iv. javaxiSvilis saxelobis Tbilisis saxelmwifo universiteti

kvitaiSvili irina revazis asuli

disertacia

saqarTvelos jandacvis saxelmwifo finansebis

marTvis srulyofis gzebi

mosapovebeli xarisxi _ filosofiis doqtoris (Ph.D) biznesis marTvaSi

mecnier – xelmZRvaneli :

ekonomikur mecnierebaTa doqtori,

profesori mixeil jibuti

Tbilisi

2008 w.

1

avtoris stili daculia

sarCevi

Sesavali -------------------------------------------------------------------------------------------------------- 3 gv.

I. jandacvis finansebis marTva: ekonomikuri arsi da ucxouri

gamocdileba ------------------------------------------------------------------------------------------ 8 gv.

I.1. finansuri menejmentisa da safinanso politikis roli jandacvis

finansebis marTvaSi sabazro urTierTobebis pirobebSi --------------- 8 gv.

I.2.jandacvis organizaciisa da dafinansebis meqanizmi sazRvargareT -- 32 gv.

II. saqarTvelos jandacvis sistemis dafinanseba sabazro

urTierTobebis pirobebSi --------------------------------------------------------------- 46 gv.

II.1. janmrTelobis dacvis mdgomareobis Sefaseba saqarTveloSi --------- 46 gv.

II.1.1. mosaxleobis janmrTeloba da misi ganmapirobebeli faqtorebi -- 46 gv.

II.1.2. saqarTvelos samkurnalo-profilaqtikuri qseli da sakadro

uzrunvelyofa -------------------------------------------------------------------------------- 65 gv.

II.2. janmrTelobis dacvis dafinanseba Tanamedrove etapze ------------------77 gv.

II.3. samkurnalo-profilaqtikuri dawesebulebis finansuri menejmentis

analizi o.RuduSauris saxelobis erovnuli samedicino centrisa da

q. Tbilisis ramodenime klinikis magaliTze --------------------------------------------

---------------------------------------------- 98 gv.

III. jandacvis finansuri meqanizmis srulyofa, bazrisa da samedicino

momsaxurebaze fasis regulireba ------------------------------------------------ 123 gv.

III.1. sabazro urTierTobebis pirobebSi saqarTvelos jandacvis finansebis

marTvis subieqtebs Soris urTierTqmedebis srulyofa -------------- 123gv.

III.2. samedicino momsaxurebis anazRaurebis formebi rogorc finansuri

menejmentis ZiriTadi ekonomikuri instrumenti --------------------------- 140 gv.

III.3. bazrisa da samedicino momsaxurebaze fasis saxelmwifo regulireba

da finansuri resursebis gamoyenebis efeqtianobis amaRlebis sxva

mimarTulebebi ------------------------------------------------------------------------------------- 158 gv.

daskvna -------------------------------------------------------------------------------------------------------- 167 gv.

gamoyenebuli literaturis sia -------------------------------------------------------------- 177 gv.

danarTi -------------------------------------------------------------------------------------------------- 184 gv.

2

Sesavali

sakvlevi Temis aqtualoba. ekonomikuri reformis pirobebSi

saqarTvelos jandacvis arsebuli sistema uunaro aRmoCnda efeqtianad

gamoeyenebina arsebuli resursebi. saqarTveloSi socialur-ekonomikuri

ganviTarebis Camoyalibebuli tendenciebi da masTan dakavSirebuli

janmrTelobis sistemis formirebis pirobaTa Sefasebebi mowmoben uaxles

wlebSi mosaxleobis nawilis sikvdilianobisa da avadobis araxelsayrel

maxasiaTebelTa SenarCunebas. Sromis bazarze mzardi daZabulobis gamo

ferxdeba mimarTvebi ara marto profilaqtikur gasinjvebTan

dakavSirebuli samedicino daxmarebisTvis, aramed avadmyofobasTan

dakavSirebulic, ris Sedegadac daavadebebi rTuldeba. cxovrebis xarisxis

gauareseba, samedicino daxmarebis sayovelTao misawvdomobis Semcireba,

pirvel rigSi, Seexo mosaxleobis socialurad naklebad dacul fenebs:

bavSvebs, moxucebs, umuSevrebs.

amJamad saqarTveloSi xorcieldeba mizanmimarTuli RonisZiebebi

jandacvis etapobrivi struqturuli reorganizaciisavis. gasatarebeli

reformis ZiriTadi amocanebia: jandacvis dargSi moqalaqeTa

konstituciuri garantiebis uzrunvelyofa, jandacvis mravalwyobianobis

Camoyalibeba saxelmwifo sistemaze mowinave poziciebis SenarCunebiT,

jandacvis dawesebulebaTa mdgradi funqcionirebis uzrunvelyofa, dargis

materialur-teqnikuri, finansuri da sakadro resursebis gamoyenebis

ekonomikuri da klinikuri efeqtianobis amaRleba.

amasTan dakavSirebiT gansakuTrebul mniSvnelobas iZens jandacvis

saxelmwifo finansuri resursebis efeqtiani gamoyenebis gzebis SemuSavebis

problema, agreTve, dafinansebis damatebiTi wyaroebis mozidvis

SesaZleblobaTa moZieba. jandacvaSi sabazro ekonomikis principebze

gadasvlasTan erTad mniSvnelovnad izrdeba finansuri menejmentis roli,

romelic gulisxmobs saresurso potencialis optimizacias. amrigad,

dResdReobiT metismetad aqtualuri rCeba sakiTxi saqarTveloSi

mosaxleobis jandacvis sistemis efeqtiani formirebis Sesaxeb. mocemuli

3

problemis finansuri aspeqti aris yvelaze rTuli da moiTxovs

gansakuTrebul yuradRebas mecnierebisa da praqtikosebis mxridan.

sakvlevi Temis Seswavlis sakiTxi. jandacvis finansebis problemis

gadaWra SeuZlebelia finansebis Teoriis safuZvlebisadmi mimarTvis

gareSe, romlebsac mieZRvna gamoCenili samamulo da ucxoeli mecnierebis:

T. verulavas, r. kakulias, m. murjiknelis, g. caavas, a. aleqsandrovas,

e. voznesenskis, l. drobozinas, v. rodionovis, m. romanovskis, v. senegovisa

da sxv. naSromebi. samedicino momsaxurebaTa sferoSi ekonomikuri

urTierTobebis reformirebis gzebma da aucileblobam asaxva hpoves

o. gerzmavas, m. murjiknelis, l. TakalanZis, l, koWlamazaSvilis,

n. RvedaSvilis, f. kotleris, l. kapenskis, n. gerasimenkos, v. griSinis,

i. komarovis, v. korCaginas, v. kriCaginas, v. kuCerenkosa da sxva avtorebis

naSromebSi.

Tumca, faqtobrivad saxelmwifo finansuri marTvis sakiTxebi

janmrTelobis sferoSi dRemde ar gamxdara sistemuri kvlevis obieqti.

Tanamedrove etapze janmrTelobis dacvis dafinansebis problemis

arasaTanado damuSavebam, Teoriulma da praqtikulma mniSvnelobam

ganapirobes sadisertacio kvlevis Temis arCeva, misi miznebi da amocanebi.

kvlevis mizani da amocanebi. sadisertacio kvlevis mizani mdgomareobs

saxelmwifo finansuri resursebis efeqtiani gamoyenebisa da jandacvis

dafinansebis moqmedi sistemis srulyofaze dafuZnebuli samedicino

momsaxurebebis realizaciis finansuri uzrunvelyofis gzebis Seswavla,

Sesabamisi Teoriuli daskvnebisa da praqtikuli rekomendaciebis

SemuSaveba.

dasaxuli miznis misaRwevad saWiro gaxda rigi, ufro konkretuli

amocanebis gadaWra:

_ jandacvis dafinansebis wyaroebis formirebasTan dakavSirebuli

saxelmwifos finansuri politikis mimarTulebebis gamovlena;

_ jandacvis finansuri resursebis gamoyenebasa da formirebasTan

dakavSirebuli jandacvis finansuri meqanizmis elementebis specifikis

Cveneba;

_ samedicino momsaxurebaTa dafinansebis wyaroebis klasifikacia;

4

_ mosaxleobis janmrTelobis mdgomareobis, janmrTelobis

determinantebis Sefaseba, jandacvis resursuli uzrunvelyofis analizi;

_ jandacvis finansuri resursebisa da dargis dafinansebis wyaroebis

formirebis Sefaseba;

_ jandacvis finansuri resursebis marTvis meqanizmis, dargis

finansuri uzrunvelyofis Seswavla;

_ samkurnalo-profilaqtikuri dawesebulebis finansuri menejmentis

analizi;

_ samedicino momsaxurebaTa anazRaurebis formis Seswavla saxelmwifo

finansuri resursebis gamoyenebis efeqtianobis amaRlebis gzebis moZiebis

mizniT;

_ samedicino momsaxurebaTa bazris kvleva da saxelmwifos mxridan

samedicino sferoze sabazro zegavlenis SezRudvis aucileblobis

gamovlena.

kvlevis obieqti _ saqarTvelos jandacvis finansuri uzrunvelyofis

saxelmwifo sistema.

disertaciis kvlevis sagania jandacvis sferoSi warmoqmnili

mmarTvelobiTi da finansuri urTierTobebi da finansuri menejmentis

aqtualuri sakiTxebi savaldebulo samedicino dazRvevis sistemasa da

samedicino samkurnalo-profilaqtikur dawesebulebebSi.

disertaciis meTodologiuri safuZvelia samamulo da ucxoeli

mecnierebisa da specialistebis naSromebi jandacvaSi finansuri

menejmentis, jandacvis marTvisa da finansebis sferoSi, sakanonmdeblo da

normatiuli aqtebi.

kvlevis sainformacio bazas Seadgenen: jandacvis dafinansebisa da

organizaciis dargSi saqarTvelos sakanonmdeblo aqtebi, saqarTvelos

mTavrobis dadgenilebebi, saqarTvelos Sromis, janmrTelobisa da

socialuri dacvis saministros meToduri da normatiuli masalebi,

saqarTvelos socialur-ekonomikuri informaciis departamentis, samedicino

statistikisa da avadobis kontrolis erovnuli centris masalebi.

kvlevis mecnieruli siaxle mdgomareobs jandacvis dafinansebis

wyaroebis formirebisadmi konceptualuri midgomebis, jandacvis

5

saxelmwifo finansuri resursebis racionaluri gamoyenebis gzebis

SemuSavebaSi:

_ gansazRvrulia cneba `jandacvis dargSi saxelmwifos finansuri

politika~, rogorc diagnostikuri, samkurnalo-profilaqtikuri da

samedicino-reabilitaciuri RonisZiebebis gatarebis gziT qveyanaSi

mosaxleobis avadobis Semcirebis, demografiuli maCveneblebis

gaumjobesebis saSualebiT mosaxleobis cxovrebis donis amaRlebis mizniT

fuladi formiT finansuri resursebis sabiujeto da arasabiujeto

fondebis formirebaze, ganawilebasa da gamoyenebaze saxelmwifos

mecnierulad dasabuTebuli saqmianobis Sinaarsi;

_ Camoyalibebulia `jandacvis finansuri meqanizmis~, rogorc

finansebis marTvis urTierTdakavSirebul elementTa sistemis, gansazRvreba

Sesabamisi samarTlebrivi da normatiuli uzrunvelyofis, finansuri

meTodebisa da instrumentebis safuZvelze, romelTa saSualebiT

xorcieldeba jandacvis finansuri resursebis efeqturi formireba da

gamoyeneba, agreTve misi elementebis specifikis gamovlena samedicino

momsaxurebaTa dafinansebis wyaroTa formirebasa da gamoyenebasTan

mimarTebaSi;

_ SemuSavebulia samedicino dawesebulebebis dafinansebis wyaroTa

saklasifikacio sqema Semdegi niSnebis gamoyofiT: centralizaciis done,

mikuTvnebuloba, saqmianobis xasiaTis, saxeebis mixedviT, rac saSualebas

iZleva ufro mkafiod gamovavlinoT dafinansebis wyaroebis struqturis

Taviseburebebi;

_ Sefasebul iqna jandacvis saxelmwifo finansuri resursebi da

gamovlenil iqna dargis finansuri potencialis formirebisa da

gamoyenebis ZiriTadi tendenciebi;

_ gakeTebulia daskvnebi samkurnalo-profilaqtikuri dawesebulebis

finansuri menejmentis analizis safuZvelze (o. RuduSauris saxelobis

mravalprofiliani erovnuli samedicino centrisa da q. Tbilisis ramdenime

wamyvani klinikis magaliTze);

_ Catarda samedicino momsaxurebaTa anazRaurebis formebis

SedarebiTi analizi da SemoTavazebul iqna RonisZiebebi maTi efeqtianad

gamoyenebis Taobaze;

6

_ SemoTavazebul iqna winadadebebi jandacvaSi saxelmwifo finansuri

resursebis gamoyenebis efeqtianobis amaRlebisa da jandacvis finansuri

resursebis marTvis saxelmwifo meqanizmis srulyofis Taobaze.

sadisertacio naSromis praqtikuli mniSvneloba. miRebuli Sedegebis

praqtikuli mniSvneloba mdgomareobs imaSi, rom kvlevis Sedegad miRebuli

Teoriuli da praqtikuli rekomendaciebi SeiZleba gamoyenebul iqnas,

rogorc mocemuli problemis Semdgom Teoriul kvlevebSi, janmrTelobis

marTvisa da ekonomikis saswavlo programebSi, agreTve saqarTveloSi

janmrTelobis dacvis reformirebis politikis SemuSavebisa da jandacvis

winaSe arsebuli aqtualuri amocanebis gadaWris RonisZiebebis dros.

disertaciis ZiriTadi debulebebi gadmocemulia samecniero

publikaciebSi (Jurnali ekonomika #5, #7, #9 2005w. #8 2006w.).

naSromis struqtura: disertacia Sedgeba Sesavlisagan, rva paragrafis

momcveli sami Tavisagan, daskvnisagan, danarTisa da gamoyenebuli

literaturis siisagan.

7

Tavi I. jandacvis finansebis marTva: ekonomikuri

Sinaarsi da ucxouri gamocdileba

I. 1. finansuri menejmentisa da

finansuri politikis roli jandacvis finansebis marTvaSi

sabazro urTierTobebis pirobebSi

marTvis praqtikas gaaCnia didi xnis istoria, Tumca marTva XX

saukunis dasawyisidanaa aRiarebulia, rogorc samecniero disciplina. anri

faioli, romelsac xSirad uwodeben menejmentis mamas, marTvas ganixilavda

rogorc universalur process, romelic Sedgeba ramodenime

urTierTdakavSirebuli funqciisgan. gansazRvravdnen ra biznesis ZiriTad

funqciebs, `klasikos~ _ Teoretikosebi gamoyofdnen warmoebas, marketingsa

da finansebs. ufro dawvrilebiT SevCerdebiT finansebis marTvis cnebis

ekonomikuri Sinaarsis ganxilvaze. finansebis marTvis sistema iTavsebs

finansur politikas, meTodebs, instrumentebs, agreTve, adamianebs,

romlebic iReben mmarTvelobiT gadawyvetilebebs da romlebic am

gadawyvetilebebs axorcieleben praqtikaSi dasaxuli miznebis miRwevis,

finansuri stabilurobisa da zrdis uzrunvelyofis mizniT. finansebis

marTvis sistema moicavs finansuri sistemis yvela rgols da gamodis

bazris pirobebSi marTvis struqturis umniSvnelovanes Semadgenel

nawilad. finansebis marTvis efeqtiani sistemis mizans warmoadgens:

ekonomikuri potencialis zrda, mogebis maqsimizaciisa da xarjebis

minimizaciisas, dafinansebis arsebuli wyaroebis saukeTeso gamoyenebas da

axalis mozidva finansuri stabilurobis uzrunvelsayofad da dasaxuli

amocanebis misaRwevad. finansebis marTvis sistemis safuZvels warmoadgens

finansuri politika, romelic dafuZnebulia moklevadian da grZelvadian

perspeqtivaSi finansuri resursebis efeqtiani gamoyenebis faqtorebis

analizze da romelic gansazRvravs finansuri samsaxurebis mimarTulebebs

[99, gv. 57].

8

finansuri menejmentis roli mniSvnelovnad izrdeba jandacvaSi

sabazro ekonomikaze gadasvlasTan dakavSirebiT.

finansuri urTierTobebis marTva, romelic moicavs maTi regulirebis

principebs, samarTlebrivi normebis, meTodebis, formebisa da xerxebis

sistemas finansuri resursebis efeqtiani gamoyenebisa da integraciis

mizniT _ finansur menejments, _ mimarTulia finansuri resursebis

moZraobis procesSi samarTalsubieqtebs Soris warmoqmnili finansuri

urTierTobebisa da finansuri resursebis moZraobis marTvisken. finansuri

menejmenti gamodis, rogorc finansebis marTvis mizniT gamomuSavebis,

finansuri meqanizmis meTodebis da instrumentebis saSualebiT maTze

zemoqmedebis ganxorcielebis procesi.

finansuri menejmentis strategia dasaxuli miznis misaRwevad

finansuri saSualebebis gamoyenebis saerTo mimarTuleba da xerxia.

finansuri menejmentis taqtika mdgomareobs, realur pirobebSi

dasaxuli miznis misaRwevad saWiro konkretuli meTodebis, xerxebis,

instrumentebis arCevaSi.

jandacvaSi finansuri menejmentis amocanebSi Sedis:

1. finansuri resursebis mobilizacia:

_ finansuri resursebis marTva;

_ miznobrivi anaricxebis akrefis optimizacia;

_ finansuri resursebis Sevsebis sxvadasxva formebis gamoyeneba.

2. finansuri resursebis Semosaval-gasavalebis strategiuli da

teqnikuri dagegmva.

_ ekonomikuri faqtorebis analizi (mikro da makro doneze), romlebic

gavlenas axdenen finansuri resursebis mobilizaciaze;

_ finansuri saSualebebis Semosaval-gasavlebis analizi (dargSi,

marTvis organoebSi, samedicino dazRvevis fondebSi, samedicino

organizaciebSi);

_ prioritetebis gansazRvra mimdinare dafinansebis gamoyofisas;

_ resursebis efeqtiani gamoyenebis programireba.

3. finansuri resursebis ganawileba:

_ dafinansebis optimaluri xerxis gansazRvra subieqtis

funqcionirebis realur pirobebSi;

9

_ adekvaturi politikis (faswarmoqmnis meTodikiT) gansazRvra da

SeTavazebul samedicino momsaxurebaTa moculobis dinamikis prognozireba.

4. finansuri resursebis gamoyenebis auditi:

_ finansuri kontroli;

_ finansuri gegmebis efeqturobis Sefaseba;

_ mmarTvelobiTi aRricxvis uzrunvelyofa.

finansuri menejmentis ZiriTadi amocanaa, rogorc mTlianad sistemis,

ise misi calkeuli elementebis, qvesistemebis finansuri simtkicis Seqmna.

finansuri sistemis sirTule ganisazRvreba misi Semadgeneli elementebis

araerTgvarovnebiT, maTi struqturuli mravalferovnebiT (gansakuTrebiT,

finansuri resursebi da wyaroebi), maT Soris, gare garemosTan

urTierTqmedebis siZneleebiT, rac arTulebs mis marTvis process da

moiTxovs finansuri menejmentis ZiriTadi principebis dacvas. rogorc

cnobilia, am ukanasknelTa ricxvs miekuTvneba: dagegmva, prognozireba,

organizacia, regulireba da kontroli.

amJamad jandacvis dafinansebis wyaroebis mravalmxrivi xasiaTi

moiTxovs finansuri menejmentis mravalvariantulobasac, romelsac

safuZvlad daedo marTvis standartuli xerxebis gamoyeneba, konkretuli

finansuri situaciis Sefasebis, adeqvaturi mmarTvelobiTi gadawyvetilebis

miRebis unari, romelsac SeuZlia optimalurad aRmofxvras warmoqmnili

problemebi.

mniSvnelovania gamovyoT jandacvaSi finansuri menejmentis

teqnologiuri etapebic:

1. informaciis: makro da mikroekonomikuri maCveneblebis

(mmarTvelobiTi da finansuri) analizi.

2. finansuri gegmis (biujetis) Sedgena: finansuri meTodebisa da

instrumentebis arCeva; dafinansebis wyaroebis Tanafardobis

gansazRvra; samedicino momsaxurebaze faswarmoqmnis

(tarifebis) meTodikis arCeva; ekonomikuri normativebis,

samedicino momsaxurebaTa moculobasa da struqturaze

dadgenili normativebis damtkiceba teritoriuli

klasifikatorebis Sesabamisad;

10

3. finansuri Sedegebis prognozireba samedicino momsaxurebaTa

moculobis; Semosavlebis, xarjebis, danaxarjebisa da

resursebis gamoyenebis efeqtianobis mixedviT;

4. finansuri gegmis (biujetis) Sesruleba _ resursebis

mobilizacia; finansuri saxsrebis xarjva;

5. finansuri gegmis Sesrulebis kontroli _ winaswari, mimdinare,

Semdgomi.

jandacvaSi finansuri resursebis mobilizaciaze zemoqmed

makroekonomikur faqtorebs miekuTvneba: mTliani Sida produqti, inflacia,

dasaqmeba da umuSevroba, erToblivi moTxovna da erToblivi miwodeba,

fiskaluri politika, finansuri bazari da fuladi politika.

biujetis formirebasa da Sesrulebaze moqmedi makroekonomikuri

faqtorebis analizis dros unda gaviTvaliswinoT:

_ samedicino momsaxurebaTa moTxovna da miwodeba;

_ faswarmoqmna;

_ resursebis bazari: samedicino dawesebulebebi, samedicino kadrebi,

wamlebi da vaqcinebi. samedicino teqnika, energetikuli da finansuri

danaxarji;

_ warmoeba da danaxarjebi: asocirebuli momsaxurebebi (stacionaruli,

ambulatoriul-politikuri, saswrafo da gadaudebeli daxmareba),

specializebuli momsaxurebebi, Sromis anazRaurebis sistemebi, resursebis

danaxarjebis efeqtianoba (samedicino momsaxurebaTa gamoSveba resursebis

erTeulze).

saqmianobis finansuri Sedegebis dagegmvisa da prognozirebis dros

saWiroa gaviTvaliswinoT finansuri saxsrebis moZraobis; samedicino

momsaxurebaTa moculobis, resursebis gamoyenebis dinamikuri maCveneblebi.

finansuri kontroli, rogorc menejmentis erT-erTi funqcia,

ganpirobebulia imiT, rom finansebisTvis, rogorc ekonomikuri

kategoriisTvis, niSandoblivia ara marto gamanawilebeli, aramed

sakontrolo funqciac. finansuri kontroli xorcieldeba samarTlebrivi

normebiT dadgenili wesiT, adgilobrivi TviTmmarTvelobis organoebisa da

saxelmwifo xelisuflebis organoebis mTeli sistemis mier. finansuri

kontrolis dros mowmdeba:

11

_ finansuri saqmianobis procesSi dadgenili wesis dacva;

_ finansuri resursebis Seqmnaze, ganawilebasa da gamoyenebaze

gansaxorcielebeli moqmedebis ekonomikuri dasabuTeba da efeqtianoba.

savaldebulo samedicino sistemis erT-erTi amocanaa samedicino

momsaxurebebze faswarmoqmnis srulyofa, maTi struqturis gansazRvra,

tarifis gamoangariSebis erTiani principebis SemuSaveba, samedicino

daxmarebis anazRaurebis wesis arCeva.

programa warmoadgens samedicino daxmarebis (samedicino

momsaxurebaTa) saxeebis CamonaTvals, daxmarebis gaweva garantirebulia

qveynis yvela macxovreblisTvis, janmrTelobis gauaresebis SemTxvevaSi.

spd-s programaTa CarCoebSi samedicino momsaxurebebs gvTavazoben

saxelmwifo licenziis mqone samkurnalo-profilaqtikuri dawesebulebebi

(spd).

spd-Ta erT-erT amocanas warmoadgens samedicino momsaxurebebze

faswarmoqmnis srulyofa, tarifebis gamoangariSebis erTiani principebis

dadgena, maTi struqturis gansazRvra, tarifis gamoangariSebisadmi

meToduri midgomebis SemuSaveba, savaldebulo samedicino dazRvevis

programebiT samkurnalo-profilaqtikuri dawesebulebebis mier

mosaxleobisaTvis gasawevi samedicino daxmarebis anazRaurebis xerxis

arCevis kriteriumTa gansazRvra.

samedicino daxmarebis anazRaurebis axali xerxebis danergvam mogvca

maTi gamoyenebis SesaZleblobebi jandacvaSi finansuri menejmentis

ZiriTadi ekonomikuri instrumentis saxiT:

_ samedicino daxmarebis gawevis struqturis srulyofa mis CarCoebSi

realuri moTxovnebis gaTvaliswinebiT;

_ samkurnalo-profilaqtikur dawesebulebebSi Semavali finansuri

saSualebebis marTva, spd-s biujetis Sesaxeb debulebebis SemuSaveba;

_ samkurnalo-profilaqtikur dawesebulebaTa efeqtian saqmianobaSi

samedicino muSakebis dainteresebis donis amaRleba.

jandacvaSi xelfasis formirebis arsebulma sistemam ar SeiZleba

daainteresos konkretuli muSaki efeqtiani da xarisxiani saqmianobiT.

amitom saWiroa jandacvis muSakebis Sromis anazRaurebis formirebis

sistemis Secvla.

12

jandacvis sistemis finansuri uzrunvelyofis sakiTxTa gadaWra

pirvelxarisxovania, rac saSualebas mogvcems movaxdinoT Camoyalibebuli

finansuri nakadebis reformireba maTi marTvisa da ganawilebis sferoSi.

sistemis subieqtebis finansuri Tanaqmedebis optimizacia saSualebas

mogvcems CamovayaliboT finansuri meqanizmebi, romlebic dagvexmarebian

ufro efeqtianad gadavWraT jandacvis mTeli sistemis problemuri

amocanebi.

amrigad, finansuri politika _ fuZemdebluri elementia finansebis

marTvis sistemaSi. saxelmwifo finansebi _ saxelmwifos finansuri

resursebis formirebasTan da maT gamoyenebasTan dakavSirebuli erovnuli

simdidris nawilisa da erToblivi sazogadoebrivi produqtis ganawileba

gadanawilebis urTierTobebia. finansebis, rogorc fuladi saxsrebis

formirebis, ganawilebis, gadanawilebisa da gamoyenebis mizniT

damyarebuli ekonomikuri urTierTobebis gansazRvrebidan gamomdinare,

saxelmwifo am urTierTobaTa organizaciis dros gansazRvravs

sazogadoebisa da Sesabamisi finansuri sistemis winaSe arsebul ZiriTad

miznebsa da amocanebs.

finansuri sistema _ finansuri urTierTobebis sxvadasxva sferoebis

erTobliobaa, romelTa procesSi xdeba fuladi saxsrebis fondebis

warmoqmna da gamoyeneba. es centralizebuli da decentralizebuli

fuladi fondebis erTobliobaa.

finansuri urTierTobebis ZiriTad mizans warmoadgens maTi iseTi

organizacia, romelic mimarTuli iqneba sazogadoebrivi simdidris zrdis

uzrunvelyofaze. am miznis miRweva SesaZlebelia mxolod saxelmwifos

arsebuli finansuri resursebisa da finansuri potencialis ganawilebis,

gadanawilebisa da gamoyenebis konkretuli formebis efeqtianobis dros.

finansuri meqanizmis efeqtianobis ganmazogadebeli maCvenebelia mTliani

Sida produqtisa da erovnuli Semosavlis, sazogadoebis keTildReobis

ZiriTadi wyaros, zrdis tempebi.

finansuri politika _ saxelmwifos saqmianobis damoukidebeli sferoa

finansur urTierTobaTa dargSi. es ekonomikuri da socialuri

ganviTarebis ama Tu im saxelmwifo programis realizaciisaTvis

saxelmwifos RonisZiebaTa kompleqsia finansuri urTierTobebis

13

gamoyenebis, finansuri resursebis mobilizaciis, maTi ganawilebisa da

gamoyenebis Taobaze.

finansuri politikis realizacia SeiZleba davyoT 3 etapad:

1) ZiriTadi miznebis dasaxva da gansazRvra, amasTanave perspeqtiuli da

uaxlesi amocanebis konkretizacia, romelTa gadaWra aucilebelia

sazogadoebis cxovrebis garkveul periodSi dasaxuli miznebis misaRwevad;

2) finansuri resursebis gamoyenebis ZiriTadi mimarTulebebis

gansazRvra, agreTve urTierTobaTa organizaciis meTodebis, saSualebebisa

da konkretuli formebis SemuSaveba, romelTa saSualebiT mocemuli

miznebi miiRweva umokles vadebSi, xolo uaxlesi da perspeqtiuli

amocanebi wydeba optimalurad;

3) kadrebis SerCeva da ganawileba, romelTac SeuZliaT dasaxuli

amocanebis gadaWra, maTi Sesrulebisa da sakuTriv dasaxuli miznebis

miRwevaze mimarTuli praqtikuli qmedebebis ganxorcielebis organizeba.

finansuri politika mimarTuli unda iqnes, upirveles yovlisa,

finansuri resursebis maqsimalurad SesaZlo moculobis formirebaze,

radgan isini warmoadgenen nebismieri gardaqmnis materialur bazas.

finansebis dargSi saxelmwifos politika damokidebulia finansuri

sistemis ganviTarebasa da misi calkeuli rgolebis damoukideblobis

zomaze.

finansuri politikis calkeul rgols warmoadgens sabiujeto

politika.

sabiujeto politikis qveS igulisxmeba saxelmwifos mier, saxelmwifo

biujetis Semosavlebis formirebis wyaroebis, biujetis xarjebis

prioritetuli mimarTulebebis, biujetis dabalansebis dasaSvebi

farglebis, sabiujeto deficitis dafinansebis wyaroebis, sabiujeto

sistemis calkeul rgolebs Soris urTierTobaTa principebis gansazRvra.

Tavis mxriv, sabiujeto politikis SemadgenlobaSi SedarebiT

damoukideblobas iZens sagadasaxado politika, sainvesticio politika,

saxelmwifo valis marTvis politika. sagadasaxado politika gansazRvravs

gadasaxadebis Semadgenlobis, maTi ganakveTebis odenobis, gadasaxadebis

TiToeul saxeze sanqciebisa da SeRavaTebis arCevas. is agebul unda iqnas

gadasaxadebis gadamxdelebisa da saxelmwifos interesebis kompromisze.

14

saxelmwifos interesebi dafuZnebulia gadasaxadiT dabegvris sakmarisobis

principze. amavdroulad gadasaxadiT dabegvram ar unda moSalos motivacia

efeqtiani saqmianobisadmi.

fasebis politika dafuZnebulia monopoliur saqonelsa da

momsaxurebebze fasebisa da tarifebis regulirebaze.

socialuri politika atarebs RonisZiebebs Semdegi mimarTulebebiT:

mosaxleobis naklebad uzrunvelyofili fenebis Semosavlebis kompensaciis

meqanizmebis SemuSaveba, socialuri SeRavaTebis sistemis mowesrigeba,

iZulebiTi migraciis daregulireba da sxv.

finansuri politika jandacvis sferoSi mimarTuli unda iqnas

adamianisaTvis yvelaze mniSvnelovani faseulobis _ misi janmrTelobis

uzrunvelyofaze.

mraval samecniero naSromSi moyvanilia ganmarteba, romelic

mocemulia jandacvis msoflio organizaciis wesdebis preambulaSi da

romelic Cven yovlismomcvelad migvaCnia: janmrTeloba _ es sruli

fizikuri, sulieri da socialuri keTildReobis mdgomareobaa da ara

marto fizikur defeqtTa da avadmyofobaTa arseboba [ 70 gv. 73; 91 gv. 42;

92 gv. 77].

am ganmartebis Sesabamisad saWiroa ganvsazRvroT ori cneba:

janmrTelobis dacva farTo gagebiT da jandacva, rogorc

mosaxleobisaTvis samedicino daxmarebis gawevaze saqmianobis specifikuri

sfero. literaturaSi jandacva ganxilulia, rogorc socialur-ekonomikur

da samedicino RonisZiebaTa sistema, romlis mizania TiToeuli moqalaqisa

da mTlianobaSi mosaxleobis janmrTelobis donis amaRleba da dacva da

romlis funqcionireba uzrunvelyofilia kadrebis, materialur-teqnikuri

bazis, Sesabamisi teqnologiebis arsebobiTa da samedicino mecnierebis

ganviTarebiT [92, gv. 83], an rogorc socialuri sferos dargi, romlis

saqmianoba mimarTulia adamianebis janmrTelobis dacvasa da ganmtkicebaze,

maTi aqtiuri cxovrebis gaxangrZlivobaze [92, gv. 89]. amave dros

aucilebelia jandacvis saqmes mivakuTvnoT gamajansaRebeli

RonisZiebebisTvis, fizkulturiT, sportiT dakavebisTvis, srulfasovani

kvebisTvis da a.S. specialur-ekonomikuri pirobebis, garemos dacvis, Sromis

usafrTxo da uvnebeli pirobebis, normaluri sacxovrebel-sayofacxovrebo

15

pirobebis uzrunvelyofis RonisZiebaTa realizacia. es RonisZiebebi

warmoadgenen zogaderovnul, saerTo-saxelmwifoebriv amocanas, romelic

gadaWril unda iqnas saxelmwifo sakanonmdeblo da aRmasrulebeli

xelisuflebis Sesabamisi organoebis, sxvadasxva sazogadoebrivi

struqturebis, sawarmoebis, uSualod mosaxleobis mier.

jandacvis organoebisa da dawesebulebis amocanas, romlebic uSualod

miekuTvnebian jandacvas, rogorc dargs, warmoadgens mosaxleobisaTvis

samedicino daxmarebis gawevaze saqmianobis organizacia, romelic moicavs

daavadebebis gamovlenas adreul stadiebsa da paTologiis wina

mdgomareobebSi, droul samedicino-socialur da fsiqologiur

reabilitacias, Sromisunarianobis aRdgenas.

mosaxleobis janmrTeloba warmoadgens eris normaluri

funqcionirebisa da socialuri keTildReobis winapirobas, naTqvamia

jandacvis evropeli ministrebis me-5 konferenciis Semajamebel dokumentSi

(evrosabWo, 1996 wlis noemberi) [57, gv.5]. amitom jandacvis, rogorc

socialuri sferos umniSvnelovanesi dargis ganviTareba arapirdapiraa

dakavSirebuli saxelmwifos saqmianobasTan.

saxelmwifo safinanso politikisa da ekonomikis finansuri

regulirebis problemebs sabazro pirobebSi mieZRvna mniSvnelovani

raodenoba rogorc qarTveli, ise ucxoeli mecnier-finansistebis

publikacia. Tumca, azrTa erToba am sakiTxis Teoriul aspeqtebze ar aris

miRweuli.

r. kakulias azriT: `finansuri politika aris saxelmwifos mier Tavisi

funqciebisa da amocanebis ganxorcielebis uzrunvelsayofad SemuSavebuli

RonisZiebebis erToblioba, romlebic vlindeba finansuri resursebis

mobilizaciaSi, da misi qveynis politikuri, ekonomikuri da socialuri

situaciidan gamomdinare sazogadoebis wevrebs Soris, erovnuli

ekonomikis, prioritetuli struqturuli dargebis da qveynis teritoriuli

erTeulebis (regionebis)~ Soris ganawileba_gamoyenebaSi. [14, gv. 70].

v. rodionova aRniSnavs saxelmwifos safinanso politikis

mravalwaxnagovnebas da Tvlis, rom igi warmoadgens sami ZiriTadi rgolis

erTobas:

16

1) finansebis ganviTarebis mecnierulad dasabuTebuli koncefciebis

gamomuSavebas;

2) finansebis gamoyenebis ZiriTad mimarTulebaTa gansazRvras

perspeqtivaSi da mimdinare periodze;

3) dasaxuli miznebis miRwevisken mimarTuli praqtikuli moqmedebebis

ganxorcielebas.

l. drobozinas azriT, safinanso politika _ finansuri resursebis

mobilizaciisken mimarTuli saxelmwifo RonisZiebebis erTobliobaa, maTi

ganawileba da gamoyeneba saxelmwifos mier misi funqciebis

Sesasruleblad [77, gv. 57]. misi azriT safinanso politika warmoadgens

finansuri urTierTobebis sferoSi saxelmwifos moqmedebis damoukidebel

sferos, romelic mimarTulia Sesabamisi finansuri resursebiT ekonomikuri

da socialuri ganviTarebis ama Tu im saxelmwifo programis realizaciis

uzrunvelyofisken [77, gv. 59].

rigi avtorebi, maT Soris, n. garetovski [75, gv. 79], l. drobozina,

safinanso politikas gansazRvraven, rogorc saxelmwifos mier Tavisi

funqciebis Sesasruleblad finansuri urTierTobebis gamoyenebis

saxelmwifo RonisZiebebis erTobliobas. am ganmartebaSi gamoiyeneba Zalze

gaurkveveli, bundovani termini `saxelmwifo RonisZiebebi~.

