad. cxrili gviCvenebs, rom repodentTa didi jgufi (33%)

ganekuTvneba socialur kategorias-dabali SemosavlebiT, maSin rodesac

maRal Semosavlian jgufs mxolod (9.8%) Seadgens. yvelaze xSiri pasuxi

saSualo Semosavlis Sesaxeb dafiqsirda 200-dan 400-mde laris farglebSi.

(cxrili 19)

cxrili 19. saSualo Semosavali

yovelTviuri

Semosavali

respodentTa

raodenoba

pasuxebis raodenoba %

100-200 62 33

200-400 58 31

400-1000 49 26.2

1000- zeviT 18 9.8

sul 187 100%

asaki SniSvenlovan rols TamaSobs sociologiuri kvlevis dros.

cxrili. 20 amtkicebs hipoTezas, rom janmrTelobis mdgomareoba da eqimTan

- 131 -

mimarTvianobis sixSire asakzecaa damkokidebuli, anu aRiniSna pozitiuri

asociacia, rac gulisxmobs, rom asakis matebasTan erTad, imatebs eqimTan

mimarTvianobac. 20-35 wlis repodentebma (27%) aRniSna rom eqims mxolod

ukiduresi aucileblobis SemTxvevaSi mimarTaven, xolo 65 wlisa da mis

zemoT asakobrivma jgufma (17%) daafiqsira eqimTan mimarTvianobis sixSire-

sul mcire TveSi erTxel mainc, razec faqtiurad arc erTma axalgazrda

respodentTa jgufma pasuxi ar gasca. amis gamo kvlevis dros moxda

asakobrivi jgufebisa da eqimTan mimarTvianobis kategoriebis

urTierTdapirispireba (chi-squire analysis ) maTi urTierT-kavSiris arsebobis

dasadgenad eqimTan vizitis sixSire aSkarad dakavSirebulia asakTan chi-

squire analizma aCvena Sedegi: df 3 da p=0.02, rac imas niSnavs, rom eqimTan

mimarTvianoba damokidebulia asakze. p mniSvnelovnad naklebia p=0.05-ze,

aqedan gamomdinare am or mniSvnelobas Soris kavSiri arsebobs. (korelacia

aris) (cxrili 20)

cxrili 20. respodenTTa asaki da maTi eqimTan mimarTvianoba

eqimTan mimarTvianoba

respodentTa asaki

20-35 36-45 46-65 65-zemoT

TveSi

erTxel

- 2 3 17

weliwadSi

erTxel

10 16 2 1

mxolod

aucileblobis

SemTxvevaSi

27 27 26 -

arasodes 4 16 26 -

respondentTa sqesis gaTvaliswineba kvlevis dros iseTive

mniSvnelovani faqtoria rogorc respodentis asakobrivi jgufi. qalsa da

mamakacs sxva da sxva Sexedulebebi aqvT janmrTelobasTan mimarTebaSi,

Sesabamisad janmrTelobis mdgomareobac maT Soris mkveTrad

gansxvavebulia. kvlevidan gamoCnda, rom qalebi (36%) ufro xSirad

mimarTaven eqims avadmyofobis SemTxvevaSi vidre mamakacebi (18%), da

- 132 -

maTTvis damaxasiaTebeli daavadebebic gansxvavebulia, magaliTad

mamakacebisTvis 50-64 askobriv jgufSi, (3%) ufro metad damaxasiaTebelia

kardiovaskularuli daavadebebi xolo, qalebSi ufro sismsivnuri (10%)

daavadebebi Warbobs, rac sxva SemTxvevebSi SeiZleba piriqiT aRmoCndes.

Catarebulma kvlevam kidev erTxel daadastura, rom arsebobs

pirdapiri korelaciuri kavSiri socialur pirobebsa da mosaxleobis

janmrTelobis mdgomareobas Soris. Cvens mier dadginda, rom Tanamedrove

pirobebSi higienuri normebis dacva ganisazRvreba imis mixedviT, Tu romel

socialur klass miekuTvneba pirovneba, rogoria misi sazogadoebrivi

urTierTobebi. es daskvna miTumetes mniSvnelovania, Tu gaviTvaliswinebT,

rom amis Sedegad xandazmuli pirebis cxovrebis wesis formireba da

SemdgomSi misi gansazRvra xdeba im kanonzomierebebiT, romelnic

axasiaTebs mocemul sazogadoebriv sistemas.

kvlevis procesSi dadginda, rom qalebi da mamakacebi araerTgvarovnad

afaseben TavianT janmrTelobas. sakuTari janmrTelobisa Tu socialuri

mdgomareobis pesimisturi Sefaseba, ufro metad damaxasiaTebelia

mamakacebisaTvis. igi metadaa gamoxatuli asakis matebasTan erTad (cxrili

21)

cxrili 21.

respondentTa mier sakuTari janmrTelobis Sefasebis Sedegebi

janmrTelobis TviTSefasebis Sedegebi abs.ricxvi %

Tavs grZnobs janmrTelad 68 13.2

avad gaxda uecrad, Tumca arc manamde

hqonia janmrTelobis kargi mdgomareoba

175 34.1

mdgomareoba gauuaresda TandaTan. 268 52.2

pasuxi ar gaucia 2 0.3

sul: 513 100.0

gamokvleulTa asakis matebasTan erTad mniSvnelovnad izrdeba im

adamianebis ricxvi, romlebic Tvlian, rom maT aqvs cudi an Zalian cudi

janmrTelobis mdgomareoba. martoxelebis umetesoba aRniSnavs, rom maTi

mdgomareoba gauaresda TandaTan (62,4%), rom didi xania avadmyofobs,

magram ase cudad jer ar yofila; 26,8% _ Tvlis, rom avad gaxda uecrad,

- 133 -

Tumca arc manamde hqonia janmrTelobis kargi mdgomareoba. mxolod 13,2%

Tvlis Tavs janmrTelad.

analizi SegviZlia gavakeToT (cxrili-23) saSualebiT

socioekonomikur mdgomareobas da samedicino servisis

xelmisawvdomobasTan dakavSirebiT, romelic amtkicebs hipoTezas, rom

adamianis finansuri mdgomareoba gansazRvravs mis janmrTelobis xarisxs.

zogierT adamians urCevnia gadaixados Zviri da miiRos xarisxiani

mkunaloba, xolo zogic, imis gamo, rom ver axerxebs finansuri barierebis

gamo saTanado samedicino momsaxurebis miRebas, irCevs ufro

dabalxarisxian da iafian momsaxurebas pirdapiri gadaxdis gziT.

statistikurma monacemebma aCvena, rom pirdapiri gadaxdebis tendencia

ufro dabal Semosavliani (58%) respodentebisTvisaa misaRebi, maRal

Semosavlian jgufebTan (75%) SedarebiT, romlebic uaryofiTad arian

ganwyobilni am tendenciis mimarT da upiratesobas momsaxurebis maRal

xarisxsa da mkurnalobas aniWeben. (cxrili 22).

cxrili 22. araformaluri gadaxdebi da Semosavlebi

respodenTTa

damokidebuleba

araformalur

gadasaxadebTan

mimarTebaSi

respodenTTa Semosavali

100-200 200-400 400-1000 1000-zeviT

uaryofiTi 42 65 75 82

dadebiTi 58 35 25 17.7

sul 100% 100% 100% 100%

aqedan gamomdinare samedicino momsaxurebis xelmisawvdomobaze

finansuri mdgomareobis damokidebuleba aSkaraa. urTierTdamokidebuleba

am or kategorias Soris gaanalizda (chi-square) analizis mixedviT sadac

aRmoCnda, rom p=0.008 rac gacilebiT naklebia 0.05 ze amitom

urTierTkavSiri mniSvnelovnad iqna miCneuli (correlation exists).

garda jandacvaze gamoyofili maRali xarjebisa, mosaxleobis

janmrTelobis mdgomareobis gaumjobesebaze moqmedebs iseTi faqtorebi,

rogoricaa, ganaTleba, kveba, sanitaruli mdgomareoba da.a.S.

- 134 -

ganaTleba - Semdeg kategoriebad dajgufda: arasruli, saSualo da

umaRlesi ganaTleba.

adamianis janmrTelobis mdgomareoba mis ganaTlebasTan mWidro

kavSirSia, rasac statistikuri monacemebic adastureben. ganaTlebas

upiratesoba mieniWa kvlevaSic, radgan rogorc msoflio jandacvis

organizacis monacembidan Cans, ganaTleba mniSvnelovnad amcirebs

janmrTelobis gauaresobis albaTobas. ganaTlebuli adamiani ufro

martivad aRiqvams janmrTelobisaTvis aucilebeli pirobebis saWiroebas da

profilaqtikuri RonisZiebisadmi upiratesobis miniWebas. kvlevis Sedegad

aRmoCnda Zlieri urTierT kavSiri (strong relationship) socioekonomikur

statussa da janmrTelobis gauaresebis risk faqtorebs Soris, rac

ganaTlebasac ukavSirdeba. respodentTa jgufi romlebic umaRlesi

ganaTlebiT SedarebiT maRal socialur klass miekuTvnen (45%)

upiratesobas droul mkurnalobasa da profilaqtikas amiWeben, xolo

dabali socialuri jgufi arasruli ganaTlebiT (24%) mkurnalobas.

(cxrili 23)

cxrili 23.

respondentTa ganaTleba da janmrTeloba

ganaTleba mkurnaloba profilaqtika Nsul

arasruli

saSualo

umaRlesi

sxva

24

30

25

21

12

26

45

17

36

56

70

38

sul 100% 100%

gansakuTrebiT dabali socialuri fenis ojaxebSi qalTa statusi da

maTi ganaTlebis done janmrTelobis mdgomareobis umTavres determinants

warmoadgens, radgan qals didi mniSvneloba eniWeba ojaxis janmrTelobis

mdgomareobis gaumjobesebaSi. iq, sadac qalTa meti nawili arasruli

ganaTlebiT xasiaTdeba, maTTvis Znelia imis gageba, Tu ra mniSvneloba aqvs

wylis sterilizacias, srulfasovan kvebas, an bavSvTa infeqciur

daavadebebTan brZolis profilaqtikur RonisZiebebs.

- 135 -

statistikuri monacemebis mixedviT aRmoCnda, rom maRal socialur

klassa (umaRlesi ganaTlebiT) da dabals (saSualo/arasruli) Soris

gamokiTxul qalebis 62% da mamakacTa 38% upiratesobas eqimTan droul

vizitsa da profilaqtikur Semowmebas aniWeben, maSin rodesac SedarebiT

dabali socialuri jgufis respodentebidan saSualod qalTa 45%-ma xolo

mamkacTa 55%-ma ganacxada, rom isini ukidures SemTxvevaSi mimarTaven eqims.

respodentebma umaRlesi ganaTlebiT, orjer meti procentulobiT aCvenes

janmrTeli cxovrebis wesis damkvidrebis tendencia vidre arasruli

ganaTlebis mqone adamianebma. (grafiki 10)

grafiki 10.

socialuri jgufebi da janmrTeli cxovrebisaTvis maTi prioritetebi

010203040506070

maRali

socialuri

fena

dabali soc

fena

qali

mamakaci

kvlevis Sedegad miRebuli daskvnebidan SeiZleba gamovyoT ramodenime

pozitiuri da negatiuri tendenciebi magaliTad:

erT-erTi pozitiuri tendencia sadazRvevo sistemis damkvidrebaa.

sadzRvevo servisiT gamokiTxulTa didi jgufi (52%) sargeblobs da

Sesabamisad isini Tvlian rom samedicino momsaxurebac gacilebiT

xelmisawvdomia, vidre im respondentebisaTvis (48%) romlebic sadazRveo

polisiT ver sargebloben. jvaredini Sedarebisas dazRveulebi gacilebiT

metad mimarTaven eqims vidre, isini, romelTa vizitic pirdapir

gadaxdebTanaa dakavSirebuli. magaliTad pensionerTa da umuSevarTaTvis,

sadazRveo sistema naklebad xelmisawvdomia, miuxedavad imisa rom

saxelmwifo programa “siRaribis daZlevis Sesaxeb” iTvaliswinebs am

socialuri jgufebis daxmarebas. amis gamo es sakiTxi kvlav aqtualuri

rCeba.

- 136 -

xelmisawvdomobasTan dakavSirebvuli problemebi, mosaxlebis ufro

xandazmuli nawilisaTvisaa aqtualuri, vidre 20-30 wlis asakis

respodentebisaTvis, rac albaT bunebrivicaa maTi janmrTelobis

mdgomareobidan gamomdinare.

maRali socialuri jgufis (anu maRalSemosavliani jgufis)

janmrTelobis saerTo mdgomareoba Rarib socialur jgufTan SedarebiT

gacilebiT ukeTesi aRmoCnda.

mosaxleobas ara aqvs srulyofili informacia janmrTelobasTan

dakavSirebuli riskebis Sesaxeb da amis gamo naklebad mimarTaven

janmrTeli cxovrebis wess (gamokiTxulTa 74% aRniSnavs rom aranair

sportul aqtivobas ar mimarTavs, es maCvenebeli gansakuTrebiT maRalia

soflisa da Rarib mosaxleobas Soris). siRaribe da nerviuli stresi

aseve sportuli cxovrebisadmi midrekilebis nakleboba, mosaxleobas

ubiZgebs, iafi, stresis ganeitralebisa da siamovnebis saSualebebisaken.

xSirad yovelive es gamoixateba mowevasa da alkoholis moxmarebaSi.

sazogadoebis janmrTelobisaTvis ZiriTad saSiSroebas moweva warmoadgens

mwevelTa raodenobam saSualod 48% Seadgina 20-30 asakobriv jgufSi rac

gacilebiT maRali aRmoCnda maRal asakobriv jgufTan 27% SedarebiT. Tu

gaviTvaliswinebT mwevlTa raodenobis zrdis maCveneblsa da

momxmarebleblTa asakobriv jgufebis maCveneblebs. msoflio jandacvis

organizaciis monacemebis mixedviT erT sul mosaxleze Tambaqos

momxmarebelTa raodenobis mixedviT saqarTvelo mowinave adgilzea sxva

qveynebs Soris.

sxva socioekonomikur determinantebTan erTad saTanado kveba

mWidrodaa dakavSirebuli janmrTelobis mdgomareobasTan,

industrializaciis, urbanizaciis da ekonomikuri cvlilebebis Sedegad

Seicvala adamianis cxovrebis wesi da Sesabamisad kvebis racionic.

kiTxvarSi respodents unda moeniSna kiTxvaze “ramdenad axerxebT

srulfasovan kvebas mTeli kviris ganmavlobaSi? Semdegi pasuxebi :

verasodes, 1-2 dRe kviraSi; 3.-5 dRe kviraSi an 6-7 dRe kviraSi;

mniSvnelovania is faqti rom respodentTa umetesobam (58% ) aRniSna, rom

ver axerxebs srulfasovan kvebas sxva da sxva mizezebis gamo xolo

- 137 -

mxolod (12%) daafiqsira rom maTi kvebis racioni srulfasovani iyo

mTeli kviris ganmavlobaSi.

es indikatori adamianis janmrTelobaze garkveuli gavlenis mqone

faqtorad CaiTvala, rac, Sedegad zrdis qronikuli daavadebebis

Camoyalibebis risks.

mdidrebisa da Raribebis urTierTdamokidebuleba samedicino

momsaxurebis Tanabrad miRebisas mniSvnelovania. aris Tu ara siRaribe an

simdidre samedicino servisis xelmisawvdomobasTan kavSirSi. rogorc

aRmoCnda es ori faqtori samdicino daxmarebis miRebisaTan pirdapir

kavSirSia.

gamokiTxul respodentTa proporciam, romlebsac miaCniaT rom

dResdReobiT samedicino momsaxureba xelmisawvdomia qalTa Soris

Seadgina (12%) mamkacebSi (20%). gamokiTxvis monacemebma gviCvena, rom

saerTo jamSi gamokiTxulTa mxolod (9%)–s miaCnia, rom dResdReobiT

samedicino momsaxureba gacilebiT xelmisawvdomia vidre is iyo ramodenime

wlis winaT. dabali Semosavlebis mqone jgufebSi respodentTa umetesobas

(34%) miaCnia, rom jandacva naklebad xalemisawvdomia, xolo im

jgufebisaTvis, romelTa Semosavali saSualod 500-1000 laria jandacvis

servisi savsebiT xelmisawvdomadaa aRqmuli. (cxrili 24)

cxrili 24. Semosavali da xelmisawvdomoba

Semosavali xelmisawvdomia ara ris xelmisawvdomi sul

100-200 6 34 40

200-400 13 26 39

500-1000 15 6 21

sul 34% 66% 100%

am jgufebs Soris kavSiri arsebobs, radgan maTi urTierTSedarebisas

p<0.05 iyo (p=0.02) rac imas niSnavs, rom korelacia arsebobs. hipoteza

mtikcdeba, rom rac ufro metia Semosavali miT ufro xelmisawvdomia

samedicino daxmarebis miReba, aseve rac ufro ganaTlebulia adamiani, miT

ufro naklebia daavadebebis sixSire da janmrTelobis mdgomareobis

gauaresebis saSiSroeba.

