Private provision of health services in Georgia

A qualitative exploration of governance behaviours

Bibliographic Data

ID21879165
AuthorsMari Tvaliashvili (0000-0002-3032-8299, World Health Organization - Pakistan), Mark Hellowell (0000-0003-3474-2080, University of Edinburgh), Tomáš Roubal (0000-0002-6137-1046, World Health Organization - Pakistan), Akaki Zoidze (0000-0002-7563-0117, Ilia State University), David Clarke (0000-0002-2315-2993, World Health Organization)
Year2025
Volume10
Issue12
Pagese018922
Publication date2025-12-01
Open AccessYes
TypeARTICLE
VenueBMJ Global Health (JOURNAL)
Journal identifiersISSN: 2059-7908 • E-ISSN: 2059-7908
PublisherBMJ (PUBLISHER • GB)
DOI10.1136/bmjgh-2025-018922
PMID41407488
OpenAlexW4417433465
LanguageEN
References cited9

INTRODUCTION: The private sector occupies a dominant position in Georgia's health system, with most hospitals, primary care clinics, diagnostic facilities, pharmacies and insurance companies under for-profit ownership. Robust governance arrangements are required to align the profit-orientation of providers with health policy objectives. METHODS: This paper examines governance arrangements in Georgia's 'mixed' health system. It draws on document analysis, key informant interviews and a validation workshop. Analysis is guided by the WHO's 'governance behaviours' framework, focusing on strategy, regulation, purchasing and information generation as well as mechanisms for policy dialogue, actor alignment and trust building. RESULTS: Georgia has established a complex array of governance mechanisms for its dominant private health sector, but these remain weakly enforced. Strategic plans lack detailed implementation and budgetary integration; regulation and purchasing structures are fragmented; data systems and oversight capacity are limited; and consultation mechanisms underdeveloped-together constraining accountability, efficiency and progress towards universal health coverage. CONCLUDING DISCUSSION: Georgia's experience highlights a persistent gap between governance intent and implementation capacity. In highly marketised systems, sustained political commitment and investment in state capacity for enforcement, data use and stakeholder dialogue are essential to align private incentives with policy goals-and advance universal health coverage

Corporate governance · Health services · Incentive · Politics · Qualitative research · Stakeholder · Global Maternal and Child Health · Global Socioeconomic and Political Dynamics · Healthcare Systems and Reforms

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