v. senCagovi cdilobs daZlios aseTi gaurkvevloba da gansazRvravs

safinanso politikas, rogorc saxelmwifos ekonomikuri politikis nawils

(qvesistemas), romelic warmoadgens `sabiujeto-sagadasaxado, sxva

finansuri instrumentebisa da saxelmwifo finansuri xelisuflebis

institutebis erTobliobas, romlebsac kanonmdeblobis Tanaxmad, gaaCniaT

saxelmwifo ekonomikuri politikis strategiuli da taqtikuri miznebis

Sesabamisad saxelmwifos finansuri resursebis formirebisa da gamoyenebis

uflebamosilebebi~ [98, gv. 82]. am ganmartebaSi gamoyofen finansur

instrumentebsa da saxelmwifo finansuri xelisuflebis institutebs da

xazgasmulia maTi erTianoba. mocemuli ganmartebis mniSvnelovan elements

warmoadgens debuleba imis Sesaxeb, rom safinanso politika _ es

ekonomikuri politikis organuli nawilia da amitom gaaCnia miznobrivi

mimarTuleba. nebismier finansur instrumentSi arsebobs kavSiri

17

ekonomikuri politikis miznebTan da mis socialur mimarTulebasTan. Cveni

azriT, es principulad mniSvnelovani debulebaa.

cxadia, rom rogoric ar unda iyos safinanso politikis ganmarteba,

is unda gamomdinareobdes misi ZiriTadi miznebidan. safinanso politikis

mizans warmoadgens finansuri resursebis moculobisa da maTi gamoyenebis

efeqtianobis gazrda. finansuri resursebis gamoyenebis efeqtianoba Zalze

mniSvnelovania, radgan is, sakuTriv, warmoadgens ekonomikaze safinanso

politikis zemoqmedebis Semowmebas. saxelmwifos safinanso politikis

SemuSavebisas da gatarebisas finansuri resursebis gamoyenebis

efeqtianobis maCvenebelTa gansazRvraze uaris Tqmam SeiZleba migviyvanos,

rogorc finansuri resursebis daqsaqsvamde, ise sazogadoebis mzard

ekonomikur da socialur moTxovnilebaTa dakmayofilebis wyaroebis

Semcirebamde. finansuri resursebis gamoyenebis efeqtianobis maCveneblebia.

ekonomikis gajansaRebisa da struqturuli gardaqmnis procesebi, agreTve

mosaxleobis cxovrebis ufro maRali donis miRweva, romelic gamodis

warmoebis ganviTarebis, finansuri resursebis gamoyenebis mimarTulebisa

da struqturis ganmsazRvrel sidided.

arsebobs safinanso politikis gatarebis sxva miznebic, magaliTad

iseTebi, rogorebicaa inflaciis tempebis Semcireba, ekonomikuri ciklebis

Serbileba da sxv. Tumca, isini arsebiTad gamomdinareoben safinanso

politikis ZiriTadi amocanebidan _ mTeli mosaxleobis keTildReobis

zrdis uzrunvelyofidan.

drois sxvadasxva periodSi ekonomistebis mier mocemul ganmartebebSi

safinanso politikis arsis analizi avtors saSualebas aZlevs

gansazRvros finansuri politika, rogorc saxelmwifos saqmianoba

finansebis ganviTarebis mecnierulad dasabuTebuli koncefciis

SemuSavebaze, misi ZiriTadi mimarTulebebis gamoyofiT, dasaxuli miznebisa

da amocanebis misaRwevad, upirveles yovlisa, qveynis moqalaqeTa cxovrebis

donis asamaRleblad, Sesabamisi finansuri meqanizmis Seqmnis gziT.

safinanso politika mowodebulia uzrunvelyos yvela saxelmwifo amocanis

gadaWra, maT Soris saxelmwifos socialuri politikis realizacia.

saxelmwifos safinanso politikis arsis Teoriuli problemebis

gaanalizebiT SeiZleba ganvsazRvroT jandacvis dargSi saxelmwifos

18

safinanso politikis arsi. mocemuli sakiTxis kvlevam saSualeba mogvca

SegvemuSavebina Semdegi ganmarteba:

finansuri politika jandacvis sferoSi gansazRvrulia rogorc

saxelmwifos mecnierulad dasabuTebuli saqmianoba sabiujeto finansuri

resursebis formirebaze, ganawilebasa da gamoyenebaze, mosaxleobis

cxovrebis donis amaRlebis mizniT, qveyanaSi demografiuli maCveneblebis

gaumjobesebis saSualebiT, mosaxleobis avadobis Semcirebis,

diagnostikuri samkurnalo-profilaqtikuri da samedicino-sareabilitacio

RonisZiebebis Catarebis gziT.

socialuri reformebis gatareba SesaZlebelia mxolod saxelmwifo

finansebis ganmtkicebis pirobebSi, rac migviyvans ekonomikur zrdamde da

socialuri sferos im dargTa finansirebisken mimarTuli sabiujeto

saSualebebis zrdis SesaZleblobamde, romelTa Soris umniSvnelovanesia

jandacva.

damokidebuleba ekonomikis mdgomareobaze aris fundamenturi principi,

romelic safuZvlad udevs efeqtiani safinanso da socialuri politikis

gatarebas, maT Soris jandacvis sferoSi.

qvemoT moyvanil sqemaze (nax. 1) sailustraciod mogvyavs mocemuli

debuleba samedicino momsaxurebaTa mimarTebaSi.

mocemuli sqema TvalsaCinod gviCvenebs pirdapir damokidebulebas

mTlianad ekonomikisa da misi nawilis, e.i. jandacvis ekonomikis

mdgomareobas Soris. ase, warmoebis moculobaTa zrdisas erTi mxriv,

matulobs biujetSi iuridiuli da fizikuri pirebis sagadasaxado da

arasagadasaxado ganacxadebi, maSasadame, centralizebuli fondebidan

samedicino dawesebulebaTa dafinansebis SesaZleblobebic ufro farTo

iqneba. amave dros sawarmoebsa da dawesebulebebSi momuSave personalebs

SeuZliaT nebayoflobiT miiRon monawileoba samedicino dazRvevaSi. meore

mxriv, sawarmoebisa da dawesebulebebis muSakTa Semosavlebis zrda

afarToebs nebayoflobiT samedicino dazRvevaSi maTi piradad

monawileobis SesaZleblobebs, xolo survilis SemTxvevaSi fasiani

samedicino momsaxurebebiT sargeblobis saSualeba iZleva, Tavis mxriv,

nebayoflobiTi samedicino dazRvevisa da fasiani samedicino momsaxurebis

gafarToebas, romelic saSualebas miscems saxelmwifos gazardos

19

jandacvis momsaxurebaTa realizaciis dafinansebis moculobebi umuSevari

mosaxleobisTvis (bavSvebisTvis, pensionrebisTvis da a.S.), e.i. imaTTvis,

romlebsac damoukideblad ar SeuZliaT aanazRauron aucilebeli

samedicino momsaxurebebi.

mTlianobaSi ekonomikis ganviTareba, ra Tqma unda, saqarTvelos

jandacvis ganviTarebis aucilebeli wanamZRvaria, Tumca es ar gamoricxavs

konkretul gardaqmnebs jandacvis, rogorc qveynis erovnuli meurneobis

damoukidebeli dargis, sakuTari finansuri resursebis formirebis

sistemaSi. am problemaTa gadaWris gzebis arCeva mniSvnelovanwilad

ganisazRvreba jandacvis dafinansebis meqanizmTa cvlilebebis

aucileblobiT sabazro meurneobis pirobebSi. gamwvavebuli konfliqti,

erovnuli ekonomikis stabilizaciis interesebidan gamomdinare, mkacri

ekonomikis zomebis miRebis aucileblobasa da socialur-ekonomikuri

politikis grZelvadian miznebs Soris, agreTve, Tavis kvals tovebs

SesaZlo gadawyvetilebebis xasiaTze.

sadisertacio kvlevis avtoris mier gaanalizebul iqna finansuri

politikis mimarTulebebi jandacvis dargSi, romlebic mocemulia Semdeg

oficialur dokumentebSi:

1. saqarTvelos jandacvis reorganizaciis koncefciis ekonomikuri

safuZvlebi;

2. jandacvis formebis axali sistemis meTodologiuri aspeqtebi;

3. 2002-2007 w.w.-Si saqarTveloSi jandacvis dafinansebis strategia;

4. saqarTveloSi saavadmyofo dawesebulebis restruqturizaciisa da

optimizaciis programa.

miTiTebul dokumentebSi arsebuli finansuri politikis ZiriTad

mimarTulebebs Soris saWiroa gamovyoT Semdegi:

_ samedicino daxmarebis miwodebis maregulirebeli normatiul-

samarTlebrivi bazis srulyofa, maT Soris, jandacvaSi finansuri

nakadebis gamWvirvalobis uzrunvelyofis, ufaso samedicino daxmarebis

garantirebuli moculobis Sesrulebis, agreTve, fasiani samedicino

momsaxurebebis legalizaciis mizniT;

20

_ dargis finansur saSualebaTa moZraobis yvela etapze jandacvis

finansebis “suladobriv principze gadasvla” Camoyalibeba, ganawileba da

xarjva;

_ regionebze saxelmwifo garantiebis farglebSi samedicino

daxmarebis gawevis pirobaTa finansuri gaTanabrebis meqanizmebis

srulyofa, mkurnalobisa da diagnostikis teqnologiaTa standartebis

danergva, jandacvis resursebis uzrunvelyofis normativebis (finansuri,

materialuri) SemuSaveba da gamoyeneba;

_ jandacvis dawesebulebebis mier mosaxleobisaTvis samedicino

daxmarebis gawevis xelSekrulebebisa da SekveTebis sistemis SemuSaveba,

rac jandacvaSi efeqtiani konkurentuli garemos Seqmnis saSualebas

mogvcems;

21

naxazi. #1

22

muSaki sax. kompania departamentebi

kontraqtebi jandacvis sxva programebiT saqarTvelos jandacvis dafinansebis modeli

specialuri Senatanebi Senatanebi centraluri jandacvis kontraqtebi biujeti saministro sabiujeto transferi

kontraqtebi savaldebulo sadazRvevo

Senatani (1%)* sam. dazRvevis** saministros

(prevenciuli programebi) Senatanebi biujeti kontraqtebi

(spd programebiT) mosaxleoba dawesebulebebi kontraqtebi

savaldebulo sadazRvevo Senatani( 3%) *

samuSaos mimcemi adgilobrivi

erToblivi Senatani araumetes 50%

kontraqti (munic. progr.)

pacientebi momsaxureba samedicino

* axali sagadasaxado kodeqsiT (2005 w. 10 ianvris) _ gauqmebulia ; **

2003 wlidan სამედიცინო დაზღვევის სახელმწიფო კომპანიამ შეწყვიტა ფუნქციონირება და შეიქმნა– სოციალური დაზღვევის ერთიანი სახელმწიფო ფონდი

23

24

Tanamedrove periodSi saqarTveloSi samedicino momsaxurebaTa

realizaciis finansuri uzrunvelyofis problemaTa gadmocemamde, Cveni

azriT, mizanSewonilia SevCerdeT jandacvis finansuri meqanizmis

specifikisa da organizaciis problemebze.

mosaxleobis jandacvis sistemaSi finansuri politikis realizeba

xdeba Sesabamisi finansuri meqanizmis saSualebiT.

mivmarTavT ra mocemuli cnebis arss, xazi gavusvaT `finansuri

meqanizmis~ cnebis Teoriuli Seswavlis sirTules, rac ganpirobebulia

mocemul sakiTxze specialuri monografiebis ar arsebobiT. miuxedavad

amisa, zogierTi mecnier-ekonomisti finansuri meqanizmis gansxvavebul

ganmartebas iZleva. r. kakulias ganmartebiT: “finansuri meqanizmi aris im

formebisa da meTodebis erTobliobaa, romlis meSveobiTac

uzrunvelyofilia ganawilebiTi da gadanawilebiTi urTierTobani,

Semosavlebisa da dagrovebis Seqmnis, fuladi saSualebebis

centralizebuli da decentralizebuli fondebis Seqmna-gamoyenebis

ganxircieleba” [14, gv.77].

n. senCagovi finansuri meqanizmis qveS gulisxmobs finansuri

berketebisa da stimulebis, dagrovebebis, fuladi Semosavlebis dagegmvisa

da marTvis organizaciis formebisa da meTodebis erTobliobas [98, gv. 72].

prof. v.m. rodionovas azriT, finansuri meqanizmi _ es sazogadoebis

ekonomikuri da socialuri ganviTarebisaTvis xelsayreli pirobebis

Seqmnis mizniT sazogadoebis mier gamoyenebuli finansuri resursebis

formirebisa da gamoyenebis meTodebis (xerxebis), finansuri urTierTobebis

organizaciis formaTa erTobliobaa [96, gv.79].

miuxedavad imisa, rom mocemuli ganmartebebi moicaven finansuri

meqanizmis ZiriTad elements, mniSvnelovan naklovanebad unda aRiniSnos is,

rom dasaxuli miznis misaRwevad finansuri elementebis gamoyenebis

SesaZlebloba miTiTebulia mxolod n. senCagovis ganmartebebSi, xolo

finansuri meqanizmis realizaciis saboloo mizanze miTiTebebi mocemulia

mxolod v. rodionovasTan. Cveni azriT, ukanaskneli avtoris mier mocemuli

finansuri meqanizmis ganmarteba ufro srulia.

jandacvis finansuri meqanizmis specifikisa da arsis Taobaze gagvaCnia

sakuTari mosazreba. jandacvis finansuri meqanizmi, Cveni azriT ganixileba

jandacvis, rogorc momsaxurebaTa sferos erT-erTi dargis, gagebidan

gamomdinare.

arasawarmoo sferos problemaTa Seswavlas sabWoTa mecnier-

ekonomistebma yuradReba miaqcies XX saukunis 50-ian wlebSi. am sakiTxs

mieZRvna naSromebi iseTi samamulo ekonomistebis, rogoricaa: l. Ciqava, r.

asaTiani; baraTaSvili e. TakalanZe l. ucxouri mecnierebis: e. Jilcovis, g.

ivanovis, v. korCaginis, l. sbitovois, v. kraJevas, v. medvedevis, kozakovis v.

panickinis v. iakobsonis da sxv. [2; 23; 6; 78; 81; 82; 83; 89;91].

termini `adamianiseuli kapitali~ gvxvdeba mravali ekonomistis

naSromSi. ase, `adamianiseuli kapitalis~ koncefciis avtorebis,

saxeldobr, p. siglisa da misi Tanamoazreebis interpretaciaSi, a. smitze

miTiTebiT `adamianiseuli kapitali~ moicavs sazogadoebis simdidresa da

resursebis odenobas adamianebis SromiTi saqmianobis Sedegad. es

sazogadoebis socialur-ekonomikuri potenciali, ekonomikuri kategoriaa,

materialuri da sulieri resursebis dagrovebaa, romelic xasiaTdeba

srulfasovani da efeqturi SromiT.

e. Jilcovi saubrobs adamianiseuli kapitalis, rogorc ucxoeli

ekonomistebis mier gamoyenebuli maCveneblis, ganviTarebis donis Sesaxeb

sxva qveynebTan SedarebisTvisa da konkretuli qveynis mosaxleobis

cxovrebis donis daxasiaTebisTvis (78, gv. 71). gaeros meTodologiis

Tanaxmad, maCvenebeli `adamianis potencialis ganviTarebis indeqsi~ asaxavs,

rogorc keTildReobis sidides, ise ama Tu im qveynis mosaxleobis

cxovrebis xarisxsac da warmoadgens saSualo ariTmetikuls cxovrebis

donis sami yvelaze TvalsaCino indikatoridan: dabadebisas sicocxlis

mosalodneli xangrZlivobis indeqsi; mosaxleobis ganaTlebis donis

indeqsi (kombinirebuli maCvenebeli, romelic gamoiTvleba, rogorc

zrdasruli mosaxleobis ganaTlebis donis indeqsi da im moswavleTa

erToblivi wilis indeqsi, romlebic Rebuloben dawyebiT, saSualo da

umaRles ganaTlebas); erT sul mosaxleze realuri mSp-s indeqsi, romlis

daricxva xdeba aSS-s dolarebSi sxvadasxva qveynebis valutaTa

myidvelunarianobis paritetis mixedviT.

rac ufro axlosaa 1-Tan adamianiseuli potencialis ganviTarebis

indeqsis mniSvneloba, miT ufro maRalia mocemul qveyanaSi adamianiseuli

25

potencialis ganviTarebis xarisxi da miT ufro axlosaa es sazogadoeba

sasurvel miznebTan. jandacvis ganviTarebis donis mixedviT pirveli

adgilebi ukaviaT iaponias, kanadas, islandias.

mosaxleobis janmrTelobis mdgomareoba gavlenas axdens adamianiseul

resursebze, maSasadame, ekonomikur da sawarmoo faqtorebzec, razec

damokidebulia saqonlisa da momsaxurebis warmoeba da, rogorc Sedegi,

aisaxeba sazogadoebis simdidris warmoebasa da dagrovebaze. gasagebia, rom

janmrTeli da ganaTlebuli muSakebis Sromis nayofiereba ufro maRali

iqneba, rac dadebiTad aisaxeba ufro maRali xarisxis saqonelTa da

momsaxurebaTa didi moculobebis warmoebaze.

Cveni azriT, sworia im avtorebis pozicia, romlebic nebismieri qveynis

ekonomikaSi socialuri sferos did da mzard rols aRiareben. eWvs ar

iwvevs is, rom momsaxurebis sferos yvela dargis ganviTarebaze

daxarjuli saSualebebi gavlenas axdenen sazogadoebis mTavar

mwarmoeblur Zalaze _ adamianze.

am TvalsazrisiT, jandacvas, rogorc dargs, romelic samedicino

momsaxurebebs uwevs mosaxleobas, gansakuTrebuli adgili ukavia, radgan

adamianis janmrTeloba Seadgens eris sicocxlisunarianobisa da

genofondis safuZvels. amitom, xazs vusvamT ra arasawarmoo sferos

progresuli mniSvnelobis mqone materialur keTildReobaTa warmoebaze,

misi aqtiuri gavlenisa da mosaxleobis keTildReobis amaRlebis

TvalsazrisiT, Cven gansakuTrebul mniSvnelobas vaniWebT jandacvas.

rogorc aRiniSna, mosaxleobis jandacvis sistemaSi finansuri

politikis realizeba xdeba Sesabamisi finansuri meqanizmis saSualebiT.

Cven mier jandacvis finansuri meqanizmi ganimarteba, rogorc

finansebis marTvis urTierTdakavSirebuli elementebis sistema Sesabamisi

samarTlebrivi da normatiuli uzrunvelyofis da agreTve finansuri

meTodebisa da instrumentebis safuZvelze, romelTa saSualebiT xdeba

jandacvis finansuri resursebis efeqtiani formireba da gamoyeneba.

jandacvis finansuri meqanizmi Cven mier sqematurad warmodgenilia nax.

2-ze.

26

jandacvis finansuri meqanizmi

jandacvis finansebis marTva

samarTlebrivi da normatiuli uzrunvelyofa

finansuri meTodebi

finansuri instrumentebi

finansuri resursebis efeqtiani formireba da gamoyeneba

nax. 2. sistemis funqcionirebis finansuri meqanizmi

qvesistema `jandacvis finansebis marTva~ Sedgeba Semdegi ori

blokisagan: finansebis marTvis kompetenciisagan, marTvis organoebis

uflebebisa da funqciebisagan (ix. nax. 3.).

jandacvis finansebis marTva

jandacvis finansebis marTvis kompetenciebi:

jandacvis finansebis marTvis organoTa uflebebi da funqciebi

saqarTvelos prezidenti;

saqarTvelos parlamenti; saqarTvelos mTavroba; Sjsd-s saministro; soc. dazRvevis saxelmwifo fondi; xelisuflebis regionaluri da adgilobrivi

organoebi

27

nax. 3. qvesistema `jandacvis finansebis marTva~.

samarTlebrivi da normatiuli uzrunvelyofa

samarTlebrivi uzrunvelyofa normatiuli uzrunvelyofa

• saqarTvelos konstitucia; • dargobrivi brZanebulebebi da gankargulebebi

• saqarTvelos sagadasaxado kodeqsi; • instruqciebi; • kanoni saqarTvelos moqalaqeTa

samedicino dazRvevis Sesaxeb;

• normativebi; • meToduri miTiTebebi;

• saqarTvelos safinanso organoebis gankargulebebi; • saqarTvelos prezidentis

brZanebulebebi; • saqarTvelos aRmasrulebeli xelisuflebis organoebisa da adgilobrivi TviTmmarTvlobis organoTa normatiuli aqtebi;

• saqarTvelos mTavrobis

dadgenilebebi; • da sxva.

• da sxva.

nax. 4. qvesistema `samarTlebrivi da normatiuli aqtebi.

jandacvis finansuri meqanizmis SemuSavebasa da realizaciaSi

saxelmwifos roli, upirveles yovlisa, ganisazRvreba samarTlebrivi da

normatiuli uzrunvelyofiT (nax. 4).

samarTlebrivi da normatiuli uzrunvelyofa warmoadgens

sakanonmdeblo da sxva samarTlebrivi aqtebis, kerZod, kanonebis,

prezidentis brZanebulebebis, mTavrobis dadgenilebis, agreTve, rogorc

centraluri sakanonmdeblo da aRmasrulebeli xelisuflebis, ise

avtonomiuri respublikebisa da adgilobrivi marTvis doneebis meToduri

miTiTebebis, instruqciebis, normativebis, normebis erTobliobas.

samarTlebrivi da normatiuli aqtebi warmoadgenen jandacvis finansebis

marTvis aparatis mmarTvelobiTi saqmianobis organizaciis safuZvels,

romelic gansazRvravs marTvis organoebis uflebebsa da funqciebs,

agreTve, sxvadasxva finansuri meTodebis moqmedebebs.

jandacvis sferoSi gamoiyeneba Semdegi finansuri meTodebi: dagegmva,

prognozireba, faswarmoqmna (SemoTavazebul samedicino momsaxurebebze

gamoTvlebis meTodikebi), samedicino dazRveva, gadasaxadiT dabegvra,

dakrediteba, materialuri stimulireba, lizingi, investireba da a.S.(nax. 5).

28

finansuri meTodebi:

• dagegmva;

• prognozireba; • samedicino dazRveva;

• investireba;

• dakrediteba;

• gadasaxadiT dabegvra; • faswarmoqmna;

• materialuri stimulireba;

• lizingi;

• kontroli da sxv.

nax. 5. qvesistema `finansuri meTodebi

finansuri meTodebisa da instrumentebis saSualebiT xorcieldeba

zegavlena jandacvaSi Camoyalibebul finansur urTierTobebze finansuri

resursebis efeqtiani gamoyenebisa da integraciis mizniT. finansuri

instrumentebis CamonaTvali, romelic gamoyofilia Cven mier jandacvis

finansuri meqanizmis calke qvesistemad, moyvanilia nax. 6-ze.

finansuri instrumentebi

• mogeba;

• Semosavali;

• amortizaciuli anaricxebi;

• saijaro gadasaxdeli;

• dividendebi;

• anabrebi;

• sapaio anaricxebi;

• saprocento ganakveTebi;

• sagadasaxado ganakveTebi;

• investiciebi;

• subsidiebi;

• fasebi da tarifebi samedicino

momsaxurebaze;

• sxv.

nax. 6. qvesistema `finansuri instrumentebi¬

ama Tu im finansuri instrumentis gamoyeneba unda pasuxobdes

mosaxleobis mxridan samedicino daxmarebis aRmoCenaSi moTxovnilebebis

dasakmayofileblad saWiro jandacvis dafinansebis wyaroebis racionaluri

gamoyenebisa da yvelaze sruli mobilizaciis amocanebs.

29

samedicino dawesebulebaTa finansuri resursebis formirebis wyaroebi

sistematizirebuli da ilustrirebulia Cven mier nax. 7-ze.

centralizaciis xarisxis mixedviT SeiZleba gamovyoT samedicino

momsaxurebis dafinansebis centralizebuli da decentralizebuli

wyaroebi. centralizebuls, e.i. sazogadoebrivi fondebidan

Camoyalibebuls, miekuTvnebian biujetis saxsrebi, agreTve, savaldebulo

samedicino dazRvevis fondis saSualebebi.

saxelmwifo biujeti aris finansuri sistemis mTavari rgoli. igi

warmoadgens fuladi saxsrebis centralizebuli fondis warmoqmnisa da

gamoyenebis formas saxelmwifo xelisuflebis organoebis funqciebis

uzrunvelsayofad. masSi koncentrirdeba saxelmwifos finansuri

resursebis mniSvnelovani nawili. jandacvis dafinansebaze mimarTuli

biujetis saxsrebi iyofa centraluri da adgilobrivi biujetebis

saxsrebad sabiujeto sistemis doneebis mixedviT.

arasabiujeto fondebi iqmneba fuladi saxsrebis akumulaciisTvis,

romlebic mimarTulia, biujetSi CaurTvel xarjTa dafinansebaze.

arasabiujeto fondebs gaaCnia mkacri miznobrivi daniSnuleba da

warmoadgenen damoukidebel finansur-sakredito dawesebulebebs.

decentralizebulebad (TviT samedicino dawesebulebebis mier

mobilizebulad) SeiZleba CavTvaloT dargis dafinansebis iseTi

arasabiujeto wyaroebi, rogoricaa nebayoflobiTi samedicino dazRvevis

saSualebebi, fasiani samedicino momsaxurebebidan, samewarmeo saqmianobidan

miRebuli Semosavlebi, saqvelmoqmedo Senatanebi, Semosavlebi fasiani

qaRaldebidan da a.S.

kuTvnilebis mixedviT jandacvis dafinansebis wyaroebi SeiZleba

davajgufoT sabiujeto da arasabiujeto wyaroebad.

30

sxva wyaroebi

31

nax. 7. samedicino momsaxurebis dafinansebis wyaroebis klasifikaciuri sqema.

samedicino momsaxurebis dafinansebis wyaroebi

centralizebuli centralizaciis donis mixedviT

decentralizebuli

arasabiujeto

biujetis donis mixedviT

kuTvnilebis mixedviT

sabiujeto

bankebisa da sxva kreditorebis kreditebi

damatebiT saqmianobidan

Semosav-lebi fasiani qaRaldebi-dan

usasyidlo da saqvel-moqmedi Senatanebi da Semowiruloba

saxeebis mixedviT

_ centraluri biujeti _ adgilobrivi biujeti

nebayoflobiTi samedicino dazRvevis saSualebebi

Semosavle_bi samewar-meo saqmiano-bidan

Semosavlebi fasiani samedicino momsaxurebi-dan

saqmianobis xasiaTidan ZiriTadi saqmianobidan

32

agreTve, SeiZleba movaxdinoT dafinansebis yvela miTiTebuli wyaros

sistematizireba saqmianobis xasiaTis mixedviT: ZiriTadi saqmianobis

Sedegad, e.i. samedicino daxmarebis gawevis Sedegad; damatebiTi saqmianobis

Sedegad, romelic uSualod ar aris dakavSirebuli mosaxleobisTvis

samedicino momsaxurebis miwodebasTan.

warmodgenili klasifikacia saSualebas iZleva ufro zustad

ganvsazRvroT samedicino dawesebulebebis mier finansuri resursebis

formirebis wyaroebi, ramac praqtikaSi xeli unda Seuwyos maT, ufro

srul, mobilizacias.

I.2. jandacvis dafinansebisa da

organizaciis meqanizmi sazRvargareT

sabazro ekonomikaze gadasvlasTan dakavSirebiT , jandacvis seqtiris

organizaciuli mowyobis, marTvisa da dafinansebis meTodebi ramdenimejer

Seicvala xelisuflebis politikis Sesabamisad.

saqarTvelos jandacvis obieqtebis (an sistemis) dafinansebis

srulyofisaTvis saWiroa gavecnoT evropul da amerikul gamocdilebas,

radgan swored am mimarTulebiT aRiniSneba mravali siaxle dargis

ekonomikaSi. am gamocdilebaze unda avagoT saqarTvelos jandacvis

dafinansebis modeli.

amJamad ekonomikurad ganviTarebul qveynebSi arseboben samedicino

daxmarebis organizaciis sakmaod efeqtiani sistemebi, romlebic iqmneboda

sxvadasxva sazogadoebriv-politikur, socialur-ekonomikur da religiur

pirobebSi. yvela es sistema, romlebsac gaaCnia ra rigi specifikuri

Tvisebebi, orientirebulia samedicino momsaxurebis amaRlebisa da

mosaxleobis janmrTelobis xarisxis gaumjobesebaze (saerTo

sikvdilianobis Semcireba, sicocxlis saSualo xangrZlivobis zrda,

axalSobilTa sikvdilianobis Semcireba da a.S.).

im monacemebis analizi, romlebic moyvanilia rusi mecnieris

C. ainekenovis mier 1900-2000 wlebSi ekonomikurad ganviTarebul qveynebSi

mosaxleobis janmrTelobis donis zrdasTan jandacvaze gaweuli

danaxarjebis donis zrdis Sefardebis mdgomareobis mixedviT, gviCvenebs,

rom msoflioSi jandacvis samsaxurebis funqcionirebis efeqtianoba

mcirdeba. ase, jandacvaze weliwadSi 10%-is toli danaxarjebis zrdisas,

1900w. janmrTelobis donis zrdam Seadgina 12%; 1930w. _ 8%; 1970 _ 4%; 1980

_ 1,3%; 2000w. _ 1% (62, gv. 81).

Tu jandacvis samsaxurebis funqcionirebis efeqtianobis qveS

vigulisxmebT Sedegebisa da danaxarjebis fardobas, maSin efeqtianobis

33

maCvenebeli SeiZleba CavweroT Semdegi formulis saxiT:

ЭΔΚΔΡ

,

sadac, ΔΡ _ mosaxleobis janmrTelobis donis zrda %-Si;

ΔКK _ jandacvaze danaxarjebis donis zrda %-Si.

Tanamedrove etapze jandacvis ganviTarebis eqstensiuri periodi

dasrulebulia da arsebuli saxiT jandacvis samsaxurebma amowures

TavianTi rezervi.

eqstensiuri faqtorebis xarjze jandacvis Semdgomi ganviTarebis

SeuZlebloba dakavSirebulia imasTan, rom janmrTelobaze sul ufro met

zegavlenas axdenen ekologiuri garemos, socialur-ekonomikuri pirobebis

cvlilebasTan dakavSirebuli faqtorebi da a.S.

socialurad orientirebuli sabazro ekonomikis pirobebSi saxelmwifo

prioritetulad yuradRebas uTmobs sazogadoebaSi socialuri

problemebis gadaWras. magaliTad, ekonomikurad ganviTarebul qveynebSi

socialuri problemebis gadaWraze gamoiyofa saxelmwifo biujetis

saxsrebis aranakleb 60%.

ekonomikurad ganviTarebul TiTqmis yvela qveyanaSi jandacvis xarjebi

win uswreben danarCeni socialuri dargis xarjebs, ganaTlebisa da

kulturis CaTvliT, da mTliani erovnuli produqtis (mep) 7-14% Seadgenen.

sazRvargareTis qveynebSi jandacvaze xarjebis zrda upiratesad

ganpirobebulia mosaxleobisTvis samedicino daxmarebis xelmisawvdomobis

gafarToebiT, samedicino momsaxurebaze tarifebis zrdiT, ZviradRirebuli

samedicino teqnologiebis gamoyenebiT, administraciuli xarjebis wilis

zrdiT da a.S. sazRvargareT, amasTan dakavSirebiT arsebiTi yuradReba

eTmoba samedicino momsaxurebis Rirebulebis zrdis Semcirebas, mimdinare

da erTdroul danaxarjebze miRebuli ekonomiis xarjze samedicino

daxmarebis xarisxisa da efeqtianobis amaRlebas.

ganvixiloT zogierT ekonomikurad ganviTarebul qveyanaSi jandacvis

dafinansebisa da organizaciis gamocdileba.

aSS-Si jandacvaze gamoyofili saxsrebis saerTo biujeti iqmneba

Semdegi fondebidan:

34

_ saxelmwifo programa medikeidi _ 10% (uzrunvelyofs samedicino

daxmarebiT Semosavlis dabali donis mqone zogierT ojaxs, sadac

kmayofaze myofi bavSvebia da yvelaze Rarib, usinaTlo da

araSromisunarian pirebs);

_ saxelmwifo programa medikeri _ 17% (uzrunvelyofs samedicino

daxmarebas maTTvis, romlebsac SeusruldaT 65 weli, da zogierT

araSromisunarians);

_ sxva samTavrobo programebi _ 15%;

_ kerZo samedicino dazRvevis saxsrebi _ 33%;

_ saxsrebi sxva kerZo wyaroebidan _ 4%;

_ moqalaqeTa piradi saxsrebi _ 21%.

1980 wlidan 1992 wlis CaTvliT aSS-Si jandacvis xarjebi gaizarda

mep-is 9%-dan 14%-mde, xolo 2000 wlisTvis isini gaizarda 19%-mde(62, gv. 89).

aSS-Si jandacvaze gamoyofili xarjebis struqtura aseTia:

saavadmyofo daxmarebaze ixarjeba 39%, saxlSi meddis mier movlaze _ 8%,

eqimTa Sromis anazRaurebaze _ 19%, sxva personalis anazRaurebaze _ 22%,

sxva samedicino xarjebi Seadgenen _ 12% (62, gv. 91).

amerikelTa umravlesoba jandacvaze gamoyofil finansur saSualebebs

Rebuloben Suamavlebis saSualebiT, romelTa saxiT gamodis 1000-ze meti

saxelmwifo da kerZo sadazRvevo kompania. Tumca, aSS-Si Camoyalibebulma

samedicino personalis Sromis anazRaurebis sistemam da kerZo sadazRvevo

samedicino kompaniebis saSuamavlo qselma jandacvis xarjebi sakmaod

maRal donemde miiyvanes. ase, magaliTad, amerikeli eqspertebis monacemebis

mixedviT, yvela SemoTavazebuli samedicino momsaxurebis daaxloebiT 25-

30%, eqim-specialistebis mowvevis, analizebis Cabarebis, operaciuli

Carevis, samkurnalo nivTierebebis SeZenis da a.S. CaTvliT, janmrTelobis

TvalsazrisiT mizanSeuwoneli, xolo rig SemTxvevebSi ki _ sazianoc iyo.

ufro metic, Tu ganvixilavT amerikuli jandacvis efeqtianobis amaRlebis

sakiTxebs, maSin, amerikeli profkavSirebis xelmZRvanelobis azriT,

optimizacia samjer `samedicino daxmarebis xarisxi _ tarifis _

xelmisawvdomoba~ xdeba erovnuli amocana.

sociologiurma gamokvlevebma gviCvenes, rom aSS-s mosaxleobis

umravlesoba mizanSewonilad Tvlis kerZo medicinis SenarCunebas, radgan

35

samedicino momsaxurebis xarisxi kerZo saavadmyofoebSi ufro maRalia,

vidre jandacvis saxelmwifo seqtorSi.

aSS-Si jandacvis organizaciuli sistemis ZiriTadi Rirebulebebia:

_ maRalkvalificiuri samedicino daxmareba, romelsac safuZvlad

udevs xarisxis federaluri standartebi;

_ amerikeli mosaxleobis jandacvis dargSi samecniero-samedicino

kvlevebisa da SemuSavebebis koordinirebuli sistemis arseboba, romelTa

dafinanseba xorcieldeba rogorc federaluri biujetis saxsrebis, ise

kerZo da saxelmwifo biznesis organizaciebisa da firmebis saxsrebis

xarjzec;

_ mTlianobaSi mosaxleobisa da, maT Soris, daqiravebuli samuSao

Zalis janmrTelobis dacvaze biznesis da saxelmwifo pasuxismgeblobis

maRali xarisxi;

_ pacientebis samarTlebrivi dacvis maRali xarisxi, maT Soris,

mosaxleobis socialurad daucveli fenebis janmrTelobis dacvis

saxelmwifo sistemis CaTvliT;

_ ganawileba “medikeidis” programiT jandacvis federaluri biujetis

Statebs Soris StatSi erT sul mosaxleze Semosavlis ukuproporciulad.

es principi Seesabameba socialur samarTlianobas, radgan naklebi

Semosavali erT sul mosaxleze StatSi gulisxmobs jandacvis miznebze

federaluri saxsrebis didi raodenobiT gamoyofas;

_ maRalkvalificiuri samedicino kadrebis momzadebis daxvewili

sistema;

_ aSS-s kanonmdebloba samedicino personalTan mimarTebaSi pacientTa

sasamarTlo sarCelebis waxalisebas axdens. es sistema, jer erTi, xels

uwyobs samedicino personalis pasuxismgeblobis xarisxis amaRlebas,

meorec, mas mivyavarT samedicino muSakebis profesiuli riskis dazRvevis

aucileblobamde.