- 138 -

saavdamyofoebsa da diagnostikur centrebSi mimarTvianobis indeqsi

mdidrebsa da Rarib mosaxleobas Soris araTanabaria. rogorc Cans,

Raribebs (dabalSemosavlian mosaxleobas) urCevnia ufro iafian samedicino

momsaxurebis provaiderebs anu polikninikebs mimarTon, vidre

ZviradRirebuls, Tumca am seqtorSic mdidarTa mimarTvianobis

procentuloba RaribebTan SedarebiT (51.4 % mdidrebi- 25.9 % Raribebi)

gacilebiT maRalia. Raribi mosaxleobis mxolod 13% xolo SedarebiT

maRali socialuri jgufis adamianebi 40% mimarTavs saWiroebis

SemTxvevaSi hospitalur samedicino momsaxurebas.

dadebiTi tendenciaa sadazRvevo sistemasTan mimarTebaSi. rac ufro

imatebs dazRveulTa ricxvi miT ufro metia eqimTan mimarTvianobac.

gamokiTxulTa 80 % miiCnevs rom dazRveva aucilebelia yvela

moqalaqisaTvis raTa samedicino momsaxureba yvelasTvis Tanabrad

xelmisawvdomi iyos. qalTa 68% da mamakacTa 32% Tvlis rom dazRvevis

meSveobiT maT miiRes bevri iseTi saxis momsaxureba, rac aqamde maTTvis

naklebad xelmisawvdomi iyo momsaxurebis maRali fasebis gamo. sirTules

am SemTxvevaSi pensionerTa da umuSevarTa klasSi vawydebiT, radgan

dazRvevis ar arsebobis gamo isini kvlav mravali barieris winaSe dganan.

Tumca axali sadazRvevo sistema, romelsac saxelmwifo gegmavs savsebiT

misaRebia. aucilebelia yoveli moqalaqe iyos dazRveuli, raTa maT SeZlon

drouli mkurnaloba da samedicino servisis miReba.

- 139 -

Tavi III. saqarTvelos pirveladi jandacvis sistemis moqmedebis

efeqturobis sistemuri analizis Sedegebi

3.1. saqarTvelos pirveladi jandacvis sistemis moqmedebis efeqturobis

sistemuri analizis Sedegebi

amJamad saqarTvelos jandacvis sistema uzrunvelyofs samedicino

momsaxurebas rogorc saxelmwifo, ise kerZo struqturebis saSualebiT.

jandacvis samsaxurebis dafinanseba sxvadasxva gziT xdeba :

♦ saxelmwifo profilaqtikuri programebi;

♦ samedicino sadazRvevo programebi;

♦ sxva jandacviTi programebi;

♦ municipaluri jandacviTi programebi;

♦ sxva seqtorebis jandacviTi programebi;

♦ fasiani samedicino momsaxureba, e.w. `Sida standartebi~.

TiToeul am SemTxvevaSi finansuri resursebis mobilizaciis wyaroebi

da marTva gansxvavebulia, magaliTad:

♦ profilaqtikuri programebis dafinanseba xorcieldeba

centraluri biujetidan gadmoricxuli TanxebiT, romelsac gankargavs

sazogadoebrivi jandacvis departamenti miznobrivi programebis

dasafinanseblad (imunizacia, infeqciuri daavadebebis, maT Soris

sqesobrivi gziT gadamdebi daavadebebis da Sidsis profilaqtika, endemuri

Ciyvis profilaqtika, narkomaniis profilaqtika, sainformacio samsaxurebis

ganviTareba, usafrTxo sisxli, mosaxleobis avadobis aqtiuri gamovlineba

da masobrivi profilaqtikuri gasinjvebi da sxv.);

♦ samedicino dazRvevis saxelmwifo kompaniis dafinanseba xdeba

savaldebulo sadazRvevo gadasaxadebis Sekrebis gziT, romelsac ixdis

damqiravebeli (3%) da daqiravebuli (1%), magram es ar aris sakmarisi

imisaTvis, rom srulad dafinansdes saxelmwifo sadazRvevo programebi

(fsiqiatria, fTiziatria, meanoba, 3 wlamde asakis bavSvTa mkurnaloba,

umweoTa damatebiTi samedicino daxmareba, onkologiur pacientTa

profilaqtika da mkurnaloba, infeqciuri daavadebebis mkurnaloba,

hemodializi, gulis iSemiur daavadebaTa mkurnaloba, transplantacia,

- 140 -

soflis mosaxleobis ambulatoriuli mkurnaloba, specifiur avadmyofTa

medikamentebiT uzrunvelyofa, bavSvTa kardioqirurgia da sxv.), amitom

deficitis Sevseba xdeba centraluri biujetidan;

♦ saxelmwifo jandacviTi programebis dafinanseba (saqarTvelos

samxedro ZalebSi gasawvev moqalaqeTa samedicino Semowmeba,

umniSvnelovanes samedicino dawesebulebaTa reabilitacia, katastrofebis

da samedicino rezervis Sevseba-ganaxleba, saxelmwifo sanitaruli

zedamxedveloba da higienuri normireba, samedicino ganaTlebisa da

mecnierebis xelSewyoba, sasamarTlo samedicino eqspertizis samsaxuris

uzrunvelyofa da sxv.) mTlianad centraluri biujetidan xorcieldeba;

♦ municipaluri jandacviTi programebis (mosaxleobis

gadaudebeli ambulatoriuli da stacionaruli daxmareba,

onkoinkurabelur avadmyofTa tkivilgamayuCeblebiT uzrunvelyofa,

mosaxleobis saswrafo-samedicino daxmarebiT uzrunvelyofa da sxv.)

dafinanseba xdeba adgilobrivi biujetebidan, risTvisac TiToeuli raioni

gamoyofs aranakleb 2.5 lars erT sul mosaxleze;

♦ Tavdacvis, Sinagan saqmeTa da uSiSroebis saministroebis

TanamSromlebis samedicino momsaxurebiT uzrunvelyofa xorcieldeba

paraleluri programebis saSualebiT centraluri biujetidan;

♦ mosaxleoba uSualod faravs gaweuli samedicino momsaxurebis

iseTi saxeebis Rirebulebas, romlebsac saxelmwifo programebi ar

moicaven.

amJamad saerTo jandacvis xarjebis 80%-s mosaxleoba ixdis da

mxolod 20%-s faravs saxelmwifo. kvlav praqtikaSia eqimebisaTvis

damatebiTi araoficialuri Tanxebis gadaxda. arsebuli sagadasaxado

krizisis gamo centraluri biujetidan jandacvaze gadaricxuli Tanxebi

bevrad CamorCeba dagegmils. gadauxdelobis sakiTxi did siZneleebs qmnis

jandacvis reformis warmatebiT ganxorcielebaSi.

iqmneba STabeWdileba, rom verc saxelmwifo, verc ucxoeli donorebi da

verc samedicino sazogadoebrioba, miuxedavad mravali mcdelobisa, ver

axerxebs im uzarmazari faseulebebis mizanmimarTul da swor gankargvas

(Seexeba es materialur bazas Tu sakadro resursebs), romelic arsebobs

Cvens qveyanaSi.

- 141 -

sakmarisia aRiniSnos, rom mxolod oficialuri monacemebiT,

saqarTvelos Sromis, janmrTelobisa da socialuri dacvis saministros

sistemaSi moqmedebs 1148 ze meti sxvadasxva dawesebuleba, romelic

axorcielebs sxvadasxva donis ambulatoriul-poliklinikur daxmarebas

(cxrili 25 )

.

cxrili 25. saqarTvelos janmrTelobis dacvis sistemis ambulatoriul-

poliklinikuri dawesebulebebis qselis struqtura.

poliklinikuri dawesebulebebi 179

dispanserebi 75

stomatologiuri poliklinikebi 100

saswrafo daxmarebis sadgurebi 72

soflis saeqimo ambulatoriebi 209

sisxlis gadasxmis sadgurebi 6

samkurnalo centrebi 51

saavadmyofoSi Semavali poliklinikebi 68

saeqimo janpunqtebi 9

saferSlo - sabebio punqtebi 379

sul 1148


mxolod TbilisSi moqmedebs 54 pirveladi jandacvis დაწესებულებa

(poliklinikebi, dispanserebi, saswrafo daxmarebis samsaxuri da sxv.), sadac

dasaqmebulia1609 eqimi da 1409 eqTani.

qveyanaSi arsebobs ararentabelurad moqmedi ambulatoriul-

poliklinikuri dawesebulebebis Warbi fizikuri da inteleqtualuri

kapitali, romelic dabali dafinansebis da sxva materialuri resursebis

deficitis pirobebSi tvirTad awevs saxelmwifos da mTlianad sazogadoebas.

sistemis struqturul-organizaciuli cvlilebebis erT-erT miznad

SesaZloa yofiliyo pirveladi jandacvis dawesebulebis reformireba

saojaxo medicinis centrebad. am kuTxiT saqarTveloSi ucxouri donorebis

daxmarebiT jer kidev XX saukunis 90-ian wlebSi daiwyo sakmarisad farTo

muSaoba. miuxedavad amisa, mTlianad sistemaSi seriozuli Zvrebi ver

- 142 -

moxerxda. dResdReisobiT saojaxo medicinis centrebSi momuSave

gadamzadebuli ojaxis eqimebi ver axdenen miRebuli kvalifikaciis

realizebas. marTalia, Tbilisis masStabiT municipalurma sadazRvevo

socialurma programam daadastura ojaxis eqimebis upiratesoba ubnis

Terapevtsa da pediatrebTan SedarebiT, magram moqmedi qselisa da kadrebis

didi nawilis muSaoba mainc araefeqtiania (cxrili 26)

cxrili 26. saqarTveloSi pirveladi samedicino daxmarebis dawesebulebebSi

daxmarebisTvis (2000 – 2006 ww.) mimarTvaTa ricxvi mosaxleobis 1 sulze.


pirveladi samedicino daxmarebis dawesebulebebSi daxmarebisTvis

mimarTvaTa ricxvi mosaxleobis 1 sulze saqarTveloSi dinamikaSi izrdeba,

magram realuri suraTis Sesacvlelad esTi tebpiT svla didixnis

perspeqtivaa.

rogorc cxrili 27 Cans, pirveladi samedicino daxmarebis

dawesebulebebSi eqimTan mimarTvianoba zedmiwevniT dabalia ara mxolod

dasavleT evropis, aramed, mezobel qveynebTan SedarebiTac. ( cxirili 27)

mimarTvaTa saxeoba 2000 2001 2002 2003 2004 2005 2006

Ambulatorul-poliklinikuri samsaxuri

eqimTan misvla 1.24 1.36 1.40 1.61 1.80 1.85 1.91

m.S.15 wlamde bavSvebi 0.93 0.98 1.10 1.40 1.64 1.57 3.31

avadmyofis binaze

monaxuleba 0.08 0.08 0.09 0.10 0.12 0.11 0.16

m.S. 15 wlamde

bavSvebis 0.19 0.19 0.20 0.24 0.26 0.25 0.28

saswrafo daxmareba

saswrafo daxmarebis

gamoZaxeba 0.034 0.031 0.04 0.04 0.05 0.10 0.16

m.S. 15 wlamde

bavSvebTan 0.003 0.002 0.003 0.004 0.003 0.038 0.08

sul mimarTvebi 1.4 1.5 1.6 1.8 2.0 2.1 2.2

- 143 -

cxrili 27. saqarTveloSi da zogierTi sxva qveynis wlis manZilze

mosaxleobis ambulatoriul-poliklinikuri dawesebulebis eqimTan

mimarTvianobis saSualo ricxvi mosaxleobis 1 sulze SedarebiTi.


aSkaraa, rom esoden savalalo mdgomareobis ZiriTadi mizezia

mosaxleobis dabali gadamxdelunarianoba saxelmwifo da municipaluri

jandacvis dafinansebis simwiris pirobebSi. amas adasturebs msoflios

jandacvis organizaciis monacemebic, romlis mixedviT, saqarTveloSi

qveynis mosaxleobis myidvelobiTi unarianobis paritetis gaTvaliswinebiT,

erTi pacientis mier gaxarjuli sakuTari saxsrebis wili gacilebiT

maRalia evropis da aziis regionis qveynebis umetesobasTan SedarebiT

(cxrili 28).

qveyana

wlebi

2005 2006 2007

somxeTi 1.8 2.77 2.96

azerbaijani 4.92 4.6 4.7

belarusi 11.8 13.2 13.6

belgia 7.4 7 6.6

CexeTi 14.8 15 14.6

dania 3.36 4.1 4.15

estoneTi 6.5 7.1 7.4

TurqeTi 2.63 4.61 5.4

TurqmeneTi ... 3.7 3.7

saqarTvelo 1.5 2.2 1.95

- 144 -

cxrili 28.

zogierTi qveynis mosaxleobis myidvelobiTiunarianobis paritetis

gaTvaliswinebiT erTi pacientis mier gaxarjuli sakuTari saxsrebis wili


arsebuli situaciis sistemuri analizi adasturebs im mosazrebas, rom

uaxloes momavalSi, ara sakuTari Tavis SenarCunebaze, aramed mosaxleobis

janmrTelbis dacvaze orentirebuli pirveladi janmrTelobis dacvis

sistemis CamoyalibebisaTvis saWiroa oTxi ZiriTadi mimarTulebis

ganviTareba esenia:

• mosaxleobaze orientirebuli pirveladi samedicino daxmareba,

romles safuZvels unda warmoadgendes xelmisawvdomobis principis

gatareba;

• Sedegze orientierebuli samkurnalo-diagnostikuri procesis

organizeba;

samedicino momsaxurebis xarisxis da efeqtianobis sistematiuri

gaumjobeseba.

qveynebi %%

somxeTi 61.7

azerbaijani 63.6

belarusi 17.6

belgia 24

CexeTi 10.2

dania 15.9

estoneTi 19

saqarTvelo 72.2

germania 11.5

irlandia 12

israeli 22.2

- 145 -

am kuTxiT niSandoblivia, rom 2010 wlamde saqarTvelos da maT Soris

dedaqalaqis mosaxleobis janmrTelobis SenarCunebisa da gaumjobesebis

ZiriTad prioritetebad miCneulia: dedaTa da bavSvTa janmrTelobis

gaumjobeseba, gul-sisxlZarRvTa daavadebebiT gamowveuli avadobisa da

sikvdilobis Semcireba, onkologiur daavadebaTa profilaqtikis,

gamovlinebebisa da mkurnalobis gaumjobeseba, travmatizmis Semcireba,

gadamdeb da socialurad saSiSi daavadebebis Semcireba, fsiqikuri

janmrTeloba, janmrTelobis xelSewyoba da cxovrebis jansaRi wesis

damkvidreba, adamianis janmrTelobisaTvis usafrTxo garemo faqtorebis

zegavlenis problemis gadaWra.

qveynis jandacvis erovnuli politikidan gamomdinare prioritetad

unda iqces prevenciuli xasiaTis programebis dafinanseba, maT Soris

kardiovaskularuli, onkologiuri, endokrinuli da sxv. daavadebebis

mimarT gatarebul RonisZiebebs, romelic iTvaliswinebs gamovlenili

paTologiis da qronikuli procesebis Tavidan acilebas.

qveynis konceptualuri ganviTarebis prioritetebSi, sabazro

ekonomikur relsebze gadasvlam moiTxova situaciis radikalizacia da

jandacvis sadazRvevo sistemaze moTxovnis gazrda. aqtualuria

problemebis gonivruli gadaWra. nawilobriv, ZiriTad problemas

warmoadgens sakiTxis teqnikur-ekonomikurad gaazrebuli meToduri

damuSaveba.

dResdReobiT, qveynis jandacvis sistemis dafinansebis wyaroebia:

• transferti centraluri saxelmwifo biujetidan;

• transferti adgilobrivi saxelmwifo biujetidan;

• miznobrivi Senatani, anaricxi, gadasaxdeli an mosakrebeli.

samive wyaros SenarCuneba, TavisTavad aucilebelia im pirobiT, rom

unda moxdes rogorc centraluri ise adgilobrivi saxelmwifo

biujetebidan transfertebis akumulireba, mesame wyaros srulad amoqmedeba

uaRresad aqtualuria, radgan perspeqtivaSi igi wamyvani unda gaxdes. aq

mTavari siZnelea ,,Senatanis” amoRebis organizaciis srulyofa

sagadasaxado samsaxurebTan aqtiuri TanamSromlobis gziT da

aucilebelia samarTlebrivi damkvidreba. mosamzadebelia samarTlebrivi

- 146 -

baza. saboloo jamSi es imis saSualebas mogvcems, rom yvela samkurnalo

programis ganxorcieleba TandaTan gadava sadazRvevo principze.