Tumca, jandacvis organizaciis amerikul sistemas rigi arsebiTi

naklovanebebi gaaCnia, maT Soris ZiriTadia:

_ jandacvaze danaxarjebis donis zrdis maRali tempebi, romlebic

xSirad ar Seesabamebian samedicino momsaxurebaTa xarisxis donesa da

zrdis tempebs. amas mivyavarT iqamde, rom kvalificiuri samedicino

36

daxmareba ar aris misawvdomi amerikelTa mniSvnelovani raodenobisTvis,

msoflioSi jandacvaze yvelaze maRali xarjebisas aSS-s mosaxleobis

janmrTelobis jamuri maCveneblebi CamorCebian sxva ekonomikurad

ganviTarebuli qveynebis maCveneblebs, rac mowmobs aSS-Si jandacvis dabal

efeqtianobaze. garda amisa, samedicino momsaxurebaTa TviTRirebulebaSi

sakmaod maRalia administraciuli xarjebis wili (rig SemTxvevaSi isini

Seadgenen samedicino momsaxurebaTa saerTo TviTRirebulebis 20%-mde);

_ samedicino muSakebis Sromis anazRaureba xorcieldeba principiT

`honorari momsaxureobisTvis~, romlis Sedegs warmoadgens rig

SemTxvevebSi pacientisTvis Warbi samedicino procedurebisa da samkurnalo

saSualebebis daniSvna;

_ samedicino dazRvevis rTuli sistema. garda amisa, sadazRvevo

saSualebebis marTvaSi decentralizacias (magaliTad, “medikeidis”

saxelmwifo programis CarCoebSi federaluri finansuri resursebis marTva

regulirdeba kerZo sadazRvevo samedicino organoebis doneze) mivyavarT

aSS-s jandacvaSi finansuri resursebis moZraobis

arakoordinirebulobamde da mravalarxianobamde;

_ sxvadasxva StatebSi erTi da igive samedicino momsaxurebis

tarifebis mniSvnelovani gansxvavebaa. aSS-s sxvadasxva StatebSi

Rirebuleba gansxvavdeba 19-15-jer.

did britaneTSi gamoiyeneba lord beverijis iniciativiT 1948 wels

miRebuli jandacvis dafinansebis modeli. am modelis arsi mdgomareobs

imaSi, rom britaneTis jandacvis biujeti ZiriTadad formirdeba

sagadasaxado Senatanebidan. sakmaod xangrZlivi drois ganmavlobaSi es

modeli warmoadgenda didi britaneTis jandacvis biujetis regulirebisa

da socialuri samarTlianobis principebis safuZvelze mosaxleobis

calkeul kategoriebs Soris gamoyofili finansuri resursebis

regulirebis efeqtian instruments.

jandacvis dafinansebisa da organizaciis britanuli sistemis

safuZvelSi Cadebulia pirveladi mediko-sanitaruli daxmarebis

prioriteti. didi britaneTis jandacvaSi zogadi praqtikis eqimTa wili

jandacvis erovnuli sistemis eqimTa saerTo raodenobis daaxloebiT 50%-s

Seadgens. eqimTa es kategoria samedicino daxmarebas uwevs avadmyofTa

37

TiTqmis 90%-s. amave dros, zogadi praqtikis eqimTa saqmianobasTan

dakavSirebuli danaxarjebis wili axlo dromde Seadgenda didi

britaneTis jandacvis biujetis saerTo moculobis daaxloebiT 6%-s.

garda amisa, qveyanaSi Camoyalibda eqim-specialistebisadmi avadmyofebis

mimarTvaTa mkafio sistema.

did britaneTSi jandacvis dafinansebisa da organizaciis ZiriTadi

Rirsebebia:

_ jandacvis dafinansebis saxelmwifo xasiaTi samewarmeo saqmianobis

subieqtTa gadasaxadis progresuli dabegvris gziT miRebuli saxsrebis

xarjze;

_ regionuli biujetebis saxelmwifo regulireba cxovrebis ufro

maRali donis mqone regionebidan cxovrebis ufro dabali donis mqone

regionebSi finansuri resursebis gadanawilebis gziT;

_ jandacvaze SedarebiT dabali (sxva ekonomikurad ganviTarebul

qveynebTan SedarebiT) danaxarjebi uzrunvelyofen mosaxleobis jandacvis

mdgomareobis maRal maCveneblebs;

_ samedicino kadrebis momzadebisa da gadamzadebis maRali done da

ganviTarebuli sistema;

_ zogadi praqtikis eqimTa Sromis anazRaurebis diferencirebuli

sistema momsaxurebadi teritoriis mosaxleobis struqturisa da

raodenobis, agreTve, gasawevi saxis samedicino daxmarebis mixedviT;

_ mdgradi sakanonmdeblo baza, romelic uzrunvelyofs pacientebis,

samedicino muSakebis, jandacvis obieqtebis, agreTve, yvela donis

jandacvis marTvis saxelmwifo organoebis uflebebsa da valdebulebebs.

britaneTSi jandacvis dafinansebisa da organizaciis sistemis

arsebuli naklovanebebis gamosworeba xdeba reformebis gziT. dadgenili

naklovanebebis daZlevis gegma winaswar gansazRvra 1992-1993ww. britaneTis

jandacvis reforma.

es naklovanebebi iyo: jer erTi, jandacvis marTvis mWidro

centralizaciam miiyvana vertikaluri kavSirebis dausabuTebel

garTulebamde jandacvis marTvis sistemaSi. ase, magaliTad, zogadi

praqtikis TiToeuli eqimi faqtiurad pirdapir debda jandacvis

saministrosTan saeqimo saqmianobaze kontraqts. aman, saboloo jamSi,

38

gamoiwvia jandacvis biujetSi administraciuli xarjebis wilis zrda,

agreTve, misi efeqtianobis Semcireba. meorec, jandacviTi saqmianobis rigi

mimarTulebebis arasakmarisma ganviTarebam mTlianobaSi hospitalizaciaze,

gegmiur operaciebsa da ambulatorul mkurnalobaze mniSvnelovani rigebi

gaaCina. garda amisa, did britaneTSi jandacvis dafinansebis arsebuli

sistema iwvevda qveynis sxvadasxva regionebSi mkurnalobisa da samkurnalo

preparatebis fasebis arsebiT gansxvavebas.

amitom SemTxveviTi ar aris is, rom momdevno wlebSi did britaneTSi

jandacvis dafinansebis sistema srulad aRar Seesabameboda sazogadoebis

moTxovnilebebs. saresurso uzrunvelyofa ar akmayofilebda moTxovnas

samedicino momsaxurebaze, romelic ganpirobebuli iyo demografiuli

cvlilebebiT, maRalxarisxian samedicino momsaxurebaSi mosaxleobis

mzardi moTxovnilebiT.

amJamad did britaneTSi mimdinare jandacvis dafinansebisa da

organizaciis reforma mimarTulia TiToeuli pacientis, jandacvis marTvis

adgilobrivi organoebis, jandacvis obieqtebis, zogadi praqtikis eqimebisa

da a.S. pasuxismgeblobis amaRlebaze.

mimdinare reformam ganapiroba samedicino daxmarebis doneTa

daaxloeba qveynis sxvadasxva regionebsa da sxvadasxva socialur jgufebs

Soris. amJamad did britaneTSi jandacvis dafinansebis struqtura aseTia:

jandacvaze gamoyofili mTeli saxsrebis 84% yalibdeba saxelmwifo

wyaroebidan, daaxloebiT 4 % _ moqalaqeTa piradi saxsrebis xarjze,

xolo danarCen nawils Seadgenda kerZo samedicino dazRvevis CarCoebSi

miRebuli saxsrebi. Tanac did britaneTSi kerZo samedicino dazRvevis

momsaxureobiT moculia mosaxleobis daaxloebiT 15% (103,gv.92). es

momsaxureoba gamoiyeneba, rogorc jandacvis dafinansebis saxelmwifo

sistemis alternatiuli momsaxurebebi damatebiTi an ufro xarisxiani

samedicino momsaxureobis miRebis mizniT.

kanadaSi moqmedebs samedicino dazRvevis saxelmwifo sistema, romelic

uzrunvelyofs gasawevi samedicino daxmarebis maRal donesa da

mosaxleobis janmrTelobis sakmaod maRal maCveneblebs. jandacvis

dafinansebisa da organizaciis kanaduri sistemis CarCoebSi upirvelesad

39

saxelmwifos xarjze faqtiurad ufasod xdeba daxmarebis gaweva, romelic

moicavs samedicino momsaxurebaTa farTo speqtrs.

kanadaSi saxelmwifos ukavia mowinave adgili jandacvis dafinansebasa

da organizaciaSi, afinansebs ra jandacvis biujetis xarjebis 75%-ze mets.

kanadaSi saavadmyofo da ambulatoruli dawesebulebebis umravlesoba

(daaxloebiT 95%) funqcionirebs arakomerciul sawyisebze.

jandacvis marTvisa da organizaciis kanaduri sistemis safuZvelSi

devs sxvadasxva donis jandacvis marTvis organoTa kompetenciis gamijvna.

ase magaliTad, erovnuli jandacvisa da socialuri keTildReobis

federaluri saministro wyvets strategiul amocanebs: gansazRvravs

federaluri biujetidan jandacvaze xarjebis odenobas, axdens samecniero

kvlevebis koordinacias, axorcielebs kadrebis momzadebasa da samedicino

daxmarebis xarisxis standartebis SemuSavebas.

kanadis eqvs provinciaSi jandacva finansdeba saerTo-sagadasaxado

Senatanebidan da federaluri dotaciebidan, xolo kanadis SemadgenlobaSi

Semaval or CrdiloeT teritoriasa da danarCen oTx provinciaSi

CamoTvlili wyaroebis garda gamoiyeneba Senatani saSemosavlo gadasaxadis

saxiT, rac Sesabamisad afarToebs SemoTavazebuli momsaxurebis speqtrs.

jandacvis organizaciis kanaduri sistema sakmaod moqnilad iTavsebs

rogorc centralizebuli, ise decentralizebuli marTvis elementebsac:

federalur xelisuflebas gaaCnia prioriteti jandacvis dafinansebisa da

organizaciis strategiuli saerTo-erovnuli sakiTxebis gadaWraSi, xolo

jandacvis obieqtebis mimdinare operatiuli saqmianobis sakiTxebis gadaWra

jandacvis marTvis adgilobrivi organoebis kompetenciaa.

amJamad kanadis jandacvis dafinanseba xorcieldeba Semdegi

wyaroebidan:

_ 30,4% gamoyofs federaluri mTavroba;

_ 42,2% _ provinciaTa mTavrobebi;

_ 1,1% _ xelisuflebis adgilobrivi organoebi;

_ 25,4% _ kerZo pirebis Senatanebi;

_ 0,9% _ muSebisTvis gadasaxdeli kompensaciebi.

jandacvis biujetis xarjviTi nawili iqmneba Semdegnairad:

_ saavadmyofoebis Senaxva _ 39,3%;

40

_ jandacvis sxva obieqtebis Senaxva _ 10,3%;

_ eqimebis Sromis anazRaureba _ 16,1%;

_ samkurnalo preparatebiT uzrunvelyofa _ 11,6%;

_ jandacvis biujetis sxva xarjebi _ 12,7% [103, gv. 71].

kanadaSi jandacvis dafinansebisa da organizaciis sistemis ZiriTadi

Rirsebebia:

_ upirvelesad jandacvis saxelmwifo dafinanseba, arakomerciul

safuZvelze samedicino daxmarebis gaweva. jandacvis dafinanseba

xorcieldeba samewarmeo saqmianobis subieqtebis progresuli gadasaxadiT

dabegvris xarjze;

_ samedicino daxmarebis xarisxze saxelmwifo kontroli;

_ samedicino dazRvevis saxelmwifo sistemis arseboba, romelic

moicavs qveynis yvela moqalaqes. am sistemis CarCoebSi pacientebs ufasod

sTavazoben samedicino momsaxurebaTa farTo speqtrs. garda amisa,

pacientebs gaaCniaT eqimisa da samedicino dawesebulebis arCevis

SesaZlebloba samedicino momsaxurebaTa miRebisas, romelTa anazRaureba

garantirebulia sadazRvevo polisiT;

_ samedicino momsaxurebaze danaxarjTa struqturaSi

administraciuli xarjebis SedarebiT dabali wili.

Tumca kanadaSi gasawevi samedicino daxmarebis Rirebuleba sakmaod

maRalia sxva ekonomikurad ganviTarebul qveynebTan SedarebiT. garda amisa,

negatiur tendencias warmoadgens samedicino momsaxureobaze danaxarjebis

mudmivi zrda. arasrulyofilia samedicino personalis Sromis

anazRaurebac, romelic dafuZnebulia principze `honorari

momsaxurebisTvis~.

jandacvis iaponur organizaciasa da dafinansebas safuZvlad udevs

bismarkis modeli, romelic adaptirebulia iaponuri sazogadoebis

sazogadoebriv-politikuri da socialur-ekonomikuri pirobebisadmi.

amJamad iaponuri modeli warmoadgens socialuri dazRvevis

zogaderovnul sistemas ganviTarebuli infrastruqturiT da dazRvevis

yvela subieqts Soris samarTlebrivi da finansuri urTierTobebis

gamarTuli meqanizmiT. samedicino dazRveva moicavs iaponiis mTel

mosaxleobas. finansuri resursebi koncentrirebulia iaponiis mTavrobis

41

mier gansazRvrul prioritetul mimarTulebebze _ profilaqtikur

RonisZiebebsa da mosaxleobis socialurad daucveli fenebis, pirvel

rigSi, moxucTa samedicino daxmarebis dafinansebaze.

jandacvis yvela finansuri resursi, romelic yalibdeba an mxolod

sadazRvevo anaricxebis xarjze, an sadazRvevo anaricxebisa da

saxelmwifos mcire dotaciebis xarjze, Tavmoyrilia iaponiaSi sadazRvevo

kavSirebSi. finansur warmomadgenlebad da sadazRvevo kavSirebis

Suamavlebad gamodian samedicino dazRvevis fondebi. am fondebis funqcias

warmoadgens samedicino dawesebulebebis mier gaweul momsaxurebaTa

faqtze warmodgenili angariSebis anazRaurebis nebarTvebis Semowmeba da

maTi gacema.

iaponiaSi arsebuli jandacvis organizaciisa da dafinansebis sistema

dazRveul pacientebs aZlevs xarjebis 90%-is dafarvis saSualebas

momsaxurebis SeTavazebis gziT, agreTve, avadmyofebis movlaze gaweuli

danaxarjebis 60%-mde anazRaurebis, bavSvis dabadebaze daxmarebis

gadaxdisa da a.S. saSualebas. finansuri saSualebebis nawili ixarjeba

profilaqtikur RonisZiebebze, maT Soris fizkulturisa da sportis

ganviTarebaze, mosaxleobaSi cxovrebis jansaRi wesis formirebaze.

jandacvis marTvis saxelmwifo organoebi gamodian samedicino

dazRvevis sistemaSi urTierTobebis regulatorad: fasebi erTnair

samedicino momsaxureobaze ar aris damokidebuli samedicino

dawesebulebis tipsa da samedicino daxmarebis gawevis doneze. amave dros

fasebi mtkicdeba centralizebulad iaponiis jandacvis saministros mier

da or weliwadSi erTxel xdeba maTi gadaxedva.

samedicino daxmarebis gaweva emyareba eqimisa da samedicino

dawesebulebis Tavisufali arCevanis princips. samedicino daxmarebis

maRali xarisxi dafuZnebulia samedicino momsaxureobisa da samedicino

dawesebulebebis konkurentuli bazris arsebobaze.

amJamad iaponiis jandacvis problemebi dakavSirebulia samedicino

momsaxurebaze xarjebis zrdasTan. am xarjebis zrda ganpirobebulia,

pirvel rigSi, xandazmuli adamianebis wilis zrdiT qveynis mosaxleobis

saerTo raodenobaSi. amJamad iaponiaSi mosaxleobis 12,6% Seadgenen 65

welze ufrosi asakis pirebi (62, gv. 116).

42

garda amisa, iaponiaSi sxva ekonomikurad ganviTarebul qveynebTan

SedarebiT, mniSvnelovnad didia xarjebi stacionarul daxmarebaze, rac

ganpirobebulia adamianebis stacionarSi dayovnebis ufro xangrZlivi

vadebiT.

safrangeTSi samedicino dazRveva xorcieldeba socialuri dazRvevis

CarCoebSi. socialuri dazRvevis erT-erT yvelaze mniSvnelovan programas

warmoadgens muSakebis erovnuli dazRvevis salaros Seqmna, romelic

emsaxureba qveynis mTeli mosaxleobis daaxloebiT 70%-s.

safrangeTSi socialuri dazRvevis yvela realizebad programas

gaaCnia avtonomiurobis maRali xarisxi jandacvis marTvis saxelmwifo

organoebTan mimarTebaSi.

safrangeTSi jandacvis dafinanseba xorcieldeba sagadasaxado

Semonatanebis saSualebiT, romelTa akrefa xdeba muSakebidan da

damsaqmeblebisgan. jandacvis saxsrebis daaxloebiT 74% Semodis

saxelmwifo wyaroebidan, xolo danarCens Seadgenen moqalaqeTa piradi

saxsrebi. saeqimo personalis Sromis anazRaureba xorcieldeba

Semdegnairad. sazogadoebriv saavadmyofoebSi momuSave eqimebi Rebuloben

xelfass, xolo kerZo saavadmyofoebSi eqimebisa da kerZo-praqtikos eqimTa

Sromis anazRaureba xorcieldeba principiT `honorari momsaxurebisTvis~.

amave dros safrangeTSi sawolis fondis 65% modis sazogadoebriv

saavadmyofoebze da 35% _ kerZoze [99, gv. 18].

safrangeTSi saxelmwifo sadazRvevo fondis saSualebiT socialuri

samedicino dazRvevis sistemiT moculia qveynis mosaxleobis daaxloebiT

80%. sadazRvevo fondis odenoba ki ar aris damokidebuli dasazRvevi

janmrTelobis mdgomareobaze, aramed ganisazRvreba mxolod misi

erToblivi wliuri Semosavlis odenobiT.

safrangeTSi ar arsebobs samedicino momsaxurebaTa Tavisufali

bazari. mTavroba mkacrad aregulirebs fasebs umetes samedicino

momsaxurebaze, maT Soris, rogorc sazogadoebriv, ise kerZo jandacvis

sferoSi momuSave eqimTa honorarebsac. aseTi midgoma gamoricxavs

samedicino momsaxurebebze danaxarjebis mniSvnelovan zrdas. magaliTad,

sabiujeto samkurnalo-profilaqtikur dawesebulebaTa Senaxvaze

yovelwliurad gamoiyofa finansuri saxsrebis garkveuli odenoba. Tuki

43

daSvebulia am saxsrebis gadaxarjva, maSin misi anazRaureba xdeba momdevno

wlis biujetis xarjze. safrangeTSi nebismieri sakiTxi ZviradRirebuli

samedicino teqnikis sazRvargareT SeZenis da eqspluataciaSi Seyvanis,

jandacvis obieqtebis mSeneblobis Sesaxeb wydeba mxolod samTavrobo

doneze. erTis mxriv, safrangeTSi jandacvis marTvis mkacrad

centralizebuli sistema amcirebs am sistemis moqnilobasa da

efeqtianobas, xolo meores mxriv, _ saSualebas iZleva vakontroloT da

vareguliroT danaxarjebis done samedicino momsaxureobisa da

mTlianobaSi jandacvaze.

amrigad, ucxoeTis qveynebSi jandacvis dafinansebis wyaroebis

gansxvavebis miuxedavad, zogierTi maTgani emyareba dazRvevis princips,

xolo zogierTi _ sagadasaxado Senatanebis sistemas.

qvemoT moyvanilia jandacvis obieqtebis dafinansebis ZiriTadi meTodebi

ucxoeTis qveynebSi. (Nnaxazi 8; 9) nax.8.

anazRaurebis sqemis mokle aRwera globaluri dafinansebis meTodiT

definicia globaluri biujeti

tipologia fiqsirebuli wliuri sufsidia

anazRaurebis

pirobiTi

erTeuli

profili da simZlavre (sawolebis an registrirebuli

pacientebis raodenoba, materialur-teqnikuri baza, da a.S.)

diagnozi (standarti), sawoldReebis profilis mixedviT

anazRaurebis

kategoria

subsidia (federaluri an federaluri + adgilobrivi)

anazRaurebis

wesi

perioduli miwodeba an yovel SemTxvevaSi pirdapir

mwarmoeblisTvis qviTris wardgenis Semdeg, sadac

miTiTebulia diagnozi, sawol-dReebis raodenoba da

Sesrulebuli samuSao

fasdebis

principi

istoriuli, funqciuri standartebi an gadasaxadis

gadamxdelis standartebi (profilebis mixedviT,

fiqsirebulebi)

ucxouri

analogebi

didi britaneTi (kunZulebze), kanada, SvedeTi, TurqeTi

(mTian zonebSi), safrangeTi, espaneTi (baskeTsa da

gaskoniaSi), aSS (veteranebis sistema da kaizer permanente)

44

nax. 9.

programuli dafinansebis meTodiT anazRaurebis sqemis

mokle aRwera

definicia programuli dafinanseba

tipologia anazRaureba gaweuli samedicino momsaxureobis

moculobis mixedviT

anazRaurebis

pirobiTi

erTeuli

diagnozi (standarti).

Sesrulebuli de-faqto samuSao, romelic

gaTvaliswinebulia diagnoziT (standartiT).

sawol-dRis profiliT,

profili da simZlavre (sawolebis an

registrirebuli pacientebis raodenoba,

materialur-teqnikuri baza da a.S.).

anazRaurebis

kategoria

subsidia (federaluri an federalui +

adgilobrivi), prospeqtiuli

anazRaurebis

wesi

pirdapir mwarmoeblisTvis qviTris wardgenis

Semdeg, sadac miTiTebulia diagnozi, sawoldReebis

raodenoba da Sesrulebuli samuSao

fasdebis

principi

gadasaxadis gadamxdelis standartebi (profilis

mixedviT, fiqsirebulebi)

ucxouri

analogebi

`di-er-ji (medikea Medicare, aSS) medikeidi da blu

krozi (Medicade Blue Crocc) holandia, nawilobriv

safrangeTi.

jandacvis organizaciuli sistemis sazRvargareTis qveynebis

gamocdilebidan saqarTvelosTan mimarTebaSi sayuradRebod migvaCnia:

- iaponiaSi arsebuli jandacvis organizaciis sistema, jandacvis

dafinansebasTan dakavSirebuli riskis gadanawilebis efeqtiani meqanizmiT;

- didi britaneTis, kanadis, SvedeTis, TurqeTis, safrangeTis, espaneTis

jandacvis globaluri biujetiT dafinansebis sistema;

45

- kanadur sistemaSi centralizebuli da decentralizebuli marTvis

Serwymis gamocdileba, sadac jandacvis obieqtebis mimdinare operatiuli

saqmianobis sakiTxebis gadaWra jandacvis marTvis adgilobrivi organoebis

kompetenciaSia;

- britanuli sistemis jandacvis organizacia, romlsac safuZvlad

udevs pirveladi mediko-sanitaruli daxmarebis prioriteti;

- aSS-s jandacvis organizaciuli sistema, maRalkvalificiuri

samedicino daxmarebiT, romelsac safuZvlad udevs xarisxis federaluri

standartebi, maRalkvalificiuri samedicino kadrebis momzadebis

daxvewili programiT, pacientebis maRali samarTlebrivi daculobiT.

aRsaniSnavia, rom ekonomikurad ganviTarebul TiTqmis yvela qveyanaSi

jandacvis xarjebi win uswreben danarCeni socialuri dargis xarjebs da

mTliani erovnuli produqtis (mep) 7-14% Seadgenen.

msoflioSi arsad ar arsebobs mxolod biujetidan dafinansebis

sistema, sadazRvevo an mxolod kerZo. yvelaze gavrcelebulia sxvadasxva

wyaroebidan dafinansebis Sereuli sistema. magaliTad, did britaneTSi,

sadac arsebobs sabiujeto dafinansebis klasikuri modeli, daaxloebiT

10% Seadgenen socialuri dazRvevidan miRebuli saxsrebi, romelTa

gadaricxva xdeba socialuri dazRvevis fondidan. xolo klasikuri

sadazRvevo sistemis mqone qveynebSi saxsrebis nawili Semodis biujetidan,

magram ZiriTad wyaros warmoadgenen gadaxdebi dazRvevaze.

saqarTvelos jandacva, evropis qveynebis msgavsad, unda iyos Sereuli,

mravalkomponentiani sistema.

46

Tavi II.

saqarTvelos jandacvis sistemis dafinanseba sabazro

urTierTobebis pirobebSi

II.1. jandacvis mdgomareobis Sefaseba saqarTveloSi

II.1.1. mosaxleobis janmrTeloba da misi ganmapirobebeli faqtorebi

mosaxleobis janmrTelobis saerTo mdgomareobis Sefasebamde

mizanSewonilad migvaCnia qveyanaSi demografiuli ganviTarebis ZiriTadi

tendenciebis ganxilva.

ukanaskneli aTwleulis ganmavlobaSi ganviTarebulma mniSvnelovanma

socialur-ekonomikurma krizisma, samoqalaqo omma, devnilTa nakadma,

gazrdilma umuSevrobam, mosaxleobis didi nawilis cxovrebis pirobebis

gauaresebam da migraciis intensivobam uaryofiTi gavlena moaxdina ara

marto mosaxleobis janmrTelobaze, aramed demografiuli ganviTarebis

ZiriTad tendenciebzec.

saqarTvelos mosaxleobis mTliani raodenobis da gansakuTrebiT

bunebrivi matebis mniSvnelovani Semcireba ukanasknel wlebSi metnaklebad

gamoxatuli iyo yvela regionSi. statistikis departamentis monacemebiT,

qveynis masStabiT bunebrivi matebis maCvenebeli 1985 wels dafiqsirebuli

51,6-dan 1993 wels 0,8-mde, xolo 2000 wels 0-mde Semcirda, 2003-2004 ww.

bunebrivi mateba 0,1 da0,2 iyo, 2005 wels igi 0,8 gaxda, 2006 wels ki ukve_1,3.

saqarTvelos mosaxleobis mTliani raodenobis gamokveTili kleba

ganpirobebulia mravali mizeziT, romlebmac, Tavis mxriv, gavlena iqonia

mosaxleobis rogorc bunebrivi, aseve meqanikuri (migraciuli) moZraobis

maCveneblebis cvalebadobaze.

mosaxleobis bunebrivi moZraobis dinamikaSi yvelaze SemaSfoTebelia

Sobadobis ukiduresi Semcireba. 1985 welTan SedarebiT Sobadobis

maCvenebeli (18,5) 1,6-jer Semcirda. Tumca, aRsaniSnavia is garemoebac, rom

47

ukanaskneli 5 wlis monacemebis mixedviT gamoikveTa Sobadobis klebis

tempis Senelebis tendencia.

cxrili 1.

bunebrivi moZraobis maCveneblebis dinamika 1990-2006 wlebSi

(100 sul mosaxleze)

wlebi qorwineba ganqorwineba Sobadoba mokvdaoba bunebrivi

mateba

1990

1995

2000

2001

2002

2003

2004

2005

2006

6,7

4,4

2,8

3,0

2,9

2,9

3,4

4,1

5,0

1,4

0,6

0,4

0,4

0,4

0,4

0,4

0,4

0,5

17,1

11,9

11,0

10,8

10,7

10,7

11,5

10,7

10,9

9,3

10,4

10,7

10,5

10,7

10,6

11,3

9,9

9,6

7,6

1,5

0,3

0,3

0

0,1

0,2

0,8

1,3

wyaro: janmrTelobis dacva, statistikuri cnobari, saqarTvelo, 2006.

1985-2003 wlebSi fertilobis koeficienti (cocxladdabadebulTa

raodenoba 15-49 wlis asakis erT qalze) 2,26-dan 1,37-mde Semcirda, 2004

wels odnav moimata (1,51) da Semdeg isev (2006 wels _ 1,4) Semcirda [naxazi

10]. naxazi 10.

fertilobis jamobrivi koeficienti

2,15

1,41,391,511,411,42

1,44

1,46

1,44

1,51,551,55

1,54

2,26

0

0,5

1

1,5

2

2,5

1985 1990 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006

48

maSin, rodesac mSobelTa Taobis bavSvebis imave raodenobiT

CanacvlebisaTvis es maCvenebeli 2,15-ze naklebi ar unda iyos, e.i. qveyana

normaluri reproduqtiulobis doneze bevrad dabali maCvenebliT

xasiaTdeba (cxrili 2).

cxrili 2.

Sobadobis asakobrivi da jamobrivi koeficientebi

(cocxladdabadebulTa raodenoba yovel 100 qalze)

dedis asaki

weli

-20

20-24

25-29

30-34

35-39

40-44

45+

Sobadobis

qonebrivi

koeficienti

1980

1985

1990

1995

2000

2001

2002

2003

2004

2005

2006

45,0

49,1

58,1

64,2

39,9

32,5

32,8

33,2

35,1

38,5

36,7

184,5

183,7

167,3

113,3

110,2

112,3

108,6

99,4

109,3

97,2

100,7

121,0

134,9

110,5

66,4

74,4

71,1

63,5

78,8

83,3

75,2

76,0

61,6

63,0

64,1

41,9

43,3

45,2

50,2

46,8

47,2

44,0

43,3

21,1

26,0

24,7

16,6

19,2

21,0

21,2

19,0

21,1

18,6

18,9

7,0

4,8

6,2

4,2

4,9

5,4

6,4

5,2

5,4

4,2

4,6

0,8

1,1

0,3

0,7

0,9

1,4

1,5

0,5

1,0

0,5

0,7

2,21

2,26

2,16

4,54

4,46

1,46

1,42

1,41

1,51

1,39

1,4

wyaro: janmrTelobis dacva, statistikuri cnobari, saqarTvelo 2005, 2006.

demografiul mdgomareobaze mniSvnelovan gavlenas mcireSvilianoba

axdens. saqarTveloSi sul ufro iklebs 3 da meti Sviliani dedebis wili.

Tu 1960 wels mesame bavSvis dabadebis wili dabadebulTa 36,5%-s Seadgenda,

amJamad es maCvenebeli 8,5%-mde aris Semcirebuli.

ukanasknel wlebSi saqarTveloSi sul ufro mcirdeba qorwinebaTa

raodenoba, rac mniSvnelovnad aferxebs qveynis mosaxleobis gamravlebas,

amasTan mraval mwvave socialur, fsiqikur da sxva xasiaTis problemas

warmoSobs. ganqorwinebaTa raodenoba SedarebiT dabalia, Tumca sakmarisad

didia imisaTvis rom uaryofiTi gavlena moaxdinos isedac dabali

Sobadobis maCvenebelze. qorwinebisa da Sobadobis maCveneblebis

Sedarebisas gamoxatulia am monacemTa TiTqmis paraleluri kleba 1990-98

49

wlebSi, Tumca ukanaskneli wlebis ganmavlobaSi es maCveneblebi

umniSvnelod matulobs [naxazi 11].

naxazi 11.

qorwinebisa da Sobadobis zogadi maCveneblebi (daqorwinebulTa da cocxladdabadebulTa ricxvi 1000 sul mosaxleze)

17,113,4

12 11,8 11,9 11,9 11,9 11,5 10,9 11 10,8 10,7 10,7 11,5 10,7 10,9

6,74,9 4,7 4,5 4,4 4,2 3,8 3,4 3,1 2,9 3 2,9 2,9 3,4 4,1 5

0

5

10

15

20

25

30

1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005

S1

1989 da 2002 wlebis aRweris Sedegebis mixedviT, saqarTveloSi

Secvlilia mosaxleobis asakobrivi ganawileba. 24,9%-dan 20,9%-mde

Semcirda 15 wlamde asakis bavSvTa procentuli Semadgenloba, xolo 65

wlis asakze meti mosaxlebis raodenoba momatebulia 8,9%-dan 12,8%-mde, es

tendencia 2006 welsac gagrZelda, am maCveneblebis mixedviT saqarTvelo

mosaxleobis daberebis maRali doniT xasiaTdeba.

2005 wlis monacemebiT saqarTveloSi sapensio asakis mamakacTa (65 da

meti wlis) ricxvma 220,8 aTass, xolo qalTa (60 da meti wlis) _ 463 aTass

miaRwia, rac jamSi 683,8 aTasis tolia. aRniSnuli mdgomareoba seriozul

problemebs uqmnis sazogadoebas, vinaidan am kontingentis janmrTelobasa

da socialur dacvaze gaweuli xarjebi mZime tvirTad awveba qveynis

50

ekonomikas. saqarTvelos demografiuli perspeqtivebic sakmaod

pesimisturia. specialistTa azriT, 2050 wlisaTvis kvlav Semcirdeba 15

wlamde asakis mosaxleobis wili, xolo demografiuli dabereba

dRevandelTan SedarebiT ufro maRali iqneba. qveynis mosaxleobis

saSualo asaki 36-37 wlidan 42-47 wlamde gaizrdeba.

analogiuri prognozebia msoflio bankisa da gaeros monacemebSic: 2015

wlisaTvis navaraudevia, rom saqarTveloSi 15 wlamde asakis mosaxleobis

wili 15,2%, xolo 65 welze meti asakisa _ 14,9% iqneba (World Development

Indicators 2005, Washington, DC, World Bank, 2005).

mosaxleobis demografiuli dabereba qveyanas mniSvnelovani socialur-

ekonomikuri problemebis winaSe ayenebs (sapensio asakis mosaxleobis

raodenobis zrda, rasac mosdevs SromisunarianTa xvedriTi wilis

Semcireba da dasaqmebulTa ekonomikuri datvirTvis mateba. es Tavis mxriv,

uaryofiTad aisaxeba erovnuli Semosavlis matebisa da Sesabamisad

cxovrebis doneze. wminda samedicino TvalsazrisiT ki igi mosaxleobaSi

qronikulad mimdinare araepidemiuri mokvdaobis matebis mizezi xdeba).

mokvdaobis koeficientma 2006 wels 9,6 Seadgina (1990 wels igi 9,3 iyo).

yvelaze maRali es maCvenebeli 2004 wels _ 11,3 iyo (SedarebisaTvis: 2004

wels aSS-Si man Seadgina _ 8,3, belgiaSi _ 9,8, TurqeTSi _ 6,2, iaponiaSi _

8,8, kanadaSi _ 7,3, fineTSi _ 9,1, CineTSi _ 6,9). gansakuTrebiT maRalia erT

wlamde asakis bavSvTa mokvdaoba _ 2006 wels man 15,8 Seadgina da, Tumca

igi wina welTan SedarebiT Semcirda (2005 wels igi 19,7 iyo), es maCvenebeli

garkveulwilad maRalia yofili sabWoTa kavSiris sxva respublikebTan

SedarebiT da mniSvnelovnad aRemateba evrokavSiris saSualo maCvenebels

[naxazi 12].

51

naxazi 12

erT wlamde asakis bavSvTa mokvdaoba (uaxlesi monacemebi)

5,446,33

6,84

7,88,63

10

11,03

11,7912,42

12,84

14,0714,96

15,1

18,127,9

29,66

5 10 15 20 25 30 350

0

5

10

15

20

25

30

35

yirgizezeTi (2005)

tajikeTi (2001)

saqarTvelo (2005)

yazaxeTi (2005)

uzbekeTi (2005)

dsT (2005)

azerbaijani (2002)

moldova (2005)

somxeTi (2003)

ruseTi (2005)

ukraina (2005)

evro-25 (2005)

latvia (2005)

litva (2005)

belorusia (2005)

estoneTi (2005)

wyaro: monacemTa baza"janmrTeloba yvelasaTvis"

kvlav maRalia mkvdarSobadobis maCvenebeli _ 2006 wels igi 14,7 iyo

(2005 wels _ 15,6). aqve unda aRiniSnos, rom bavSvTa mokvdaobis Semcirebis

tendencia ganpirobebulia Sobadobis zogadi SemcirebiT da ar asaxavs

dedaTa da bavSvTa jandacvis sferoSi Seqmnil mZime viTarebas.

2006 wlis daavadebianobisa da avadobis wina wlis monacemebTan

Sedareba cxadyofs, rom zogadad qveyanaSi daavadebianobac da avadobac

momatebulia daavadebaTa TiTqmis yvela ZiriTad klasSi (cxrili 3).

52

daavadebianobis da avadobis maCveneblebi

samkurnalo-profilaqtikur dawesebulebebSi (2004-2006 ww.)

daavadebianoba Aavadoba daavadebaTa ZiriTadi klasebi

X dsk-s mixedviT 2004 2005 2006 2004 2005 2006

infeqciuri da parazituli

daavadebebi

1786,1 1812,8 1523,8 1271,3 1235,2 1020,5

simsivneebi 935,6 991,4 1054,2 190,9 191,3 208,9

endokrinuli sistemis, kvebis,

nivTierebaTa cvlis da imunitetis

darRveva

3628,1 3738,4 3648,1 684,4 720,2 628,9

sisxlisa da sisxlmbadi organoebis

daavadebebi

370,0 373,0 387,6 196,8 194,5 213,7

fsiqikuri aSlilobebi 2445,8 2165,8 2178,3 174,7 160,5 154,2

nervuli sistemis da grZnobaTa

organoebis daavadebebi

3289,1 3689,5 3992,5 1178,5 1255,3 1410,5

sisxlis mimoqcevis sistemis

daavadebebi

6494,8 7228,3 7720,8 1616,1 1883,0 1891,0

sasunTqi organoebis daavadebebi 7022,3 7510,2 8675,3 5387,9 5698,6 7134

saWmlis momnelebeli organoebis

daavadebebi

2591,1 3700,6 3207,1 958,1 1941,6 1286,9

Sard-sasqeso sistemis daavadebebi 774,5 773,8 1812,7 543,7 533,6 917,6

orsulobis, mSobiarobis da

mSobiarobis Semdeg periodis garT.