1996 wels somxeTis statistikis departamentis monacemebiT saSualo

xelfasi TveSi 20 dolars Seadgenda. gaeros 1996 wlis gamokvlevebis

Tanaxmad somxeTis mosaxleobis 87% siRaribis zRvars qveviT arsebobda,

qveynis mosaxleobis 1/3 rCeba gansakuTrebiT mZime mdgomareobaSi.

gansxvaveba yvelaze Rarib da yvelaze mdidar ojaxebs Soris Seadgens 1/27-

s. umuSevroba somxeTSi erT-erTi mniSvnelovani problemaa. 1990 wels

dasaqmebulTa raodenobam Seadgina 1,69 mln. kaci, romelTa Soris 80%

saxelmwifo sawarmoebSi iyo dasaqmebuli. saxelmwifo sawarmoebis

gaCerebam masobrivi umuSevroba gamoiwvia. mogvianebiT ekonomikaSi

dasaqmebulTa raodenoba 1,5%-iT Semcirda, Tumca jandacvis sistema dRemde

rCeba somxeTis makroekonomikuri problemebis da sabWoTa memkvidreobis

marwuxebSi. umuSevroba, mosaxleobis dabali Semosavlebi mniSvnelovnad

amcirebs jandacvis saerTo xarjebs mosaxleobis samomxmareblo xarjebis

struqturaSi, rac Tavis mxriv samedicino momsaxureobas ar aZlevs

saSualebas miiRos mTliani Semosavlebi Tavisi SesaZleblobebidan.

somxeTis samedicino sistema jer kidev flobs mniSvnelovan ZiriTad

fondebs. amasTan, amerikeli eqspertebis SefasebiT ZiriTadi fondebis

datvirTva mxolod 30%-iT xdeba. arasakmarisi dafinanseba, reformis

araTanmimdevruloba iwvevs jandacvis momsaxurebis xarisxis gauaresebas.

somxeTis janmrTelobis sistema ganicdis TandaTanobiT gauaresebas,

romelic pirdapir proporciulia sazogadoebis janmrTelobis

maCvenebelze.

sicocxlis saSualo xangrZlivoba somxeTSi 79 wlidan 72 wlamde

Semcirda. gaizarda sikvdilianoba gul-sisxlZarRvTa daavadebaTa Sedegad:

yovelive zemoTaRniSnuli faqtorebi ganmsazRvrelia jandacvis sistemis

xelmisawvdomobis problemisa romelic iseve rogorc dsT-s sxva

qveynebisaTvis aqac aqtualuria.

somxeTis jandacvis sistemis finansuri problemebis dasaZlevad

mniSvnelovani roli saerTaSoriso organizaciebs akisriaT. pirveladi

jandacvis rgolis gaZlierebisaTvis msoflio bankma daafinansa proeqti,

romlis mixedviTac 10 mln. dolaris SeRavaTiani krediti gamoiyo.

- 147 -

somxeTis mTavrobis mier dawyebuli jandacvis reforma mniSvnelovan

wilad dakavSirebulia pirveladi jadacvis xarisxis gaumjobesebasTan,

razedac modis mosaxleobis xarjebis didi nawili. proeqti

dafinansebulia saerTaSoriso ganviTarebis asociaciis (IDA) mier.

jandacvis reforma somxeTSi, dawyebuli 1995 wels, mxardaWerili da

damtkicebulia UNICEF, EU/TACIS da WHO/EURO meSveobiT.

somxeTis jandacvis sistemis cvlilebis mTavar momentad miiCneva

samedicino bazris decentralizacia da jandacvis dafinansebis

diferencireba. risk-faqtorebis Skalis mixedviT.

dsT-s sxva qveynebis msagvsad azerbaijanis jandacvis sistema

xasiaTdeba resursebis araefeqturobiT. aqac gacilebiT meti eqimi da

eqTania vidre saWiroa. azerbaijanSi 1990 wels yovel 1000 kacze modioda

3,9 eqimi, Sesabamis periodSi kanadaSi 2,1 eqimi da inglisSi 1,6 eqimi. ar

aris ganviTarebuli saojaxo medicinis sistema. samedicino personalis

kompetencia saerTaSoriso eqspertebis azriT dabalia. 1998 wels yovel

1000 kacze modioda 8,4 saavadmyofo sawoli. saavadmyofoebi azerbaijanSi

gamoirCevian datvirTvis dabali procentiT (28%). didia araoficialuri

xarjebis wili jandacvis seqtorSi. aseve didia saavadmyofoSi pacientis

darCenis norma, kerZod, 17 dRe. xSirad pacientebi mkurnalobis yvelaze

iaf gzas irCeven, rac yovelTvis ar aris dakavSiebuli maTi mkurnalobis

xarisxianobasTan. jandacvis momsaxurebis xarisxis kleba sul ufro da

ufro SesamCnevia. jandacva gamoirCeva qveynis teritoriaze araefeqturi

resursebis ganawilebiT. mravali Senoba dangrevis pirasaa misuli.

saavadmyofoebSi ZiriTadi fondebis gamoyeneba mwiria. jandacvis reformebi

gamococxlda axali sakanonmdeblo iniciativis Sedegad, romelsac hqvia

kanoni ‘”mosaxleobis janmrTelobis dacvis Sesaxeb.~

1998 wels prezidentis brZanebiT daiwyo reformis strategiis

SemuSaveba. dokuments hqvia ‘jandacvis reorientaciis generaluri

koncefcia.~ jandacvis axali sistema Semdegi principebiT xasiaTdeba:

jandacvis gegmazomieri qselis Seqmna da misi racionaluri gamoyeneba;

sistemis safinanso bazis ganviTareba; pirveladi jandacvis

prioritetuloba; sanitarul-epidemiologiuri sistemis reforma;

sadazRvevo sistemis danergva; sajaro jandacvis privatizacia da sxva.

- 148 -

dokumenti “jandacvis reformis saxelmwifo programa~ ar aris detaluri

samoqmedo gegma da misi mravali sakiTxi, iseTebi rogoricaa

sazogadoebrivi jandacvis biujetis zrda mSp-is 1,6%-dan 6,6%-mde,

ararealurad gamoiyureba.

aqve SevexebiT DALY-is indeqsis maCvenebels, romelsac ara erT

qveyanaSi Zalze didi mniSvneloba eniWeba. aRniSnuli indeqsi janmrTeli

sicocxlis mdgomareobis xangrZlivobazea orientirebuli. msoflio

jandacvis organizaciis mier gamokvleul qveyanaTa Soris azerbaijani 65-e

adgilzea da saerTo jamSi saSualo janmrTeli sicocxlis xangrZlivoba

63,7 wels Seadgens. qalTa da mamakacTa janmrTeli sicocxlis

xangrZlivoba ase gamoiyureba: qalebi - 66,7 w.; mamakacebi - 60,6 w

DALY-is anu janmrTeli sicocxlis xangrZlivobis indeqsis mixedviT

azerbaijanSi SesamCnevad Camouvardeba saqarTveloSi analogiur

maCvenebels.

1999 wlis monacemebiT azerbaijanSi moqmedebs 755 jandacvis centri,

1024 saavadmyofo da poliklinika, 757 samedicino ambulatoria da 288

samSobiaro saxli. yovel 10 000 mosaxleze 39,2 eqimi da 9,52 damxmare

medpersonali modis. qveyanaSi moqmedi 11 samedicino kvleviTi instituti

ikvlevs da Seiswavlis mTel rig samedicino problemebs. Tumca qveyanaSi

janmrTelobis dacvis realur suraTs ver asaxavs es ukanaskneli

monacemebi. saavadmyofo sawolebis 90% ganTavsebulia iseT SenobebSi,

romlebic saSualo donis standartebsac ki ver akmayofileben. garda amisa,

isini ganicdian medikamentebisa da samedicino aRWurvilobis deficits.

dafinansebis ganxriT mdgomareoba savalaloa; jandacvis sferos

saxelmwifo biujetis mxolod umciresi nawili xmardeba, rac ganapirobebs

sruliad minimalur moTxovnilebebis daukmayofileblobas.

1998 wlidan zogadad msoflioSi gaizarda iseTi daavadebebis ricxvi,

rogoricaa: tuberkuliozi, Sidsi, infeqciuri daavadebebi da a.S. gaxSirda

daavadebebi dakavSirebuli narkomaniasTan, alkoholizmTan, toqsikur

nivTierebebTan. wylis cudma xarisxma da sanitaruli mdgomareobis

dabalma donem intensiuri daavadebebis da epidemiebis gamwvaveba gamoiwvia.

saqarTveloSi magaliTad, 2006 wels, pirveladi jandacvis

dawesebulebebSi eqimebTan mimarTvebis raodenoba 1 sul mosaxleze

- 149 -

gaizarda da 2,2 Seadgina. gazrdilia avadobis zogadi maCvenebelic, Tumca

zogierT daavadebaTa klasSi aRiricxa avadobis maCveneblis kleba.

2006 wels saqarTveloSi marTalia dafiqsirda tuberkulozis, kleba,

Tumca es am problemas naklebad wyvets. statistikis departamentis

mixedviT Sidsis da aiv-inficirebis 912 SemTxvevidan (231 qali da 681

mamakacia), aiv-iT inficirebis 607 da Sidsis 305 SemTxvevaa dafiqsirebuli.

gamovlenili Sidsis da aiv-infeqciis axali 276 SemTxvevidan 156 SemTxveva

(56,5%) narkotikebis ineqciuri momxmarebelia.

infeqciuri daavadebebis ricxvi 2000-2006 wlamde gaizarda da yvelaze

maqsimalurs 2004 wels miaRwia 1271.3 SemTxveva dafiqsirda da aqedan

stacionarSi aRiricxa daavadebulTa 379.3 SemTxveva, romelTagadn bavSvTa

hospitalizaciis mizezi nawlavuri infeqciebia. es monacemebi da maCveneblebi

miuTiTebs jandacvis sistemis araefeqtur muSaobaze da arasrulfasovan

sistemaze.

SeiZleba gamovyoT ramdenime siZnele jandacvis samsaxuris reformis

gatarebaSi:

♦ organizaciuli da struqturuli cvlilebebis neli tempi;

♦ komunikaciis saSualebebis nakleboba;

♦ saxelmwifo programebis arasruli dafinanseba;

♦ naklebad srulyofili material-teqnikuri baza;

♦ statistikuri informaciis arasrulyofili Segroveba;

♦ saqmianobis sawyis etapebze konsultaciebis dagvianeba.

jandacvis erovnuli politika yuradRebas amaxvilebs qveyanaSi

pirveladi jandacvis prioritetulobaze. pirveladi jandacvis

dawesebulebebis saqmianoba (859 ambulatoriuli dawesebuleba, 114

ambulatoriuli ganyofileba saavadmyofoebSi, 53 samedicino punqti da 512

saferSlo punqti) efuZneba Semdeg principebs:

♦ samedicino daxmarebis uzrunvelyofa TiToeuli

registrirebuli pacientisaTvis;

♦ xelmisawvdomi xarisxiani samedicino daxmareba;

♦ mkurnalobisa da profilaqtikis Tanafardoba;

- 150 -

♦ Sedegiani ambulatoriuli da stacionaruli daxmarebiT

uzrunvelyofa;

♦ momuSave mosaxleobis daxmareba specialuri ambulatoriuli

miRebis ganrigis dawesebis gziT.

pirveladi jandacvis dawesebulebebi uzrunvelyofen:

♦ mosaxleobis samedicino ganaTlebas;

♦ dedaTa da bavSvTa janmrTelobis dacvas;

♦ imunizacias;

♦ endemuri daavadebebis profilaqtikas;

♦ gavrcelebuli daavadebebisa da travmebis mkurnalobas;

♦ esencialuri medikamentebis ganawilebas.

Cveulebriv, am dawesebulebebis materialuri baza ar Seesabameba

Tanamedrove sanitariul moTxovnebs Senobis, wyliT momaragebis,

kanalizaciis, eleqtromomaragebis, telefoniT uzrunvelyofis da a.S.

TvalsazrisiT. arasaTanadoa maTi momarageba aRWurvilobiT da sxva

samedicino daniSnulebis sagnebiT. personalis xelfasi Zalian dabalia, ar

arsebobs materialuri waxalisebis formebi da aqedan gamomdinare

momsaxurebis xarisxis gaumjobesebis da pacientebTan urTierTobis

gaRrmavebis miswrafebac naklebia. 1998 wels Catarebuli gamokiTxvis

Tanaxmad 830 respondentidan daaxloebiT 60% ukmayofiloa ambulatoriuli

momsaxurebiT.

saqarTveloSi miuxedavad mTeli rigi progresuli cvlilebebisa, jer

kidev uaryofiTi damokidebulebaa jandacvis sferos mimarT, rogorc

samedicino momsaxurebis xarisxis TvalsazrisiT, aseve resursebis

gadanawilebiTac. imisaTvis rom janmrTelobis statusi gaZlierdes

saxelmwifos Careva aucilebelia. arsebuli sabazro ekonomikaze

damokidebuli qveynebis gamocdileba miuTiTebs imaze rom, mTliani

prioritetulobis ganmsazRvreli samomavlo gegmebi axali,

demokratiuli RirebulebebiT ganisazRvros. axali sistemebi adamianebze

orintirebuli unda iyos, metad mimarTuli individualuri pacientebisa da

garkveuli jgufis moTxovnebze, Tansaworuflebianobaze, umuSevrobaze da

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socialur siRaribeze, axali Rirebulebebi orientirebuli unda iyos

janmrTelobaze mis xarisxsa da pirvelad janmrTelobis dacvis seqtoris

gaZlierebaze.

saxelmwifo politikis strategia, romlis mizania Seamciros

arainfeqciuri daavadebebis tvirTi sazogadoebSi, da xeli Seuwyos

sazogadoebis janmrTelobas da Tanabar xelmisawvdomobas saWiroebs

pozitiur cvlilebebs sazogadoebisaTvis socioekonomikuri mdgomareobis

gaumjobesebis xelSewyobiT.

miuxedavad saqarTveloSi jer kidev arsebuli arasaxarbielo

ekonomikuri da politikuri mdgomareobisa, qarTuli saxelmwifo sxva

mraval strategiebs Soris, swored jandacvis ganviTarebasa da masTan

dakavSirebul sirTuleebs irCevs. siRaribis daZlevis programasTan erTad

jandacvis sistemac gacilebiT efeqturi da xelmisawvdomi gaxdeba

sazogadoebis yvela wevrisaTvis da mxolod amis Semdgom, momdevno etapi

iqneba mimarTuli xarisxis gaumjobesebaze, ise rogorc es ganviTarebul

qveynebSi xdeba.