631,6

820,1

958,5

521,6

707,4

799,7

kanisa da kanqveSa ujredisis

daavadeba

774,5 773,8 879,6 543,7 533,6 612,9

Zval-kunTovani sistemis da

SemaerTebeli qsovilis daavadebebi

731,5 838,2 961,9 245,5 301,1 405,1

Tandayolili anomaliebi 147,3 134,9 131,3 27,3 24,4 28,7

perinatalur periodSi warmoqmnili

calkeuli mdgomareobebi

86,7 85,8 57,7 53,4 56,3 40,7

simptomebi da arazustad aRniSnuli

mdgomareobebi

133,0 126,3 140,2 72,3 57,7 90,7

tramvebi da mowamvlebi 845,2 814,7 747,9 14206,2 15902,

6

675,2

sul 33053,

4

35823,3 37980,2 14206,2 15902,

6

17303,2

wyaro: janmrTelobis dacva, statistikuri cnobari, saqarTvelo, 2005, 2006.

53

2006 wels sicocxleSi pirvelad dadgenil daaxloebiT aRricxuli

daavadebebis SemTxvevebis raodenoba 11%-iT gaizarda. avadobis

struqturaSi wamyvani adgili ukavia sunTqvis organoTa, sisxlis

mimoqcevis (gulis iSemiuri daavadeba da arteriuli hipertenzia),

endokrinuli sistemis, nervuli sistemis daavadebebs.

qveyanaSi arsebulma sakmaod daZabulma sanitarul-epidemiurma

mdgomareobam, romelic ganpirobebuli iqna dasaxlebuli punqtebis

sanitaruli keTilsaimedobis gauaresebiT, xarisxiani sasmeli wyliT

momaragebaSi Seqmnili problemebiT, siRaribesTan dakavSirebuli

socialuri pirobebis gauaresebiT da profilaqtikuri jandacviTi

programebis dafinansebis uaRresad dabali doniT, mniSvnelovani

sirTuleebi Seuqmna infeqciur daavadebaTa profilaqtikas da kontrols.

miuxedavad imisa, rom 2006 wels infeqciur da parazituli daavadebebis

sicocxleSi pirvelad dadgenili diagnoziT aRricxuli SemTxvevebis

raodenobam 2005 welTan SedarebiT 16,6%-iT daiklo, mTlianobaSi maTi

raodenoba kvlavindeburad maRali rCeba.

magaliTad, 2006 wels mkveTrad matulobs virusuli hepatitis

SemTxvevebi _ 2005 welTan SedarebiT igi 44,5%-iT gaizarda. agreTve

gamovlinda difteriis, leiSmaniozis SemTxvevaTa mateba. am ukanasknelis

SemTxvevaTa raodenobam wlebis mixedviT Sesabamisad Seadgina: 2003 w. _ 103,

2004 w. _ 125, 2005w. _ 161, 2006w. _ 174. ukanasknel wlebSi saqarTveloSi

aRiniSneba malariis SemTxvevebi, romelic likvidirebuli iyo, magram

arsebobda yvela bunebrivi piroba Semotanis SemTxvevaSi misi

gavrcelebisaTvis. wlebis ganmavlobaSi sxvadasxva uwyebebis mier

kompleqsurad xorcieldeboda malariis likvidaciis RonisZiebebi _

daWaobebuli adgilebis amoSroba, mcire bonifikacia, gadamtanebis

masobrivi mospoba SxamqimikatebiT, malariasaSiS qveynebSi wamsvlel da

Camosul pirTa registracia da samedicino-profilaqtikuri meTvalyureoba,

qimioprofilaqtika antimalariuli saSualebebiT. 90-ian wlebSi malariis

profilaqtikaze mimarTuli RonisZiebebis daufinanseblobam gamoiwvia

saerTod gaciebisa da, maT Soris, malariis gadamtani anofeliebis ricxvis

zrda, rasac Tan daerTo azerbaijansa da somxeTSi malariis epidemia.

saqarTveloSi malariis pirveli SemTxvevebi 1996 wels gamovlinda

54

(4 SemTxveva). Semdgom wlebSi igi mkveTrad matulobs (2002 wels _ 474

SemTxveva). 2003-2006 wlebSi SeimCneva klebis tendencia, Tumca malariis

aRmofxvraze saubari jer naadrevia.

saqarTvelos TiTqmis mTel teritoriaze gamovlenilia cofi

cxovelebSi. upatrono, moxetiale cxovelebis mniSvnelovani momravlebis

gamo mosalodnelia epizootiis kidev ufro swrafi gavrceleba. 2006 wels

samedicino dawesebulebebs antirabiuli daxmarebisaTvis mimarTa 41 961

pacientma.1 amasTan, kvlav arakeTilsaimedo situaciaa cofis sawinaaRmdego

kompleqsur RonisZiebaTa gatarebis TvalsazrisiT, gansakuTrebiT

raionebSi.

1992-1996 wlebSi saqarTveloSi moxda tuberkulozuri infeqciis

afeTqeba, mogvianebiT, mosaxleobis socialur-ekonomikuri mdgomareobis

gauaresebis fonze tuberkulozma qveynis mosaxleobis im socialur

fenebSi SeaRwia, sadac misi gavrceleba wina wlebSi tradiciulad dabali

iyo. 2006 wels qveyanaSi registrirebuli iyo tuberkulozis 4 261 axali

SemTxveva (avadobis maCvenebeli 100 000 sul mosaxleze _ 96,9) [naxazi 13].

yofili sabWoTa kavSiris qveynebSi tuberkulozis axali SemTxvevebis

maCvenebeli sakmaod cvalebadia 39,8-dan (estoneTi) 175,6-mde (yazaxeTi),

Tumca, unda aRiniSnos, rom 2005 wlis saqarTvelos maCvenebeli (98,1) dsT-s

qveynebis saSualo maCvenebelze (87,1) metia.

qveyanaSi SidsiT daavadebulTa da aiv-infeqciebis SemTxvevaTa

raodenoba _ 2006 wels dafiqsirda 912 SemTxveva. 2005 wlidan SedarebiT

Sidsis da aiv-infeqciebis axali SemTxvevebis raodenoba 14%-iT gaizarda.

yovelwliurad matulobs triqomoniazis da qlamidiuri infeqciebis

SemTxvevaTa raodenoba (avadoba Sesabamisad 25,8 da 83,2); aRiniSneba

sisxlisa da sisxlmbadi organoebis daavadebebis mateba.

55

naxazi 13.

tuberkuloziT avadobis maCvenebeli

21,9

67

134,1

119

96,998,194,8

92,8

96,5

86,4

96,5101

99,2

57,9

22,727,6

0

20

40

60

80

100

120

140

160

1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006

wyaro: janmrTelobis dacva, statistikuri cnobari, saqarTvelo, 2006

2006 wlis daavadebianobis maCvenebeli 1,3-jer aRemateba 2000 wlis

analogiur maCvenebels (cxrili 4). cxrili 4.

sisxlis da sisxlbadi organoebis daavadebaTa gavrceleba

saqarTveloSi 2000-2006ww.

2000 2001 2002 2003 2004 2005 2006

1.

2.

3.

4.

registrirebul avadmyofTa

raodenoba

daavadebianobis maCvenebeli 100

000 mosaxleze

axal SemTxvevaTa raodenoba

avadobis maCvenebeli 100 000

mosmosaxleze

13189

297,4

6784

153,0

16330

371,0

8511

193,4

16442

376,1

7730

176,8

14695

339,5

7400

170,9

16175

370,0

8605

196,8

16305

373,0

8505

194,6

17048

387,6

9397

213,7

wyaro: janmrTelobis dacva, statistikuri cnobari, saqarTvelo, 2006

56

mosaxleobis avadobis struqturaSi sul ufro did adgils ikavebs

endokrinuli daavadebebi, romlebic sabiujeto saxsrebis sul ufro mzard

danaxarjs moiTxovs [naxazi 14]. es ganpirobebulia imiT, rom pacientTa

sakmaod did raodenobas esaWiroeba specifikuri medikamentebiT, sakvebi

produqtebiT, hormonaluri preparatebiT momarageba.

naxazi 14

endokrinuli sistemiT daavadebebiT avadobis maCvenebeli

2183,1

2498,12647

2768,8 27472958,8

3138,9

946,2757,4 724,1 717,3 687,5 666,7 684,4 720,2

2870

0

500

1000

1500

2000

2500

3000

3500

1998 1999 2000 2001 2002 2003 2004 2005

wlis bolosaTvis

axali SemTxvevebi

wyaro: janmrTelobis dacva, statistikuri cnobari, saqarTvelo, 2005

gansakuTrebiT sagangaSoa fsiqikuri da qceviTi aSlilobebis mkveTri

mateba. 2006 wels 2000 welTan SedarebiT igi 2,2-jer gaizarda (bavSvebSi _

4,1-jer). izrdeba agreTve sisxlis mimoqcevis sistemis daavadebebi. 2006

wels 1998 welTan SedarebiT igi 2,2-jer gaizarda.

57

cxrili 5.

sisxlis mimoqcevis sistemis daavadebebi saqarTveloSi 1998-2006 ww.

Ddaavadebis dasaxeleba 1998 1999 2000 2001 2002 2003 2004 2005 2006

sisxlis mimoqcevis sistemis

daavadebebi

m.S. pirvelad dadg. diagnoziT

3527,1

1000,6

4524,7

1029,2

4257,4

999,2

4838,1

1297,3

5322,4

1299,6

5776,8

1481,7

6494,8

1616,1

7228,3

1888,0

7720,8

1891,0

gulis revmatiuli daavadebebi

m.S. pirvelad dadg. diagnoziT

321,5

62,6

335,6

65,8

332,7

70,6

341,2

73,4

356,3

73,6

358,8

68,9

350,6

76,0

378,8

82,7

471,2

100,0

hipertenzia _ sul

m.S. pirvelad dadg. diagnoziT

1422,1

380,7

1872,1

429,8

1853,4

412,0

2158,9

535,6

2410,4

569,9

2730,6

686,4

3108,2

801,9

3620,5

950,7

3861,5

917,4

gulis iSemiuri daavadeba

m.S. pirvelad dadg. diagnoziT

1219,7

385,9

1536,6

300,8

1392,2

289,3

1602,6

432,9

1760,8

400,1

1875,7

441,0

1955,1

449,8

2213,2

545,7

2373,2

569,9

wyaro: janmrTelobis dacva, statistikuri cnobari, saqarTvelo 2005, 2006.

aqve aRvniSnavT, rom 2006 wels sicocxleSi pirvelad dadgenili

diagnoziT aRricxul avadmyofTa raodenobam wina welTan SedarebiT

moimata da mTlianad registrirebul avadmyofTa TiTqmis 30% Seadgina,

Tumca 1936-1996 wlebSi es maCvenebeli 9-11%-is farglebSi meryeobda.

ukanasknel wlebSi arteriuli hipertenziis mkveTri momateba

gamowveulia qveynis mosaxleobisaTvis Semdegi risk-faqtorebiT: siRaribe,

kvebis reJimis darRveva, alkoholisa da Tambaqos moxmarebis zrdiT,

stresuli mdgomareobiT da a.S.

amrigad, qveyanaSi Tanamedrove samedicino demografiul situacias

sistemuri krizisis xasiaTi aqvs. am sistemis Semadgeneli nawilebia:

Sobadobis krizisul zRvramde Semcireba, garkveulwilad mokvdaobis zrda,

mosaxleobis progresirebadi Sekvecili kvlavwarmoeba zogierT raionSi,

mosaxleobis bunebrivi matebis Semcireba, janmrTelobis gauareseba, gare

da Sida migraciis farTo masStabebi, demografiuli procesebis marTvis

dabali done.

unda aRiniSnos, rom janmrTeloba socialuri da ekonomikuri

ganviTarebis umniSvnelovanesi resursia, janmrTelobasa da mdgrad

ganviTarebas Soris mWidro kavSiri arsebobs.

58

janmrTelobis cneba farTo da mravalfaqtorulia da garda

biologiurisa, igi socialur, kulturul, ekonomikur da politikur

elementebsac moicavs, rac Tavis mxriv, adamianis janmrTelobaze dadebiT

an uaryofiT zemoqmedebas axdens.

kerZod, adamianis janmrTeloba keTildReobis mraval (individualur,

ojaxisa da mTeli sazogadoebis doneze moqmed) faqtorTanaa

dakavSirebuli, rogoricaa: kvebis racioni, cxovrebis wesi, samedicino

momsaxurebis xelmisawvdomoba da sxv. aq udidesi roli socialur-

ekonomikur faqtorebs (determinantebs) _ piradi usafrTxoeba, Semosavali,

sayofacxovrebo pirobebi, socialuri mxardaWera da sxv. _ eniWeba. magram

yvelaze mniSvnelovani da mTavari faqtorebia Semosavali, ganaTlebis done

da dasaqmeba, TiToeuli maTgani erTmaneTTan garkveul kavSirSia, Tumca

TiToeuli maTgani mosaxleobis socialur-ekonomikuri statusis sxvadasxva

aspeqts asaxavs. sxvadasxva faqtorTa wili avadobis tvirTSi mocemulia

cxrilSi 6.

cxrili 6.

avadobis tvirTis determinantebi

# faqtori wili (%)

1 siRaribe 3,1

2 umuSevroba 2,9

3 profesiuli saqmianobiT gamowveuli 3,6

4 narkotikebis moxmareba 2,4

5 alkoholis moxmareba 8,4

6 Tambaqos moxmareba 9,0

7 Warbi wona 3,7

8 xilisa da bostneulis arasakmarisi

moxmareba

3,5

9 cximiani sakvebis Warbi moxmareba 1,1

10 hipodinamia 1,4

wyaro: Determinants of the burden of desease in the European Union, Stockholm, National Institute of Public

Health, 1997.

59

siRaribesTan aris asocirebuli iseTi infeqciuri daavadebebi,

rogoricaa Sidsi, malaria, tuberkulozi, diarea da a.S. es daavadebebi

dabal SemosavlebTan, sufTa wylisa da sanitariis naklebobasTan, sakvebis

arasrulfasovan moxmarebasTan, samedicino daxmarebaze xelmisawvdomobis

ararsebobasTanaa dakavSirebuli. arsebobs siRaribis korelacia ara marto

infeqciur, aramed fsiqikur daavadebebTanac. miuxedavad imisa, rom

simdidre ar aris fsiqikuri janmrTelobis aucilebeli winapiroba da arc

siRaribea am daavadebaTa aucilebeli gamomwvevi mizezi, arsebobs

mosazreba, rom siRaribe aris fsiqikuri daavadebis determinati da Sedegic

aqedan gamomdinare, mizanSewonilad migvaCnia zogadad ganvixiloT

saqarTveloSi mosaxleobis cxovrebis donis ZiriTadi maCveneblebi.

ukanasknel aTwleulSi msoflioSi mimdinare globaluri procesebis

fonze saqarTveloSi, iseve rogorc evropisa da centraluri aziis

regionis gardamavali ekonomikis qveynebSi, aRiniSna siRaribis donis

mniSvnelovani zrda. mTliani Sida produqtis moculoba mniSvnelovnad

CamorCeba gardamaval periodamde arsebuls, rac ZiriTadad politikur,

ekonomikur da sazogadoebriv cxovrebaSi momxdarma cvlilebebma

ganapiroba.

1994-1997 wlebSi ekonomikuri reformisa da stabilizaciis

ganxorcielebis Sedegad miRweul iqna ekonomikis zrda da inflaciis

mkveTri kleba, ramac Seamcira siRaribis done qveynis garkveul nawilebSi,

ZiriTadad qalaqebsa da maT SemogarenSi. 1996-1997 wlebSi mTliani Sida

produqtis saSualo wliuri zrdis tempma 10%-s gadaaWarba, xolo

inflacia 13,8%-dan (1996 w.) 7,3%-mde (1997w.) Semcirda. 1998 wlidan

saqarTvelos ekonomikaSi ganviTarebulma krizisulma movlenebma

mniSvnelovnad Seaferxa ekonomikuri zrda, ris gamoc momdevno wlebSi

SesamCnevi gaxda siRaribis gaRrmaveba mTeli qveynis masStabiT. mSp-s

saSualo wliuri zrda 1998-1999 wlebSi 3%-mde Semcirda. amave wlebSi

inflaciis maCvenebeli 10,7%-10,9% iyo. 2000 wels aRiniSna mSp-s saSualo

wliuri zrdis kidev ufro dabali maCvenebeli _ 1,8%, Tumca, inflaciis

done TiTqmis 2,5-jer Semcirda da 4,6% Seadgina.

ekonomikuri zrdis TvalsazrisiT 2001 wels gamoikveTa dadebiTi

tendencia, rac mSp-is 4,8%-ian zrdaSi gamoixata. Semdeg wlebSi es

60

tendencia SenarCunda da 2003 wels 1996 wlis dones gautolda kidec,

Tumca 2004 wels mSp-is zrdis tempma kvlav daiklo da inflacia gaizarda.

2005 wels qveyanaSi sagadasaxado sferoSi gatarebuli reformebis Sedegad

kvlav daiwyo ekonomikuri zrda [naxazi 15] da inflaciis Semcireba [naxazi

16], saqarTveloSi Sinameurneobebis nominaluri Semosavlebis moculoba

ukanasknel wlebSi zrdis tendenciiT xasiaTdeba da 2001 wels, 1996 welTan

SedarebiT, 25%-iT gaizarda. Tumca, es zrda jer kidev ar aris sakmarisi

siRaribis arsebiTi SemcirebisaTvis.

naxazi 15

11,20%10,70%

2,90% 3%

1,80%

4,80%5,50%

11,10%

5,90%

9,60%

0%

2%

4%

6%

8%

10%

12%

1996 1997 1998 1999 2000 2001 2002 2003 2004 2005

wyaro: saqarTvelos statistikuri weliwdeuli - 2006

61

naxazi 16

0,0%

2,0%

4,0%

6,0%

8,0%

10,0%

12,0%

14,0%

16,0%

1996 1997 1998 1999 2000 2001 2002 2003 2004 2005

wyaro: saqarTvelos statistikuri weliwdeuli – 2006

oficialuri monacemebiT, 2005 wels wina welTan SedarebiT

Sinameurneobis saSualo Tviuri Semosavlebi gaizarda rogorc qalaqad,

ise soflad da TiTqmis orjer gadaaWarba 2001 wlis Semosavlebs

(cxrili 7).

cxrili 7.

erTi Sinameurneobis saSualoTviuri Semosavali (lari)

2001 2002 2003 2004 2005

sul qveyanaSi 173,7 226,9 242,3 277,3 303,5

qalaqad 170,5 202,5 233,8 253,2 297,6

soflad 177,2 253,4 250,6 302,1 309,4

wyaro: saqarTvelos statistikuri weliwdeuli _ 2006.

62

2005 wels Sinameurneobebis mTliani xarjebi TveSi erT

Sinameurneobaze 389,7 lari iyo (2004 w. _ 361,6 lari) samomxmareblo

xarjebi ki 351 lari (2004 wels _ 315,7 lari). Sinameurneobebis resursebis

ZiriTadi nawili sursaTze ixarjeba (136,4 lari), jandacvaze _ 20 lari.

fuladi da arafuladi sasursaTo xarjebis wili mTliani xarjebis

daaxloebiT 56%-ia. Sinameurneobebis xarjebSi didia e.s. arafuladi

xarjebis (sakuTari warmoebis an ufasod miRebuli sursaTi) wili _

mTliani xarjebis daaxloebiT 20%. amis gamo Sinameurneobebis socialur-

ekonomikuri mdgomareoba mniSvnelovnad sakuTari miwidan miRebul

mosavalzea damokidebuli.

ukanaskneli wlebis ganmavlobaSi mkveTrad imata mosaxleobaSi

socialur-ekonomikurma uTanxmoebam. Semosavlebis faqtiuri ganawilebis

mixedviT uTanabrobis maCvenebeli (`jinis~ indeqsi) 1997-2000 ww. 0,52-0,53

farglebSi iyo.

Tumca, unda aRiniSnos, rom uTanabrobas ufro kargad asaxavs `jinis

indeqsi~ mTliani moxmarebis mixedviT, romlis mniSvneloba amave periodSi

0,39-s ar aRemateboda. `jinis~ indeqsi mTliani Semosavlebis mixedviT

TandaTan mcirdeba da 2005 welsac, iseve, rogorc 2004 wels, 0,44 iyo.

uTanabroba SedarebiT dabalia moxmarebis SemTxvevaSi, romlis mixedviT

`jinis~ indeqsi 0,39-is tolia, rac ufro Tanabari ganawilebis maCvenebelia

(cxrili 8).

cxrili 8.

socialur-ekonomikuri uTanabroba

`jinis~ indeqsi 2001 2002 2003 2004 2005

mTliani Semosavlebis

mixedviTY

0,5 0,47 0,49 0,44 0,44

mTliani moxmarebis mixedviT 0,38 0,37 0,38 0,38 0,39

wyaro: saqarTvelos statistikuri weliwdeuli _ 2006

63

1994 wels siRaribis done saarsebo minimumis mimarT anu Raribebis

raodenobis wili mTel mosaxleobaSi 80% iyo, 1995 wels _ 60%.

2004 wels saarsebo minimumis mimarT siRaribis donem qveyanaSi 52%

Seadgina. es maCvenebeli 1994 wels 80%, 1995 wels _ 60%, 2003 wels _ 54,%-s

Seadgenda. aRsaniSnavia, rom saqarTveloSi 2004 wlidan saarsebo minimumis

gaangariSebis meTodika Seicvala. Tu adre saarsebo minimumi iangariSeboda

normatiuli statistikuri meTodiT da emyareboda 2500 kilokaloriis

sasursaTo kalaTis Rirebulebasa da minimalur arasasursaTo xarjebs,

2005 wlidan minimaluri saarsebo minimumi iangariSeba statistikuri

meTodiT, romelic emyareba mosaxleobis yvelaze uqoneli 10%-is

faqtobriv minimalur moxmarebas. am midgomam adrindeli maCveneblebis

koreqtireba gamoiwvia. 2002 w. saarsebo minimumma 127,9 l. Seadgenda, 2004

wels igi 84,3 lari iyo. gaangariSebis meTodis Secvlis Semdeg siRaribis

donis 2004 wlis maCvenebeli 52%-is nacvlad oficialurad dafiqsirda

35,7%, xolo 2005 wels 39,4%. siRaribis gamoTvlis 2004 wlamde arsebuli

meTodiT, 2005 wels igi 57,7% Seadgens. 2006 wels gaangariSebis axali

meTodiT siRaribis maCvenebelma 40,3% Seadgina. 2006 wels statistikis

departamentis mier Catarebuli gamokvlevebis Sedegad, dafiqsirebul

muSakTa 32%-s, anu 1/3 saarsebo minimumze naklebi xelfasi hqonda, xolo 20

aTasamde daqiravebuli adamiani 20 larze nakleb xelfass iRebda, maSin,

roca saarsebo minimumi Sesabamis periodSi 197 lari iyo. amave periodSi

oficialuri monacemebiT, 350 aTasi umuSevari iqna aRricxuli.

siRaribe qalaqad da soflad mniSvnelovnad gansxvavebul movlenas

warmoadgens, siRaribe qalaqad ZiriTadad arasrulfasovan kvebasTanaa

dakavSirebuli, rac saerTo jamSi ufro mwvave da Rrma siRaribis

maCvenebelia. soflad mcxovrebTa umTavres problemas fuladi resursebis

deficiti da socialuri infrastruqturis dabali done ganapirobebs.

rac Seexeba umuSevrobas, 2006 wels man saqarTveloSi 13,6% Seadgina

(umuSevrobis bunebriv doned 6-7% iTvleba). eqspertebi umuSevrobas

pirdapir ukavSireben genofonds. 1989 wels qveyanaSi yovel 1000 sulze 7

qorwineba modioda, 2006 wels _ mxolo 5. umuSevroba uSualod zemoqmedebs

janmrTelobis mdgomareobaze.

64

amrigad, saqarTveloSi amJamad arsebuli socialur-ekonomikuri

mdgomareoba jer-jerobiT optimizmis safuZvels ar iZleva. `Raribi eri

janmrTeli ver iqneba~ _ sayovelTaod cnobili es gamonaTqvami

zedmiwevniT sworad asaxavs qveyanaSi mosaxleobis janmrTelobis mxriv

Seqmnil viTarebas, razecmetyveleben kidevac zemoaRniSnuli monacemebi.

aqedan gamomdinare, metad aucilebeli da aqtualuria qveyanaSi siRaribis

daZlevis amocanis gadaWra.

65

II.1.2. saqarTvelos samkurnalo-profilaqtikuri qseli da

sakadro uzrunvelyofa

jandacvis dafinansebis strategiis mizania saqarTvelos mosaxleobis

samedicino momsaxurebis efeqtiani da stabiluri dafinansebis

uzrunvelyofa. jandacvis dafinansebis realizebis strategiis erT-erT

ZiriTad mimarTulebas warmoadgens stacionaruli seqtoris

racionalizacia da samedicino personalis optimizacia.

2006 wlis monacemebiT saqarTveloSi funqcionirebda 271 stacionari,

romelTagan 269 Sromis, janmrTelobisa da socialuri dacvis

saministros, xolo 2 sxva uwyebebis daqvemdebarebaSi iyo. (cxrili 9).

cxrili 9

saqarTvelos samkurnalo-profilqtikuri qselis struqtura

maT Soris samkurnalo-profilaqtikuri

dawesebulebebi

sul saministro sxva

uwyebebi

stacionaluri dawesebulebebi 271 269 2

dispanserebi

damoukidebeli

75

75

_

poliklinikuri dawesebulebebi 179 175 4

stomatologiuri poliklinikebi 100 100 _

saswrafo daxmarebebis sadgurebi 72 72 _

soflis saeqimo ambulatoriebi 209 209 _

sisxlis gadasxmis sadgurebi 6 6 _

Cvil bavSvTa saxlebi 2 2 _

samecniero-kvleviTi institutebi 20 20 _

samkurnalo centrebi 51 51 _

Semavali

saavadmyofoSi Semavali poliklinikebi

68

68

_

saeqimo janpunqtebi 9 9 _

soflis saeqmimo ambulatoriebi 481 481 _

saferSlo-sabebio punqtebi 379 379 _

wyaro: janmrTelobis dacva, statistikuri cnobari, saqarTvelo 2006.

66

2006 wels saqarTvelos stacionarul dawesebulebaTa qselSi sawolTa

raodenoba 16455 Seadgenda. qveyanaSi sawolebis datvirTvis saSualo

maCvenebelia 123,1 dRe. qveynis saSualo maCvenebelTan SedarebiT igi

maRalia aWaraSi (160,3), imereTSi (150,2), Tbilissa (136,9) da samcxe-javaxeTSi

(121,5) (cxrili 10).

cxrili 10.

stacionarebis qselis struqtura

2006 wels

sawolTa

raodenoba

wlis

bolos

sawolebiT

uzrunvel-

yofa 100

000 sul

mosaxleze

datvirTva

sawolze

(dRe)

dayovneba Bbrunva

saqarTvelo _ sul 16 455 374,1 127,8 7,4 17,1

Tbilisi 7 197 653 136,9 7,7 17,8

aWara 1 281 338,9 160,3 7,5 21,5

guria 345 248,0 114,7 6,8 17,0

raWa-leCxumi da qvemo

svaneTi

1246 522,5 75,7 7,2 10,4

mcxeTa-mTianeTi 179 144,0 78,4 4,1 19,2

samcxe-javaxeTi 673 322,9 121,5 9,8 12,3

qvemo qarTli 1044 205,5 78,5 5,5 14,2

imereTi 2590 370,6 150,2 8,4 17,9

kaxeTi 763 188,8 99,2 5,0 19,9

Sida qarTli 830 264,5 112,9 7,6 14,9

afxazeTi 52 _ 62,2 5,4 11,5

samegrelo 1246 263,8 94,4 7,0 13,4

wyaro: janmrTelobis dacva, statistikuri cnobari, saqarTvelo 2006

saerTod ki aRsaniSnavia, rom qveyanaSi sawolebis gamoyenebis

maCvenebeli ukanasknel wlebSi mcirdeboda, mxolod 2005-2006 wlebSi

SeimCneva mcireodeni mateba (cxrili 11).

67

cxrili 11

sawolis saSualo wliuri datvirTva da avadmyofTa

sawolze dayovneba 1990-2006 www.

wlebi sawolebis saSualo wliuri

datvirTva. (dRe)

avadmyofis sawolze

dayovneba

1990

1995

2000

2005

2006

208

100,1

97,9

118

127,8

14,9

13,4

10,1

7,7

7,4

wyaro: janmrTelobis dacva, statistikuri cnobari, saqarTvelo 2001-2006 ww.

rogorc cxrilidan Cans, 2006 wels sawolebis datvirTva 1990 welTan

SedarebiT TiTqmis ganaxevrda, sawolze dayovneba ki 14,9-dan 7,4-mde davida.

aRsaniSnavia, rom 1980-85 ww. (e.w. sabWour periodSi) sawolTa datvirTva

yovelwliurad 280 dRes Seadgenda, sawolze dayovneba ki saSualod 15

dRes.

sawolTa profilis mixedviT datvirTvis maRali maCvenebliT

xasiaTdeba tuberkulozis (274,5), fsiqiatriuli da narkologiuri (263,7),

pediatriuli (172,0), onkologiuri da radiologiuri (224,8) sawolebi.

sawolze datvirTvis SedarebiT dabali maCvenebelia oTolaringologiur

(34,6) da ofTalmologiur (64,2) sawolebze (cxrili 12).

68

cxrili 12.

sawolTa fondi profilis mixedviT da misi

gamoyenebis maCveneblebi 2006 wels

sawolTa profili

sawolTa

raodenoba

datvirT-

va

sawolze

(dReebSi)

dayovneba

brunva

Terapiuli

pediatriuli

qirurgiuli

onkologiuri da radiologiuri

infeqciuri

tuberkulozis

sameano-ginekologiuri

nevrologiuri

fsiqiatriuli da narkologiuri

oTolaringologiuri

ofTalmologiuri

2879

1866

3990

429

1104

562

3294

455

1540

211

204

72,3

151,3

90,1

224,8

101,4

274,5

108,1

134,9

263,7

34,6

64,2

6,3

9,4

5,7

18,0

6,8

53,4

4,5

9,8

72,1

1,4

3,6

11,8

16,5

15,9

12,4

15,3

5,1

23,8

14,2

3,6

24,1

18,0

wyaro: janmrTelobis dacva, statistikuri cnobari, saqarTvelo 2006.

2006 wels samkurnalo-profilaqtikur dawesebulebebSi

hospitalizebuli iyo 277 191 avadmyofi. wina welTan SedarebiT

hospitalizebulTa saerTo raodenoba 5,4%-iT gaizarda (cxrili 13).

69

cxrili 13

registrirebul da hospitalizirebul

avadmyofTa raodenoba 2005-2006 ww.

2005 2006 daavadebaTa ZiriTadi klasebi OIX dsk-s mixedviT

hospitaliz

ebuli sul

gardai

cvala

hospitalize

buli sul

gardai

cvala

sul

infeqciuri da parazituli daavadebebi

simsivneebi

endokrinuli sistemis, kvebis, nivTierebaTa cvlis da

imunitetis darRvevebi

sisxlis da sisxlbadi organoebis daavadebebi

fsiqikuri aSlilobebi

nervuli sistemis daavadebebi

sisxlis mimoqcevis sistemis daavadebebi

sasunTq organoTa daavadebebi

saWmlis momnelebel organoTa daavadebebi

Sard-sasqeso sistemis daavadebebi

orsuloba, mSobiroba da mSobiarobis Semdgomi

periodis garTulebebi

kanisa da kanqveSa ujredebis daavadebebi

ZvalkunTovani sistemis da SemaerTebel qsovilTa

daavadebebi

Tandayolili anomaliebi

perinatalur periodSi warmoqmnili mdgomareobebi

simptomebi da arazustad aRniSnuli mdgomareoba

tramvebi da mowamvlebi

262296

17071

9357

4039

821

4310

10810

28284

44406

28280

11144

66336

2824

2684

1712

5957

3015

21247

5095

184

234

62

18

105

175

1919

229

470

79

8

8

6

85

606

290

618

277191

17254

10358

4364

994

4752

6657

33503

47340

28865

11419

70234

3133

3047

1812

5884

2493

21041

5464

206

238

92

14

86

177

2098

316

496

179

5

6

11

63

273

273

wyaro: janmrTelobis dacva, statistikuri cnobari, saqarTvelo 2006

daavadebaTa ZiriTadi klasebis mixedviT hospitalizaciis xvedriT

wilSi, iseve rogorc gasul wels, wamyvani adgili eWira orsulobas,

mSobiarobasa da mSobiarobis Semdgomi periodis garTulebebs (70234

SemTxveva), sasunTqi organoebis (47340), sisxlis mimoqcevis sistemis

(33503), saWmlis momnelebel organoTa (28865) daavadebebs.

2006 wels saqarTvelos stacionarebSi gakeTda 100303 operacia

(letaloba 0,6%). 1991 wlidan operaciebis raodenoba ganuxrelad

klebulobda da 2000 wlisaTvis gakeTebuli operaciebis ricxvma 1991

70

welTan SedarebiT 61,5%-iT daiklo. miuxedavad ukanaskneli wlebis

ganmavlobaSi gakeTebuli operaciebis raodenobis matebisa, 2006 wels

klebam 1991 welTan SedarebiT 44,1% Seadgina (cxrili 14).

cxrili 14

qirurgiuli operaciebis raodenoba 2006 wels

wlebi sul maCvenebeli

1000 sul

mosaxleze

letalo

ba %

bavSvebi saerTo

raodenobis

%

zogadi

narkoziT

saerTo

raodeno

bis %

letaloba

% zogadi

narkozis

SemTxvevaS

i

1991

1995

2000

2001

2002

2003

2004

2005

2006

179377

97583

69360

75905

77657

82626

90790

98695

100303

33,

18,9

15,6

17,2

17,8

19,1

20,8

22,6

22,8

0,5

0,7

0,8

0,7

0,7

0,7

0,7

0,7

0,6

26082

10774

9262

10725

10463

10970

10945

11655

11194

14,5

11,0

13,4

13,7

13,5

13,3

12,05

12,7

14,1

69549

32360

32363

34173

35261

39386

43030

54499

54771

38,8

33,2

40,9

45,0

45,4

47,4

47,4

55,2

54,6

0,01

0,01

0,04

0,02

0,03

0,03

0,02

0,01

0,01

wyaro: janmrTelobis dacva, statistikuri cnobari, saqarTvelo 2006.

pirveladi samedicino momsaxureba saqarTveloSi warmodgenilia

dawesebulebis farTo qseliT (ambulatoriebi, poliklinikebi, qalTa

konsultaciebi, dispanserebi da saferSlo-sabebio punqtebi soflad)

(cxrili 15).

71

cxrili 15

ambulatoriul-poliklinikuri dawesebulebebi

regionebis mixedviT 2006 wels

polikli-

nika

dispan

seri

samkurna

lo

centri

qalTa

konsulta

cia

saeqimo

ambulato

ria

Tbilisi

aWara

guria

raWa-leCxumi da qvemo svaneTi

samegrelo da zemo svaneTi

mcxeTa-mTianeTi

samcxe-javaxeTi

qvemo qarTli

imereTi

kaxeTi

Sida qarTli

afxazeTi

sxva uwyebebi

saqarTvelo

100

17

5

3

19

3

14

10

31

21

13

9

4

249

12

9

5

_

6

_

5

6

14

7

4

2

_

70

23

3

3

_

4

_

_

2

3

3

1

_

_

42

9

_

3

1

4

1

1

19

4

_

2

11

2

27

11

20

103

6

21

2

_

209

wyaro: janmrTelobis dacva, statistikuri cnobari, saqarTvelo 2006.

Tu gaviTvaliswinebT ukanasknel wlebSi avadobis maCveneblis

momatebas daavadebaTa yvela ZiriTadi klasis mixedviT, mimarTvaTa

raodenoba ambulatoriul-poliklinikur dawesebulebebSi mkveTrad iklebs

(cxrili 16).

72

cxrili 16

ambulatoriul-poliklinikur dawesebulebebSi mimarTvaTa

raodenoba erT sul mosaxleze 1990-2006 ww.

wlebi mimarTvebi sul avadmyofis binaze

monaxuleba

1990

1995

2000

2001

2002

2003

2004

2005

2006

8,0

2,7

1,4

1,5

1,6

1,8

2,0

2,1

2,2

_

_

0,08

0,08

0,09

0,1

0,12

0,11

0,16

wyaro: janmrTelobis dacva, statistikuri cnobari, saqarTvelo 2001-2006 ww.