miuxedavad imisa, rom reformebis pirvelma stadiam sakmao

sirTuleebiTa da problemebiT Caiara, sistemam Tavisi efeqtianoba

mravaljer daadastura. garda amisa saxelmwifo cdilobs umTavresi

prioritetuli mimarTulebebiT mosaxleobisaTvis aucilebeli,

xelmisawvdomi da Tanabari samedicino momsaxurebis uzrunvelyofas.

amJamad, qveyanaSi praqtikulad nawilobriv gadawyda samedicino

momsaxurebisa da samkurnalo saSualebebis zogadad xelmisawvdomobis

problema anu am SemTxvevaSi igulisxmeba sxva da sxva saSualebelis

mravalferovneba da konkurentunariani garemo, mimdinareobs kerZoO

seqtoris ganviTareba, Semodis axali teqnologiebi da sagrZnoblad

gaumjobesTa momsaxurebis pirobebi, Tumca es metwilad kerZo seqtors

exeba, Mmagram zedmiwevniT mwvaved dgas maTdami mosaxleobis didi

nawilis ekonomikuri xelmisawvdomobis uzrunvelyofis sakiTxi. miuxedavad

imisa, rom 2005-2007 ww. miRweulia jandacvis biujetis TiTqmis sammagi

zrda mosaxleobis didi nawili sruli speqtriT mainc ver sargeblobs

kvalificiuri samedicino daxmarebiT. saTanado sadazRvevo sistemis

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Camoyalibeba da fasebis daregulireba albaT samomavlod am problemasac

moxsnis da xalxis moTxovnas daakmayofilebs.

janmrTelobis dacvis sistemaSi ganxorcielebulma reformebma Seqmna

winapiroba mosaxleobis samkurnalo daxmarebis sadazRvevo sistemaze

gadasvlisaTvis. saxelmwifo programebis moculoba da Sesabamisad

dazRveuli mosaxleobis raodenoba sistematiurad izrdeba. saxelmwifo

sadazRvevo programebis amoqmedeba ki, erTis mxriv, stimuls miscems

mosaxleobis mimarTvianobis zrdas, meores mxriv saSualebas mogvcems

SevafasoT realuri moTxovnis done samedicino momsaxurebis sxvadasxva

saxeobebze. iafi dazRveva uzrunvelhyofs mosaxleobis maqsimaluri mocvas,

rac TavisTavad garanti iqneba Tanabari xelmisawvdomobis misaRwevad.

saqarTvelos mosaxleobis janmrTelobis saerTo mdgomareobaze

calkeuli RonisZiebebis gavlena da Sesabamisad janmrTelobis ZiriTadi

maCveneblebis Secvla SeuZlebelia drois mokle monakveTSi. reformebis

Sedegebi, rogorc wesi, Tavs iCens garkveuli drois gasvlis Semdeg. amitom

aucilebelia periodulad mciremasStabiani kvlevebis Catareba, raTa

Sefasdes mosaxleobis garkveuli jgufebis janmrTelobis mdgomareoba.

janmrTelobis mdgomareoba damokidebulia ekonomikur, kulturul,

fsiqologiur garemos da cxovrebis stilis faqtorebze. maRali

socioekonomikuri statusi gulisxmobs karg sacxovrebel pirobebs, swor

kvebas, janmrTeli cxovrebis wess, rac Sesabamisad janmrTelobazec

aisaxeba. swored am faqtorebis gamo saxelmwifom yvelanairad unda

gamonaxos gzebi misi mosaxleobisaTvis jansaRi cxovrebis pirobebis

Sesaqmnelad, rac pirvel rigSi socialuri da ekonomikuri mdgomareobis

gaumjobesebis Sedegad miiRweva da Sesabamisad qveynis ganviTarebac ufro

efeqturad ganxorcieldeba. jandacvis srulyofili sistemis Sesaqmnelad

dafinansebis efeqturi politikaa aucilebeli. jandacvis dafinansebis

politika da saxelmwifos politika jandacvis sferoSi unda

warmoadgendes erTi mTlianobas.

udaoa, jandacvis sistemis dafinansebis politikis SemuSaveba

garkveul sirTules warmoadgens da dafinansebis axali principebis

danergvac mniSvnelovan gavlenas axdens rogorc pacientis, aseve

samedicino personalis qcevis motivaciaze. man SeiZleba mosaxleobis

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garkveuli jgufebisaTvis Seamsubuqos, an gaaZnelos samedicino daxmarebis

xelmisawvdomoba. dafinansebis axali meqanizmebis danergva iwvevs

samedicino daxmarebis mTeli sistemis gardaqmnas da es gardaqmna xanmokle

drois periodSi rTulad misaRwevia, Tumca metad sasurvelic.

reformis Sedegad samedicino momsaxureba saqarTveloSi unda gaxdes

ekonomikurad gamarTuli, momxmarebelze orientirebuli, sadazRveo

principebTan mWidrod dakavSirebuli, rac udaod gaxdis am sistemis

muSaobas gacilebiT efeqturs da sayovelTaod xelmisawvdoms. efeqturi

da moqnili sistema, romelic ara mxolod mogebazea orientirebuli,

aramed momsaxurebis xarisxzec, romelic aseve did yuradRebas uTmobs

mosaxleobis moTxovnas-pirveladi daxmarebis Tu muSaobis operatiulobis

saxiT, yovelTvis warmatebuli da gamarTlebulia, rac agreTve xarisxis

gaumjobesebis sawindaricaa. jandacvis reformis efeqturad gatarebis

Sedegad saqarTvelos saxelmwifo strategia samedicino momsaxurebis

xelmisawvdomobasTan dakavSirebiT dadebiTad gadawydeba, rac xels

Seuwyobs sazogadoebis janmrTelobis saerTo mdgomareobis gaumjobesebas,

sikvdilianobis Semcirebas da saWiroebis SemTxvevaSi xarisxiani

mkurnalobis miRebas. aqcentis gadatana pirveladi samedicino daxmarebis

rgolze saSualebas miscems sistemas uzrunvelyos saqarTvelos yoveli

moqalaqe xelmisawvdomi samedicino daxmarebiT.

amgvarad, Teoria samedicino momsaxurebis xelmisawvdomobasTan

dakavSirebuli problemebis Sesaxeb, SeiZleba misive hipotezebiT

damtkicebulad CaiTavlos, radgan kvlevam gviCvena, rom: rac ufro meti

Raribi adamiania qveyanaSi, rac ufro mwvavea socialuri garemo, rac ufro

korumpirebulia saxelmwifo da rac ufro dabalia misi ekonomikuri

ganviTarebis done, miT ufro cudia sazogadoebis janmrTelobis saerTo

mdgomareoba da metia samedicino servisTan dakavSirebuli problemebic,

amitom swori saxelmwifo politika, zustad gaTvilili strategiebi da

sazogadoebis mxardaWera aucilebelia saerTo keTildReobisa da

erovnuli miznebis misaRwevad.

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3.2. kvlevis procesSi miRebuli Sedegebis ganxilva

rodesac saubaria ganviTarebadi qveynebis jandacvis sistemebze da

maT strategiebze aucilebelia saqarTvelos jandacvis sistemis saerTo

mdgomareobis da misi erovnuli strategiebis ganxilvac. saxelmwifo

dafinansebis politika gulisxmobs prioritetuli sferoebis dafinansebas

da saxelmwifo biujetis xarjebis efeqtur gadanawilebas. saqarTvelos

amJamindeli biujetis struqtura prioritets momsaxurebis sferos aniWebs,

xolo rac Seexeba danaxarjebs jandacvaze saxelmwifo biujetidan 2006

wels 230 mln. lari gamoiyo, mTlianad Jandacvaze 1160 mln. lari daixarja

rac mSp-is 8,4% Seadgens.

saqarTveloSi jandacvaze saxelmwifo danaxarjebis wili dabalia,

Tumca aRiniSneba saxelmwifo xarjebis yovelwliuri zrdac. ase

magaliTad, 1990 wels saqarTveloSi saxelmwifos xarjebi jandacvaze erT

sul mosaxleze gaTvliT mxolod 83 TeTrs Seadgenda, 2006 wels igi 51.84

laramde gaizarda (32 US$), anu aRniSnul periodSi saxelmwifos xarjebi

jandacvaze TiTqmis 62-jer gaizarda. jandacvaze saxelmwifo danaxarjebis

zrdas migvaniSnebs agreTve, mTlian Sida produqtSi jandacvaze

saxelmwifo xarjebis procentuli wilis zrdac.

magaliTad, Tu 1990 wels jandacvaze saxelmwifos danaxarjebis

procentuli wili mTlian Sida produqtSi 0,05 %-s Seadgenda, 2006 wels

igi 1.8 %-mde gaizarda. 1990-1995 wlebSi jandacvaze saxelmwifos mier

gamoyofili Tanxa yovelwliurad 4,5-4,3 milioni laris farglebSi

meryeobda. jandacvis sistemaSi dawyebuli reformebis Sedegad, 2006

wlisaTvis jandacvaze saxelmwifos mier gamoyofili Tanxa 230 milion

laramde gaizarda.

1990–iani wlebis bolos statistikuri monacemebis mixedviT

saqarTveloSi samedicino momsaxurebasa da medikamentebze danaxarjebis

maCveneblebi, erT sul mosaxleze, yovelTviuri Semosavalidan Seadgenda 25

%, xolo yirgizeTSi 65 %, maSin rodesac rumineTsa da ruseTSi igi

Seadgenda 5 % da 5 % Sesabamisad. (Lewis, 2000:22) (grafiki 11) saSualebiT

kargad Cans Tu ramdenad didia danaxarjebi medikamentebze sadac

- 155 -

saxelmwifo ganviTarebis garkveul etapze imyofeba da sadac saxelmwifos

roli dabalia jandacvis dafinansebaSi.

grafiki 11. danaxarjebi samedicino momsaxurebasa da medikamentebze

xarjebi medikamentebze

25%

65%

5% 5%

saqarTvelo

yirgizeTi

rumineTi

ruseTi


jandacvis seqtorze saxelmwifo danaxarjebis arc Tu ise maRali

maCvenebliT gamoirCeva azerbaijanic, romlis mTliani Sida produqtis

danaxarji 3%-s Seadgens. yofil sabWoTa kavSiris sivrceSi yvelaze maRal

maCvenebels ruseTi aRwevs (6 %), Tumca aqve unda gaviTvaliswinoT is

faqtic rom ruseTi mosaxleobis moculobiTac mkveTrad gansxvavdeba sxva

qveynebisgan, rac albaT nawilobriv am faqtsac ganapirobebs, ruseTis

Semdeg %-lad modis yirgizeTi (5.6%), somxeTi (5.4%), estoneTi (5.3%) da

saqarTvelo (5.3%). aRniSnul mdgomareobaSi azerbaijani SeiZleba yvelaze

warmatebulad CaiTvalos sxva danarCen qveynebTan SedarebiT. (grafiki 14)

grafiki 12. dsT-s qveynebis danaxarjebi mSp (GDP-%) –is mixedviT


sabazro ekonomikisaken gardamaval periodSi myofi bevri qveyana waawyda

iseT mniSvnelovan problemas jandacvis momsaxurebis sferoSi, rogoricaa

Tanasworuflebianoba da momsaxurebis xelmisawvdomoba, rac siRaribis

- 156 -

zrdisa da resursebis Semcirebis Sedegia, Tumca marto es mizezebi

damakmayofileblad ver CaiTvleba. rogorc aRvniSneT, gardamaval etapamde

yofili sabWoTa kavSiris sistema agebuli iyo erT centralizebul

“semaSko”-s modelze, romelic warmoadgenda erTian integrirebul,

sazogadoebis yvela fenisaTvis erTnairad xelmisawvdom sistemas, radgan

jandacvis momsaxureba am dros iyo sruliad ufaso. magram es modeli

ZiriTadad stacionarul mkurnalobaze iyo orientirebuli da aRmoCnda

rom saerTod ar iTvaliswinebda sazogadoebis moTxovnas.

sabazro ekonomikaze gadasvlis Sedegad moxda ekonomikuri

liberalizacia. iseTma qmedebebma, rogoricaa privatizacia, deregulacia,

decentralizacia da sabazro meqnizmebis Semosvlam gaaZliera konkurencia

da gaaumjobesa efeqturoba, Tumca yovelive aman Tavisi zegavlena iqonia

pacientTa momsaxurebis Tansawor xelmisawvdomobazec. mniSvnelovnad

gazrdil siRaribis viTarebaSi gamoikveTa axali saxis siRaribis forma es

aris regionaluri uTanasworoba, rac erT erTi damaxasiaTebli problema

gaxda gardamavali qveynebisTvis. zogierT aRmosavleT evropis qveynebSi,

sadac mkveTrad Semcirda siRaribis maCveneblebi- araTanabari xelfasebi da

gansxvaveba qveynis qalaqur Tu periferiul cxovrebas Soris, mainc

warmoiSveba seriozuli problemebi servisisadmi xelmisawvdomobasTan

dakavSirebiT.

jandacvis sitemasTan dakvSirebuli mravali problemis garda,

romlebic arsebobs ruseTisa da yofili dsT-s qveynebSi, maT Soris

saqarTveloSic, bevri maTgani jandacvis politikasTan dakavSirebuli

sakiTxebia, romlebic reformis nawilia, aqedan gamomdinare isini did

yuradRebas moiTxoven.

dsT-s qveynebSi da kerZod ruseTis SemTxvevaSi saavadmyofoebi da

klinikebi ar aris saTanadod aRWurvili, ar mimdinareobs eqimTa

gadamzadeba, ar aqvT saTanado anazRaureba da SeiZleba iTqvas, rom ar

arsebobs xarisxiani menejmentis sistema, Tumca am qveynis mcdeloba

gadasuliyo da reforma gaetarebina “sadazRveo medicinis” ganxriT

absoluturi kraxiT damTavrda da warumatebeli aRmoCnda, magram wamoiWra

mniSvnelovani politikis sakiTxebi, romlebsac gamokvleva da xangrZlivi

ganxilva esaWiroeba. SesaZlo Sedegebisa da alternatiuli politikis

- 157 -

mimarTulebebis gauTvaliswineblobis SemTxvevaSi dasaSvebia rom ruseTma

da sxva saxelmwifoebmac miiRon jandacvis gaumjobesebuli xarisxi, magram

aman SeiZleba mkveTrad SezRudos saerTo xelmisawvdomoba, rac TavisTavad

gamoiwvevs fasebis zrdas.

msoflio bankis konsultaciebis mixedviT reformatorebma unda

gaiTvaliswinon warmatebuli dasavluri mimarTulebebi da gamocdilebebi

da aicilon Tavidan SesaZlo Secdomebi, romlebic sxva ganviTarebulma

qveynebma ukve gadalaxes. jandacvis dafinansebis reforma arc Tu

warmatebuli aRmoCnda dsT –s sivrceSi da aseve janmrTelobis dazRvevac

ar aRmoCnda Semosavliani am seqtorSi. iseve rogorc janmrTelobaze

araTanabarma sazogadoebrivma danaxarjebma, savaldebulo sadazRveo

samedicino daxmarebis sqemis kvlevamac ruseTSi aCvena, rom am regionSi

iyo regionaluri Tanabarxelmisawvdomobis problema.