2006 wels ambulatoriul-poliklinikur dawesebulebebSi mimarTvaTa

raodenobam 2,2 Seadgina (1990 wels igi 8,0, xolo 1985 wels _ 9,9-s

Seadgenda).

1990-ian wlebSi 2004 wlamde mcirdeboda fizikur pirTa raodenoba,

romelTac gaewiaT saswrafo daxmareba. 2004 wlidan 2006 wels es

maCvenebeli 3-jer gaizarda, rasac xeli Seuwyo prezidentis nacionalurma

`saswrafo samedicino daxmarebis~ programis ganxorcielebam (cxrili 17).

73

cxrili 17

fizikur pirTa raodenoba, romelTac gaewiaT saswrafo samedicino

daxmareba 1998-2006 ww.

maT Soris

ubeduri

SemTxvevis

dros

ucabedi avad

gaxdomis dros

mSobiarobis da

paTologiuri

orsulobis

dros

avadmyofebis,

mSobiareebs da

axalSobile--

bis gadayvana

wlebi pirveladi

samedicino

daxmareba

sul

sul % sul % sul % sul %

1988

1990

1995

2000

2001

2002

2003

2004

2005

2006

1309352

1268859

156920

150645

135539

162376

192641

218188

453422

683003

62373

53629

7774

7982

7618

8421

10166

19560

38594

49068

4,8

4,2

5,0

5,3

5,6

5,2

5,3

8,9

8,5

6,4

1111850

1107048

144533

138383

124233

147701

172589

191379

393183

599335

84,9

85,9

92,1

91,9

91,7

91

89,6

87,7

86,7

87,8

26897

23583

1317

1366

1126

1243

2104

3137

5246

6584

2,1

1,9

0,8

0,9

0,8

0,8

1,1

1,4

1,2

1,0

96563

84598

3296

2914

2562

5011

7782

4112

16399

33016

7,4

6,7

2,1

1,9

1,9

3,1

4,0

1,9

3,6

7,8

wyaro: janmrTelobis dacva, statistikuri cnobari, saqarTvelo 2006.

mTlianobaSi ki SeiZleba davaskvnaT, rom yvelaferi es (jandacvis

pirveladi qselis dautvirTaoba, arsebuli sawolfondis gamoyenebis

maCveneblebis Semcireba) metyvelebs imaze, rom mosaxleoba samedicino

dawesebulebas mimarTavs mxolod ukidures SemTxvevaSi, rodesac

avadmyofis mdgomareoba metad garTulebulia.

amrigad, saqarTvelos jandacvis sistemaSi reformebis ganxorcielebas

mosaxleobis janmrTelobis mdgomareobaSi sasikeTo cvlilebebi ar

mohyolia. piriqiT, saxezea, erTi mxriv sistemuri samedicino-demografiuli

krizisi, meore mxriv ki, samedicino dawesebulebebSi mosaxleobis

mimarTvaTa raodenobis mkveTri Semcireba da Sesabamisad, maTi

dautvirTaoba.

am fonze aRsaniSnavia, rom saqarTveloSi arasodes ar hqonda adgili

samedicino kadrebis naklebobas. piriqiT, samedicino momsaxurebis

74

xarisxisa da efeqtianobis ganmsazRvreli erT-erTi kriteriumi uaxloes

warsulSi iyo maTi mzardi raodenoba.

miuxedavad ukanasknel wlebSi samedicino personalis raodenobis

klebisa, saqarTvelo erT-erTi pirvelia msoflioSi eqimTa raodenobiT

(cxrili 18).

cxrili 18.

mosaxleobis samedicino kadrebiT uzrunvelyofa

(1990-2006 ww.)

eqimebi saS. samed. personali

wlebi raodenoba 10 000

mosaxleze

raodenoba 10 000

mosaxleze

1990

1995

2000

2003

2004

2005

2006

26850

21252

21063

20962

21396

20311

20597

49,6

41,2

45,2

48,6

49,3

46,1

46,8

53143

38541

26179

21906

21622

21053

20207

98,1

74,7

58,1

50,8

49,7

47,9

45,9

wyaro: janmrTelobis dacva, statistikuri cnobari, saqarTvelo 2006.

rogorc cxrilidan Cans, 2006 wels eqimTa raodenobam 10 000

mosaxleze gaangariSebiT 46,8 Seadgina (SedarebisaTvis: aSS-Si 25,7,

belgiaSi _ 17, iaponiaSi _ 13, inglisSi _ 12, germaniaSia _ 22,6). eqimTa

uzrunvelyofis maCvenebeli saSualoze maRalia q. TbilisSi (92,4),

regionebSi yvelaze dabalia samcxe-javaxeTSi (21,3) da qvemo qarTlSi (21,4).

maSasadame, saqarTveloSi dasaqmebul eqimTa 50% TbilisSia Tavmoyrili,

maSin, rodesac regionebSi samedicino kadrebis ukmarisobas aqvs adgili.

amasTan, saqarTveloSi darRveulia Tanafardoba eqimebsa da saSualo

samedicino personals Soris: erT eqimze modis 1 saSualo samedicino

personali (nacvlad jandacvis msoflio organizaciis mier

rekomendirebuli 1:4 Tanafardobisa).

75

samedicino kadrebSi ZiriTadad Warboben Terapevtebi (10,8%),

pediatrebi (8,9%), mean-ginekologebi (7,0%) (cxrili 19).

cxrili 19

samedicino kadrebi saqarTveloSi

2001-2006 ww.

2001 2002 2003 2004 2005 2006

saSualo med. personalis raodenoba

eqimebi (fizikuri piri)

m.S. Terapevti

qirurgi (bavSvTa qirurgebis CaTvliT)

anesTezeolog-reaminatologi

travmatolog-orTopedi

kardiologi

urologi

onkologi

pediatri

infeqcionisti

otolaringologi

nevropaTologi

ofTalmologi

stomatologi

mean-ginekologi

fTiziatri

dermato-venerologi

fsiqiatri

endokrinologi

sxva specialistebi

23360

19513

2421

1861

922

313

545

211

228

2096

340

354

593

357

1436

1534

192

266

193

267

6151

23356

20225

2354

1057

905

305

576

211

227

2067

348

344

631

345

1483

1476

161

259

234

275

6962

21906

20962

2256

1108

922

298

591

221

253

1867

315

348

655

355

1412

1466

171

245

205

255

8019

21396

21622

2470

1011

881

261

621

212

249

1812

279

324

658

362

1306

1450

166

270

228

279

8783

21053

20311

1951

883

832

261

613

191

225

1706

266

292

609

347

1300

1418

177

247

233

293

8477

20207

20597

1969

935

878

273

594

231

233

1674

255

292

613

354

1242

1407

138

241

235

286

8578

wyaro: janmrTelobis dacva, statistikuri cnobari, saqarTvelo 2006

rogorc aRvniSneT, eqimebiT uzrunvelyofis maCvenebeli gansakuTrebiT

maRalia TbilisSi, rac Seexeba saSualo samedicino personals, es

maCvenebeli maRalia TbilisSi (68,5), aWaraSi (53,2) da raWa-leCxumSi da

qvemo svaneTSi (69,5), xolo dabalia qvemo qarTlSi (25,4), kaxeTSi (27,5).

aRsaniSnavia is garemoebac, rom Tbilissa da kaxeTSi eqimebis raodenoba

Warbobs saSualo samedicino personalis raodenobas (Sefardeba 1,25:1 da

1,13:1 Sesabamisad) (cxrili 20).

76

cxrili 20

samedicino kadrebis uzrunvelyofa regionebis mixedviT

2006 wels

eqimebi saS. samed. personali

regionebi raodenoba 10000 sul

mosaxleze

raodenoba 10000 sul

mosaxleze

Tbilisi

aWara

guria

raWa-leCxumi daqvemo svaneTi

samegrelo da zemo svaneTi

imereTi

kaxeTi

mcxeTa-mTianeTi

samcxe-javaxeTi

qvemo qarTli

Sida qarTli

afxazeTi

saqarTvelo sul

10193

1168

427

156

1192

2790

1314

385

444

1086

1016

292

20579

92,5

30,9

30,7

32,0

25,2

39,9

32,5

31,0

21,3

21,4

32,4

_

46,8

7549

2012

501

339

1442

3211

1110

415

805

1289

1196

228

20207

68,5

53,2

36,0

69,5

30,5

45,5

27,5

33,4

28,6

25,4

38,1

_

45,9

wyaro: janmrTelobis dacva, statistikuri cnobari, saqarvelo 2006

saqarTveloSi eqimebis 15%-ze meti 60 wlisa da metisaa, xolo 40%-is

asaki 49 wels aRemateba. analogiuri viTarebaa eqTnebis mxrivac. rogorc

aRvniSneT, specialistebis udides nawils Terapevtebi Seadgenen,

romelTagan 12% 60 wels gadacilebulia, mean-ginekologebi specialistebis

mTliani odenobis 7%-ia, am kategoriaSic aRiniSneba daberebis tendencia.

es sakiTxi, dedaTa da bavSvTa janmrTelobis dacvis prioritetulobis

gaTvaliswinebiT sayuradReboa da saTanado asaxvas saWiroebs

reproduqciuli janmrTelobis politikasa da strategiaSi.

stacionaruli seqtoris racionalizacia da samedicino personalis

optimizacia mniSvnelovan gavlenas moaxdens jandacvis resursebis

dabalansebaSi da gazrdis saxelmwifo xarjebis efeqturobas stacionarul

mkurnalobaSi.

77

II.2. janmrTelobis dacvis dafinanseba

Tanamedrove etapze

jandacvis erovnuli politikis dokumentSi saqarTvelos mTavrobam

gansazRvra, rom jandacvis dafinansebis strategiis ZiriTadi mizani

iqneboda danaxarjebis saxelmwifo da kerZo investireba, danaxarjebis

wilis gazrdisa da mosaxleobis mxridan jandacvaze pirdapiri

(formaluri da araformaluri) danaxarjebis Semcirebis gziT.

jandacvis erovnuli politikiT gansazRvruli zogadi miznebis

ganxorcielebisaTvis arCeul iqna jandacvis dafinansebis sistemis Semdegi

saSualovadiani amocanebi:

1. jandacvisaTvis gaTvaliswinebuli sazogadoebriv-finansuri

saxsrebis mobilizaciis gaumjobeseba;

2. mosaxleobisTvis saxelmwifos mier samedicino momsaxurebis

Sesyidvis sistemis gaumjobeseba;

3. jandacvaze gamoyofili finansebis gamoyenebis gaumjobeseba da

regionaluri uTanasworobis Semcireba;

4. samedicino daxmarebis dafinansebasTan dakavSirebuli riskebis

gadanawilebis meqanizmis efeqtianobis amaRleba da samedicino

dazRvevis kerZo seqtorSi finansuri resursebis mobilizaciis

stimulireba da sxv.

mosaxleobis janmrTelobis mdgomareoba qveynis usafrTxoebisa da misi

siZlieris erT-erTi umniSvnelovanesi Semadgeneli nawilia. amitom

jandacvis sistemaSi investireba mosaxleobis janmrTelobis mniSvnelovan

determinants warmoadgens. mosaxleobis janmrTelobis mdgomareobis

gaumjobesebaze mimarTuli saxelmwifos ZiriTadi qmedebebi unda moicavdes

mosaxleobisaTvis minimalurad aucilebeli samedicino momsaxurebis

finansur da geografiul xelmisawvdomobas, socialur-ekonomikuri

uTanasworobis Semcirebisa da adamianuri potencialis ganviTarebas.

2005 wels saxelmwifos mier nakisri samedicino daxmarebis

RonisZiebebi momsaxurebis tipis mixedviT dajgufebul iqna janmrTelobis

dacvis saxelmwifo programebSi, ZiriTadi mimarTulebebis Sesabamisad:

78

_ janmrTelobis xelSewyobis, daavadebaTa prevenciis da

epidkontrolis saxelmwifo programa;

_ socialuri dazRvevis erTiani saxelmwifo fondis janmrTelobis

dacvis programebi: mosaxleobis ambulatoriuli daxmarebis saxelmwifo

programa, mosaxleobis stacionaruli daxmarebis saxelmwifo programa da

mosaxleobis specifikuri medikamentebiT uzrunvelyofis saxelmwifo

programa;

_ socialuri sferos institucionaluri da funqcionaluri reformis

xelSewyobis saxelmwifo programa.

programebis prioritetulobis kriteriumebs warmoadgenen qveyanaSi

mosaxleobis sikvdilianobisa da avadobis struqtura, zogierTi saxis

daavadebebis mimdinareobis Taviseburebebi da maTi socialurad saSiSi

xasiaTi da mosaxleobis socialurad daucveli jgufebisa da fenebis

arseboba, romlebic ganicdian samedicino momsaxurebaTa Zlier deficits

Semosavlebis donesTan mimarTebaSi am momsaxurebaTa maRali Rirebulebis

gamo.

ufro detalurad ganvixiloT is mizezebi, romelTa gamo saxelmwifo

afinansebs saxelmwifo programebSi warmodgenil samedicino momsaxurebaTa

saxeebs.

socialur-ekonomikuri pirobebis gauareseba mZimed aisaxa bavSvebis

janmrTelobis mdgomareobaze, razec mowmoben avadobisa (respiratoruli,

parazituli, infeqciuri da sxv.) da sikvdilianobis (gansakuTrebiT

neonataluris) maRali maCveneblebi. bavSvebis janmrTelobasTan

dakavSirebuli problemebis gadaWra moiTxovs saxelmwifos mxridan

gegmazomieri RonisZiebebis Catarebas, ramac ganapiroba `bavSvebisTvis

samedicino daxmarebis erTiani saxelmwifo programis~ Seqmna.

janmrTelobisTvis maRali riskis mqone orsulTa, mSobiareTa da

axalSobilTa kvalificirebuli samedicino daxmarebiT uzrunvelyofas

iTvaliswinebs orsulTa samedicino daxmarebis programa. am programis

ZiriTad mizans warmoadgens orsulobasTan da mSobiarobasTan

dakavSirebuli garTulebebis, dedisa da bavSvis sikvdilianobis Tavidan

acileba. socialur-ekonomikuri pirobebis mkveTrma gauaresebam da

mosaxleobis migraciuli procesebis aqtivizaciam gamoiwvia tuberkuloziT

79

avadobis maCveneblis zrda. avadobis maRali maCveneblisa da daavadebis

socialurad saSiSi xasiaTis gaTvaliswinebiT, tuberkulozis winaaRmdeg

mimarTuli RonisZiebebi gansazRvrul iqna rogorc saxelmwifos

umniSvnelovanesi prioriteti.

fsiqikuri daavadebebis qronikulma xasiaTma, mkurnalobis xangrZlivi

kursis aucileblobam, avadmyofebis socialurad saSiSma moqmedebebma da

fsiqiatrul klinikebSi Seqmnilma situaciam, ganapirobes fsiqiatriis

saxelmwifo dafinansebis aucilebloba.

qveynis socialur-ekonomikuri ganviTarebis mocemul etapze

mosaxleobis garkveuli nawili ganicdis ukidures ekonomikur gaWirvebas,

amitom maTTvis praqtikulad xelmiuwvdomeli xdeba elementaruli

samedicino daxmareba.

mdgomareobis gaumjobesebisaTvis da samedicino momsaxurebis

xelmisawvdomobis gazrdisaTvis saxelmwifos mier SemuSavebul iqna iseTi

RonisZiebebi, romlebic qveynis mosaxleobisaTvis uzrunvelyofen drouli

da kvalificirebuli gadaudebeli (urgentuli) daxmarebis aRmoCenas.

programa `gulis iSemiuri daavadebis mkurnalobis~ saxelmwifo

uzrunvelyofam ganapiroba is faqti, rom am daavadebebs pirveli adgili

ukaviaT sikvdilianobis struqturaSi. Sesabamisad, didi mniSvneloba

eniWeba daavadebis efeqtian mkurnalobas mosaxleobis avadobisa da

sikvdilianobis Semcirebis mizniT.

avadobisa da sikvdilianobis struqturaSi avTvisebian simsivneebs

ukaviaT meore adgili, jandacvis erT-erT umniSvnelovanes problemad

rCeba avTvisebiani simsivneebis adeqvaturi mkurnaloba. aqedan gamomdinare,

momzadebul iqna onkologiuri daavadebebis mkurnalobis saxelmwifo

programa.

infeqciuri daavadebebi miekuTvnebian socialurad saSiSi

nozologiebis ricxvs. amave dros, maTi gavrcelebis dinamika warmoadgens

jandacvis sistemis efeqtian funqcionirebis umniSvnelovanes maCvenebels.

`infeqciuri daavadebebis mkurnalobis~ programis mizans warmoadgens

infeqciuri daavadebebis gavrcelebis Semcireba, avadobis da

sikvdilianobis Semcireba, adeqvaturi RonisZiebebis Catareba epidemiebis

dros. Tirkmlis qronikuli ukmarisoba miekuTvneba umZimes daavadebebs da

80

Sesabamisi mkurnalobis gareSe miyavs letalur Sedegebamde. amitom

saxelmwifom sakuTar Tavze aiRo Tirkmlis qronikuli ukmarisobiT

daavadebuli pacientebis programuli uzrunvelyofa.

Tirkmlis qronikuli ukmarisobis mkurnalobis yvelaze efeqtian

meTods warmoadgens organos transplantacia. miTiTebuli operacia

xasiaTdeba avadmyofis socialuri reabilitaciis maRali maCvenebliT.

miTiTebulis gaTvaliswinebiT SemuSavebul iqna `organoebisa da

qsovilebis transplantaciis~ programa.

`medikamentebiT specifikuri avadmyofebis uzrunvelyofis~ saxelmwifo

programa uzrunvelyofs mZime qronikuli daavadebebiT (diabeti, hemofilia

da sxv.) daavadebul adamianebs specifikuri medikamentebiT. am programis

mizans warmoadgens avadmyofTa sicocxlis xarisxis gaumjobeseba da misi

gaxangrZliveba. rac Seexeba `samegrelosa da zemo svaneTis regionis

iZulebiT gadaadgilebuli mosaxleobis damatebiTi samedicino daxmarebis

programas~, mas ganapirobeben iZulebiT gadaadgilebul pirTa

mravalricxovneba da ekonomikuri gaWirveba, ramac negatiuri gavlena

moaxdina maTi janmrTelobis mdgomareobaze.

ganvixiloT socialuri dazRvevis erTiani saxelmwifo fondis

janmrTelobis dacvis programebis dafinansebis principebi:

meanobis programa

orsulTa patronaJis anazRaureba xorcieldeba warmoebuli vizitebis

mixedviT 30 lari qalaqSi:

orsulTa patronaJis standarti finansurad daubalansebelia: tarifi

unda 2-3 jer gaizardos imisaTvis, rom dawesebulebam SeZlos srulad

Caataros standartiT ganxorcielebuli RonisZiebebi.

orsulTa stacionaruli momsaxurebis anazRaureba xorcieldeba erTi

SemTxvevisTvis dadgenili saSualo fasiT:

- saqalaqo donis dawesebulebebisTvis _ SemTxveva 120 lari,

fiziologiuri axalSobilis movla 15 lari (Tanagadaxda 30 lari

amoRebulia programidan Sromis, jandacvisa da socialuri dacvis

ministris #226H brZanebiT);

- raionuli donis dawesebulebebisTvis _ SemTxveva 100 lari,

fiziologiuri axalSobilis movla 11 lari (Tanagadaxda 20 lari

81

amoRebulia programidan Sromis, jandacvisa da socialuri dacvis

ministris #226H brZanebiT);

melogineebSi sefsisis SemTxvevebis anazRaureba xorcieldeba

antisefsisur centrSi standartis tarifiT.

miTiTebuli tarifi met-naklebad Seesabameba am profilis

`gasaSualoebuli~ standartis xarjebs; TavisTavad standarti unda

iyofodes ramodenime erTeulze sxvadasxva xarjTtevadobis mqone

nozologiuri SemTxvevebis Sesabamisad.

bavSvTa samedicino daxmarebis programa

bavSvTa patronaJisaTvis da ambulatoriuli mkurnalobisTvis _ 2

lari TveSi erT sulze, Tu ganxorcielebuli iqneba kontaqti

dazRveulTan (e.i. sadamkvirveblo viziti an viziti avadmyofobis gamo).

tarifi 2 lari erT dazRvevaze sofelSi, albaT, misaRebia, radgan

realurad xorcieldeba mxolod medpersonalis (eqimis an meddis) viziti

dazRveulTan; laboratoriuli kvlevebiT uzrunvelyofa aq minimaluria da

TiTqmis utoldeba nuls. amiT unda vaRiaroT is, rom 0-3 wlamde asakis

bavSvTa patronaJis moculoba sofelSi darRveulia. samagierod, qalaqSi

patronaJis ufro sruli, dapirebulTan miaxloebuli gawevis

SesaZlebloba ufro metia, Tumca aq tarifi unda utoldebodes Tundac

10lars.

bavSvTa kardioqirurgiis dafinanseba xorcieldeba damtkicebuli

standartisa da tarifebis saSualebiT, limitirebis wesiT. 3 wlamde asakis

bavSvebSi _ ufasoa, 3 welze ufrosi asakis avadmyofebSi Tanagadaxda Ria

operaciaze Seadgens 20%, xolo daxuruli tipis operaciaze _ 25 %.

am profilis standartebi warmoadgenen gansakuTrebul gamonakliss

rig saxelmwifo standartSi _xarjebi gaTvaliswinebuli srulad.

onkologiuri daavadebebis diagnostika da mkurnalobis programa

programis anazRaureba xorcieldeba globaluri biujetiT

dafinansebis principiT (rogorc ambulatoriaSi, ise stacionarSi)

nozologiuri jgufebisTvis dadgenili tarifebis Sesabamisad, Tanagadaxda

programiT gaTvaliswinebul nozologiur jgufebze _ fiqsirebulia.

samedicino nawilis finansuri dabalansebisaTvis standartebis

Rirebuleba unda gaizardos 180-200%-iT.

82

qimioTerapiul momsaxurebaze gaTvaliswinebulia Tanagadaxda.

1. Tanagadaxda ar exeba bavSvTa kontingents.

2. mozrdilTa qimioTerapiaSi medikamentebis Rirebulebisas 300

laramde, Tanagadaxda Seadgens medikamentis Rirebulebis 50%.

Rirebulebisas _ 300larze meti Tanagadaxda Seadgens 300 laris 50%-s

plus medikamentebis 300 larze meti Rirebuleba.

3. mozrdilTa hematologiaSi medikamentebis Rirebulebisas X lari

(Tbilisis onkohematologiis institutSi X=200 lari, xolo baTumsa da

quTaisSi X=150 lari) Tanagadaxda Seadgens medikamentis Rirebulebis 50%,

xolo X larze meti Rirebulebisas _ medikamentebis Rirebulebis 100%.

standartebi dabalansebulia finansurad (Tanagadaxdis xarjze;

Tanagadaxda xSirad aRwevs iseT sidides, rom ramodenimejer aRemateba

standartul tarifs), magram daxmarebis moculoba TavisTavad sakmaod

mizerulia.

fsiqiatriuli daxmarebis programa

ambulatoriuli daxmareba xorcieldeba Catarebuli vizitebis mixedviT (vizitis Rirebuleba 3,30 lari) saSualod araumetes 8 vizitisa erT pacientze.

stacionarSi gatarebuli sawol-dReebis mixedviT (sawol-dRis

Rirebuleba 5,76 lari).

dRis stacionarSi gatarebuli sawol-dReebis mixedviT (sawol-dRis

Rirebuleba 4,23 lari).

bavSvebisTvis da mozrdilebisTvis stacionarSi gatarebuli sawol-

dReebis mixedviT (sawol-dRis Rirebuleba 6,39 lari);

iZulebiTi mkurnalobis dawesebulebebs calke unazRaurdeba xarjebi

dacvaze Sss-Tan dadebuli xelSekrulebis safuZvelze gamoyofili qvotis

farglebSi.

stacionaruli standartebi (sawol-dRe) sakmaod cudadaa

dabalansebuli _ realurad maTi tarifi unda iyos 150- 200%-iT meti.

ftiziatriuli daxmarebis programa

ambulatoriuli daxmareba xorcieldeba yovelTviurad gamoyofili biujetiT, miuxedavad Sesrulebuli samuSaosi.

stacionarSi gatarebuli sawol-dReebis mixedviT (sawol-dRis

Rirebuleba 8,50 lari) gamoyofili biujetis farglebSi.

83

ltolvilTa sakurorto momsaxurebaze registrirebuli sawol-

dReebis mixedviT (sawol-dRis Rirebuleba 12,00) gamoyofili biujetis

farglebSi.

stacionarul standartebSi gamoyofilia `savaldebulo nawili~,

romelic finansurad dabalansebulia (standartis darCenili nawili

iTvleba sarekomendaciod da amitom dawesebulebas ufleba aqvs aiZulos

pacienti gadaixados Tanxa); agreTve, araadeqvaturia ambulatoriuli

nawilisTvis dadgenili biujeti _ is arasakmarisia imisaTvis, rom

normalurad Catardes programis am nawiliT gaTvaliswinebuli

RonisZiebebi. saWiroa gavzardoT es Tanxebi 150-200 %-iT.

programis dafinanseba xorcieldeba faqtiuri xarjebis mixedviT

gamoyofili limitis farglebSi.

umweoTa damatebiTi samedicino daxmarebis programa

ambulatoriuli daxmarebis dafinanseba warmoebs ganxorcielebuli vizitebis mixedviT (viziti 3 lari) araumetes 10 vizitisa erT dazRveulze.

araadeqvaturia vizitis fasi _ is ar asaxavs programiT

gaTvaliswinebuli momsaxurebis realur Rirebulebas (deficiti

daaxloebiT 100%).

q. Tbilisis 1 stacionaruli dawesebulebisa da regionaluri donis

dawesebulebebis dafinanseba xorcieldeba globaluri biujetis principiT,

xolo q. Tbilisis danarCen dawesebulebebSi damtkicebuli standartisa da

tarifebis saSualebiT, limitirebis wesiT, gadaudebeli daxmarebis

(municipaluri nozologiebis) 100%-iani dafinansebiT.

raionul dawesebulebebSi dafinanseba xorcieldeba damtkicebuli

standartisa da tarifebis saSualebiT, limitirebis wesiT, araumetes 50%

municipaluri Tanagadaxdis gaTvaliswinebiT.

infeqciuri daavadebebis mkurnalobis programa

Tbilisis infeqciuri paTologiis, Sid-isa da klinikuri imunologiis

centris dafinanseba xorcieldeba globaluri biujetis principiT, xolo

danarCen dawesebulebebSi ki _ damtkicebuli standartisa da tarifebis

saSualebiT, limitirebis wesiT.

tarifebi araadeqvaturia, saWiroa maTi gadaxedva.

dializis programa

84

hemodializis dafinanseba xorcieldeba Catarebuli seansebis

raodenobis mixedviT gamoyofili limitis farglebSi. seansis Rirebuleba

90,28 laria (36,04 lari asanazRaurebeli Tanxa da 54,24 lari _ masalebis

Rirebuleba).

ambulatoriuli peritonialuri dializis dafinanseba xorcieldeba

saSualo-dRiuri danaxarjebis mixedviT gamoyofili limitis farglebSi

(mxolod medikamentebi) gasaSualoebuli dRiuri Tanxa _ 59,5 lari.

stacionaruli peritonialuri dializis dafinanseba xorcieldeba

standartis tarifiT (centralizebulad SeZenili medikamentebis fasis

gamoklebiT). SemTxvevis Rirebuleba _ 3056,89 lari. standarti finansurad

dabalansebulia.

gulis iSemiuri daavadebebis mkurnalobis programa

programis dafinanseba ganxorcielebuli iqneba Sesrulebuli samuSaos

mixedviT TiToeul operaciaze damtkicebuli tarifis Sesabamisad.

programiT Tanagadaxda pacientebis mxridan Seadgens gegmuri

angioplastikis 30%. operacia aorto-koronarul Suntirebaze _ 30%.

tarifi dabalansebulia, magram Tanagadaxdis xarjze.

programuli dagegmvis umniSvnelovanes pirobas warmoadgens problemis

codna, maTi gaanalizebis da maTi ricxvidan yvelaze mwvave da

mniSvnelovani problemebis gamoyofis unari. aseTi amocana yovelTvis

dakavSirebulia im resursebis SezRudulobasTan, romlebic gaaCnia

qveyanas, dargs, organizacias gamovlenili problemebis gadasaWrelad.

amitom programebis formirebisas saWiroa, erTis mxriv, mxolod

prioritetuli problemebis gadaWra da, meores mxriv, maT gadasaWrelad

resursebis qona.

saqarTvelos socialuri dazRvevis erTiani saxelmwifo fondis mier

1999-2007 wlebSi janmrTelobis dacvis saxelmwifo programebis dafinanseba

xdeboda sxvadasxva wyaroebidan. kerZod: 1999wels ori wyarodan –

damqiraveblTa da daqiravebulebis mier xelfasebidan gadaxdili

savaldebulo dazRvevis SesatanebiT (3%+ 1%) da centraluri biujetis

transferidan. 2002-2004 wlebSi zemoaRniSnul wyaroebs daemata

teritoriuli erTeulebis biujetebidan gadacemuli Tanxebi. 2005 wlidan

programebis dafinanseba xdeba mxolod sabiujeto asignebebiT.

85

2005 wels, wina welTan SedarebiT, socialuri dazRvevis erTiani

saxelmwifo fondis janmrTelobis dacvis programebis dafinanseba mxolod

1%-iT gaizarda (cxrili 21). xolo 2006 wels wina welTan SedarebiT

socialuri dazRvevis erTiani saxelmwifo fondis janmrTelobis dacvis

programebis dafinanseba 34%-iT gaizarda da 93 mln. laridan (2005w.) 125,7

mln. lari Seadgina. mosaxleobis ambulatoriuli daxmarebis programis

dafinanseba 2005 wels 15 mln. lari Seadgina, xolo 2006 wels gaizarda 2,7

mln. lariT . 2005 wels mosaxleobis stacionaruli daxmarebis

saxelmwifo programas daemata prezidentis nacionaluri programa

`saswrafo samedicino daxmareba~ (9,4 mln. lari). sul stacionaruli

daxmarebis saxelmwifo programis dafinanseba 2005 wels mxolod 827 aTasi

lariT gaizarda. 2006 wels მოსახლეობის სტაციონარული დახმარების სახელმწიფო

პროგრამის უმწეოთა დამატებითი სამედიცინო დახმარების კომპონენტი , სოციალურად

დაუცველი მოსახლეობის დამატებითი სამედიცინო დახმარების პროგრამა გაერთიანდა და

ეწოდა სიღარიბის ზღვარს ქვემოთ მყოფი მოსახლეობის სამედიცინო დაზღვევის კომპონენტი.

მისი დაფინანსების გეგმა განისაზღვრა 15,4 მლნ. ლარით. სულ სტაციონარული დახმარების

სახელმწიფო პროგრამის დაფინანსება გაიზარდა 37,3 მლნ. ლარით რეფერალური დახმარების

კომპონენტის, პრეზიდენტის ნაციონალური პროგრამის ”სასწრაფო სამედიცინო დახმარება

(თითქმის გაორმაგდა), ორგანოთა და ქსოვილთა ტრანსპლანტაციისა და თირკმლის

ჩანაცვლებითი თერაპიის კომპონენტის, გულის ქირურგიის სახელმწიფო პროგრამის

დაფინანსების მკვეთრი ზრდისა და სიღარიბის ზღვარს ქვემოთ მყოფი მოსახლეობის

სამედიცინო დაზღვევის კომპონენტის დამატების ხარჯზე.

mosaxleobis specifikuri medikamentebiT uzrunvelyofis saxelmwifo

programis dafinanseba 22,5%-iT gaizarda da man 9,5 mln. lari Seadgina.

xolo 2006 wels mosaxleobis specifikuri medikamentebiT uzrunvelyofis

saxelmwifo programis dafinansebm 10,3 mln.lari Seadgina.

socialuri dazRvevis erTiani saxelmwifo fondis samedicino socialuri

eqspertizis biuroebis materialur-teqnikuri bazis mowesrigebis mizniT

fondis programebs daemata samedicino socialuri eqspertizis programa 1,3

mln. laris odenobiT.

2005 wels janmrTelobis dacvis saxelmwifo programebis dafinansebis

gegmiuri maCvenebeli 2004 welTan SedarebiT 2,8%-iT Semcirda _ 107 mln.

laridan 104 mln. laramde, radgan socialuri sferos instituciuri da

86

funqciuri reformis xelSewyobis saxelmwifo programidan calke iqna

gamoyofili samedicino dawesebulebebis optimizaciis programa.

programebis dafinansebis moculobam 100,9 mln. lari Seadgina (2004 w. _

102,4 mln. lari), rac dagegmilis 96%-ia.

cxrili 21

jandacvaze saxelmwifo danaxarjebi (aTasi lari)

programis dasaxeleba

gegma Sesruleba dafinanseba gegmis dafnan-

sebis %

2004 3365,3 3023,9 3253 96,7% janmrTelobis xelSewyobis, daavadebaTa prevenciisa

da epidkontrolis saxelmwifo programa

2005

2974,9

2848,8

2893,5

97,3%

2004 6963,5* 5572,6* 6563,2* 94,3% socialuri sferos institucionaluri da funqciuri

reformis xelSewyobis saxelmwifo programa

2005

4763,8

4650,1

4712,4

98,9%

2004 96569,0 80875,3 92568,2 95,9% socialuri dazRvevis erTiani saxelmwifo fondis

janmrTelobis dacvis programebi

2005

97087,3

83724,3

93303,8

96,1%

2004 600 540,4 599,9 100,0%

SezRuduliSesaZleblobebis mqone pirTa samedicino

daxmareba

2005 1280,5 1191,7 1191,7 93,1%

2004 8359 8178,7 8149,1 97,5% saministros centraluri aparati, teritoriuli

organoebi, saqveuwyebo dawesebulebebi, sajaro

samarTalis iuridiuli pirebi

2005

10840,3

10670,0

10664,2

98,4%

2004 2213,0 2206,3 2203 99,5% socialuri dazRvevis erTiani saxelmwifo fondis

administraciuli xarjebi jandacvaze

2005

2691,7

2532,7

2532,7

94,1%

2004 4125,0 4124,6 4112,5 99,7% samedicno dawesebulebebis optimizaciis programa

2005 26112,2 26244,1 26112,2 100,0%

2004 3429,2 4278,8 3960,4 115,5% ucxoeTidan miRebuli dafinansebis wyaroebiTa da

grantebiT gansaxorcielebeli investiciuri proeqtebi

(moicavs saTemo dazRvevis proeqtsac)

2005

26132,0

17967,3

17967,3

68,8%

2004 1019,1 116,1 1019,1 100,0% paraleluri samsaxurebi

2005 1754,1 1754,1 1754,1 100,0%

samedicino socialuri eqspertizis programa 2005 1411,2 1341,0 1341,0 95,0%

2004 122518,1 105842,1 118315,9 96,6%

sul 2005 175048,0 152924,1 162472,9 92,8%

* Seicavs samedicino dawesebulebaTa optimizaciis programis xarjebs.

wyaro: Sromis, janmrTelobisa da socialuri dacvis saministro, www.moh.gov.ge

87

2004 welTan SedarebiT Semcirda janmrTelobis xelSewyobis,

daavadebaTa prevenciis da epidkontrolis saxelmwifo programebis

rogorc gegmiuri, ise dafinansebis maCveneblebi. samedicino

dawesebulebebis reabilitaciisa da maTi Tanamedrove samedicino

aparaturiT aRWurvis prioritetulobis gamo, socialuri sferos

instituciuri da funqciuri reformis xelSewyobis saxelmwifo

programidan calke gamoiyo samedicino dawesebulebebis optimizaciis

programa da misi dafinanseba TiTqmis 6-jer gaizarda.

2005 wels saxelmwifo biujetidan saqarTvelos Tavdacvis, iusticiis

saministrosa da Sinagan saqmeTa saministros mier samedicino

momsaxurebaze daixarja 1,7 mln. lari , xolo 2006 wels -1,9 mln. lari .

2005 wels saxelmwifo biujetSi ucxoeTidan miRebuli dafinansebis

wyaroebiTa da grantebiT ganxorcielebuli sainvesticio proeqtebi

mimarTuli iyo aiv/Sidsis, da malariis prevenciisa da kontrolis, DOTS DO

strategiis srulyofis, tuberkulozisa da leikemiis kontrolis,

socialuri dacvis reformis momzadebis pirveladi jandacvis ganviTarebis,

saavadmyofoTa restruqturizaciis, saTemo dazRvevis ganviTarebis

proeqtebze. gegmiT gaTvaliswinebuli 26 mln. laris nacvlad, 2005 wels

daixarja 18 mln. lari ,xolo 2006 wels 22,2 mln. Llari.