1990-ian wlebSi ruseTSi jandacvis dafinansebisaTvis resursebis

araTanabarma gadanawilebam regionebSi gamoavlina regionaluri

disbalansi xelmisawvdomobis mxriv. aRmoCnda rom sadazRvevo sistemis

mocva regionebSi araTanabaria. araTanbari gadanawileba gamoixateba

rogorc eTnikur umciresobebs Soris , (84%-64%is winaaRmdeg) aseve

qalaqisa da soflis doneze (World Bank 2003). geofrafiuli mdebareoba da

socioekonomikuri statusi samedicino momsaxurebis miRebisas erT-erT

mniSvnelovan faqtors warmoadgens. geografiul mdebareobaSi igulisxmeba

gansxvavebuli viTareba qalaqsa da sofels Soris, rasac emateba aseve

gansxvaveba socialur mdgomareobebs Soris am regionebSi.

regionebis doneze finansuri barierebi gacilebiT mniSvnelovan

rols TamaSobs arsebul viTarebaSi vidre qalaqis doneze. arsebuli

statistikuri monacemebidan gamomdinare logikuria daskvna imis Sesaxeb

rom finansuri barieriebi aris yvelaze mniSvnelovani SemzRudveli

faqtori samedicino momsaxurebis xelmisawvdomobisTvis. araTanabari

xelmisawvdomoba ki yvelaze metad sxva mraval faqtorebs Soris rig

qveynebSi SeiZleba mimdinare gardamavali etapis Sedegag miviCnioT. garda

regionaluri araTanabari resursebis ganawilebisa, arsebobs kidev meore

problema qalaqsa da sofels Soris, es aris mZime infrastruqturuli Tu

transportTan dakavSirebuli problema. qalaqisa da soflis araTanabari

- 158 -

mdgomareoba aseve gamoxatavs socioekonomikur araTanabar mdgomareobas,

radgan soflis mosaxleoba qalaqis mosaxleobasTan SedarebiT gacilebiT

Raribia. “liberalizaciis Sedegad ruseTSi magaliTad transportis fasi

gaizarda, ramac aseve gazarda xarjebi samedicino momsaxurebisTvis

soflis mosaxleobaSi- ambobs devisi. (Davis 2001:68). soflis mosaxleobas

misi azriT uWirs medikamentebis Sesyidva radganac fasebi sul ufro da

ufro naklebad xelmisawvdomi xdeba.

mk kiim (McKee . 2002). Tavis naSromSi ganixila arsebuli hospitaluri

seqtoris problematikac. igi aRniSnavs, rom saavadmyofoebis raodenobis

Semcireba unda ganxorcieldes qalaqSi arsebuli mcire saavadmyofoebis

gauqmebis xarjze. magaliTad yazaxeTis saavadmyofoebSi, 1990 da 1997

wlebSi gadaudebeli mkurnalobisaTvis gankuTvnili sawolTa raodenoba

40% -iT Semcirda, rac metwilad soflebSi arsebul 684 patara

saavadmyofos 208-mde Semcirebis Sedegi iyo. miuxedavad imisa rom

saavadmyofoebis restruqturizacia aucilebel process warmoadgenda am

regionSi, iseT viTarebaSi, rogoric iyo saxelmwifos mier jandacvaze

gamoyofili danaxarjebis mkveTri Semcireba da priveladi janmrTelobis

dacvisa da zogadi praqtikis eqimis mdgomareobis gaujobesebis

aucilebloba, periferiebis saavadmyofoebis daxurva da alternatiuli

samedicino samaxurebis ar arseboba, rogorc aRmoCnda gaxda mizezi

samedicino momsaxurebisadmi araTanabari xelmisawvdomobis zrdisa.

(McKee . 2002).

qalaqisa da periferiis urTierTgavlena sazogadoebis

janmrTelobaze gamoikvlies sxva avtorebmac (Kalediene da Petrauskiene 2004).

kvleva Catarda 1990-2000 wlebSi, litvaSi. maTi hipoteza qalaqisa da

soflis mosaxleobis janmrTelobis mdgomareobas Soris gansxvavebis

Sesaxeb damtkicda sikvdilianobis maCvenebelis cvalebadobis mixedviT.

sikvdilianoba ufro maRali iyo periferiebSi da ZiriTadi faqtorebi

gulsisxlZarRvTa da sxva arainfeqciuri daavadebebis mizezebi aRmoCnda,

rac gamowveuli iyo samedicino momsaxurebis araTanabari

xelmisawvdomobiT. (Kalediene and Petrauskiene 2004). Tumca unda aRiniSnos rom

mxolod teritoriuli barierebi ar SeiZleba CaiTvalos saTanado servisis

- 159 -

miRebis SeuZleblobis sababad. albaT aqac ZiriTad faqtors mainc socio-

ekonomikur statusamde mivyavarT.

ganxilul samecniero naSromTa Sedarebisas, avtorTa TiToeuli

maTgani eTanxmeba azrs, rom arsebobs mniSvnelovani kavSiri

socioekonomikur statussa da janmrTelobas Soris, ara marto

centralur da aRmosavleT evropaSi, aramed dsT qveynebSi da maT Soris

saqarTveloSic, am Sedegebis Sedareba sakmaod rTuli aRmoCnda, radgan

bevri qveynis dapirispireba arc ise iolia. dasavleT evropis qveynebis,

gardamaval qveynebTan Sedarebisas TvalsaCinoa gansxvaveba, rogorc

mTliani Sida produqtis danaxarjebis procentul maCvenebelSi jandacvis

seqtorze, aseve strategiul mimarTulebebs Soris. magaliTad,

ganviTarebuli qveynebi gacilebiT orientirebulni arian epidemiologiur

problemebsa da sazogadoebis janmrTvelobaze, xolo ganviTarebadi

qveynebis ZiriTad strategiul mimarTulebas jer kidev socioekonomikuri

problemebis gadalaxva warmoadgens.

socio-ekonomikuri determinantebi gansazRvravs samedicino

momsaxurebis Tanabarxelmisawvdomobas. magaliTad: sacxovrebeli

pirobebi, cxovrebis xarisxi da sxva. janmrTelobis Sesaxeb (LLH) msoflio

jandacvis organizaciis mier SemuSavebuli standartuli kiTxvaris

mixedviT Catarebuli socialuri kvlevis SedegebiT Cans, rom savaraudod

gardamavali qveynebis Raribi mosaxleobisTvis, mdidrebisagan

gansxvavebiT, damabrkolebel bariers samedicino momsaxurebis maRali

fasebi warmoadgens (Falkingham 2004)

xelmisawvdomobis problematikasTan dakavSirebul erT-erT faqtors

araformaluri gadaxdebi warmoadgens, rac aRmoCnda erTaderTi gza,

romelic misi gamWvirvalobis da oficialurad gadaqcevis SemTxevevaSi

asparezs miscems winawar dafinansebis sistemas, romelic yvelaze saimedod

emyareba gadasaxadebs. sabWoTa kavSiris daSlis Semdeg dsT-s qveynebSi

movlenebi erTmaneTis msgavsad ganviTarda. socialur da ekonomikur

mdgomareobis mixedviT SeiZleba iTqvas, rom TiTqmis yvela maTganSi

reforma aucilebel pirobas warmoadgenda, Tumca yoveli maTganisaTvis

misTvis damaxasiaTebeli Taviseburebebi da gansxvavebuli mimarTulebebic

niSandoblivia. magaliTad 90-iani wlebis pirvel naxevarSi somxeTis

- 160 -

mosaxleobis cxovrebis done mniSnelovnad daeca. gansakuTrebiT

mniSvnelovani vardna SeimCneva 1992-93 wlebSi, rac gamoiwvia fasebis

liberalizebam, miwisZvram da sagareo-ekonomikuri kavSirebis Sewyvetam.

1990-ian wlebSi saxelmwifo dafinansebis sakmarisi an alternatiuli

gzebis Zebna uSedego aRmoCnda, mogvianebiT xelfasebic aRar rigdeboda

saavadmyofoebSi da samedicino maragic Semcirda. aseT mdgomareobaSi

araformaluri gadaxda gardauvali gaxda. yovelive es mkveTrad aisaxeba

mosaxleobis Rarib fenebze romelTa sasicocxlo zRvari mkveTrad iklebs,

socialuri mgomareobis mizeziT.

literaturis mimoxilvisas cxadad gamoCnda, rom 1990-iani wlebidan

samedicino momsaxurebis araTanabari xelmisawvdomobis tendencia sul

ufro da ufro gaZlierda, razec gansakuTrebiT imoqmeda araformaluri

gadaxdebis zrdis faqtorma, ramac Taviseburad uaryofiTi gavlena iqonia

samedicino momsaxurebis Tanabar xelmisawvdomobaze.

levisma Tavis naSromSi ganixila samedicino momsaxurebis

xelmisawvdomobis problema da masTan dakavSirebuli faqtorebi. am

naSromSi Camoyalibda ZiriTadi hipoTezebi romelTa mixedviTac :

savaraudod araformaluri gadasaxadebis zrda da siRaribe pirdapir

urTierTkavSirSi arian erTmaneTTan da amasTanave gavlenas axdenen

mosaxleobis saerTo janmrTelobaze, rac samedicino momsaxurebis

araTanabari xelmisawvdomobis mizezia. hipotezis testireba ganxorcielda

statistikis departamentis mier, erT sul mosaxleze gaTvlil

statistikuri monacemebis mixedviT, sxva da sxva regionebSi:

saqarTveloSi, rumineTSi, yirgizeTSi, albaneTSi ruseTSi da sxva

aRmosavleT evropisa da dsT-s qveynebSi. Sedegebs Semdeg daskvnebamde

mivyavarT:

I . savaraudod avadmyofobis dros Raribi mosaxleoba gacilebiT

naklebad mimarTavs samedicino momsaxurebas da ufro metad, gamoTqvams

wuxils im damabrkolebeli barierebis Sesaxeb, rac mkurnalobasa da

samedicino momsaxurebas Tan axlavs. am bariers mkurnalobisa da

samedicino momsaxurebis maRali fasebi qmnian.

II. rac ufro izrdeba araformaluri gadasaxadebi, miT ufro

izrdeba araTanbari xelmisawvdomobis problema Rarib mosaxleobaSi

- 161 -

aqedan gamomdinare, am ori hipotezis ganxilva da maTi

urTierTkavSiris gansazRvra mniSvnelovnia. momsaxurebis maRali fasebi

momxmareblisTvis miuwvdomelia da mosmaxurebis Rirebulebis zrdasTan

erTad, dabalSemosavliani sazogadoebisTvis, misi miRebac gacilebiT

rTuli xdeba, rac TavisTavad xels uwyobs siRaribis zrdasac.

araformaluri gadasaxadebi SeiZleba CaiTvalos, momsaxurebisadmi

mimarTvianobis Semcirebis ZiriTad mizezad, sxva da sxva regionebSi ara

marto ruseTsa da aRmosavleT evropis qveynebSi, aramed saqarTveloSic.

kvlevebi amtkicebs, rom msgavsi gadaxdebi aris erT erTi yvelaze

gaumarTlebeli da usamarTlo jandacvis dafinansebis forma, romelic

yvelgan sxva da sxvagvaria.

msoflio bankma Caatara kvleva mosaxleobis mier samedicino

momsaxurebis miRebisas araformalur gadaxdebis intensivobis Sesaxeb.

maCveneblebi erT sul mosaxleze, maTi yovelTviuri Semosavlebis mixedviT

gansxvavebulia. am gansxvavebas ganapirobebs sxva da sxva mizezebi, maT

Soris geografiul mdebareoba-qalaqisa da soflis doneze. magaliTad

somxeTSi es maCvenebeli qalaqis doneze Seadgens 8% ,xolo soflis 4%.

aseTive mdgomareobaa sxva qveynebis sofelsa da qalaqs Soris samedicino

momsaxurebisas araformalur gadaxdebTan dakavSirebiT. (World Bank 1997).

xelmisawvdomobis donis gansazRvrisTvis, kvleva CautardaT adamianTa

im jgufs, romlebic ver axerxebdnen eqimTan vizits, an kidev maRali

fasebis gamo ver axerxebdnen eqimis mier gamowerili wamlebis SeZenas.

amgvari respodentebis proporciulobam, 50% Seadgina yofil sabWoTa

kavSiris qveynebSi, magaliTad: somxeTi, saqarTvelo da moldaveTi, xolo

yirgizeTis respublikaSi, aRmoCnda, rom mTliani mosaxleobis 36 %

saerTod ver axerxebs eqimis mier gamowerili wamlebis SeZenas. Lewis, (2000:

24). yovelive es naTeli magaliTia Tu ramdenadaa qveyanaSi miRweuli

Tanbarxelmisawvdomoba samedicino servisisadmi.

balabanovas, falkingemisa da luisis azriT, bulgareTSi (Balabanova

and McKee 2002b), tajikeTSi (Falkingham 2004) azerbaijansa da ukrainaSi (Lewis

2000: 24) Catarebuli kvlevebis Tvisobriv monacemTa analizma aCvena, rom

servis provaiderebi araformalur gadasaxadebis fasebs aweseben imis

mixedviT Tu ramdenad gadaxdisunariania xalxi. pirdapiri gadaxdebi aris

- 162 -

yvelaze regresiuli forma dafinasebisa da aqvs didi zegavlena

samedicino servisis xelmisawvdomobaze, romelic yvelaze mZime tvirTad

awveba Rarib mosaxleobas. (Lewis 2000; World Bank 2001; McKee 2003).

statistikuri Sefasebis mixedviT amgvari gadaxda Seadgenda yofili

dsT qveynebis 70 % . mosaxleoba zogi ixdida oficialurad zogic

araoficialur gadasaxads. metismetad gaWirvebul mdgomareoabaSi

Cavardnil mosaxleobas aseTi viTareba kidev ufro urTulebda

jandacvisadmi momsaxurebis xelmisawvdomobas. isini ubralod ver iReben

janmrTelobis momsaxurebas, romelic legalurad saxelmwifom unda

uzrunvelyos. Rarib mosaxleobis nawili acxadebs rom naklebi

xelmisawvdomoba maT saSualebas ar aZlevT miiRon aucilebeli samedicino

daxmareba. mosaxleobis mesamedi yazaxeTSi, TurqmeneTSi da tajikeTSi

cxovrobs dReSi $4.30 aSS –ze nakleb siRaribis zRvars qvemoT. SeiZleba

ganisazRvros sami tipis araformaluri gadaxda rac adamianebs TavianT

uflebebs ulaxavT samedicino servisis miRebis dros. esenia. jandacvis

provaiderebi (iqneba es kerZo Tu saxelmwifo) aweseben oficialur

gadasaxadebs.

nawilobriv oficialuri gadasaxadebi, rogoricaa gadasaxadebi

wamlebsa da samedicino saSualebebze da mesame - avadmyofebi uxdian

araoficialur Tanxas med personals, rogoc winapiroba an saCuqari maTi

momsaxurebisTvis.

yovelive es kargi magaliTia imisa Tu ramdenad TanasworobiT

sargeblobs mosaxleoba samedicino momsaxurebiT. mosaxleoba iZulebulia

eqimTan viziti gadados, an ukidures SemTxevvamde Tavs aridebs eqimTan

vizits. am maCveneblebis mixedviT somxeTi (92.5%), iseve rogorc saqarTvelo

Rarib mosaxleobas Soris ruseTTan SedarebiT mowinave adgilze dgas

(78.9%). (cxrili 29)

- 163 -

cxrili 29.

respodentebi romlebic avadmyofobis SemTxvevaSi Tavs arideben

eqimTan vizits.