2005 wels qveynis teritoriuli erTeulebis biujetebidan janmrTelobis

dacvis RonisZiebebisaTvis gaweuli xarji (41,3 mln. lari), wina wlisgan

gansxvavebiT, mTlianad moxmarda municipalur programebs (2004 wels 15,4

mln. lari gadairicxa socialuri dazRvevis erTian saxelmwifo fondSi

ambulatoriuli da urgentuli programebis dasafinanseblad, xolo 27 mln.

lari moxmarda municipalur programebs). aWaris (75%-iani zrda), Tbilisisa

(10%-iani zrda) da afxazeTis (6%-iani zrda) garda, sagrZnoblad Semcirda

sxva teritoriuli erTeulebis mier jandacvaze gamoyofili Tanxebi,

imereTsa da guriis regionSi ki TiTqmis ganaxevrda. 2006 wels qveynis

teritoriuli erTeulebis biujetebidan janmrTelobis dacvis

RonisZiebebisaTvis gaweuli xarji TiTqmis ganaxevrda da 20 mln. lari

Seadgina. (cxrili 22).

88

cxrili 22

teritoriuli erTeulebis mier janmrTelobis dacvis RonisZiebaTa

dafinansebaze gaweuli xarjebi (aTasi lari)

saqarTvelos teritoriuli

erTeulebi mxareebis mixedviT

2004 w. 2005 w. 2006 w.

afxazeTi 869,0 922,9 541,6

aWara 4763,0 8323,4 6890

Tbilisi 17884,7 19759,8 5965,3

kaxeTi 1568,5 1233,9 631,3

imereTi 4242,7 2232,6 1496,9

samegrelo da zemo svaneTi 2335,3 1493,2 1113,3

Sida qarTli 1703,3 1365,3 532,0

qvemo qarTli 4319,4 3237,8 2067,0

guria 899,3 461,5 232,6

samcxe-javaxeTi 2390,5 1458,7 592,8

mcxeTa-mTianeTi 854,9 602,9 484,0

raWa-leCxumi da qvemo svaneTi 521,3 283,3 202,8

sul jami 42351,9 41375,4 20741,3

wyaro: Sromis, janmrTelobisa da socialuri dacvis saministro, www.moh.gov.ge

jandacvis erovnuli angariSebis monacemebiT, 2006 wels saqarTveloSi

jandacvaze mTlianma danaxarjebma 1160 mln. lari Seadgina, rac mSp-is 8,6%-

ia. aqedan jandacvaze saxelmwifo danaxarjebze modis 250 mln. lari

(21,6%), saerTaSoriso daxmarebebze 60 mln. lari (5,2%), danarCeni ki _

mosaxleobis mier kerZo danaxarjebia .

2007 wels saqarTveloSi jandacvaze mTlianma danaxarjebma 1386 mln.

lari Seadgina, rac mSp-is 8,2%-ia. aqedan jandacvaze saxelmwifo

danaxarjebze modis 249 mln. lari rac jandacvaze mTliani danaxarjebis

18% ,xolo mTliani Sida produqtis 1,5 %-ia. [nax.17; nax.18 ].

89

naxazi 17

jandacvis danaxarjebis struqtura

18,1% 16,4% 14,9% 15,4% 19,5% 21,6% 18,0%

73,1% 71,5% 77,6% 78,4% 77,7% 73,2% 75,0%

8,8% 7,5% 6,2% 5,2% 7,0%2,8%

12,1%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

2001 2002 2003 2004 2005 2006 2007

saerTaSoriso

daxmarebebi

kerZo

danaxarjebi

saxelmwifo

danaxarjebi

wyaro: Sromis, janmrTelobisa da socialuri dacvis saministro. www.moh.gov.ge

mosaxleobis cxovrebis pirobebze mniSvnelovan zegavlenas axdens

saxelmwifos mier janmrTelobis dacvis sferoSi nakisri valdebulebebi,

amitom jandacvis ganviTarebis done, janmrTelobis ZiriTadi indikatorebi

(sicocxlis saSualo xangrZlivoba, dedaTa da bavSvTa sikvdilianoba da

sxv.) da samedicino daxmarebisadmi mosaxleobis xelmisawvdomoba qveynis

ekonomikuri ganviTarebis pirdapirproporciulia.

2006 wels saxelmwifo biujetidan jandacvaze daixarja 234 mln. lari.

teritoriuli erTeulebis biujetidan municipaluri programebisaTvis

daixarja 20,7 mln. Llari. sul saxelmwifo danaxarjma jandacvaze 250

mln. lari Seadgina (2005 w. _ 195 mln. lari), rac naerTi biujetis 5,6%,

xolo mTliani Sida produqtis 1,8%-ia . [nax.18]

90

naxazi 18

jandacvaze saxelmwifo danaxarjebi saqarTveloSi

12994

250250

195

107 108

1,4 1,41,3

1,3

1,7

1,8

1,5

0

50

100

150

200

250

300

2001 2002 2003 2004 2005 2006 20070

0,5

1

1,5

2

mln lari mSp-is %

wyaro: Sromis, janmrTelobisa da socialuri dacvis saministro. www.moh.gov.ge

Sromis, janmrTelobisa da socialuri dacvis saministros mier

janmrTelobis dacvis RonisZiebebze (ucxoeTidan miRebuli dafinansebis

wyaroebiTa da grantebiT ganxorcielebuli investiciuri proeqtebis

gamoklebiT) 2005 wels daixarja 132 mln.Llari (2006 wels 184,2 mln.Llari) ,

aqedan prevenciisa da mkurnalobis programebze (SSmp jandacviTi

RonisZiebebis CaTvliT) mxolod 88 mln. lari, Tu erTmaneTs SevadarebT

saministros mier jandacvaze gaweuli danaxarjebis zrdis temps da

prevenciisa da mkurnalobis programebis zrdis temps, sagrZnob

gansxvavebas miviRebT, zrdis maRali tempi ZiriTad sainvesticio

programebsa da administrirebaze modis [nax.19]

91

naxazi 19

prevenciisa da mkurnalobis programebis danaxarjebis Sedareba saministros mier jandacvis RonisZiebebze gaweul danaxarjebTan

(mln.lari)

101,1

84,4

72,1

60,9

51,6

87,8

59,769,7

83,8

131,9

0

20

40

60

80

100

120

140

2001 2002 2003 2004 2005

Series1

Series2

prevenciisa da mkurnalobis programebi

saministros mier jandacvis RonisZiebebze gaweuli danaxarjebi

wyaro: Sromis, janmrTelobisa da socialuri dacvis saministro, socialuri dazRvevis

erTiani saxelmwifo fondi. www.moh.gov.ge

saqarTveloSi jandacvis dafinansebis dinamika cxadyofs, rom 1994

wlidan erT sul mosaxleze saxelmwifo danaxarjebi daaxloebiT 25-jer

gaizarda da 2006, 2007 wels erTY sul mosaxleze 57 lari Seadgina (nax.20),

Tumca es 6-jer naklebia, vidre, magaliTad, es 1990 wels iyo _ 149 dolari.

janmrTelobis msoflio organizaciis rekomendaciiT ki mosaxleobis

minimalurad aucilebeli samedicino momsaxurebis Tanabrad

xelmisawvdomobisaTvis saWiro xarjebi weliwadSi erT sul mosaxleze 34

dolari, anu saxelmwifo danaxarji erT sul mosaxleze sul mcire 70

lari mainc unda iyos.

92

Nnaxazi 20

jandacvis saxelmwifo danaxarjebi erT sul mosaxleze saqarTveloSi (lari)

2,2 6,19,1

5,8

9,312,67

2227

27 33

48

57 57

1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007

wyaro: Sromis, janmrTelobisa da socialuri dacvis saministro, www.moh.gov.ge

saqarTvelos mier erT sul mosaxleze jandacvaze danaxarjebis

odenoba 9-10-jer CamorCeba litvisa da estoneTis, TiTqmis 5-jer ruseTis

mier erT sul mosaxleze jandacvaze gamoyofil saxelmwifo danaxarjebs

da bevrad naklebia aRmosavleT evropis qveynebze. jandacvaze mTlian

danaxarjebSi, saxelmwifo danaxarjebze modis 18% maSin rodesac evropis

regionSi aseTi maCvenebeli 2005 wels 68,5% Seadgina . jandacvaze

saxelmwifo danaxarjebis xvedriTi wilis mixedviT mTlian danaxarjebSi

2005 wels evropis regionis 53 qveynis Soris saqarTvelo boloan mesame

adgilze iyo. mas CamorCeboda mxolod tajikeTi da azerbaijani,xolo 2007

wels - bolo adgilzea. (cxrili 23).

93

cxrili 23

jandacvaze saxelmwifo danaxarjebis wili

jandacvaze

saxelmwifo

danaxarjebis wili

mSp-dan,

2004

jandacvaze

saxelmwifo

danaxarjebis wili

mTliani

danaxarjebSi, 2004

jandacvaze

danaxarjebi erT

sul mosaxleze

(dolari), 2004

aSSD( 2005) 15,2 45,1 2862

Germania ( 2005) 10,7 76,9 2499

Sveicaria 6,8 58,4 2310

gaerTianebuli samefo 7 85,9 2174

CexeTi 6,5 90,7 1209

ungreTi 6 71,8 958

slovakeTi 5,1 88 730

bulgareTi 4,3 55,8 354

poloneTi 4,5 70 567

litva 4,9 75,4 615

estoneTi 4,2 76 590

belarusi 4,7 75,1 556

latvia 3,3 51,6 387

ruseTi 3,2 59,8 341

yazaxeTi 2,4 62,4 245

ukraina 3,9 66,5 240

TurqmeneTi 2,5 64,8 145

moldova 4,2 56,5 114

sasomxeTi 1,3 23,1 74

saqarTvelo( 2007)* 8,2 18 81

uzbekeTi 2,3 42,1 71

azerbaijani 0,9 24,6 39

wyaro: WHO, Health for all Data Base.

94

rogorc aRiniSna, jandacvis dafinanseba saxelmwifos mxridan 2005

wlidan xdeba mxolod sabiujeto asignebebiT^, rac ar aris sakmarisi

samedicino momsaxurebaSi mosaxleobis moTxovnis uzrunvelsayofaT. (nax.21)

saqarTvelos jandacvaSi mZime mdgomareobis daZlevis finansur aspeqts

warmoadgens jandacvis dafinansebisTvis xarjebis moculobis zrdis

aucilebloba. amasTan dakavSirebiT pirveli rigis amocanas warmoadgens

finansuri resursebis gamonaxva jandacvis dafinansebis saxsrebis wilis

etapobrivi zrdisTvis.

jandacvis sistemaSi arsebuli problemebis daZlevis mizniT, Cvens

mier SemoTavazebulia jandacvis dafinansebaze gamoyofili saxelmwifo

finansuri saxsrebis wilis gazrda . rac SesaZlebelia miRweuli iqnas

samedicino miznobrivi gadasaxadebis SemoRebiT da sabiujeto dafinansebis

gazrdiT. amasTan jandacvis xarjebis dafinansebaSi farTod unda iyos

Cabmuli mosaxleoba nebayoflobiTi dazRvevisa da Tanagadaxdis formiT.

Nnaxazi 21

jandacvaze saxelmwifo danaxarjebis tendecniebi saqarTveloSi

38 38 4350 50 56 55

67 7280 75 77 74 71 71

8610

6 120

149

5 8 5 8 9 11 14 1421 27 33 33

0

20

40

60

80

100

120

140

160

1970

1972

1974

1976

1979

1981

1983

1985

1987

1990

1997

1999

2001

2003

2005

2007

0%

2%

4%

6%

8%

10%

12%

jandacvaze sax elmwifo danax arjebi mosaxleobis erT sulze (aSS

dolari)sax elmwifo biujetis %

mSp-is %

95

II.3. samkurnalo-profilaqtikuri dawesebulebis finansuri menejmentis

analizi akademikos o. RuduSauris saxelobis mravalprofiliani erovnuli

samedicino centrisa da q. Tbilisis ramdenime mowinave klinikis magaliTze

rogorc ukve aRiniSna, saqarTveloSi bolo aTwleulis manZilze

mimdinareobs janmrTelobis dacvis sistemis reforma, romlis ZiriTad

amocanasac mosaxleobis xelmisawvdomoba da xarisxiani samedicino

momsaxurebiT uzrunvelyofa warmoadgens. am gardaqmnaTa procesSi

umniSvnelovanesi aRmoCnda samedicino momsaxurebis mimwodebelTa da

gadamxdelTa gamijvna, ramac jandacvis sferoSi urTierTobis axali,

Zvelisagan metad gansxvavebuli wesebi daamkvidra.

nebismieri saxis samedicino dawesebulebis Camoyalibebis mizania im

xasiaTis momsaxurebis gaweva, romelzec moTxovna arsebobs da romlis

realizaciac samedicino, socialur da ekonomikur efeqts iZleva. miznidan

gamomdinare, yalibdeba dawesebulebis elementebi; profili, masStabi,

ganlageba, kadrebi, finansebi, momarageba da sxva. miznis ganxorcielebisa

da misi elementebis amoqmedebisaTvis aucilebelia marTvis aparatis

Camoyalibeba, radganac marTvis gareSe miznis miRweva SeuZlebelia,

nebismieri organizaciis marTva dRevandel dinamiur droSi sakmaod rTuli

samuSaoa, romlis warmatebiT SesrulebisaTvis sakmarisi ar aris marto

mza formulebiT sargebloba. xelmZRvaneli unda uTanawyobdes zogad

WeSmaritebebsa da mravalricxovan variantebs.

klinikaSi arsebobs mmarTvelobiTi muSaobis iseTi saxeebi, romlebic

erTmaneTisagan gansxvavdebian ierarqiuli doneebiTa (vertikaluri

ganzomileba) da pasuxismgeblobis areebis mixedviT (horizontaluri

ganzomileba). ierarqiuli doneebis mixedviT isini dayofilia samad;

pirveli, saSualo da maRali donis menejerebad. menejerebis es dayofa

ganpirobebulia menejerul funqciebSi da elementebSi monawileobis

miRebis doniTa da maTi gamoyenebis xarisxis mixedviT. garda amisa, yvela

donis menejeri Tavisi ierarqiuli donis Sesabamisad monawileobas iRebs

mewarmeobis iseTi aucilebeli rolis ganxorcielebaSi, rogoricaa

racionalizatoruli-inovaciebis danergva. horizontaluri menejerebis

saqmianobiTi gansxvavebuloba gamowveulia pasuxismgeblobis areebis

96

TaviseburebiT da Seicavs sami ZiriTadi tipis (funqcionalurs,

generalurs da saproeqto) menejers.

samedicino saqmianoba Tavisi mravalferovnebiTa da sirTuliT, axali

teqnologiebis gamoyenebis maRali doniT SeiZleba nebismier sawarmoo

process gavutoloT. isic unda aRiniSnos, rom SesaZlebeli gaxda

teqnologiebis mravali variantis damuSaveba da maTgan saukeTesos SerCeva.

am mizezebis gamo uaRresad garTulda samedicino saqmianobis marTvis

procesi, ramac gamoiwvia misi danawileba sferoebad. sadReisod samedicino

menejmenti moicavs:

1. hospitalis(ur) menejments;

2. socialuri dazRvevis menejments;

3. administraciul menejments;

4. marketingis menejments;

5. safinanso menejments;

6. kadrebis menejments;

7. satransporto menejments da a.S.

jandacvis momsaxurebis mwarmoeblebi (ambulatoriebi, saavadmyofoebi

da sxva) gadavidnen sameurneo angariSze da yvela dawesebulebis

organizaciul-samarTlebrivi forma aris SezRuduli pasuxismgeblobis

sazogadoeba (Sps) an saaqcio sazogadoeba (ss). stacionaruli qselis

calkeul dawesebulebaSi arsebuli tendenciebi mniSvnelovanwilad

gansazRvraven erTiani sistemis xarjT-efeqtianobas. amdenad calke

aRebuli saavadmyofoebis finansuri marTvis analizi mniSvnelovani

instrumentia seqtorSi arsebuli problemebis gamoaSkaravebisa da

Sesabamisi gadaWris gzebis ZiebisaTvis. imasTan dakavSirebiT, rom

samedicino dawesebulebebi gansxvavdebian zomiT, profiliT, mflobelobis

formiT erTmaneTisagan da udidesi nawili aRricxvasa da finansur

angariSgebas awarmoebs sakaso meTodiT, rac ewinaaRmdegeba buRaltruli

aRricxvis saerTaSoriso standartebs. srulad Seswavlis mizniT

aucilebelia maTi Seswavla samedicino dawesebulebis doneze . am mizniT

Cven SevarCieT mravalprofiluri samedicino dawesebuleba - kerZod ss

“akad. o. RuduSauris sax. erovnul samedicino centri”.

97

samedicino dawesebulebas (ss akad. o. RuduSauris saxelobis

`erovnuli samedicino centri~, SemdgomSi _ centri) marTavs

sameTvalyureo sabWo da aRmasrulebeli menejeri generaluri direqtoris

saxiT.

sameTvalyureo sabWos amtkicebs qonebis marTvis saagento, Sromis,

janmrTelobisa da socialuri dacvis saministrosTan SeTanxmebiT.

sameTvalyureo sabWo dakompleqtebulia farTo sazogadoebis

warmomadgenlebiT, maT Soris samedicino sazogadoebis warmomadgenelebiT.

sameTvalyureo sabWos arCeuli hyavs sameTvalyureo sabWos Tavjdomare da

sameTvalyureo sabWos Tavjdomaris moadgile. zogadad, sameTvalyureo

sabWos kompetencia ganisazRvreba saqarTvelos kanoniT mewarmeTa Sesaxeb.

sameTvalyureo sabWos Semdegi daniSnuleba akisria:

1. ZiriTad mizans warmoadgens: centris miznis, amocanisa da politikis

gansazRvra imisaTvis, raTa uxelmZRvanelos organizacias gacxadebuli

misiis Sesasruleblad:

_ Camoyalibeba misiisa da im miznebis, romelTa miRweva garkveul

etapze uzrunvelyofs misiis Sesrulebas;

_ daadginos politika, romliTac ixelmZRvanelebs centris

administracia dawesebulebis marTvaSi;

_ ganixilos da daamtkicos centris ganviTarebis strategiuli gegma

(mokle da grZelvadiani).

2. gansazRvravs, ramdenad efeqtianad iqna ganxorcielebuli politika,

anu Seafasos Sedegebi:

_ gansazRvravs Sefasebis indikatorebs, warmatebis niSnulebsa da

angariSgebis formats;

_ amtkicebs indikatorul gegmas;

_ gansazRvravs samedicino momsaxurebis xarisxis Sedegebis

indikatorebs.

3. uzrunvelyofs centris marTvis efeqtianobas:

_ irCevs generalur direqtorsa da dargobriv direqtorebs;

_ maT aniWebs Sesabamis Zalauflebas, rac moiTxovs centris efeqtiani

marTvas (saqarTveloSi Zalauflebis delegirebis sakiTxi

reglamentirebulia ZiriTadad kanonmdeblobiT);

98

_ afasebs generaluri direqtorisa da dargobrivi direqtorebis

muSaobas (angariSebis gacnoba, analizi, Sefaseba da daskvnis gamotana

centris funqcionirebisa da mdgomareobis Sefasebis fonze);

_ finansuri angariSebi (balansi, angariSi mogebisa da zaralis

Sesaxeb, angariSi naRdi fulis moZraobis Sesaxeb);

_ operaciuli angariSebi;

_ xarjT-efeqtianobisa da kapitalis mdgomareobis angariSi;

_ prognozebis Sefaseba;

_ angariSi gaweuli samedicino momsaxurebebis Sesaxeb.

centris marTva xorcieldeba ierarqiuli (`piramiduli~) principiT.

administraciuli ierarqiis saTaveSi imyofeba generaluri direqtori.

generalur direqtors niSnavs sameTvalyureo sabWo. generaluri

direqtori erTpirovnulad agebs pasuxs sameTvalyureo sabWos winaSe

centris saqmianobaze (warmateba_warumateblobaze) da funqcionirebis

yvela aspeqtze. generaluri direqtoris funqciebis delegirebas awarmoeben

direqtorebi, romlebic xelmZRvaneloben Sesabamis ofisebs:

cxrili 24

o. RuduSauris sax. erovnuli samedicino centris marTvis struqtura

teqnikuri direqtori teqnikur-sameurneo

ofisi

pirobebis uzrunvelyofa

centris uwyvetad

funqcionirebisaTvis

finansuri direqtori finansuri ofisi centris finansuri

resursebis marTva (dagegmva,

angariSsworeba, kontroli)

samedicino direqtori samedicino samsaxurebi samedicino momsaxurebaTa

warmoebis xarisxisa da

uwyvetobis uzrunvelyofa

direqtori samedicino

programebze kontrolisa

da marTvis sferoSi

samedicino samsaxurebi warmoeba, samedicino

programebis marTva da maTi

Sesrulebis xarisxis

uzrunvelyofa

mTavari eqTani saeqTno samsaxurebi momxmarebelTa samedicino

momsaxurebisa da eqTnis

samsaxuris uzrunvelyofa

99

rac Seexeba centrSi momuSave samedicino personals, arian daqiravebuli muSakebi.

_ klinikaSi dasaqmebul eqimebs meti SesaZleblobebi gaaCniaT

samedicino praqtikisaTvis (Sesabamisi pasuxismgeblobiT).

_ centrSi pacientebis moTavseba, samedicino momsaxurebis gaweva

SeuZliaT Sesabamisi kvalifikaciis mqone sxva dawesebulebebSi momuSave

eqim-specialistebs.

samedicino (saeqimo) praqtikasTan dakavSirebuli profesiuli

sakiTxebis daregulireba ekisreba centris eqimTa samedicino sabWos.

samedicino sabWos sxdomebi tardeba regularulad, TveSi erTxel.

samedicino sabWo akompleqtebs ramdenime komisias. es komisiebia:

1. samedicino daxmarebis xarisxis kontrolis komisia;

2. samedicino Canawerebis komisia;

3. bioeTikuri komisia;

4. Sidahospitaluri infeqciebis kontrolis komisia;

5. samkurnalo saSualebaTa komisia;

6. samedicino standartebisa da protokolebis komisia;

7. uwyveti ganaTlebis diplomamdeli da diplomisSemdgomi komisia.

8. samecniero sabWo.

aRniSnuli komisiebi uzrunvelyofen centris samedicino momsaxurebis

xarisxis, samedicino momsaxurebis standartebisa da uwyveti ganaTlebis

sistemis organizebas, rac ZiriTadad gamoixateba maT mier gaweuli

saqmianobidan. unda aRiniSnos, rom centri warmoadgens axali tipis

maRali donis samedicino momsaxurebis dawesebulebas, romlis

struqturaSic warmodgenilia qvedanayofebi rogorc ambulatoriuli, aseve

stacionaruli daxmarebisaTvis. yvelaze metad yuradReba misaqcevia

stacionaruli samedicino daxmarebisTvis, radganac es momsaxureba eweva

saxelmwifo programebiT samedicino daxmarebas, sul 2004 da 2005 wlebSi

stacionarulad gatarebul pacientTa raodenoba Seadgens Sesabamisad 3106

da 4911, saidanac saxelmwifo programebiT gatarebulia 2067 (67%) da 4049

(82%) pacienti, gatarebul sawol-dReTa raodenobam Seadgina 20957 da 35458,

saidanac saxelmwifo programebiT gatarebulia 17552 (84%) da 32658 (92%)

sawol-dRe, sawolTa brunvam ki Seadgina 15,7 da 25,1, letalobis

100

maCvenebelma Seadgina 3,1 da 2,7 procenti, sawolze dayovnebis maCvenebelma

Seadgina 6,7 da 7,2, sawolis datvirTvam Seadgina 106 da 184. aqve

warmogidgenT centrSi samedicino momsaxureba Catarebuli pacientebis

statistikur maCveneblebs TiToeuli samsaxuris mixedviT. (danarTi #4)

kacobriobis ganviTarebis yvela istoriul etapze janmrTelobis dacvis

sfero Tavisi bunebiT Tavisebur sasworze imyofeboda. medicinis dargis

swrafma ganviTarebam, misma indusrializaciam, sul ufro mzardma

konkurenciam samedicino daxmarebis mimwodebelTa Soris daadastura, rom

sadReisod es sfero (miuxedavad arsebuli Taviseburebebisa) sabazro

principebze dayrdnobiT viTardeba. am TvalsazrisiT, igi

sazogadoebisaTvis garkveul materialur faseulobas warmoadgens.

adamianis sicocxlis SenarCunebis an gaxangrZlivebis saWiroeba garkveul

ekonomikur dasabuTebas moiTxovs.

saqarTveloSi dRes samedicino bazarze aris Semdegi suraTi:

a) daavadebis mkurnalobis saxelmwifo fasi (saxelmwifo

standartebiT tarifia gansazRvruli) umetes SemTxvevaSi atarebs

formalur xasiaTs, radganac ver asaxavs daavadebaTa mkurnalobis realur

Rirebulebas.

b) samedicino momsaxurebis "sabazro fasi", rogorc wesi,

momxmarebels uwevs samedicino momsaxurebis safasuris anazRaureba

aRniSnuli "sabazro fasebiT" (aRsaniSnavia, rom fasTasxvaoba mZime

tvirTad awevs pacients mxrebze). "sabazro fasi" SedarebiT ufro

srulyofilad asaxavs realur Rirebulebas.

Ddafinanseba Semdegi saxsrebiT xdeba:

_ centraluri biujetis saSualebebiT;

_ centraluri biujetis saxsrebiT sauwyebo qselisTvis;

_ oficialuri tarifebiT paketgareSe momsaxurebisaTvis;

_ nebayoflobiTi samedicino dazRvevis saxsrebiT;

_ sxva saxsrebiT.

es saxsrebi saboloo adresatamde gaivlian sxvadasxva struqturebs.

esenia:

_ Sromis, janmrTelobisa da socialuri dacvis saministro;

_ kerZo sadazRvevo kompaniebi/fondebi;

101

_ samedicino dawesebulebebi;

_ sxva uwyebebi;

_ momxmarebeli (pacienti).

dafinansebis potenciuri wyaroebia:

_ municipaliteti;

_ saqarTvelos socialuri dazRvevis erTiani saxelmwifo fondi*;

_ momxmarebeli (pacienti);

_ kerZo sadazRvevo kompaniebi/fondebi;

_ Sromis, janmrTelobisa da socialuri dacvis saministro.

saxelmwifo samedicino standartebi da misgan gamomavali tarifebi ver

asaxaven samedicino momsaxurebas srulyofilad, qveyanaSi arsebuli

biujetis simwiridan da arsebuli resursebis araefeqtianad xarjvidan

gamomdinare. gansakuTrebiT unda aRiniSnos is mniSvnelovani rezervi,

romelic arsebobs kerZo sadazRvevo kompaniebis saxiT, amasTanave Tu

gaviTvaliwinebT, rom es ukanaskneli saqarTveloSi faqtobrivad

Canasaxovan stadiaSia, dazRvevis sistemis ganviTarebasTan erTad moxdeba

centris dafinansebaSi Sesabamisi Tanxebis wilis zrda. mxedvelobaSia

misaRebi is Tanxebic, romelTa miReba SesaZlebelia eqimTa (eqTanTa)

diplomamdeli da diplomisSemdgomi momzadebidan.

centrSi mimdinareobs ramdenime saxis saxelmwifo programa, romlis

saSualebiTac saqarTvelos mosaxleobis garkveuli nawili sargeblobs

ufaso samedicino daxmarebiT, anu mkurnalobis Tanxas anazRaurebs

saxelmwifo. saxelmwifos mxridan asi procentiT dafinanseba xdeba eqvsi

programis farglebSi:

_ bavSvebisaTvis samedicino daxmarebis programa;

_ referaluri daxmarebis programa;

_ meanobis programa;

_ umweoTa samedicino daxmarebis programa;

_ umweoTa samedicino daxmarebis damatebiTi programa;

_ wvevamdelTa samedicino programis saxelmwifo programa.

----------------------------------------------

* saqarTvelos socialuri dazRvevis erTiani saxelmwifo fondi - 2008 wlidan,

janmrTelobisa da socialuri programebis saagento.

102

nawilobrivi dafinanseba xorcieldeba urgentuli samedicino

daxmarebis programis farglebSi, sadac pacientma unda gadaixados

mTliani Rirebulebis 25%, xolo danarCen 75%-s ixdis saxelmwifo.

miuxedavad imisa, rom am programebis mixedviT saxelmwifo sakuTar

Tavze iRebs dafinansebis udides nawils, rogorc ukve zemoT aRiniSna, igi

formalur xasiaTs atarebs da mosaxleobis sruli uzrunvelyofisaTvis

sxvaoba mZime tvirTad awveba pacients.

centris saqmianobis finansuri mxare asaxvas hpovebs finansur

angariSgebaSi.

finansuri angariSgeba warmoadgens buRaltruli aRricxvis

standartebis Sesabamisad Segrovil, damuSavebul da momxmareblisaTvis

gansazRvruli formiT momzadebul saerTo daniSnulebis finansur

informaciaTa erTobliobas, romlis mizania, daexmaros informaciis

momxmareblebs ekonomikuri gadawyvetilebis miRebaSi sawarmos finansuri

mdgomareobis, saqmianobis Sedegebisa da finansuri mdgomareobis

cvlilebis Sesaxeb saimedo informaciis miwodebiT.

finansuri angariSgeba moicavs sawarmos aqtivebs, valdebulebebsa da

sakuTar kapitals. am informaciaze dayrdnobiT momxmarebels SeuZlia

daadginos sawarmos finansuri struqtura, likvidoba da

gadaxdisunarianoba, agreTve ekonomikuri garemos cvlilebebTan Seguebis

unari. finansuri angariSgebis sruli komponenti unda moicavdes:

1. balanss;

2. angariSs mogebisa da zaralis Sesaxeb;

3. angariSs, romelic uzrunvelyofs informacias:

a) sawarmos sakuTar kapitalSi nebismieri cvlilebebis Sesaxeb; an

b) sakuTar kapitalSi cvlilebebis Sesaxeb, romelic ar aris

gamowveuli kapitalTan dakavSirebuli da mesakuTreebis mier

ganxorcielebuli sameurneo operaciebiTa da maTTvis kapitalis

ganawilebiT.

4. angariSs fuladi saxsebis moZraobis Sesaxeb;

5. sabuRaltro politikisa da axsna-ganmartebiT SeniSvnebs [38,punqti7].

103

zogadad, sawarmos mier Sedgenili da warmodgenili angariSebis

klasificireba SeiZleba moxdes:

1. Sedgenis periodis mixedviT:

a) wliuri angariSi;

b) naxevari wlis angariSi;

g) mimdinare angariSi;

2. daniSnulebis mixedviT:

a) Sida moxmarebis angariSi;

b) zogadi daniSnulebis angariSi.

3. informaciis moculobis mixedviT:

a) finansuri angariSi;

b) Sereuli informaciis Semcveli angariSi.

4. gamoyenebuli Sefasebis mixedviT:

a) ucvleli fasebis mixedviT Sedgenili angariSi;

b) mimdinare fasebiT Sedgenili angariSi.

finansur angariSSi warmodgenili informacia sasargeblo iqneba

mxolod maSin, Tu mas gaaCnia Sesabamisi xarisxi an Tvisebrivi

maxasiaTeblebi. es maxasiaTeblebia:

1. aRqmadoba;

2. Sesabamisoba;

3. saimedooba;

4. Sesadarisoba.

finansuri angariSgebis momzadeba unda eyrdnobodes utyuar da

obieqtur Tvalsazriss sawarmos finansuri mdgomareobis, misi saqmianobis

Sedegebisa da finansuri mdgomareobis, cvlilebebis Sesaxeb. utyuari da

obieqturi informaciis warmodgenis SesaZleblobas iZleva informaciis

TiToeuli xarisxobrivi maxasiaTeblisa da buRaltruli aRricxvis

saerTaSoriso standartebis gamoyeneba, rac xels Seuwyobs samedicino

momsaxurebis saxeobebis racionalurad danergvasa da mis uzrunvelyofas,

gaaumjobesebs menejmentis gamarTul muSaobas.

saaRricxvo politika SemuSavda Semdeg kanonebsa da kanonqvemdebare

aqtebze dayrdnobiT: saqarTvelos kanoni "mewarmeTa Sesaxeb"; saqarTvelos

kanoni "buRaltruli aRricxvisa da angariSgebis regulirebis Sesaxeb";

104

saqarTvelos sagadasaxado kodeqsi; saqarTvelos parlamentTan arsebuli

buRaltruli aRricxvis standartebis komisiis mier samoqmedod

damtkicebuli buRaltruli aRricxvis saerTaSoriso standartebi (bass),

igi SeiZleba Seicvalos centris struqturaSi da/an bass-Si (buRaltruli

aRricxvis saerTaSoriso standarti) Sesuli cvlilebebis gaTvaliswinebiT.

centris finansuri angariSgeba emyareba funqcionirebadobisa da daricxvis

ZiriTad daSvebebs. buRaltruli aRricxvisa da finansuri angariSgebis

momzadebis kompiuteruli programiT ganxorcielebisaTvis, SeirCa "oris

buRalteria", moxda aRniSnul programaSi garkveuli cvlilebebis Setana

centris struqturidan da saqmianobidan gamomdinare, gakeTda angariSTa

gegmaSi Sesabamisi subangariSebi da qveangariSebi. mTlianad aRricxvaze

iqna mibmuli menejeruli analizis baza, romelic mogvcems ekonomikur

informacias saerTo mdgomareobis kuTxiT. finansuri angariSgebis

momzadebas safuZvlad udevs buRaltruli aRricxvis daricxvis meTodi.

sameurneo operaciebis Sedegebisa da sxva movlenebis aRiareba xdeba maTi

moxdenisTanave. daculia Semosavlebisa da xarjebs Soris Sesabamisobis

principi. xarjebis aRricxva xdeba ekonomikuri Sinaarsis mixedviT,

maragebi ki aRiricxeba mudmivi meTodiT.

Semosavlebisa da xarjebis aRricxvisa da angariSgebaSi asaxvis

meTodika arsebiTad Seesabameba bass (buRaltruli aRricxvis

saerTaSoriso standartis) “struqturuli safuZvlebis” moTxovnebs.

Semosavlebi warmodgenilia Semdegi saxiT:

_ saoperacio Semosavlebi _ asaxulia Semosavali centris mier

gaweuli momsaxurebebidan. miTiTebuli Semosavlis dokumenturi gaformeba,

angariSebis korespondencia arsebiTad sworia da Seesabameba mogebisa da

zaralis Sesaxeb angariSSi asaxul maCveneblebs.

_ arasaoperacio Semosavlebi _ asaxulia humanitaruli daxmarebis

saxiTa da usasyidlod miRebuli aqtivebi.

_ sxva Semosavlebi.

centrSi 2004-2005 wlebis ganmavlobaSi faqtiurad Sesrulebuli

samuSaos moculobam Seadgina 7677920 lari da 10642384 lari, sadac

saxelmwifo programiT Sesrulebuli samuSaos moculobam Sesabamisad

Seadgina 4724804 lari (62%) da 8016638 lari (75%), Sesrulebuli samuSaos

105

moculobidan miRebul iqna 4658631 lari da 6246104 lari, sxvaoba

Sesrulebasa da aRiarebas Soris gamowveulia saxelmwifo programebiT

ganxorcielebuli samuSaoTi, rac Seadgens 2130619 larsa (45%) da 3620358

lars (45%). rogorc zemoT moyvanili tarifebidan Cans, 2005 wels 2004

welTan SedarebiT Sesrulebuli samuSaos moculobaSi namati saSualod

Seadgens 39%-s, rac ganpirobebulia ZiriTadad saxelmwifo programebis

xarjze, xolo Semosavali Sesrulebuli samuSaos moculobidan Seadgens

4406634 larsa da 54599598 lars, sadac saxelmwifo programebiT miRebuli

Semosavali Seadgens 2253597 larsa (57%) da 3067913 lars (56%), Tumca 2005

wels 2004 welTan SedarebiT miRebuli Semosavali saSualod izrdeba 24%-

iT, standartebis xarjze. gansxvaveba saxelmwifo programebiT Sesrulebas,

aRiarebasa da miRebas Soris xdeba saxelmwifos mier damtkicebuli

tarifebis gamo, rac mZime tvirTad awveba rogorc centrs, ise pacientsac.

mimdinare aRricxvaSi xarjebi dajgufebulia maTi rolisa da

daniSnulebis mixedviT Cveulebrivi saqmianobis procesSi. faqtiurad

xarjebis aRricxva xorcieldeba operaciuli da araoperaciuli xarjebis

WrilSi, xolo rac Seexeba xarjebs finansur angariSSi, isini

warmodgenilia ekonomikuri Sinaarsis mixedviT anu elementuri xarjebis

WrilSi. miTiTebuli xarjebis analizi gviCvenebs, rom 2004-2005 wlebis

ganmavlobaSi mTliani xarjebis 57% _ 43% modis personalis Senaxvis

xarjebze, 18% _ 11% modis gamoyenebuli nedleulisa da masalebis

xarjebze, 6%-36% _ amortizaciul anaricxebze. xarjebi mogebisa da

zaralis Sesaxeb angariSSi warmodgenilia bass 1 (buRaltruli aRricxvis

saerTaSoriso standarti) muxli 80-is formatis mixedviT.

warmodgenili xarjebidan yvelaze mniSvnelovania samedicino

personalis Sromis anazRaureba. msoflioSi arsebuli jandacvis

modelebis Tanaxmad, samedicino personalis Sromis anazRaureba atarebs

erTmaneTisagan gansxvavebul xasiaTs, romelic xorcieldeba sxvadasxva

safexurebiT, agreTve, gvxvdeba samedicino personalis Sromis anazRaurebis

sxva principebic, romelTa Soris mniSvnelovania erTjeradi moqmedebis

dafinanseba, rodesac eqimis TiToeuli moqmedeba pacientTan mimarTebaSi

Sefasebulia da amis safuZvelze xdeba misi dafinanseba.