ganviTarebadi

qveynebi

ukidure

sad

Raribebi

mdidrebi Raribebi mdidrebTan

SefardebiT

somxeTi 92.5 36.6 2.53

saqarTvelo 78.9 38.1 2.07

moldaveTi 66.7 33.3 2.00

yazaxeTi 63.0 10.3 6.12

ukraina 54.1 3.1 17.45

yirgizeTi 52.0 9.5 5.47

ruseTi 13.1 2.2 5.95

belorusia 0.0 0.0 -


luisi (Lewis), iseve rogorc falkingemi (Falkingham 2004). eTanxmeba im

azrs, rom SedarebiT ganviTarebul qveynebSic ki, rogoricaa, magaliTad

poloneTi, Cexoslovakia da sxva qveynebi, mosaxleobis mcire nawili (11%)

mainc awydeba dabrkolebas samedicino momsaxurebis maRali fasebis gamo

magaliTad medikamentebis SeZenisas, xolo mosaxleobis garkveul nawils

ki (26%-)s ubralod miaCnia, rom medikamentebis Rirebuleba metismetad

Zviria Tumca es maT gadaulaxav bariers ar uqmnis. rac Seexeba

pensionerebs maTTvis medikamentebis SeZena da mkurnalobis Catareba

sakuTari saxsrebiT gacilebiT rTulia, radgan araformaluri

gadasaxadebi imdenad maRalia, rom srulyofili samedicino momsaxurebis

miReba Znelad misaRwevi xdeba. (Lewis, 2000: 25)

sazogadoebis janmrTelobis saerTo mdgomareobas gansazRvravs

qveynis socialuri da ekonomikuri determinantebi. qveynis socialur da

ekonomikur determinantebs ki misi demografiuli da socioekonomikuri

mdgomareoba gansazRvravs sikvdilianobisa da avadobis maCvnebliT, aseve

Sobadobis ricxviTa da sicocxlis xangrZlivobiT, gansxvaveba am

maCveneblebSi dasavleT evropasa da aRmosavleT evropas Tu dsT-s

- 164 -

qveynebSi mkveTrad gansxvavebulia. 1991-1994 wlebSi yofil sabWoTa kavSiris

qveynebSi mamakacebSi siscocxlis xangrZlivobam 4 wliT daiwia, xolo

qalebisTvis 2.3 wliT Semcirda. igive periodSi ruseTSi vaJTa Sobadoba 6

wlamde Semcirda xolo gogonaTa 3 wliT, rac sikvdilianobis gazrdaze

metyvelebs. kvlevebma, rogorc indiviualur aseve mosaxleobis maStabiT

daamtkica faqti, rom sikvdilianobis krizisis ZiriTadi gamomwvevi mizezi

dabali socialurekonomiuri jgufi iyo. Tu ramdenad gadamwyvet rols

TamaSobs materialuri statusi samedicino momsaxurebis miRebisas da

ramdenad axdens igi gavlenas araformaluri, pirdapiri gadaxdis zrdis

konteqstSi warmoadgens arsebiTi mniSvnelobis sakiTxs da garkveul

Seswavlasac moiTxovs. miCneulia rom cxadad Tu farulad

socioekonomiuri dabrkoleba janmrTelobis mdgomareobas RaribebSi ufro

da ufro auaresebs.

samedicino momsaxurebis Tanabari xelmisawvdomobac garkveuli

determinantebiT ganisazRvreba. mravali kvlevaa Catarebuli sxva da sxva

socialuri uTanasworobis dasamtkiceblad risk-faqtorebis

determinantebis Sefasebis safuZvelze. esenia alkoholi, moweva, sakvebi,

fizikuri datvirTva Tu gadaZabva, Tu sxva fsiqologiuri faqtorebi

romlebic SeiZleba mizezebad dasaxeldes. magram yovelive zemoTxsenebuli

mizezebi korelaciaSi modis siRaribesTan da masTan dakavSirebul

socialur ekonomiur mdgomareobsTan. socialur ekonomikuri maCvenebeli

yvelaze metad cxadad tajikeTis magaliTze Cans. pirvelad daxmarebas

yvelaze xSirad es qveyana mimarTavs, vidre hospitalSi moTavsebis uflebas

moipovebs.

mosaxlebis 50 % Soris romlebic ar mimarTaven samedicino

momsaxurebas avadmyofobis dros imitom rom ar aqvT gadaxdis unari sxva

qveynebTan erTad aRmoCnda saqarTvelo, moldaveTi da somxeTi. yirgizeTSi,

magaliTad mosaxleobis umetesobas ar SeuZlia eqimis mier daniSnuli

wamlebis SeZena. tajikeTSi kidev meti adamiani ver axerxebs elementaruli

daxmarebis miRebas. rodesac saubaria araTanabar xelmisawvdomobasTan

dakavSirebul problemebze pirvel rigSi unda ganvixiloT resursebis

araTanabari gadanawilebis problema, rogorc regionalur aseve saqalaqo

Tu sxva doneze. regionebis doneze gansakuTrebiT mniSvnelovania

- 165 -

araTanabari gadanawileba qalaqsa da sofel Soris. sadac

socioekonomikuri gansxvaveba ufro metad SesamCnevia. soflis mosaxleoba

yovelTvis ufro Raribia vidre qalqis.

hutonma 2002 wels gamoikvlia samedicino momsaxurebis resursebis

ganawileba. romelic aranakleb mniSvnelovania jandacvis menejmentis

efeqturobisTvis. man gamoikvlia samedicino momsaxurebisadmi

uTanasworobis seqtoruli da geografiuli wyaroebi. mas miaCnia, rom

uTanasworoba samedicino servisis miwodebisas warmoiSva sazogadoebrivi

resursebis araTanabari ganawilebisas sxva da sxva regionebsa da sxva da

sxva janmrTelobis seqtorebs Soris. monacemebi aRebulia msoflio bankis

mier Catarebuli sxva da sxva regionebis gamokiTxvebis Sedegebidan. man

aRmoaCina, rom azerbaijanSi, sazogadoebrivi danaxarjebi jandacvaze

Seadgenda mxolod (GDP) mSp-is 1.4 %-s. 1998 wlis monacemebis mixedviT didi

gansxvaveba resursebis gadanawilebaSi SesamCnevia iq sadac erT sul

mosaxleze danaxarji $2-3-ia da iq sadac mxolod 1.2$-ia (World Bank 2003).

dsT-s qveynebisa Tu aRmosavleT da centraluri evropis qveynebis

Sedarebisas mkveTrad Cans mWidro kavSiri socioekonomikur statussa da

adamianis janmrTelobas Soris. am kuTxiT agreTve aRsaniSnavia migraciisa

da migrantebis problema da maTi Tansaworuflebianoba emigrirebul

qveynis sazogadoebis wevrebTan mimarTebaSi samedicino momsaxurebisas.

migracia qveynis socialur ekonomikuri mdgomareobis erTerTi

indikatoria. igi aseve mniSvnelovan gavlenas aqxdens sxva qveynis

ekonomikur viTarebazec. migracia centraluri aziisa da aRmosavleT

evropis qveynebSi gansakuTrebiT aqtualuria.

migraciis TvalsazrisiT ruseTi aSS-s Semdeg meorea msoflioSi,

xolo evropa da centraluri azia ganviTarebadi qveynebidan emigrirebul

mosaxleobis erT mesameds iTvlis. komunizmis dacemis Sedegad mkveTrad

gafarTovda mosaxleobis georgrafiuli sacxovrebeli adgilis Secvla,

rogorc dsT-s qveynebs Soris aseve mis gareTac. 1990-2006 wlebis

ganmavlobaSi migracia yvelaze metad aRiniSneboda dasavleT evropis

qveynebisaken iseve rogors aSS-sken. migracia zogadad gavlenas axdens

qveynis demografiul maCvenebelzec rac gamoixateba rogorc mosaxleobis

SemcirebaSi aseve qveynis ekonomikur maCveneblebSic. rac ufro viTardeba

- 166 -

qveynis ekonomika miT ufro naklebia migracia. Tumca aseve migracia

gavlenas axdens qveynis makroekonomikis zrdaze, iseve rogorc dadebiTad

moqmedebs migrirebul qveynebSi SromiT investiciaze, rac iafi muSaxeli

saxiT aixsneba.

mosaxleobis gadinebas sazRvargareTis qveynebSi da maT arCevans

ganapirobebs rogorc saerTo migraciis tendencia aseve qveynis ekonomikuri

mdgomareoba. magram es marto maRal da dabal anazRaurebad qveynebiT

rodi ganisazRvreba magaliTad: msoflio bankis 2002 wlis statistikuri

monacemebis mixedviT iseT or qveyanaSi rogoricaa slovakeTi da tajikeTi,

romelTagan erTi maRal anazRaurebadi saxelmwifoa, xolo meore dabal

anaRzRaurebad qveyanaTa ricxvs miekuTvneba dsT da evropis qveynebis

mixedviT mniSvnelovani migarcia am or qveyanas Soris ar fiqsirdeba, rac

gvaZlevs imis saSualebas vifiqroT rom migraciis ZiriTad ganmsazRvrel

indikators mxolod maRalSemosavliani qveynebi ar ganapirobeben.

miuxedavad imisa, rom mTavari ganmsazRvreli migraciisa aris

cxovrebis pirobebis gaumjobeseba anu siRaribis daZleva da samuSao

adgilebi, romelic gardamaval qveynebSi metad aqtualur problemas

warmoadgens. migracia sainteresoa rogorc ganviTarebadi aseve

ganviTarebuli qveynebis kuTxiT, radgan migrantebi TavianTi SemosavlebiT

exmarebian sakuTar ojaxebs rac aseve Semdeg maTi qveynis ekonomikazec

aisaxeba, Tumca arsebobs meore mxarec. migrantebi iqneba es kvalificiuri

legaluri, Tu aralegaluri da naklebad kvalificiuri TavianTi wvlili

emigrirebul qveyanaSic SeaqvT. anu aralegalurad momuSave emigrantebi ar

ixdian gadasaxadebs da aseve adgilobriv muSa xelTan gacilebiT iafi

muSaxelia.

ase rom am urTierT gadamkveTi gzebidan sargebeli SeiZleba orive

qveynisTvis iyos, magram rac Seexeba migrantTa Tansaworuflebianobas da

xelmisawvdomobas samedicino daxmarebis sferoSi, es ukve kiTxvis niSnis

qveS dgas. evropisa da aSS-s qveynebi uzrunvelyofen TavianT moqalaqeebs

samedicino dazRvevis saTanado formebiT zrunvas, rac maTTvis gacilebiT

xelmisawvdomia. sakiTxi migrantebTan dakavSirebiT metad mtkivneulia,

radgan momsaxureba metismetad Zviria da am sazogadoebis

warmomadgenlebisTvis miuwvdomeli. jandacvis servisi migrantebisTvis arc

- 167 -

ise martivad xelmisawvdomi da miTumetes Tanabaria. miuxedavad imisa rom

sakmaod rTulia migrantTa ricxvis dazusteba msoflio bankis monacemebiT

savaraudod es cifri 200 milion adamians aRwevs. demografiuli da

ekonomikuri disbalansi qveynebs Soris SeiZleba migraciis ZiriTad

faqtorad CaiTvalos.

arsebobs mkvlevarTa meore nawili mag: ebkok-i (1985w.) da mogvianebiT

i.komarovo (1994w.), romlebic miiCneven, rom adamianis janmrTelobis

SenarCunebasa Tu gauaresebaze ZiriTad zemoqmedebas axdens socialuri

garemo, memkvidreobiTi biologiuri faqtorebi da fizikuri garemo.

mxolod mcire (8-12%) SemTxvevaSi eniWeba gadamwyveti roli samedicino

faqtorebs rogoricaa jandacvis sistemis mier gaweuli arasrulfasovani

momsaxurebis done. maSasadame, cxovrebis wesi warmoadgens im sferos,

romelic gadamwyvetad moqmedebs mosaxleobis janmrTelobaze.

ramodenime qveynis sociologiuri kvlevebis jvaredini (cross analysis)

analizi (LLH survey) sicocxlis xangrZlivobis, cxovrebis standartebisa

da janmrTelobis gamokiTxvis meTodologiiT, SesaZleblobas gvaZlevs

ukeTesi daskvnebis gasakeTeblad. am kiTxvaris monacemebis analiziT advili

gasagebia socioekonomikuri uTanasworoba garkveuli periodis

ganmavlobaSi konkretul regionSi, konkretul socialur jgufebs Soris,

konkretul magaliTebze dayrdnobiT, rac metad mniSvnelovani da

xelsayreli meTodia dakvirvebisTvis.

Tu ramdenad axdens zegavlenas sqesi socioekonimikur statussa da

janrTelobis urTierTkavSirs Soris arainfeqciur daavadebebTan(NCD)

mimarTebaSi aris sakiTxi, romelic mravali kvlevis sagania, Tumca am

sakiTxis Rrmad Seswavlis mcdeloba naklebia. estoneTSi magaliTad qalTa

da mamakacTa Soris socioekonomikuri statusis ganmsazRvreli

damaxasiaTebeli mniSvnelovani faqtorebi, rogoricaa materialuri

statusi an ganaTleba, qalebisTvis gacilebiT mniSvnelovania, magram igive

mamakacebisTvis gacilebiT naklebad mniSvnelovania.

saintereso informaciis momcemi iqneba im kiTxvarebs Soris kavSiris

povna, romlebic gaTvlilia socioekonomikur sakiTxebze. im kiTxvarebidan,

romlebic yuradRebas janmrTelobaze amaxvileben ufro meti (NCD-is)

arainfeqciur daavadebebTan dakavSirebuli unda iyos, radgan NCD-is

- 168 -

kvlevis Sedegebi qveynis doneze gacilebiT mniSvnelovania sociologiuri

mdgomareobis Sesafaseblad. miRebuli monacemebidan yvelaze did

sirTules warmoadgens socioekonomikuri statusis sxva da sxvagvari

ganzogadeba da gazomva. (Kakwani 1997; Mackenbach and Kunst 1997.)

ganxilul literaturul masalebs Soris naklovanebad SeiZleba

CaiTvalos is rom ar aris sakmarisi informacia socioekonomiur

ganmasxvaveblebis Sesaxeb arainfeqciur daavadebebsa da sikvdilianobis

SemTxvevebSi respublikebsa da yofili sabWoTa kavSiris qveynebSi.

aucilebelia socioekonomikur statusisa da arainfeqciur qronikul

daavadebebs Soris kavSiris gamokvleva sicocxlis xangrZlivobis kuTxiT.

cota raodenobaa gamokiTxvebisa, romelSic Sedis kiTxva “bavSobaSi

gadatanili ekonomiuri/materialuri gaWirvebis Sesaxeb” romelmac

SeiZleba garkveuli gavlena iqonios janmrTelobaze, anu warsulSi

gadatanili materialuri gaWirveba an sxva saxis danaklisi SesaZloa

mWidro kavSirSi iyos janmrTelobis gauaresebasTan.

Catarebuli mecnieruli kvlevebis mixedviT, janmrTelobaze gavlenas

axdenen Semdegi garemoebebi: kveba, ganaTleba, Semosavali da cxovrebis

wesi, garemo pirobebi.

am faqtorze bevradaa damokidebuli kvebis produqtebis moxmarebis

dinamikac, romelic ukanasknel wlebSi mkveTrad Seicvala. arsebuli

monacemebiT mosaxleobis umetesi nawilis yoveldRiur racionSi ZiriTadad

Sedis puri da purproduqtebi (sxvadasxva socialuri jgufebisaTvis 65-dan

85%-mde), bostneuli - 8-14%, xili sezonis mixedviT - 2-12%. amasTan

mkveTrad iklo rZisa da rZis produqtebis (2-8% sxvadasxva jgufebis

mixedviT), xorcisa da xorcis produqtebis (5-12%), Saqrisa da sakonditro

nawarmis (2-6%) moxmarebam.

mosaxleobis kvebis racionis kaloriulobam sxva qveynebSiac iklo,

magram dsT-s qveynebSi, da maT Soris saqarTveloSi es procesi gacilebiT

swrafad mimdinareobs. amasTan, sakvebis racionis kaloriuloba ufro

dabalia, vidre dadgenili fiziologiuri norma.

sakvebi janmrTelobasTan mimarTebaSi uZlieresi faqtoria.

statistikis mixedviT mosaxleobis 51.8% dReSi 2500 kilo kaloriaze

naklebs iRebs sakvebidan. sakvebi SeiZleba iyos, rogorc kargi da

- 169 -

janmrTelobisTvis sasargeblo, aseve iseTi daavadebebis gamomwvevic,

rogorebicaa mag: gulsisxlZarRvTa, simsivnuri, diabeti Tu sxva qronikuli

saxis daavadebebi rac SesaZlo araswori kvebis Sedegad iyos

provocirebuli.

- 170 -

Ddaskvnebi da rekomendaciebi

yvela qveynis pirvelad jandacvaSi, medicinis sxva ganxrebisagan

gansxvavebiT, Zalze cota kvlevaa Catarebuli. aq mtkicebulebebi naklebia

da iluziebi Warbobs. 2003 wels msoflio jandacvis organizacia daJinebiT

moiTxovda jandacvis sistemis momavali, dafuZvneboda pirvelad jandacvas,

rac daaxloebiT niSnavs ,,gadasaxdebis dakisrebasa da uwyvet Zalisxmevas

warmomadgenlobiTobis gasaumjobeseblad”. evropaSi, msoflio jandacvis

organizaciis lublianas dadgenilebiTac xazi gaesva igive principebs, anu

pirvelad jandacvaze aqcents.

erTerTi mniSvnelovani faqtori, romelic moqmedebs mosaxleobis

jamrTelobis mdgomareobaze, aris erovnuli keTildReoba da misi

gadanawileba. socialur fenebsa da jamrTelobas Soris urTierTkavSiri,

faqtiurad kargad aris gamokvleuli evropaSi, sadac jamrTelobis

uzrunvelyofa araTanabradaa gadanawilebuli. imisaTvis rom naTeli

movfinoT mdgomareobas, Uunda vaRiaroT, rom jandacvis sistemas ar

SeuZlia Seqmnas janmrTeloba, magram ZaluZs misi gamosworeba an

optimizacia: tanjvis, avadobis da sikvdilianobis prevencia. jamrTeloba

ar aris ,,adamianuri kanoni” ase rom iyos sikvdilianoba da avadoba

iqneboda ,,adamianisaTvis uCveulo da arakanonieri”.

nebismier jandacvis sistemas gadasawyveti aqvs, Tu rogor imuSavebs

TiToeuli safexuri da ra urTierT damokidebuleba iqneba maT Soris.

TiToeul safexurs Tavisi gasagebi roli unda hqondes da amave dros

mxardaWerili unda iyos resursebiT, organizaciiTa da ganaTlebiT

(saswavlo kursebi da zedamxelvelobiTi funqcia). mag: qveyanaSi

daavadebaTa prevencia SesaZloa erToblivad xorcieldebodes, radgan saqme

imunizacias exeba, SesaZloa maTi organizeba pirvelad jandacvaSic,

rogorc es fineTSi, italiaSi da holandiaSi xdeba. cnobilia, rom im

regionSi sadac arc Tu saxarbielo ekonomikuri da socialuri situaciaa,

jandacvis momsaxurebas gacilebiT meti resursebi da daxvewili

samedicino programebi esaWiroeba.

- 171 -

msofliom gadaWriT aRiara pirveladi jandacvis fundamentaluri

upiratesoba da aucilebloba jandacvis sistemis efqturobaSi. dRemde

jandacvis programebis mimdinareobisas da gamoikveTa ZiriTadi

problemebi:

1) jandacvis programebi mosaxleobis saWiroebis umetesobas ar moicavs;

2) jandacvis programebi mosaxleobis moTxovnebs ar pasuxobs;

3) limitirebuli dafinanseba seriozul problemebs uqmnis samedicino

momsaxurebis miwodebis dros;

4) momxmareblebis mier samedicino momsaxurebis miuReblobis mizezebia :

ara imformirebuleba; teritoriuli problema; sxvadasxva saxis samedicino

momsaxurebis misaRebad regionebis mosaxleobas uwevs sxvadasxva manZilze

gadaadgileba, rac finansur, drois da klimatur problemebs ukavSirdeba;

5) ZiriTad problemad programebis marTvaSi pirvel adgilzea araswori

dagegmva da menejmenti, mozadebuli kadrebis deficiti, komunikaciebis

deficiti;

6) programaSi ar aris asaxuli regionaluri Taviseburebebi klimato-

geografiuli, mimosvlis saSualebebi, saTanado kadrebi, momxmarebelTan

sakomunikacio saSualebebis gamoyenebis SesaZlebloba;

7) arasakmarisi dafinanseba, gansakuTrebiT wlis bolos, daxmarebis

mimwodebels uqmnis seriozul problemas momxmarebelTan;

8) umweoTa programebis farglebSi gaTvaliswinebuli momsaxurebis

raodenoba ar შeesabameba limitirebul dafinansebas rac xSirad

konfliqtisa da pacientTa uflebebis darRvevis mizezi xdeba. unda

aRiniSnos, rom es ukanaskneli umravles SemTxvevaSi ar xdeba gansjis

sagani vinaidan momxmarebeli oficialuri saCivrisgan Tavs ikavebs. aseve

gasaTvaliswinebelia, rom momxmarebelTa umravlesoba pensioneri da

xandazmulia da aucilebeli xdeba sruli paketis gamoyeneba;

9) sakmarisad rTulia, paketiT gaTvaliswinebuli momsaxureobis efeqturi

marTva, rodesac adgili aqvs dafinansebis dagvianebas da Seusabamobas,

Rirebulebasa da raodenobas Soris;

10) samedicino personalis kmayofilebis xarisxi da samedicino

dawesebulebis SesaZleblobebisa da saqmianobis Sefaseba Zalze dabalia;

- 172 -

11) adgilobrivi marTvis organoebidan ara programebis xelSewyoba,

dasaxvewia programebis monitoringisa da Sesrulebuli samuSaos

kontrolis meqanizmebi da formebi.

gamokvlevis Sedegad dadginda, rom seriozul problemas warmoadgens

programebis danergva da marTva. ar aris koordinirebuli monitoringisa

da Sefasebis sistemebi, vertikaluri kavSirebi: samedicino dawesebulebis

xelmZRvanelobasa da saministros Soris programebis mimdinareobis,

ganxorcielebis siZneleebis, momsaxureobis gaumjobesebis realuri gzebis

Sesaxeb aseve programebis mimdinareoba adgilebze gavlenas ar axdens

axali gadawyvetilebebis miRebasa da programuli uzrunvelyofis

cvlilebebze:

• sicialuri programebiT uzrunvelyofis Sesaxeb informacia ar aris

xelmisawvdomi mosaxleobis farTo masebisTvis. masmediis saSualebiT ar

xdeba programebis Sesaxeb mosaxleobis regularuli informireba.

• samedicino dawesebulebSi pacientebs ar eZlevaT amomwuravi informacia

programebis moculobis, gavrcelebisa da dafinansebis Sesaxeb, xolo

programuli dafinansebis formebisa da moculobebis swrafi cvla kidev

ufro aZnelebs swori informaciis gavrcelebas.

• programis dagegmvisas ar aris gaTvaliswinebuli regionaluri

Taviseburebani (maRalmTiani regionebisaTvis gaZnelebuli mimosvla da

damatebiTi komunikaciebis mozidva) da mosaxleobis saWiroebani, rac

gavlenas axdens samedicino momsaxureobis xelmisawvdomobaze.

• mniSvnelovania adgilobrivi TviTmarTvelobis organoebis mxridan

samedicino dawesebulebebSi programis ganxorcielebis xelSewyoba.

• limitirebuli programuli dafinansebis pirobebSi samedicino

dawesebulebas ar SeuZlia gauwios samedicino momsaxureoba Tvis

bolosaTvis dadgenili formatiT, rac pacientis mxridan konfliqtis

xSiri mizezi xdeba.

• programuli dafinansebis dagvianeba saSulod TiTqmis ramodenime TviT

aZnelebs programiT mosaxleobis dakmayofilebis maRali xarisxis miRwevas.

• xarisxiani samedicino momsaxureobis miwodeba gaZnelebulia maRal

xarisxiani kadrebis simciriT, gansakuTrebiT maRal mTian regionebSi,

- 173 -

dabali anazRaureba ver uqmnis samedicino muSaks sakmaris motivacias

xarisxiani samedicino momsaxureobis miwodebaSi.

saqarTveloSi bolo periodSi ganviTarebuli uaryofiTi cvlilebebi

mkafiod aisaxa mosaxleobis socialur mdgomareobaze, gansakuTrebiT im

ojaxebze, romlebic wlebis ganmavlobaSi xelmokled cxovrobdnen, ver

gaumklavdnen qveyanaSi mimdinare politikur-ekonomikuri gardatexebis

fonze finansur siZneleebs da ukiduresad gauWirdaT.

dRes, rodesac qveyanaSi dawyebulia umniSvnelovanesi Zvrebi umravles

sferoSi reformebis umokles vadaSi gasatareblad, rodesac kerZo

seqtoris xelSewyobis, investiciebis mozidvis mizniTa da

infrastruqturi ganviTarebis paralelurad Seqmnilia saukeTeso biznes-

garemo, rodesac saxelmwifo miiltvis Tanamedrove, evropuli

standartebis Sesabamisobis miRwevisaTvis Tavdacvis, jandacvis,

ganaTlebisa da sxvadasxva mniSvnelovan dargebSi, parkebis, skverebisa da

sportuli moednebis mSeneblobebis aucileblobis fonze erT-erT

umTavres problemad rCeba qveynis mzardi ekonomikuri ganviTarebis

landSaptSi mZime socialuri foni.

Cveni qveynis jandacvis sistemam, semaSkos modelis

decentralizaciis Semdgom, mravaljer ganicada transformacia.

mravaljeradi mcdeloba jandacvis sistemis reformis aRmoCnda

arasakmarisi, amitom saboloo Sedegze zemoqmedeba ver moaxdina

SemuSavebulma meTodikebma da praqtikulma instruqciebma.

miuxedavad am procesebisa, qveyanaSi da maT Soris TbilisSi realurad

arsebobs ararentabeluri samkurnalo dawesebulebebis Warbi fizikuri da

inteleqtualuri kapitali, dabali dafinansebis pirobebSi stimulis

araseboba, resursebis deficiti, gadamxdelunarianobis dabali maCvenebeli,

saxelmwifos tvirTad awevs samkurnalo dawesebulebebis xarjis (gasavali)

anazRaureba, Semosavlebis simciris mizezia aradamakmayofilebeli marTva,

araefeqturi midgomebi da Ria korufcia stimulis ararsebobis fonze.

jandacvis sistema saWiroebs globalur reformas, gvaqvs ra marTlac

Rirebuli resursi, romelsac racionalizacia da gardaqmna esaWiroeba.

- 174 -

jandacvis sistemis politikuri argumentia: bazari – es aris panacea

(griffin 1989w.) jandacvis sistemis ekonomikuri politikis 3 mTavari

mizania:

1. saerTo danaxarjebis Semcireba (gasavlebis makroekonomikuri kontroli);

2. efeqturoba (resursebis mikroekonomikuri ganawileba);

3. dakmayofileba (gadamxdelTunarianobis maCveneblis gazrda).

dReisaTvis msoflios bevr qveynebSi amowurulia jandacis sistemis

eqstensiuri ganviTarebis SesaZleblobebi. jandacvis resursebis meqanikuri

gazrdis meSveobiT janmrTelobaze zemoqmedeba praqtikulad aRaraa

gamarTlebuli da mZime tvirTad awveba ekonomikas. gaCnda jandacvis

ganviTarebis intensiur gzebze gadayvanis, samedicino daxmarebis xarisxisa

da efeqturobis gazrdis, masSi dabandebuli resursebidan (romelic xSir

SemTxvevaSi klebulobs) meti Sedegianobis miRwevis aucilebloba.

jandacvis nacionaluri politika unda Seesabamebodes Semdeg

kanonzomierebebs:

1. janmrTelobis mdgomareobis gaumjobeseba;

2. mosaxleobis dakmayofileba (gaweuli samedicino momsaxureobis

mocvisa da xarisxis gaTvaliswinebiT);

3. samedicino daxmarebis xarisxis uwyveti amaRleba;

4. marTvis efeqturobis amaRleba;

5. pacientTa saWiroebebze aqcentirebuli xarisxis totaluri marTva;

6. finansuri riskebisgan dacva: ar gulisxmobs mosaxleobis

gaTavisuflebas samedicino momsaxureobaze gadasaxadebisgan,

samarTlianobis principis realizaciis gaTvaliswinebiT, pirvel rigSi

finansuri riskisgan dacvas saWiroebs garkveuli socialuri

kategoriebi (miznobrivi socialur-ekonomiuri da jandacviTi

programebis SemuSaveba mag: garkveuli kategoriebis socialuri

dazRveva);

7. resursebis efeqturi gamoyeneba jandacvis regulaciis sabazro

meqanizmebis ganviTarebis pirobebSi;

8. jandacvis sistemis socialur-ekonomikuri efeqturoba: minimaluri

resursebiT maqsimaluri Sedegis miRweva.

- 175 -

jandacvis sistemis globaluri reforma iTvaliswinebs mkveTr

cvlilebebs yvela mimarTulebiT: dafinanseba, organizacia, regulireba,

romelic unda aisaxos samedicino daxmarebis rezultatze. sadazRvevo

principebze gadasvla, jandacvis dawesebulebebis optimizacia da

restruqturizacia, pirveladi jandacvis ganviTarebis mizniT saojaxo

eqimis modelis srulyofili gavrcoba-ganviTareba, kadrebis gadamzadeba,

dafinansebis axal formaze gadasvla, infrasrtuqturis gaZliereba.

reformis ganxorcieleba cvlilebebis kompleqsuri procesia,

sistemuri cvlilebebis miRweva garkveul dros moiTxovs.

dafinansebis mkveTri gazrda ar iZleva efeqts, Tu ar iqneba

ganviTarebuli infrastruqtura da efeqturi da moqnili jandacvis

sistema; aucilebelia finansebis swori gadanawileba prioritetulobis

mixedviT, mosaxleobis socialurad daucvel fenebze orientireba da

samedecino dawesebulebebisTvis dafinansebis mxridan stimulis gaCena.

reformis erT-erTi nawilia sazogadoebis informaciuloba. bazris

globalurma Semotrialebam SeiZleba gamoiwvios negatiuri da skeptikuri

damokidebuleba momxmarebelTa mxridan.

municipaluri biujetiT samkurnalo jandacviTi programebis saxiT

finansdeboda iseTi komponentebi, romlebic ar iyo gaTvaliswinebuli

centraluri biujetiT, magram mniSvnelovan problemas warmoadgenda.

saqarTvelos Sromis, janmrTelobisa da socialuri dacvis

saministros iniciativiT ganisazRvra is socialurad daucveli ojaxebi,

romlebzec gavrceldeba saxelmwifos mier dadgenili SeRavaTebi da

daxmarebebi. aRsaniSnavia, rom saqalaqo samsaxuris mier dazRveuli

kontingentis umetesoba moxvda aRniSnul bazaSi.

saqarTvelos jandacvis sistemis reformis mixedviT, samedicino

momsaxurebis miwodebis programuli dafinansebis forma mTlianad

Seicvala sadazRvevo principiT, rac saxelmwifo finansebis xarjvis

gamWirvaleobas iTvaliswinebs. amasTanave, bazisuri paketi, romelic

moicavs rogorc ambulatoriul, ise stacionarul mkurnalobas,

gankuTvnilia siRaribis zRvars myofi mosaxleobisTvis. Sesabamisad,

gauqmebul iqna daxmarebebi kategoriebis mixedviT, ramac sazogadoebis am

nawilis ukmayofileba gamoiwvia.