106

jandacvis sxvadasxva sistemebSi samedicino personalis xelfasi

gansxvavebulia, maT Soris arsebobs Semdegi tipebi:

1. sabazro xelfasi;

2. xelfasi datvirTvis mixedviT;

3. xelfasi regionalobis principebidan gamomdinare;

4. xelfasi riskebidan gamomdinare.

aSS-Si eqimTa Sromis anazRaurebis sistema ramdenadme Seicvala da

Semdegi formiT Camoyalibda:

1. Sromis anazRaureba gajansaRebuli pacientebis raodenobis

mixedviT;

2. Sromis anazRaureba pacientis daavadebis simZimidan gamomdinare;

3. Sromis anazRaureba pacientis mkurnalobisas eqimis mier danazogi

Rirebulebidan gamomdinare.

samedicino personalis Sromis anazRaurebis am meqanizmebs gaaCniaT

TavianTi uaryofiTi da dadebiTi maxasiaTeblebi. dadebiTia is, rom

erTjeradi moqmedebis anazRaurebis SemTxvevaSi eqims uCndeba daintereseba,

raTa imuSaos maqsimaluri SesaZleblobebiT, Tumca dabali

gadaxdisunarianobis SemTxvevaSi eqimi, sityvis pirdapiri mniSvnelobiT,

iZulebulia `eZebos~ pacienti da xSirad imoqmedos misTvis naklebad

cnobil sferoebSi. anazRaurebis formis mixedviT TiToeul namkurnalev

pacientze honorireba dadebiTia iq, sadac eqimTa raodenoba ar aris

maRali mosaxleobis raodenobasTan SedarebiT. mdgradi xelfasis

saSualebiT eqimTa Sromis anazRaurebis formis dadebiT mxares

warmoadgens samuSaoze eqimTa sruli koncentrireba im SemTxvevaSi, Tu es

xelfasi miekuTvneba maRali Semosavlebis rangs. am xelfasis uaryofiT

maxasiaTebels warmoadgens is, rom saSualo Semosavlebis donidan

xelfasis CamorCena iwvevs eqimSi interesis dakargvasa da mis

korumpirebulobas. centrSi samedicino personalis Sromis anazRaureba

xorcieldeba datvirTvis mixedviT Sesrulebuli samuSaos moculobidan

gamomdinare ( gatarebuli pacientTa raodenoba da s/d raodenoba ).

[danarTi # 5, 6,7,8 ]

centris finansuri angariSi momzadebulia daricxvis meTodiT, garda

fuladi saSualebebis moZraobis Sesaxeb informaciisa. Sesabamisad,

107

sawarmos marTvis kuTxiT, arsebiTi yuradReba unda daeTmos fuladi

saxsrebis moZraobas. aseTi informacia gvaZlevs SesaZleblobas:

1. SevafasoT sawarmos mokle da grZelvadiani gadaxdisunarianoba;

2. davadginoT, SeuZlia Tu ara sawarmos aanazRauros dividendebi da

kreditebi;

3. ganvsazRvroT damatebiT dafinansebaze sawarmos moTxovnebi;

4. movaxdinoT momavali periodisTvis fuladi saxsrebis moZraobis

prognozireba;

5. davadginoT gansxvavebaTa mizezi wminda mogebasa (zaralsa) da

fuladi saxsrebis wminda zrdas (klebas) Soris da sxv.

fuladi saxsrebis moZraobis Sesaxeb srul informacias gvaZlevs

fuladi saSualebebis moZraobis Sesaxeb angariSSi _ finansur angariSSi

Semavali komponenti, romelic iyofa sam ZiriTad komponentad (jgufad),

bass 7-is (buRaltruli aRricxvis saerTaSirosi standartis) axsna-

ganmartebiT, fuladi saSualebebis moZraobis Sesaxeb angariSSi asaxul

unda iqnes saangariSgebo periodisTvis fuladi saSualebebis nakrebi,

romlebic dajgufebuli iqneba operaciul, sainvesticio da finansur

saqmianobad. fuladi nakadebis operaciuli, sainvesticio da finansuri

moqmedebis mixedviT, dajgufeba exmareba informaciis momxmarebels

finansur mdgomareobaze mocemuli moqmedebis zegavlenis Sefasebasa da

moqmedebis or saxes Soris Tanafardobis dadgenaSi. centris fuladi

saSualebebis moZraobis Sesaxeb angariSidan gamomdinare, 2004-2005 wlebis

ganmavlobaSi fuladi saSualebebis wminda zrda-Semcirebam Seadgina 23376

lari da 85689 lari, rac miuTiTebs dadebiT tendenciaze da saxelmwifo

programiT ukeTesi dafinansebis SemTxvevaSi rCeba centris ganviTarebis

perspeqtiva (danarTi # 9).

politikis ganmsazRvrelebi ver axerxeben samedicino dawesebulebebis

warmadobis seqtoralur monitorirebas (aqcentiT finansur menejmentze),

aseve ver xerxdeba am etapze anazRaurebis perspeqtiuli meTodebis

danergva: warmadobaze dafuZnebuli globaluri biujeti, regionaluri

kapitacia da a.S. aSkaraa, rom sistemis cvlileba unda xdebodes

sinqronulad, urTierTSemxvedrad, qvemodan-zemoT da piriqiT, Tu

samedicino dawesebulebebs eqnebaT resursebisa da Rirebulebebis

108

aRricxvianobis srulyofili teqnika da meTodologia, SesaZlebeli

gaxdeba anazRaurebis sxva ufro efeqtiani meTodebis danergva, rac

mniSvnelovnad gazrdis TiToeuli daxarjuli laris efeqtianobisa da

saboloo jamSi dadebiTad imoqmedebs mosaxleobis janmrTelobis

mdgomareobaze.

finansuri Sefasebis indikatorebis SerCevisas, prioriteti mieniWaT

imaT, romelTa meSveobiTac SesaZlebeli gaxdeba pasuxis gacema Semdeg

fundamentur kiTxvebze:

1. aris Tu ara organizaciis miznebi Tavsebadi maT dasafinanseblad

saWiro resursebTan;

2. zrunavs Tu ara organizacia kapitalis reinvestirebaze;

3. aris Tu ara Sesabamisoba resursebis daniSnulebasa da maT

moxmarebas Soris;

4. aris Tu ara arsebuli resursebi sakmarisi.

finansuri mdgomareobis analizis dros gamoyenebul iqna finansuri

maCveneblebis oTxi ZiriTadi jgufi, romlebic dawvrilebiT aRweren

samedicino dawesebulebis finansur mdgomareobas drois gansazRvrul

periodSi da iZlevian SesaZleblobas gaeces pasuxi zemoT moyvanil

kiTxvebs. amave dros, TiTqmis yvela warmodgenili koeficienti warmoadgens

samedicino dawesebulebis industriuli normebis nawils. iqedan

gamomdinare, rom saqarTveloSi ar arsebobs ara marto samedicino

dawesebulebaTa industriuli normebi, aramed, saerTod industriuli

normebi, SedarebisaTvis gamoyenebul iqna aSS-s jandacvis finansuri

menejmentis asociaciis mier dadgenili normebi, romlebic SemdgomSi

naxsenebi iqneba, rogorc kleverlis normebi. [113, gv.193-227]

likvidurobis koeficienti, miuTiTebs moklevadiani aqtivebisa da

valdebulebebis menejmentze, kleverlis norma Seadgens 1,35-2,38. aRniSnuli

koeficienti Seicavs or maCvenebels: esenia gadafarvis koeficienti da

kritikuli Sefasebis koeficienti.

gadafarvis koeficienti anu kavSiris dadgena moklevadian aqtivebsa

da moklevadian valdebulebebs Soris, romelic aqtualuria moklevadiani

finansuri problemebis gadasaWrelad. gadafarvis koeficienti, rogorc

109

wesi, asaxavs organizaciis unars dafaros mimdinare valdebulebebi erT

welze nakleb periodSi.

mimdinare aqtivebi

gadafarvis koeficienti (gk) = ________________________

mimdinare valdebulebebi

2004 weli 2005 weli

gk=80,369378544,4249915

=1,15* gk= 82,570724809,6908714

=1,21*

kritikuli Sefasebis koeficienti (kSk) _ es igivea, rac gadafarvis

koeficienti, mxolod ufro mgrZnobiarea, igi gamoiTvleba mimdinare

valdebulebebisadmi moklevadiani investiciebidan, samedicino

momsaxurebidan miRebuli fuladi saxsrebisa da samedicino momsaxurebidan

misaRebi Tanxebis jamis SefardebiT:

kSk= ebivaldebuleb mimdinare

biinvesticie nimoklevadiamoTxovnebisesxebi fuladi ++

2004 weli 2005 weli

kSk=80,369378506,3709120

=1,01* kSk=82,570724809,6908714

=1,09*

-------------------------------------------------------

* wyaro: koeficientebi daTvlilia klinikis mogeba-zaralisa da balansis uwyisebis

safuZvelze, danarTi №8 , № 10.

brunvadobis koeficienti xazs usvams xarjvas gamosavalTan

mimarTebaSi aqtivebis efeqtian gamoyenebas fardobaSi xarji/sawyisi.

miTiTebuli koeficienti moicavs oTx maCvenebels. esenia: aqtivebis

brunvadobis koeficienti, moTxovnebis brunvadobis koeficienti, dRiuri

moTxovnis koeficienti da valdebulebaTa brunvadobis koeficienti. yvela

110

miTiTebul koeficients gaaCnia sakuTari norma, romelic mocemuli iqneba

TiToeuli maTganis ganxilvis dros.

aqtivebis brunvadobis koeficienti (abk) asaxavs, Tu ramdenad

efeqtianad gamoiyeneba aqtivebi dawesebulebis finansuri moTxovnebis

Sesasruleblad, anda gviCvenebs dawesebulebis finansur amonagebs,

romelic mogvca erTi laris Rirebulebis aqtivma. misi gamoTvla xdeba

saerTo aqtivebisadmi wminda operaciuli Semosavlebis fardobiT da

gviCvenebs, Tu ramdenad efeqtianad gamoiyeneba aqtivebi dawesebulebis

finansur saWiroebaTa dasakmayofileblad. miTiTebuli koeficientis norma

Seadgens 0,07-1,1.,

aqtivebis brunvadobis koeficienti (abk) aqtivebi saerTo

Semosavali operaciuli wminda=

2004 weli 2005 weli

7 252 816,41 10 295 084,14

abk = __________ = 0,95 * abk = ____________ = 0,30*

7 621 224,98 33 868 994,02

moTxovnebis brunvadobis koeficienti (mbk) miuTiTebs, Tu ramdenad

efeqtianad xdeba warmodgenili angariSebiT momsaxurebaze Tanxis gadaxda

(an piriqiT, Seferxeba). misi gamoTvla xdeba debitoruli angariSebisadmi

samedicino momsaxurebis wminda Semosavlis fardobiT. koeficientis

sidide gansazRvravs organizaciis unars samedicino momsaxurebaTa

myidvelobidan amoiRos misi kuTvnili Tanxebi mokle drois ganmavlobaSi.

miTiTebuli koeficientis norma Seadgens 4,44-6,34.

mbk=angariSebi debitoruli

Semosavali wminda miRebuli idanmomsaxureb samedicino

2004 weli 2005 weli

111

mbk=75,366817741,7252816

=1,98* mbk=19,605949514,10295084

=1,70*

dRiuri moTxovnebis koeficienti (dmk) aCvenebs dReebis saSualo

raodenobas, romelic saWiroa moTxovnebis fuladi gadaqcevisaTvis. igi

gamoiTvleba misaRebi moTxovnebis kalendarul dReebze namravlis

SefardebiT operaciul SemosavlebTan. amiT xazi esmeba erT

gansakuTrebul moments, Zalzed didi mniSvneloba aqvs moTxovnebis droul

anazRaurebas.

misaRebi moTxovnebis kalendarul dReebze namravli

dmk = _________________________________________________

operaciuli Semosavlebi

2004 weli 2005 weli

dmk=41,7252816

75,1338880863 =184,60* dmk=

14,1029508435,2211715744

=214,83*

valdebulebebis brunvadobis koeficienti (vbk) gviCvenebs kavSirs

valdebulebebsa da sasaqonlo-materialur maragebze gaweul xarjebs

Soris. igi gamoiTvleba sasaqonlo-materialur maragebze gaweuli

danaxarjebis SefardebiT valdebulebebTan. amdenad koeficienti gviCvenebs

sasaqonlo-materialuri maragebis xarjis brunvas momwodeblebTan

warmoqmnil valdebulebebTan mimarTebaSi. aRniSnuli koeficientis norma

Seadgens 5,29-8,05. Tu kalendarul dReebs gavyofT valdebulebebis

brunvadobis koeficientze miviRebT saSualo periods, rodesac ifareba

valdebulebebi.

sasaqonlo-materialur maragebze gaweuli danaxarjebi

vbk = ___________________________________________________

valdebulebebi momwodeblebTan

112

2004 weli 2005 weli

vbk=90,125674400,1609205

=1,28* vbk=73,163935700,1629205

=0,99*

warmadobis koeficienti, fokusirebulia aqtivebis efeqtur

gamoyenebaze, anu zomavs ramdenad kargad miiRweva finansuri da

organizaciuli amocanebi. aRniSnuli koeficientis gasazomad gamoiyeneba

operaciuli nazardis, aqtivebze ukugebisa da SeRavaTebis koeficientebi.

TiToeul koeficients gaaCnia Tavisi norma, romelic mocemuli iqneba

ganxilvis dros.

operaciuli nazardis koeficienti (onk) asaxavs momsaxurebis Sedegad

miRebul Semosavalsa da am momsaxurebis warmoebaze gaweul xarjebs

Soris gansxvavebas rogorc procentul wils sufTa operaciuli

Semosavlidan. igi gamoiTvleba operaciuli mogebis, anu operaciuli

Semosavlebisa da operaciuli xarjebis (igulisxmeba Semosavali da xarji

samedicino momsaxurebidan) sxvaobis SefardebiT sufTa operaciul

SemosavlebTan.

operaciuli mogeba

onk = _____________________________

sufTa operaciuli Semosavali

2004 weli 2005 weli

onk=00,7252816

00,773811 =0,11* onk= 93,10351774

98,341713−= - 0,03*

113

aqtivebze ukugebis koeficienti (auk) asaxavs aqtivTa gamoyenebis

efeqturobas, aCvenebs aqtivebSi investirebul yovel larze miRebul

mogebas. igi gamoiTvleba sufTa mogebis SefardebiT saerTo aqtivebTan.

aRniSnuli koeficientis norma Seadgens 0,02-0,07. Tu dawesebuleba

zaraliania, praqtikulad SeuZlebelia am koeficientis dadebiTi

maCveneblis arseboba, anu faqtiurad TiToeuli laris aqtivis gamoyenebas

ekonomikuri sargeblis nacvlad, piriqiT, moaqvs dawesebulebidan

sargeblis gadineba, rac sabolood ararentabelurs xdis saqmianobas.

mogeba

auk = ________________

saerTo aqtivebi

2004 weli 2005 weli

290 609,18 - 195 104,80

auk = __________ = 0,04* onk = ____________ = - 0,01*

7 621 224,98 33 868 994,02

SeRavaTebis koeficienti (Sk) gviCvenebs araanazRaurebadi momsaxurebis

wils mTlianad aqtivebSi. igi gamoiTvleba SeRavaTebis (saeWvo valebis)

SefardebiT saerTo aqtivebTan. SeRavaTebSi igulisxmeba aunazRaurebeli

Tanxebi samedicino momsaxurebidan da sakontraqto SeRavaTebi. aRniSnuli

koeficientis norma Seadgens 0,12-0,24. koeficienti sakmaod arsebiTia

maRali donis menejmentisaTvis, vinaidan gviCvenebs gadaxdis uunaro

pacientebis raodenobas, organizaciis mier gakeTebuli SeRavaTebis

sidides.

SeRavaTebi

Sk = ________________

saerTo aqtivebi

114

2004 weli 2005 weli

sk=98,762122475,3668166

=0,48* sk=02,33868994

19,6059495=0,18*

kapitalizaciis koeficienti, romelic gansazRvravs finansur

struqturaSi grZelvadiani kapitalis wils, xSirad am koeficients

moixsenieben rogorc berketis maCvenebels. aRniSnuli koeficienti Seicavs

or maCvenebels esenia: valisa da kapitalis koeficienti da sesxis

koeficienti, maCveneblebis zrda gviCvenebs an grZelvadiani

valdebulebebis zrdas, an kapitalis Semcirebas. orive SemTxvevaSi

SeiZleba iTqvas, rom dawesebuleba kargavs moqnilobas finansuri

moTxovnilebebis dasakmayofileblad da izrdeba riski damfuZneblebis

mier dawesebulebidan amonagebis (dividendis saxiT) amoRebisa.

valisa da kapitalis koeficienti (vkk) gamoiTvleba grZelvadiani

valdebulebebis SefardebiT mTlian kapitalTan. maSasadame, igi zomavs

kapitalis im nawils, romelic gadasaxdelia grZelvadiani valdebulebebis

dasafaravad.

grZelvadiani valdebulebebi

vkk = ____________________________

mTliani kapitali

2004 weli 2005 weli

vkk=18,392743980,3693785

=0,94* vkk=20,28161745

82,5707248=0,21*

115

sesxis koeficienti (sk) gviCvenebs grZelvadiani valdebulebebis wils

aqtivebis dafinansebaSi. igi gamoiTvleba grZelvadiani valdebulebebis

SefardebiT mTlian aqtivebTan.

grZelvadiani valdebulebebi

sk = ____________________________

mTliani aqtivebi

2004 weli 2005 weli

sk=98,762122480,3693785

=0,49* sk=02,33868994

82,5707248=0,17*

zemoT moyvanili monacemebidan naTlad Cans, rom yvelaze rTulia

realobasa da Canafiqrs (survilebs) Soris optimaluri wertilis povna.

Tu Sefasebebi daeyrdnoba mxolod dRevandel dRes, maSin amiT gaizrdeba

yoveldRiur marTvaSi maTi gamoyenebis xarisxi, magram waagebs Canafiqris

ganxorcieleba, im idealisken swrafva, romelic aisaxeba akad. o.

RuduSauris saxelobis erovnuli samedicino centris, rogorc axali tipis

klinikis xedvasa da misi Seqmnis misiaSi da, piriqiT, Tu SevecdebiT

ZiriTadi yuradReba gadavitanoT momavalze, imaze, Tu rogor unda

gamoiyurebodes da funqcionirebdes axali tipis samedicino dawesebuleba,

maSin amiT es xels Seuwyobs swrafvas idealuri dawesebulebis Seqmnisken,

magram waagebs im Sefasebebis Rirebuleba, romlebic gamoyenebuli iqneba

centris dRevandel marTvaSi. am rTuli amocanis gadaWra mxolod centris

mmarTvelobis pasuxismgeblobisa da SesaZleblibis farglebs Sordeba.

arsebobs uamravi garemoeba, dabrkoleba Tu riski, romlebic sxvadasxva

xarisxiT scildeba centris mmarTvelobis kompetenciebs. amasTan, Tu

movaxdenT proecirebas kritikuli daSvebebis (varaudebis) da riskebis,

romlebsac SeuZliaT Seuqmnas saSiSroeba Canafiqris ganxorcielebas da

maT kontr-zomebis maSin SevZlebT optimaluri wertilis moZebnas. (naxazi

22).

116

pirvel svetSi formulirebuli iqneba varaudi an riski, romelmac

SeiZleba seriozuli gavlena iqonios Canafiqris ganxorcielebaze, meore

svetSi davakonkretebT, ra zarali SeiZleba miadges centris progress

momavlis saavadmyofomde, mesame svetSi mocemul iqneba arasasurveli

gamosavlis prevenciis an danakargis Sesamcirebeli kontr-RonisZiebebi.

117

naxazi 22

varaudebi da riskebi mosalodneli gavlena (arasasurveli gamosavali)

kontr-RonisZiebebi

1 disbalansi centris winaSe wayenebuli moTxovnebisa da saxelmwifos SesaZleblobebs Soris

1) diskreditacias ganicdis axali tipis samedicino dawesebulebis arsebobis idea

2) zaraldeba centris imiji/reputacia sazogadoebis TvalSi

3) qveiTdeba centris momsaxurebis xelmisawvdomoba mosaxleobis araSeZlebuli fenebisaTvis

4) centri iZulebuli xdeba gadavides arajansaR ekonomikuri reJimSi (mag. ZiriTadi saSualebebis cveTisa da sxva arapirdapiri xarjebis ignorirebis Sedegad)

1) centris, rogorc saxelmwifosTvis strategiuli samedicino dawesebulebis mimarT maqsimalurad realisturi grZelvadiani midgomis Camoyalibeba

2) centris marTvis, funqcionirebisa da dafinansebis maqsimaluri gamWirvaloba da sajarooba sazogadoebis mxardaWeris mosapoveblad – iTxovs did drosa da Zalisxmevas, magram uzrunvelyofs mdgrad Sedegs

2 dafinanseba arasrulia

1) deficituri biujeti 2) arapirdapiri,

moraluri zarali (personals aRar jera garantirebuli xelfasebis, ilaxeba menejmentis imiji/reputacia da a.S.)

3) iqmneba araoficialuri (jibidan) anazRaurebebis moTxovnis gaCenis safrTxe

1) damkveTTan xelSekrulebaSi damcveli muxlebis (pirobebis) maqsimalurad Cadeba – sakmaod rTulad ganxorcielebadia dRevandeli sakontraqto urTierTobebis praqtikidan gamomdinare

2) biujetis dagegmvaSi xarjviTi nawilis Semcireba

3) debitoruli davalianebebisa da uimedo valebis marTvis moqnili sistemis SemoReba

3 dafinanseba wyvetilia

1) Seferxebebi operaciul ciklSi (mag. maragebis amowurva, saxelfaso davalianebebi)

1) naRdi fulis rezervebis Seqmna (naklebad SesaZlebelia dRevandeli dafinansebis pirobebSi)

2) maragebis Sesyidvebis maqsimalurad ganvadebiT ganxorcieleba

118

varaudebi da riskebi mosalodneli gavlena (arasasurveli gamosavali)

kontr-RonisZiebebi

4 ar moqmedebs samuSaos Sesrulebis Sefasebis sistema

1) qveiTdeba samedicino momsaxurebis xarisxi

2) qveiTdeba saSemsruleblo disciplina

3) personalSi qreba motivacia da swrafva Sedegebze orientirebuli saqmianobisken

1) profesiuli da administraciuli momTxovnelobis gamkacreba

5 ar xerxdeba samedicino kadrebis optimizacia

1) samedicino momsaxurebis pirobiTi erTeulis TviTRirebuleba rCeba maRali

2) qveiTdeba samedicino personalis loialuroba, TviTkontroli da organizeba, qveiTdeba samedicino momsaxurebis xarisxi

1) mkacri Sida licenzirebis sistemis danergva uwyveti ganaTlebis funqcionirebis fonze

2) samuSaos Sesrulebis perioduli Sefasebis sistema

3) sakadro politikis gamWirvaloba da principuloba

6 ar igegmeba kadrebis swavlebis da permanentuli ganviTarebis programa

1) kadrebis (samedicino, menejerebis) ganviTarebisa da motivirebis dabali done.

2) “karieris platos” sindromis arseboba (menejerebSi)

1) dawesebulebaSi uwyveti ganaTlebis sistemis (samedicino kadrebi) danergva.

2) menejerebSi swavlebis saWiroebis gamovlenisa da ganviTarebis programis danergva

7 iqmneba asimetria samedicino bazarze saxelmwifo Sesyidvebis (SekveTebis) TvalsazrisiT

1) SeiZleba zarali miadges centris reputacias

1) saxelmwifom unda gadasinjos tarifebi (saxelmwifo standartebis) da Tanabari konkurenciis pirobebSi ganaxorcielos samedicino momsaxurebis Sesyidva

119

warmodgenili informacia exeboda axali tipis, evropuli

standartebis saavadmyofos.

Cavatarod ramodenime saxelmwifo samedicino dawesebulebis

monacemebis analizi , romlebic mTlianobaSi warmoadgenen hospitalur

seqtorSi dawesebulebaTa arsebul suraTs. analizisTvis SerCeul iqna

q. Tbilisis samedicino dawesebulebebi prioritetuli saxelmwifo

programebiT, romlebic ganlagdnen Semdegi kriteriumebis mixedviT, esenia:

1. mravalprofiliani;

2. specializirebuli;

3. samSobiaro;

4. pediatriuli.

SerCeuli jgufebidan SesaZlebeli gaxda garkveuli paralelebis

gavleba sxvadasxva tipis, donisa da momsaxurebis momwodebeli samedicino

dawesebulebebis safinanso mdgomareobasa da simZlavreebs Soris:

cxrili 25

samedicino dawesebulebebis koeficientebi

mravalprofi

liani

specializire

buli

samSobiaro pediatriuli koeficientebis

dasaxeleba

da norma 2004w. 2005w. 2004w. 2005w. 2004w. 2005w. 2004w. 2005w.

gk (1,35-2,38) 0,61 0,64 0,50 0,50 1,26 0,98 3,42 5,20

abk (0,07-1,1 ) 0,32 0,45 1,15 0,65 1,45 1,51 0,49 4,29

mbk (4,44-6,34) 1,69 1,77 0,57 0,59 8,16 7,48 2,46 2,23

vbk (5,29-8,05) 0,89 0,91 0,78 0,81 3,57 4,70 1,14 1,47

onk -0,72 -0,41 -0,13 -0,07 -0,04 -0,03 -1,83 -0,07

auk (0,02-0,07) -0,23 -0,18 -0,29 -0,03 -0,06 -0,02 -0,31 -0,04

• wyaro: koeficientebi daTvlilia mocemuli klinikebis mogeba-zaralisa da

balansis uwyisebis safuZvelze.

120

sadac :

Ggk – gadafarvis koeficientia;

Babk - aqtivebis brunvis koeficientia;

Bmbk- moTxovnebis brunvis koeficientia;

vbk- valdebulebebis brunvis koeficientia;

onk- operaciuli nazardis koeficienti;

auk- aqtivebze ukugebis koeficienti.

unda aRiniSnos, rom yvela samedicino dawesebuleba elementarulad

saWiroebs materialur-teqnikuri bazis ganaxlebas, amisaTvis idealur

SesaZleblobas warmoadgens sesxi, magram amJamindeli fulad-sakredito

politika da aseTi kreditis misaRebad samedicino dawesebulebaTa

menejerebis mzadyofnis done SeiZleba ar Seesabamebodnen saTanado

standartebs.

rogorc ukve zemoT aRiniSna, es monacemebi moicaven standartul

dawesebulebebs, romlebic profiliT, zomiT da a.S. gansxvavdebian

erTmaneTisagan, magram mTlianobaSi warmoadgenen hospitalur seqtorSi

dawesebulebaTa finansuri marTvis arsebul suraTs. monacemebis

gaanalizebis Semdeg naTeli xdeba is, rom:

1. samSobiaro saxlebSi da pediatriul klinikebSi sxva profilis

klinikebTan SedarebiT ukeTesi maCveneblebia ,rac ZiriTadad ukeTesi dafinansebis

reJimisa da Sida standartebiT meti gayidvebis moculobis Sedegia;

2. umravlesoba ganxiluli samedicino dawesebuleba wamgebiania, da

Sesabamisad arc erTSi ar xorcieldeba aqtivebis efeqturi gamoyeneba;

3. samedicino dawesebulebebSi ar mimdinareobs gadauxdeli momsaxurebis

wilis gaangariSeba, rac sakmaod mniSvnelovani informaciaa analizisTvis

prognozirebisTvis da swori gadawyvetilebis miRebisTvis mmarTvelobis yvela

doneze ;

4. umetes SemTxvevaSi dawesebulebaTa miznebi araa Tavsebadi maT xelT

arsebul finansur resursebTan. xSirad samedicino dawesebulebebi

iReben monawileobas iseT programebSi, romelTa Sesrulebac

gacilebiT aRemateba maT SesaZleblobebs;

121

5. samedicino dawesebulebebi ar zrunaven kapitalis reinvestirebaze,

rac gulisxmobs samedicino momsaxurebebidan miRebul TiToeul

larSi Semdgomi ganviTarebisTvis gankuTvnili danazogis Seqmnas;

6. samedicino dawesebulebebis umetesoba faqtiurad aranair finansur

saSualebebs ar mimarTavs uaxlesi teqnologiebis dasanergad da

personalis motivirebisTvis;

7. sabuRaltro aRricxvisa da finansuri angariSgebis

mouwesrigeblobis gamo, xSir SemTxvevebSi SeuZlebeli xdeba

dawesebulebebis Sefaseba raime zogadi maCveneblebiT;

8. arcerT samedicino dawesebulebaSi ar xorcieldeba finansuri

menejmentis Sefaseba raime indikatoruli sistemiT. samedicino

dawesebulebebis marTvis arcerT doneze ar aris miRebuli finansuri

efeqtianobis Sefasebis standartuli da obieqturi indikatorebis

nakrebi, romelic miscemda rogorc calkeuli dawesebulebis

menejersa, ise saministrosa da gadamxdelebs finansuri aqtivebis

obieqtur suraTs da daexmareboda maT calkeuli gadawyvetilebebis

arCevasa da miRebaSi;

9. sxvadasxva dawesebulebebis finansuri marTvis efeqtianobis

Sedarebisas mniSvnelovania gamoviyenoT indikatorebis nakrebi, rac

saSualebas gvaZlevs gamovricxoT calkeuli garegani faqtorebi da

uSualod SevafasoT xelmZRvanelTa menejeruli aRricxvis

SesaZleblobebi.

122

Tavi III. jandacvis finansuri meqanizmis srulyofa,

bazrisa da samedicino momsaxurebaze fasis

regulireba

III.1. saqarTvelos jandacvis

finansebis marTvis subieqtebs Soris urTierTqmedebis

srulyofa sabazro urTierTobebis pirobebSi

sabazro urTierTobebis pirobebSi jandacvis sistemis funqcionirebis

ekonomikuri da socialuri Sedegebi mniSvnelovanwilad ganpirobebulia am

sferos marTvis efeqtianobiT.

jandacvis sfero mudmivad ganicdis uamravi sakmaod cvalebadi

mmarTvelobiTi faqtoris zemoqmedebas, rogoricaa: sazogadoebis

socialuri SekveTa mosaxleobis janmrTelobis Sesabamisi donis

uzrunvelyofaze; warmoebul samedicino produqciasa da momsaxurebaze

moTxovnis Secvla; cvlilebebi sagadasaxado kanonmdeblobaSi; inflacia

da a.S.

amrigad, uzrunvelyofil unda iqnes jandacvis finansuri resursebis

efeqtiani gamoyeneba, xolo finansuri resursebis marTva, rogorc

jandacvis marTvis procesis Semadgeneli nawili, iZens prioritetul

mniSvnelobas.

finansuri resursebis marTva gulisxmobs jandacvis finansuri

resursebis moZraobis marTvas, agreTve, am moZraobis procesSi warmoqmnil

finansur urTierTobebis marTvas jandacvis efeqtianobis amaRlebis

mizniT.

ganvixiloT jandacvis finansebis subieqtebi da CavataroT maTi

funqcionirebis Sefaseba ukanasknel periodSi.

jandacvis saxelmwifo dafinansebis procesSi ZiriTadi roli

miekuTvneba finansTa saministros, romlis saqmianobaSi arsebuli xarvezebi

seriozulad aisaxeba samedicino programebis dafinansebis procesze,

kerZod:

1. saqarTvelos finansTa saministroSi Sedgenili gegmiuri maCveneblebi

praqtikulad yovelTvis gacilebiT dabalia Sjsd-is saministros

123

prognozebsa da saqarTvelos ekonomikuri ganviTarebis saministros mier

momzadebul indikatorul gegmaze;

2. finansTa saministro arcTu iSviaTad arasavaldebulod Tvlis

biujetiT gaTvaliswinebuli Tanxebis gamoyofas jandacvis saxelmwifo

seqtorisTvis Sjsd-is saministros mier gansazRvruli prioritetebiT;

3. rodesac saqme exeba davalianebas, maSin valis saxiT fiqsirdeba is,

rac aqvs Sjsd-is saministros dawesebulebebis winaSe da ara is, rac aqvs

TviT finansTa saministros jandacvis saministros winaSe.

saxelmwifo marTvis sistemis reorganizaciis Sedegad reformis

dasawyisSi jandacvis sistemaSi moxda strategiuli da taqtikuri

amocanebis gamijvna da maTi ganawileba qveynis centralur xelisuflebasa

da adgilobrivi marTvis organoebs Soris. saqarTvelos bunebriv-sameurneo

zonebis mixedviT Camoyalibebul iqna jandacvis regionaluri marTvis 13

centri.

jandacvis marTvis regionaluri organo Sedis adgilobrivi

xelisuflebis adgilobrivi TviTmmarTvelobis SemadgenlobaSi. igi axdens

saxsrebis akumulirebas sxvadasxva miznobrivi programebis

ganxorcielebisTvis regionis sameurneo ganviTarebis donis Sesabamisad.

regionaluri centris saqmianobis prioritetuli mimarTulebebis saxiT

gansazRvrulia mosaxleobis uzrunvelyofa maRalkvalificiuri samedicino

daxmarebiT da regionSi Semavali samedicino dawesebulebebis saqmianobis

koordinaciiT. regionis samkurnalo-profilaqtikur dawesebulebebs

daekisra pirveladi samedicino daxmarebis aRmoCena, diagnostikisa da

mkurnalobis Tanamedrove meTodebis danergva, bazuri programebiT

gaTvaliswinebuli profilaqtikuri RonisZiebebis Catareba.

Sjsd-is saministros prerogativad rCeba marTvis globaluri,

strategiuli programebis gadaWris sakiTxebi:

_ saxelmwifo programebis formireba da ganxorcieleba;

_ jandacvis zogadi mdgomareobis Sefasebis kriteriumebis formireba;

_ saxelmwifo samkurnalo standartebisa da normativebis SemuSaveba

da kontroli;

_ samedicino dawesebulebebisa da personalis akreditacia-

licenzirebis procesis uzrunvelyofa;

124

_ dargSi samecniero-teqnikuri programebisTvis xelSewyoba;

_ sistemis informaciuli da inteleqtualuri uzrunveyofa;

_ jandacvis mdgomareobaSi regionebs Soris warmoqmnili disbalansis

aRmofxvra.