- 176 -

unda aRiniSnos, rom kategoriebad dayofa TavisTavad mianiSnebs maTi

daucvelobis statuss (invalidi, martoxela, marCenaldakarguli), Tumca ar

gamoricxavs maT socialur keTildReobas.

pirveladi janmrTelobis dacvis sistema ar gulisxmobs mxolod

mosaxleobis samedicino momsaxurebas, aramed eris janmrTelobis

gaumjobesebisaTvis iseTi umniSvnelovanesi RonisZiebebis gatarebasac,

rogoricaa usafrTxo garemos, sasmeli wylis da sakvebis uzrunvelyofas,

gonivruli demografiuli politikis gatarebas, jansaRi cxovrebis wesis

xelSewyobas da sxv. janmrTelobis dacvis sistemis XXI saukunis modeli

unda eyrdnobodes samarTlianobis, xelmisawvdomobisa da

Tanasworuflebianobis principebs. amasTan, mosaxleobis janmrTelobis

mdgomareobis Sefaseba unda xorcieldebodes ara mxolod avadobis,

invalidobisa da sikvdilianobis maCveneblebiT, aramed pirovnebis, ojaxisa

da mTlianad sazogadoebis socialuri, fizikuri da fsiqikuri

keTildReobiTac.

pirveladi janmrTelobis dacvis sistemis prioritetebis SerCeva da

strategiebis Camoyalibeba unda emyarebodes Semdeg ZiriTad faseulobebsa

da principebs:

♦ janmrTeloba, rogorc sazogadoebis socialuri ganviTarebis

mTavari mizani;

♦ Tanasworuflebianoba da solidaroba mosaxleobis

janmrTelobis dacvis saqmeSi;

♦ pirovnebaze orientirebuli janmrTelobis dacvis sistemis

ganviTareba;

♦ mecnieruli dasabuTeba, gulisxmiereba da angariSgeba, rogorc

janmrTelobis dacvis sferoSi SesamuSavebel da gansaxorcielebel

RonisZiebaTa eTikuri safuZveli;

♦ janmrTelobis dacvis strategiaTa mdgradoba. janmrTelobis

dacvis ganviTarebis strategia gulisxmobs sam ZiriTad mimarTulebas:

1) avadobisa da travmebis Tavidan acilebas da janmrTelobis

gaumjobesebisaTvis gamiznuli RonisZiebani;

2) avadmyofebisa da travmirebulebisTvis aucilebeli samedicino

momsaxurebis uzrunvelyofa;

- 177 -

3) janmrTelobis dacvis ganviTarebis interesebidan gamomdinare

sazogadoebis resursebis mobilizebis axali meqanizmis Camoyalibeba.

mosaxleobis janmrTelobis mdgomareobis gaumjobeseba gulisxmobs am

saqmeSi mTeli sazogadoebis monawileobas. aqedan gamomdinare, jandacvis

erovnuli politikis danergvis ZiriTad etapebs unda warmoadgendes:

1) iseTi struqturebis Seqmna, romlebic uzrunvelyofen multiseqtorul

da organizaciul TanamSromlobas da koordinacias;

2) sxvadasxva dawesebulebebis, organizaciebis da mTeli sazogadoebis

informireba imis Sesaxeb, Tu ra RonisZiebebis gatarebaa saWiro yoveli

moqalaqis Tu mTlianad sazogadoebis janmrTelobis mdgomareobis

gaumjobesebisaTvis;

3) saTanado kvlevebisa da sainformacio sistemebis ganviTareba

janmrTelobis dacvis dagegmvis, calkeuli programebis realizaciisa da

maTi Sefasebis organizebis mizniT;

4) jandacvis erovnuli politikis ganxorcielebisaTvis farTo speqtris

partnioruli urTierTobebis damyareba.

SemoTavazebuli rekomendaciebi ar arsebobs pirveladi jandacvis

saukeTeso modeli, romlis kopirebac SesaZlebelia. evropis pirveladi

jandacvis, aq ganxiluli saukeTeso modelebi, SesaZloa dagvexmaron rom

gavigoT bazisuri sakiTxebi, iseTebi rogoricaa susti zogadi praqtikis

negatiuri rgolis damsxvreva da ,,geiT qiferobis” mniSvneloba. magram aq

sakmarisi informaciis Semcveli jandacvis politikis kanonebis,

gamzadebuli paketi, romelic dabolovdeba SesaniSnavi pirveladi

jandacvis sistemiT, ar aris mocemuli. yvela qveyanam unda amoirCios

sakuTari gza, Tavisi istoriis, kulturis, simdidrisa da

sociopolitikuri garemos gaTvaliswinebiT.

SemuSavda Semdegi rekomendaciebi :

1. pirveladi jandacvis samecniero baza Raribia, fasebis SeRavaTianobis,

konkurentunariani alternativebis mtkicebulebebTan mimarTebaSi.

saqarTvelos pirveladi jandacva, jandacvis sistemis fuZe unda gaxdes;

2. saqarTveloSi eqTnebs, menejerebs, farmacevtebsa da kadris sxva wevrebs

susti araformaluri politikuri Zalaufleba gaaCniaT, romelic garkveul

wilad Seefasebaa maTi reputacias. msoflos bevr qveyanaSi zogadi

- 178 -

praqtikosebi, pirvelad jandacvaSi wamyvani specialistebi arian, sxva

specialistebTan SedarebiT, ukeTesi reputaciiTa da politikuri

ZalauflebiT ;

3. saqarTveloSi zogad praqtikosebs esaWiroebaT minimaluri datvirTva,

imisaTvis rom SeinarCunon TavianTi codna da gamocdileba. aRniSnulidan

gamomdinare saxelmwifom unda moiZios organizebis, anazRaurebis, samuSao

Zalis dagegmvis gansxvavebuli gzebi;

4. zogadi praqtikosebi, sxva specialistebTan SedarebiT, zrunaven mravali

daavadebis SemTxvevaSi, ise rom xarisxs ar aqveiTeben da xSirad maTi

momsaxureba naklebi fasi Rirs. radgan isini garkveulwilad ,,filtraven”

specialistebTan kontaqtis survilis mqone mosaxleobas swored am

prioritetebidan gamomdinare saqrTveloSi unda gaizardos

specialistebisTvis gamoyofili grZelvadiani dabal procentiani

kreditebi;

5. araformaluri politikuri Zalaufleba eqvsi ZiriTadi partniori

dajgufebis xelSia: mTavrobis, damzRvevebis, specialestebis, pacientebis,

saswavlo, kvleviTi dawesebulebebisa da jandacvis industriis. ZiriTadi

wyaro araformaluri politikuri Zalauflebisa aris: sakuTreba da

finansuri resursebi, ganaTleba da informaciuli resursebi, socialuri

da politikuri mxardaWera. moqmedi pirebis urTierTqmedeba aucilebelia

Seicvalos. jandacvis politika ori gziT: urTierTqmedebebis Sesaxeb

kanonebis modifikaciiT, resursebis ganTavsebisa da gadanawilebis

saSualebiT;

6. saqrTvelos mTavrobam pirveladi jandacvis mxardasaWerad, unda

aamoqmeddes resursebi da kanonebi, xeli Seuwyos zogad praqtikas aTi

ZiriTadi qmedebis sSualebiT: a) sxva specialistebze xelmisawvdomobis

limitirebiTa da zogadi praqtikosebisaTvis funqciis miniWebiT.

b) makoordinirebuli reformis mxardaWerisa da pirveladi jandacvis

bazisuri maxasiaTeblebis xazgasmiT, rogorebicaa: koordinacia,

xangrZlivoba da masStaburoba. g) sakmao raodenobis finansuri da

samedicino resursebis ganTavsebiT, ramac pirveladi jandacvis

specialistebs saSualeba unda misces epasuxos pacientTa met zogad

problemebze, rogoricaa qronikuli daavadebebi da mosaxleobis avadoba,

- 179 -

gadaWran pacientTa mTeli raodenobis 90%-is problemebi pirveladi

jandacvis kompetenciis farglebSi d)kapitaciis meTodis, rogorc

anazRaurebis meTodis, dafuZvnebiT (plius fuladi waxaliseba da saerTo

miznis stimulireba) aseve pacientTa siis SemoRebiT (SesaZebloba imuSaos

sazogadoebasTan). e)pirveladi jandacvis profilis gafarToebis Sesaxeb

reformis mxardaWeriT. v)rogorc gadawyvetilebebis miRebis

decentralizaciis, aseve profesiuli qselebis Seqmnis tolfasi

mxardaWeriT. z)studentebis miRebis raodenobis SezRudva da

savaldebulo profesiuli swavleba; T)ganaTlebis produqtirebisa da

gavrcobis xelSewyobiT;

7. radgan zogad praqtikosebs specialistebis msgavsi, an ukeTesi xelfasi

aqvT, amitom maT ukeTesi gamocdileba da samecniero bazaze dayrdnobili

codna moeTxovebaT da es marTlac specifiuri maxasiaTebelia zogadi

praqtikisa. aRniSnulidan gamomdinare zogad praqtikosebs unda mieces

saSualeba, TviTonve SeZlon mniSvnelovani gadawyvetilebis miReba,

pacientTa nebismier problemasTan dakavSirebiT.

8. zogad praqtikosTa asociaciebis, gasaZliereblad aucilebelia

Tormeti ZiriTadi mimarTulebais gaZliereba:

a)profesiuli damokidebuleba b)yoveldRiur praqtikaSi pirveli kontaqtis

uflebis monopolirebis samecniero dasabuTeba; g)multidi-

sciplinaruli jgufebis arseboba; d)gafarTovebuli politikuri

davalebebi; e)codnis produqtireba (kvlevebis); v)informaciuli

kontroli (dabali da maRali teqnologiebis gamoyenebis saSualebiT);

z)erovnuli jandacvis fasebis kontrolirebaze zegavlena; T)jandacvis

individualuri kanonis xelSewyoba; i)mosaxleobis kmayofileba;

k)lobireba ara marto gamomuSavebis sakiTxebTan mimarTebaSi;

l)adgilobrivi zogadi praqtikosebis, TviTmakoordinirebeli marTvelobis

xelSewyoba, qselebis msgavsi mowyobis saSualebiT,

m)samedicino ganaTlebis uwyvetobis ganviTareba da xelaxali akreditaciis

xelSewyoba;

9. saqarTveloSi arsebuli finansuri deficitis miuxedavad aucilebelia,

kvlevebis mxardasaWeri fondebis Seqmna. kvlevebi araformaluri politikis

wyaroa, radgan is zrdis codnisa da informaciis resursebs. saukeTeso

- 180 -

modelis mqone qveynebSi, zogad praqtikosTa kvlevlevebi kargadaa

ganviTarebuli, da mxardaWerilia universitetebisa da kvleviTi institubis

mier. erovnuli da saerTaSoriso saxelmwifo da kerZo organizaciebi

exmarebian kvlevebs, fondebisa da bazisuri nimuSebis warmoebiT,

magaliTad rogoricaa klasifikaciebi da sxva.

10. saqarTveloSi zogadi praqtika ZiriTadad RaribTa jandacvad aRiqmeba,

rac mcdari warmodgenaa da dargisTvis didi zianis momtania.

saxelmwifodan aucilebelia mosaxleobis iformireba am stereotipis

Sesacvlelad da aRniSnulisTvis RonisZiebebis dafinanseba.

ar arsebobs pirveladi jandacvis gamzadebuli, saukeTeso modeli,

romlis pirdapir kopirebacaa SesaZlebeli. pirvelad jandacvaSi zogadi

praqtikosebi mTavari moqmedi pirebi arian. pirveladi jandacvaa wamyvania

jandacvis sistemis ganviTarebisa da dabalansebis TvalsazrisiT.

mTavrobam da specialistTa asociebma, mZlavri pirveladi jandacvis

sistemis Camoyalibebas xeli unda Seuwyon universitetebis, kvlevebis,

damzRvevebis, pacientebisa da jandacvis industriis xelSewyobiT.

Zalze cudia rom mravali kritikuli kiTxva pirveladi jandacvis

ganviTarebis sakiTxTan mimarTebaSi upasuxod aris darCenili, yovelive

amas mivyavarT daskvnamde, rom arc erTma qveyanam ar unda isargeblos

meoris magaliTiT, rogorc receptiT. srulyofis meqanizmebi aris moqmedi

pirebisa da dainteresebuli mxareebis ZiriTadi kompetencia.

- 181 -

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health core and spcio-economic change. Pediatrics, 1988, 81, 4, 542-548.

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181. Dialogue on International Migration and Development Round Table 1 September 14, 2006

p.1-9

danarTi IO

kiTxvari: samedicino momsaxurebis xelmisawvdomoba

1. sqesi:

1. mamrobiTi 2. mdedrobiTi

- 192 -

2. asaki: ------------------------------

3. ojaxuri mdgomareoba:

1. daojaxebuli 2 dasaojaxebeli 3. ganqorwinebuli

4. qvrivi 5.sxva

4. sacxovrebeli adgili

1. qalaqi 2. raioni 3. sxva

5. saSualod yovelTviuri Semosavali ?

1. 100-200; 2. 200-400; 3. 400-100; 4. 1000-meti 5. sxva

6. ganaTleba:

1. umaRlesi; 2.saSualo; 3. arasruli 4. arc erTi

7. Tqveni saqmianobis tipi:

1. fizikuri samuSao; 2. inteleqtualuri samuSao; 3 umuSevari

4. arc erTi

8. ojaxis wevrTa raodenoba : --------------------------------------

9. gyavT Tu ara ojaxis eqimi?:

K1. diax 2. ara

10. ramdenad xSirad mimarTavT eqims?

1. TveSi erTxel, 2. weliwadSi erTxel, 3. saWiroebisamebr;

4 ukiduresi aucileblobis SemTxvevaSi 5 arasodes

11. ramdenad xSirad gixdebad saavadmyofoSi mkurnaloba?

1. weliwadSi erTxel 2. mxolod aucileblobis SemxvevaSi

3. arasodes 4. sxva

- 193 -

12 ras aniWebT upiratosobas ?

1. mkurnaloba; 2. profilaqtikuri gamokvleva.

13 rodesac eqimis konsultacia gWirdebaT vis mimarTavT ?

1. TqvenTvis nacnob eqims 2. nebismier uaxloes poliklinikis

(ubnis) eqims.

3. saavadmyofos eqims 4 sxva

14. Tqveni azriT saWiroebs Tu ara pirveladi jandacvis sistemis

reformirebas?

D1. diax 2. ara 3. ar vici 4. sxva

15. ra azrisa xarT pirveladi jandacvis sistemis mimdinare reformis

Sesaxeb, romelic

gulisxmobs 100 axali saavadmyofos aSenebas?

1. Zalian momwons 2. momwons 3. vfiqrob es arafers Secvlis

4. ar momwons 5. winaaRmdegi var 6. arc erTi.

16 TqvenTvis ra waramoadgens pirveladi jandacvis sistemis reformis

prioritets?

1. mkurnalobis gaiafeba

2. mkurnalobis xarisxis gaumjobeseba

3. mkurnalobis Tanabrad yvelasaTvis xelmisawvdomoba

4. arc erTi

17 Tqveni azriT pirveladi jandacvis sistemis reformis Sedegad:

1. gaizrdeba mkurnalobis fasi

2. Semcirdeba mkurnalobis Rirebuleba

3. gaxdeba Tanabrad xelmisawvdomi

4. gaxdeba ufro efeqturi

- 194 -

5. sxva

18 Tqveni azriT romeli daavadebebia dResdReobiT saqarTveloSi

yvelaze metad gavrcelebuli?

1.gul-sisxlZarRvTa daavadebebi 2. endokrinuli daavadebebi

3. infeqciuri daavadebebi 4. onkologiuri daavadebebi

5. sxva.

19 Tqveni azriT aris Tu ara amJamaad jandacvis servisi Zviri?

1. ki 2. ara 3. ar vici 4. sxva

20 Tqveni azriT ra tipis gadasaxadia ufro mosaxerxebeli

pacientisTvis ?

1. araoficialuri 2. fiqsirebuli 3. dazRveviT

4 arc erTi 5. sxva

21 axerxebT Tu ara eqimis mier gamowerili wamlebis SeZenas?

1. ki 2. ara 3. sxva.

22 rogoria Tqveni janmrTelobis saerTo mdgomareoba?

1. kargi 2. cudi 3. arc erTi 4. sxva

23 ramdenad xSirad svamT alkoholur sasmelebs ?

1.yovel dRe 2. xSirad; 3. iSviaTad; 4. arasodes 5. sxva

24 xarT Tu ara mweveli?

1.ki 2. ara

25 radenad axerxebT srulfasovan kvebas?

1. 1-2 dRe kviraSi; 2. 3.-5 dRe kviraSi 3. 6-7 dRe kviraSi

4. verasodes, 5.sxva

- 195 -

26 misdevT Tu ara cxovrebis jansaR wess (raime sportis

saxeobas)?

1. ki 2. ara 3. sxva

27 migaCniaT Tu ara rom samedicino momsaxureba

dResdReobiT xelmisawvdomia?

1 ki 2. ara 3. ar vici 4. sxva

28. mogwonT Tu ara sadazRveo sistema?


29. migaCniaT Tu ara rom dazRveviT samedicino servisi ufro

xelmisawvdomia?


30. xarT Tu ara dazRveuli?

1. ki 2. ara 3. sxva

Documents

jandacvis menejmentis srulyofis meqanizmebi, pirveladi jandacvis