Sjsd-is saministros roli jandacvis finansuri resursebis

mobilizaciis sakiTxSi minimaluria, deficituri dafinansebis pirobebSi.

saministro axorcielebs mxolod Semosavlebis aRricxvas. amJamad Sjsd-is

saministros ar gaaCnia samedicino momsaxurebaTa uSualo mimwodeblis

funqcia. saministros SenarCunebuli aqvs mxolod gansakuTrebuli

mniSvnelobis specifikuri programebis uSualod Sesasyidi funqcia (ase,

magaliTad `sxva jandacviTi programebi”-s uzrunvelyofa).

rogorc Cven ukve aRvniSneT, jandacvis reformis pirvel wlebSi

Sjsd-is saministrom ganaxorciela mmarTvelobiTi funqciebis

mniSvnelovani nawilis delegireba da decentralizacia, rac usaTuod iyo

progresuli nabiji. ukanaskneli wlebis gamocdilebam gviCvena, rom

marTvis saSualo da adgilobrivi done, avtonomiuri da naxevrad

avtonomiuri saxelmwifo Sesasyidi organizaciebi da samedicino

dawesebulebebis didi nawili aRmoCndnen moumzadebelni am ufleba-

valdebulebebis adeqvaturi ganxorcielebisTvis. amis Sedegad ukanaskneli

ori wlis ganmavlobaSi Sjsd-is saministroSi aSkarad gamovlinda marTvis

recentralizaciis niSnebi, rac gamoixata sdf, sazogadoebrivi jandacvis

departamentisa da samedicino dawesebulebebis mmarTvelobiT, finansur da

sakontaqto funqciaTa ganxorcielebis SezRudvaSi.

samedicino programebis dafinansebis Semdeg subieqts warmoadgens

sazogadoebrivi jandacvis departamenti, romelic Seqmnil iqna yofili

sanitarul-epidemiuri sistemis gayofis Sedegad. miuxedavad imisa, rom

departamenti organizaciulad imyofeba Sjsd-is saministros

daqvemdebarebaSi, misTvis damaxasiaTebelia gansazRvruli avtonomia,

gaxsnilia calke angariSi da ufleba aqvs funqciurad gamoiyenos saxsrebi.

samedicino programebis dafinansebis subieqts _ organos, romelic

ukanasknel periodamde axorcielebda savaldebulo samedicino dazRvevas _

samedicino dazRvevis fonds (sdf) _ kanoniT `samedicino dazRvevis

Sesaxeb~ mieniWa sruli finansuri, mmarTvelobiTi da sakontaqto

125

damoukidebloba. qveynis yovel regionalur administraciul teritoriaze

funqcionirebda fondis filiali, romelic ganlagebuli iyo mxaris

administraciul centrSi (imereTis filiali ganlagebulia q. quTaisSi,

kaxeTis _ q. TelavSi da a.S.). kompanias hqonda, agreTve, filialebi aWaris

a/r da afxazeTis a/r. garda amisa, fondis centralur ofiss uSualod

emorCileboda cxinvalis warmomadgenloba.

sdf-is arsebobis ramdenime wlis ganmavlobaSi srulyofil iqna

sakontaqto mmarTvelobiTi aRricxvis sistemebi. Tumca mis saqmianobaSi

gamoixata mmarTvelobiTi RonisZiebebis dabali efeqturoba da

arastabiluri dafinanseba, xolo Sedegad _ finansuri davalianeba

sakontaqto dawesebulebebis winaSe da kompaniis mxridan kontraqtorebis

mier Sesrulebuli samuSaoebis srulfasovani kontrolis uunaroba. ra

Tqma unda, es ganapirobebda pacientebisTvis gaweul momsaxurebaTa dabal

xarisxs, sadazRvevo saSualebebis araefeqtur gamoyenebas, dazRveulTa

uflebebis darRvevas.

mosaxleobisTvis SeTavazebul sadazRvevo programebsa da qveyanaSi

samedicino dazRvevis saxelmwifo sistemis warmatebul ganxorcielebaze

pasuxs agebs sdf, rogorc Semsrulebeli. kompanias nawilobriv ekisreba

pasuxismgebloba finansurad arabalansirebuli, ararealuri fasebiT

gamoangariSebul sadazRvevo paketzec da samedicino momsaxureobis

xelmiswvdomobisa da pacientTa uflebebis dacvis gauaresebazec.

dafinansebis Semdeg subieqts warmoadgenen jandacvis regionaluri

fondebi. jandacvis marTvis adgilobrivi organo SeimuSavebda konkretul

programebs, romelTa nawili, samedicino dazRvevis Sesaxeb kanonis

Tanaxmad, iyo qveynis erTiani sadazRvevo programis SemadgenlobaSi. am

programebsa da biujets amtkicebdnen adgilobrivi sakrebuloebi. xdeboda

finansuri saSualebebis mobilizacia jandacvis e.w. regionalur fondebSi,

Semdeg ki xdeba regionis SemadgenlobaSi Semavali raionuli

dawesebulebebis dafinanseba, romlebic axdenen jandacvis municipaluri

programebis realizacias. jandacvis municipaluri biujetis formirebis

wyaros warmoadgenda adgilobrivi biujeti. rogorc wesi, igi yalibdeboda

gadaricxvebisagan adgilobriv biujetSi da centralur biujetSi

gadaricxvebis im nawilisagan, romelic sakanonmdeblo wesiT rCeboda

126

adgilebze. Tumca am wess ar icavda mravali municipaliteti, radgan

qveynis mraval raions ar Seswevda unari damoukideblad Camoeyalibebina

adgilobrivi biujeti da amisaTvis iRebda centraluri biujetis

transfertebs, e.i. faqtiurad jandacvis adgilobrivi biujetis saSualebebi

arcTu iSviaTad sulac ar warmoadgenen adgilobrivi warmoSobis

saSualebebs, isini faqtiurad warmoadgendnen centraluri biujetis

mizanmimarTul transferebs. sayovelTaod cnobilia is problemebi,

romlebic dakavSirebulia qveynis biujetTan da mis SesrulebasTan.

aqedan gamomdinare, advili warmosadgenia jandacvis regionaluri

fondebis mdgomareoba, romlebic cdilobdnen finansuri saSualebebis

mobilizacias im raionebidan, romlebsac ar gaaCniaT es saSualebebi an Tu

gaaCniaT, maSin ar surT mezobeli raionis mosaxleobis dafinanseba.

Sedegad, gamodis, rom jandacvis adgilobrivi biujetebis umravlesoba

realurad arsebobda mxolod qaRaldze, xolo saSualebebis gamoyofa

faqtiurad uxdeboda mainc mosaxleobas. is mizeruli finansuri

saSualebebi, romelTa mobilizacia municipaluri jandacvis

dafinansebisTvis ase Tu ise xerxdeboda, xSirad gamoiyeneboda sxva

miznebisTvis, ramdenadac praqtikulad araviTari pasuxismgebloba ar

ekisreboda oficialur pirebs jandacvis municipaluri biujetis

SeusruleblobisaTvis.

ganvixiloT dafinansebis Semdegi subieqti _ samedicino

dawesebulebebi reformis dawyebisTanave yvela saxelmwifo dawesebuleba

damoukidebel iuridiul pirad iqca. Seicvala samedicino dawesebulebebis

iuridiuli statusi da sabiujeto organizaciebis nacvlad maT uwodeben

saxelmwifo (saxazino) sawarmoebs, xolo 1999-2000 wlebSi moxda am

dawesebulebebis Camoyalibeba saaqcio sazogadoebebad da SezRuduli

pasuxismgeblobis sazogadoebebad saxelmwifos 100%-iani wilobrivi

monawileobiT.

mizeruli finansuri resursebis ganawilebam zedmet samedicino

dawesebulebebsa da kadrebze, minimumamde daiyvana xarjebi, romlebic

gaTvaliswinebulia kapitaluri investiciebisTvis, obieqtebis movlisTvis,

materialur-teqnikuri bazis gaumjobesebisTvis, samedicino personalis

Sromis anazRaurebisTvis.

127

samedicino dawesebulebaTa Senoba-nagebobebis umravlesoba SeiZleba

davaxasiaToT rogorc ZiriTadad amortizebuli, Warbi simZlavreebiT, cudi

wyal-gayvanilobiTa da eleqtromomaragebiT; samedicino kadrebis Warbi

raodenobiT, romlebsac umravles SemTxvevaSi dabali kvalifikacia aqvT.

meores mxriv, saxelmwifo dafinansebis arastabilurobam da cudad

informirebuli pacientis faqtorma ganapirobes is, rom pacientisagan

Tanxis ukanonod miRebis mTavar iniciators warmoadgens

dabalanazRaurebadi, araxelsayreli kontraqtiT momuSave, Sesabamisi

mmarTvelobiTi codnisa da Cvevebis armqone, Warbi da dabalkvalificiuri

samedicino personali.

aqedan gamomdinare, jandacvis reformis erT-erT strategiul

mimarTulebad dasaxul iqna samedicino dawesebulebebis qselis

optimizacia da restruqturizacia. 1998 wels saqarTvelos jandacvis

saministrom msoflio bankTan erTad SeimuSava samedicino dawesebulebaTa

qselis stacionaruli seqtoris restruqturizaciis generaluri gegma. 1999

wels saqarTvelos mTavrobis mier generaluri gegmis I etapis miRebis

Semdeg dawyebul iqna stacionaruli seqtoris gardaqmnis

farTomasStabiani programa, rac iTvaliswinebda saavadmyofoebis Senoba-

nagebobebis likvidaciasa da privatizacias, samedicino personalis

optimizacias, saavadmyofoebis qselis Semcirebas. samedicino

dawesebulebaTa Senoba-nagebobebis privatizaciis Sedegad miRebuli

Semosavlebis reinvesticia xdeba saavadmyofoebis restruqturizaciis

specialuri fondis saSualebiT restruqturizaciis procesSi da isini

gamoiyeneba saxelmwifo sakuTrebaSi darCenili jandacvis strategiuli

obieqtebis reabilitaciisTvis; gamoTavisuflebuli samedicino personalis

sakompensacio paketis anazRaurebisTvis; gamoTavisuflebuli

personalisTvis gadamzadebis SesaZleblobis uzrunvelsayofad da

samkurnalo-profilaqtikuri qselis marTvis sistemis gasaumjobeseblad.

stacionaruli seqtoris optimizaciis mizniT, msoflio bankis mier

gamoyofili iqna SeRavaTiani krediti daaxloebiT 9,4 mln. aSS-s dolaris

odenobiT.

128

2002-2003 wlebSi restruqturizacia Seexo 49 samedicino dawesebulebas

(maT Soris jandacvis 26 stacionarsa da 23 pirvelad ambulatorias), ris

Sedegac maTi raodenoba Semcirda 15-mde.

reorganizaciis Sedegad samedicino personalis ricxvidan

gamoTavisuflebel iqna 734 adamiani, romlebisTvisac kompensaciis saxiT

gamoyofil iqna 710863 lari.

rac Seexeba jandacvaze saxelmwifo danaxarjebs, saqarTvelos

socialuri dazRvevis saxelmwifo fondis mier 2001-2007ww. jandacvis

saxelmwifo programebis dafinanseba xdeboda sxvadasxva wyaroebidan,

kerZod: 2001 wels ori wyarodan _ damqiravebelTa da daqiravebulebis mier

xelisuflebidan gadaxdili savaldebulo dazRvevis SesatanebiT (3%+1%)

da centraluri biujetis transferidan. 2002-2004 wlebSi zemoaRniSnul

wyaroebs daemata teritoriuli erTeulebis biujetebidan gadacemuli

Tanxebi, romelic mimarTuli iyo gadaudebeli da ambulatoriuli

daxmarebis programebis dasafinanseblad, 2005-2007 wlebSi programebis

dafinanseba xdeboda mxolod sabiujeto asignebebiT.

jandacvis seqtoris organizaciuli mowyobis marTvisa da dafinansebis

saxelisuflebo politikis cvlilebis Sesabamisad SeiZleba gamovyoT

Semdegi etapebi: 2001-2002 wlebi, 2003-2004 wlebi da 2005-2007 wlebi.

2001-2002 wlebSi arsebobda `samedicino dazRvevis savaldebulo

Sesatani~ (damqiraveblis saxelfaso fondze daricxuli 3%+ daqiravebulis

xelfasis 1%), anu damqiraveblis da daqiravebulis gadaxdil Tanxebs ukve

gansazRvruli hqonda daniSnuleba. kanonis Tanaxmad, aRniSnuli Sesatani

ar warmoadgenda qveynis biujetis Semosavlebis wyaros, igi ufro kerZo

saxsrebs warmoadgenda, romlebic jandacvisTvis iyo gankuTvnili. unda

aRiniSnos, rom 2001-2002 wlebis modeli sakmaod rTuli aRmoCnda, radgan

sistemis funqcionirebis De Iure sqema arsebiTad gansxvavdeba De Facto

viTarebisgan. `samedicino dazRvevis savaldebulo Sesatani~ sinamdvileSi

iyo erTgvari Sualeduri kategoria `savaldebulo Sesatansa~ da

`mizanmimarTul sabiujeto gadasaxads~ Soris. Segrovebis teqnikiT

(`misamarTi~ _ eqskluziurad samedicino dazRvevis saxelmwifo kompania)

`3+1~ Sesatans waagavda, xolo gadamxdelisa da gadaxdis proceduris

aRricxvis teqnikiT _ mizanmimarTul sabiujeto gadasaxads.

129

2003 wlidan samedicino dazRvevis saxelmwifo kompaniam Sewyvita

funqcionireba da Seiqmna axali struqtura _ socialuri dazRvevis

erTiani saxelmwifo fondi, gauqmda samedicino dazRvevis savaldebulo

Sesatani da jandacvis saxsrebi gaerTianda socialuri dazRvevis

gadasaxadSi, romlis safuZvelzec xdeboda socialuri xarjebis

damfinansebeli sagangebo fondis, e.w. specfondis formireba.

2003 da 2004 wlebis biujetis kanonis mixedviT saxelmwifo biujeti

Sedgeboda centraluri biujetisa da specfondebisagan (maT Soris

saqarTvelos socialuri dazRvevis erTiani saxelmwifo fondi). miuxedavad

imisa, rom socialuri dazRvevis gadasaxadi, yvela sxva gadasaxadisagan

gansxvavebiT, gansazRvravs gadasaxadis mizans, mimarTulebas, qveynis

kanonmdeblobiT aris biujetis formirebis wyaro da jandacvis erovnul

angariSebSi 2003 wels am gadasaxads mieniWa calke kodi (savaldebulo

saxelmwifo sadazRvevo gadasaxadi). es gadasaxadi iseTive wesiT Sedioda

xazinaSi, rogorc sxva wminda sabiujeto gadasaxadebi _ calke mimRebi

angariSi xazinaSi socialuri dazRvevis gadasaxadisaTvis ar arsebobda.

amgvarad, igi isev warmoadgens Sualedur kategorias msgavsad `samedicino

dazRvevis savaldebulo Sesatanisa~, magram amjerad mizanmimarTul

sabiujeto gadasaxadsa da wminda sabiujeto gadasaxads Soris.

2005 wels socialuri dazRvevis gadasaxadi uqmdeba da Semodis

socialuri gadasaxadi, romelic uSualod biujetSi akumulirdeba da

socialuri dazRvevis erTiani saxelmwifo fondis jandacvis programebis

dafinanseba mxolod sabiujeto asignebebiT xorcieldeba.

imdenad, ramdenadac jandacvis erovnuli angariSebis momzadebisas

gamoyenebuli iqna daricxvis meTodi, 2001-2006 wlebSi faqtiuri Sesruleba

sakmaod aRemateboda realur dafinansebas, maT Soris sxvaoba ki

saxelmwifo biujetis valad aRiricxeboda da misi gastumreba xdeboda

momdevno wlebSi, amitom realur dafinansebasa da faqtiurad

Sesrulebuli samuSaos Soris sxvaoba miekuTvna saxelmwifo biujets.

130

cxrili 26

socialuri dazRvevis dafinansebis wyaroebi

(aTasi lari)

wyaroebi 2001 2002 2003 2004 2005 2006

saxelmwifo biujetis

transferi

samedicino dazRvevis

gadasaxadi

teritoriuli

erTeulebis

biujetebidan gacemuli

Tanxebi

sul

19313,7

20981,7

40295,4

26900,5

18400,0

3900,0

49200,5

27990,2

36300,0

5376,4

69666,6

65546,8

15409,1

80955,9

88608,0

88608,0

128645,5

126381,2

wyaro: erovnuli moxseneba saqarTvelos mosaxleobis janmrTelobis mdgomareobis Sesaxeb.

sSjsds. 2005.

finansur agentebzeI finansuri wyaroebidan saxsrebis gadanawileba

mocemulia cxrilSi 27.

samedicino dawesebulebebSi faswarmoqmnaze da samedicino

momsaxurebis anazRaurebaze saxelmwifo regulirebis sistema sustia, rac

saSualebas aZlevs medpersonals da samedicino dawesebulebebis

xelmZRvanelebs ekonomikuri mizanSewonilobisa da racionalurobis gareSe

daaweson fasebi samedicino momsaxurebaze.

I finansuri agentebi _ yvela ekonomikuri subieqti, romelic finansuri wyarodan iRebs Tanxebs da axdens maT gankargvas samedicino momsaxurebis, farmacevtuli saqonlis, samedicino ganaTlebis, mecnierebisa da jandacvasTan dakavSirebuli nebismieri saqonlis dasafinanseblad.

131

cxrili 27

finansuri wyaroebidan finansur agentebze Tanxebis

ganawileba 2001-2006 ww (aTasi lari)

(jandacvis RonisZiebebis dafinansebisTvis)

2001 2002 2003 2004 2005 2006

centraluri biujeti

a) Sjsd saministro

b) saz. jandacvis departamenti

g) daavadebaTa kontrolisa da

samed statistikis erovnuli

centri

d) daavadebaTa kontrolisa da

samed statistikis erovnuli

centri

e) saq. janmrTelobis da

socialuri proeqtebis

ganmaxorcielebeli centri

v) Tavdacvis saministro

z) Sinagan saqmeTa saministro

T) iusticiis saministro

i) uSiSroebis saministro

k) samTavrobo dacva

l) omis veteranTa depart.

m) samedicino saganmanaTleblo

dawesebulebebi

n) saavadmyofoTa restruqtiri-

zaciis fondi

sxva

socialuri dazRvevis erTiani

saxelmwifo fondi

6082,1

11139,6

914,4

152,3

398,1

110,7

244,8

461,1

14,5

815,8

19313,7

6322,4

12749,5

284,7

1530,7

414,9

123,9

342,8

486,9

688,5

26900,5

6825,1

3897,4

608,7

729,1

932,3

1191,7

527,1

104,3

176,2

321,1

85,5

762,2

27990,5

8524,3

3222,1

186,0

354,4

567,8

132,8

786,9

108,7

441,9

301,1

388,1

65546,7

8584,7

567,1

626,4

1120,4

771,5

870,0

112,6

1678,6

553,8

20978,8

308,8

88608,0

5247,3

680,1

626,4

2412,4

17783,4

1329,9

1548,6

811,2

47792,1

4214,8

128645,5

ucxoeTidan miRebuli

dafinansebis wyaroebiT da

grantebiT ganxorcielebuli

investiciuri proeqtebi

a) saavadmyofoTa

restruqturizaciis fondi

b) aramomgebiani institutebi,

romlebic emsaxurebian

117,7

132

Sinameurneobebs

g) sxva danarCeni

210,4

974,5

841,0

1333,2

sadazRvevo gadasaxadebi da

Senatanebi

socialuri dazRvevis erTiani

saxelmwifo fondi

36300,0

q. Tbilisis meriis saxsrebi

a) q. Tbilisis Sjsd saqalaqo

samsaxuri

b) sadazRvevo erTiani

saxelmwifo fondi

g) sxva kerZo samed. dazRveva

10536,9

2459,0

9484,0

2101,1

8944,8

880,7

15495,3

2389,4

19759,8

2956,3

3000,0

aWaris a/r saxsrebi

a) aWaris a/r jandacvis

saministro

b) soc. dazRvevis erT.sax. fondi

503,9

4500,0

5661,0

2389,4

21737,7

6890,9

541,6

afxazeTis a/r/ saxsrebi

afxazeTis a/r/ jandacvis samin.

769,4

813,3

618,7

869,0

922,9

541,6

sxva danarCeni teritoriuli

erTeulebis saxsrebi

a) jandacvis sxva municipaluri

organoebi

b) socdazRvevis erTiani sax.

fondi

damqiraveblis mier gadaxdili

jandacvaze savald. gadasaxadi

soc. dazRvevis erTiani sax.

fondi

15735,3

13800,0

daqiravebulis jandacvaze

savaldebulo gadasaxadi

soc. dazRvevis erTiani

saxelmwifo fondi

5245,4

4600,0

wyaro: erovnuli moxseneba saqarTvelos mosaxleobis janmrTelobis mdgomareobis Sesaxeb.

sSjsds. 2007.

133

rogorc ukve aRvniSneT, 1999 wlidan, jandacvis erovnuli politikis

SemuSavebisa da danergvis dawyebasTan erTad meti yuradReba daeTmo

pirvelad jandacvis dafinansebas. `soflis mosaxleobisa da mTiani

regionebis mosaxleobisTvis damatebiTi samedicino daxmarebis~ programam

gazarda pirveladi samedicino daxmarebis saxelmwifo dafinanseba. 2001

wlidan es programa gaxda prioritetuli, rac iqca seriozul nabijad,

saqarTvelos mTavrobis mxridan, pirveladi samedicino daxmarebiT

mosaxleobis uzrunvelyofis srulyofis gzaze. xorcieldeba

reformirebuli pirveladi samedicino daxmarebis seqtorisTvis kadrebis

momzadebis programa. es mravaletapiani programa iTvaliswinebs amJamad

arsebuli specializirebuli pirveladi daxmarebis uzrunvelyofis

sistemis gardaqmnas, sadac ojaxis eqimi (zogadi profilis eqimi) iqneba

mosaxleobisTvis pirveladi samedicino daxmarebis mTavari mimwodebeli. am

proeqtisa da amJamad ganxorcielebadi saerTaSoriso organizaciebis

(USAID, IMC, UMCOR) sxva proeqtebis gamocdileba safuZvlad edeba

`pirveladi jandacvis~ modelis saboloo danergvas, 2002-2007 wlebis

ganmavlobaSi mxardaWerili iyo proeqti pirveladi jandacvis reformis

Taobaze, msoflio bankis mxardaWeriT, pirveladi jandacvis reformis

CarCoebSi.

amrigad, jandacvis dafinansebis momavali strategiis ZiriTad

ganmsazRvrel faqtorebs warmoadgenen samedicino qselis optimizacia da

pirveladi samedicino daxmarebis sistemis ganviTareba.

Cven mier Catarebuli analizis Sedegad SeiZleba gamovyoT Semdegi

amocanebi jandacvis finansuri uzrunvelyofis sakiTxis gadasaWrelad:

1. jandacvaze gamoyofili finansuri resursebis marTvis meqanizmis

gaumjobeseba da regionebs Soris ganawilebis meqanizmis srulyofa.

saxelmwifo finansuri resursebis marTvis meqanizmis araefeqtianoba

da regionaluri uTanasworoba, romelic dakavSirebulia jandacvaze

Tanxebis gamoyofasTan, mniSvnelovan wilad gamowveulia saxelmwifo

dafinansebis wyaroebisa da struqturebis danawevrebiT _ pasuxismgebloba

samedicino dazRvevis saxelmwifo paketis dafinansebaze daekisra

ramodenime saxelmwifo struqturas. arcTu iSviaT SemTxvevaSi,

adgilobrivi marTvis organoebis daudevrobis Sedegad ar xorcieldeba

134

regionebSi gaTanabrebis meqanizmi (municipaluri fondebis gaerTianeba

jandacvis regionalur fondad _ regionaluri fondi).

dgeba saxelmwifo dafinansebis centralur organoebSi (sdf, Sjsd

saministros sazogadoebrivi jandacvis departamenti) sxvadasxva

wyaroebidan miRebuli saSualebebis TavmoyriT am problemis gadaWris

amocana.

2. saxelmwifos mier mosaxleobisTvis garantirebuli samedicino

momsaxurebis minimumis (saxelmwifo Sesyidvebis sistemis) gaumjobeseba.

xSir SemTxvevaSi saxelmwifos mier samedicino momsaxurebaTa

saxelmwifo Sesyidvebis dabali xarisxi gamowveulia finansuri

arabalansirebulobiT, centralur da municipalur doneze maT

ganxorcielebasTan dakavSirebuli xarvezebiT; samedicino dazRvevis

saxelmwifo paketis dafinansebaze pasuxismgebel subieqtTa siuxviT. am

problemis gadasaWrelad saWiroa:

_ Sesabamisi cvlilebebis Setana saxelmwifo paketsa da samedicino

dazRvevis tarifebSi;

_ saxelmwifo biujetSi xarjebis realuri dagegmva da samedicino

momsaxurebis dafinansebis prioritetuloba;

_ samedicino momsaxurebis anazRaurebis meqanizmisa da faswarmoqmnis

procesis srulyofa realur maCveneblebze dayrdnobiT.

3. qveyanaSi winaswari gadaxdiT samedicino momsaxurebis (dazRvevis)

SemoRebam SesaZlebeli gaxada finansuri riskis gadanawileba avadmyofidan

janmrTelze da Raribidan mdidarze. dazRvevis Semdgomi srulyofiTa da

ganviTarebiT Semsubuqebul unda iqnes mosaxleobis meti nawilis

finansuri mdgomareoba, jandacvis dafinansebasTan dakavSirebuli riskis

gadanawilebis meqanizmis efeqturobis amaRleba da samedicino dazRvevis

kerZo seqtorSi finansuri resursebis mobilizaciis stimulireba.

unda aRvniSnoT rom, samedicino dazRvevis ganviTarebis samTavrobo

gegmis mTavari mizania _ kerZo samedicino dazRvevaze damyarebuli

dafinansebis modelis ganviTareba.…

gegmis mixedviT, etapobrivad ganxorcieldeba arsebuli saxelmwifo

jandacviTi programebis (ambulatoriuli programis CaTvliT) Canacvleba

135

sadazRvevo produqtebiT –samedicino momsaxurebis Sesyidvis Canacvleba

sadazRvevo momsaxurebiT.

Aarsebobs samedicino momsaxurebis modelis samuშao versia. romlis

mixedviT შჯსდ სამინისტრო განახორციელებს შემდეგს:

1 შეიმუშავებს კანონს ჯანდაცვის დაფინანსების შესახებ, სადაც განსაზღვრავს:

ა) “უნივერსალურ პაკეტს” და მის შემადგენლობას, რომელსაც დააფინანსებს

საზოგადოებრივი სახსრებით და უფასოდ an მცირე თანაგადახდის საფასურად

შესთავაზებს მოსახლეობას. სახელმწიფო პასუხისმგებლობა ჯანდაცვის

დაფინანსების სფეროში გაიყოfa ორ ჯგუფად:

სახელმწიფო პასუხისმგებელია მთელი მოსახლეობის წინაშე სახეlმწიფო

სახსრებით უზრუნველყოს “უნივერსალური პაკეტით” გათვალისწინებული

მომსახურება:

- საზოგადოებრივი ჯანდაცვის ღონისძიებები;

- ოჯახის ექიმის მოდელზე დაფუძნებული პირველადი ჯანდაცვის

სისტემა (პჯდ), რომელიც საცხოვრებელ ადგილთან სიახლოვეში

აწვდის მოსახლეობას პრევენციულ, სამკურნალო და

რეაბილიტაციურ მომსახურებას;

- გადაუდებელი სასწრაფო სამედიცინო დახმარება – გადაუდებელი

ტრანსპორტირება სამედიცინო დაწესებულებამდე და

დაწესებულებებს შორის;

- ფსიქიატრია, ტუბერკულოზი და აივ/შიდსი (ამბულატორიული და

ჰოსპიტალური მომსახურება);

- სპეციფიკური მედიკამენტებით უზრუნველყოფა.

ბ) განსაზღვრავს ფინანსურად ხელმისაწვდომ „დამატებით პაკეტს“ და

სამედიცინო დაზღვევის ბაზარზე მისი რეალიზაციისa და სახელმწიფოს მხრიდან

მისი რეგულირების პრინციპებს, რომელსაც სახელმწიფო შეუძენს სიღარიბის

ზღვარს ქვემოთ მყოფ მოსახლეობას;

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გ) ორივე პაკეტის ფარგლებში სამედიცინო მომსახურების შესყიდვის,

მიმწოდებელთა შერჩევა-კონტრაქტირების და შესყიდული მომსახურების

ანაზღაურების პრინციპებს;

დ) სამედიცინო ბაზარზე ფასწარმოქმნის სახელმწიფო რეგულირების

მექანიზმებს;

2. რეგულაციებისა და საკანონმდებლო ინიციატივის საშუალებით სახელმწიფო

ხელს შეუწყობს კერძო ინვესტიციების მოზიდვას ჯანდაცვის სფეროში.

3. ექიმების რაოდენობისა და კვალიფიკაციის რეგულირებისთვის სახელმწიფო

გამოიყენებს ლიცენზირებას, სერთიფიცირებას და პერიოდულ რესერტიფიცირებას.

4. მიმწოდებლების ოპტიმიზაციის და ხარისხის კონტროლის მიზნით

სახელმწიფო გამოიყენებს სამედიცინო დაწესებულებათა რეგისტრაციას,

ლიცენზირებას da აკრედიტაციას.

სამი ვარიანტი, თუ როგორ შეუძლია საქართველოს სოციალური დაზღვევის

ერთიანი სახელმწიფო ფონდს (დესფ-ს) განახორციელოს დამატებითი სადაზღვევო

პაკეტის შესყიდვასთან დაკავშირებული ფუნქციები:

ვარიანტი 1 : სდესფ-ი უზრუნველყოფს დამატებითი პაკეტის ანაზღაურებას

ღარიბებისთვის და ყიდის იმავე პაკეტს მოსახლეობის დარჩენილი

ნაწილისთვის. კერძო სადაზღვევო კომპანიები ყიდიან დამატებით და აგრეთვე

“დამხმარე” სადაზღვევო პაკეტს.

Ees varianti SesaZlebelia იმ შემთხვევისთვის, თუ კი მომავალში ქვეყანა

გადაწყვეტს სოციალური დაზღვევის ფარგლებში სამედიცინო დაზღვევის სისტემის

შემოღებას. ინდივიდები, რომლებსაც სახელმწიფო არ უზრუნველყოფს დამატებითი

პაკეტით, შეძლებენ ეს პაკეტი შეისყიდონ სდესფ-ისგან ან კერძო სადაზღვევო

კომპანიებისგან. ეს დაზღვევას ხელმისაწვდომს გახდის მთელი მოსახლეობისთვის.

მაგრამ, სდესფ-ი იგივე პირობებში იქნება, რაც სხვა დანარჩენი კერძო სადაზღვევო

კომპანიები. არსებობს საფრთხე, რომ ის ვერ შეძლებს კონკურენციის გაწევას და

შედარებით ჯანმრთელი პაციენტები (დასაქმებულები და ახალგაზრდები) არჩევენ

კერძო დაზღვევას, რაც გამოიწვევს გაკოტრების საფრთხეს, და საბოლოო ჯამში

სერიოზული რისკის ქვეშ აყენებს ღარიბი მოსახლეობისათვის მომსახურების

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ხელმისაწვდომობას თუკი სდესფ-ს მოუწევს მომსახურებაზე ანაზღაურების შემცირება,

რათა დაფაროს უფრო მაღალი რისკების ხარჯები. agreTve, სდესფ-ი იქნება ისეთივე

რეგულირების პირობებში რაც ნებისმიერი კერძო სადაზვევო კომპანია და შესაბამისად

ვერ მოახდენს ამ უკანასკნელთა არაპირდაპირ რეგულირებას.

ვარიანტი 2: სდესფ-ი უზრუნველყოფს დამატებითი პაკეტის ანაზღაურებას

ღარიბებიsთვის და ყიდის იმავე პაკეტს მოსახლეობის დარჩენილი

ნაწილისთვის. კერძო სადაზღვევო კომპანიები ყიდიან “დამხმარე” სამედიცინო

დაზღვევის პაკეტს.

Ees varianti perspeqtiulia იმ შემთხვევისთვის, თუ კი მომავალში ქვეყანა

გადაწყვეტს სოციალური დაზღვევის ფარგლებში სამედიცინო დაზღვევის სისტემის

შემოღებას. wina variantisagan gansxvavebiT, დამატებითი პაკეტის ფარგლებში

მიმწოდებლებისათვის გადახდა არ მოხდება სხვადასხვა ფასების მიხედვით და არც

გადახდის განსხვავებული სისტემები იქნება გამოყენებული კერძო და არა-კერძო

პაციენტებისთვის. ასე რომ, გაძლიერდება შემსყიდველის როლი და ძალაუფლება.

ინდივიდები, რომლებსაც სახელმწიფო არ უზრუნველყოფს დამატებითი პაკეტით,

შეძლებენ ეს პაკეტი შეისყიდონ სდესფ-ისგან. მაგრამ, იქმნება სამედიცინო დაზღვევის

დამატებითი პაკეტის მონოპოლისტი მზღვეველი / შემსყიდველი, - არის საშიშროება

რომ მზღვეველმა არ გაითვალისწინოს მოსახლეობის საჭიროებები და მოთხოვნები.

ვარიანტი3: სდესფ-ი კონტრაქტს აფორმებს კერძო სადაზღვევო კომპანიებთან

დამატებითი პაკეტის მომსახურების მიწოდებისთვის.

ეს varianti აუცილებელია თუკი ქვეყანა გეგმავს ძირითადად კერძო სექტორს

დაეყრდნოს დამატებითი პაკეტის დაფინანსებისთვის. radgan შეამზადებს

სადაზღვევო ბაზარსა და მარეგულირებელ გარემოს, რათა მოიცვან მომსახურების

ფართო სპექტრი მთელი მოსახლეობისთვის.

კერძო სადაზღვევო კომპანიებისთვის სახელმწიფო კონტრაქტების შეთავაზება,

იძლევა კერძო სადაზღვევო მოცვის რეგულირების მნიშვნელოვან მექანიზმს, რათა

უზრუნველყოფილ იქნეს აუცილებელი სერვისების მოცვა. ეს ასპექტი ნაკლებადაა

დაცული დღეს საქართველოში და შედეგად, კერძო დაზღვევა ძვირი და

არახელმისაწვდომია მოსახლეობის დიდი ნაწილისთვის.

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არსებობს საფრთხე, რომ კერძო სადაზღვევო კომპანიები არ დაინტერესდებიან

ამ შეთავაზებით, რადგან ნაკლებად სავარაუდოა, რომ ისინი რაიმე მოგებას

მიიღებენ ქვეყნის უმეტეს ნაწილში, განსაკუთრებით მკაცრი რეგულირების

პირობებში.

4. jandacvisaTvis gaTvaliswinebuli finansuri saSualebebis

mobilizaciis gaumjobeseba.

ჯანდაცვის სექტორის დაფინანსებაში, ანალოგიურად სხვა ქვეყნებისა

მნიშვნელოვნად უნდა გაიზარდოს სახელმწიფოს წილი, რაც შესაძლებელია

მიღწეული იქნას მიზნობრივი გადასახადების შემოღებით და საბიუჯეტო

დაფინანსების გაზრდით. ამასთან ჯანდაცვის ხარჯების დაფინანსებაში ფართოდ

უნდა იყოს ჩაბმული მოსახლეობა ნებაყოფლობითი დაზღვევისა და თანაგადახდის

ფორმით.

am winadadebis realizacia, gazrdis saqarTvelos saxelmwifo

jandacvis SesaZleblobas, gaaumjobesebs mosaxleobis mdgomareobas,

Seamcirebs avadobas, gaaxangrZlivebs mosaxleobis SromiT aqtivobas, rac

gazrdis SromiTi resursebis xarisxs da mTlianobaSi Sromis nayofierebas.

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III.2. samedicino momsaxurebebis anazRaurebis formebi, rogorc

finansuri menejmentis ZiriTadi ekonomikuri instrumenti jandacvis

finansuri resursebis racionaluri gamoyenebisTvis

rogorc cnobilia, qveynis ekonomikuri mdgomareobidan gamomdinare,

jandacvaze gamoyofil saxsrebs ar SeuZlia srulad daakmayofilos

samedicino momsaxurebaSi mosaxleobis moTxovna. amitom saxelmwifo

Semoifargleba samedicino momsaxurebis bazuri programiT

gaTvaliswinebuli anazRaurebiT, romelic garantirebulad misawvdomia

qveynis TiToeuli moqalaqisTvis. amave dros saWiroa davnergoT iseTi

finansur-ekonomikuri meqanizmi, romelic uzrunvelyofs gamoyofili

finansuri saxsrebis optimaluri gamoyenebis SesaZleblobas.

saWiroa aRiniSnos, rom ar arsebobs anazRaurebis iseTi sistema,

romelic gaiTvaliswinebda yvela faqtorsa da Taviseburebas samedicino

momsaxurebis organizaciis saqmeSi. aucilebelia optimaluri sistema,

romelSic urTierTSewyobili iqneba msoflioSi gavrcelebuli

anazRaurebis aprobirebuli formebi.

samedicino momsaxurebis anazRaurebis meqanizmi gansazRvravs

gadasaxadis gadamxdelis fuladi saxsrebis odenobasa da Semosavals

samedicino dawesebulebebSi, agreTve, momsaxurebaTa saxeebs, romlebzec

dgindeba fasebi da xdeba gadasaxadis Setana.

mwarmoeblisa da momxmareblis pirdapiri urTierTobisas, mwarmoeblis

mier SeTavazebul momsaxurebebze momxmareblis (pacientis) mxridan

gadaxdisunariani moTxovnis arsebobis SemTxvevaSi anazRaurebis sakiTxi

wydeba martivi garigebis Sedegad. magram, rodesac Cven saqme gvaqvs iseT

moqmedebasTan, roca momxmarebeli mwarmoeblisTvis Rirebulebis

anazRaurebis funqcias gadascems mesame pirs (igulisxmeba biujeti an

sadazRvevo kompania), maSin aseT SemTxvevaSi aucilebeli xdeba, rom am

mesame pirma an gadasaxadis gadamxdelma winaswar SeaTanxmon, erTis mxriv,

momxmarebelTan _ samedicino momsaxurebis moculoba da saxe da, meores

mxriv, mwarmoebelTan _ fasi, romelsac is miiRebs gadasaxadis

gadamxdelisagan garkveuli saxisa da moculobis samedicino momsaxurebis

gawevisTvis.

140

ganvixiloT msoflio praqtikaSi arsebuli samedicino momsaxurebis

anazRaurebis formebi:

1. TiToeuli saxis samedicino momsaxurebis anazRaureba _

diagnostikuri da samkurnalo mizniT Catarebuli procedurebis,

samedicino manipulaciebis identifikacia, wamlebis daniSvna da

gacema, Sedegad gamoiwereba saerTo angariSi da waredgineba

gadasaxadis gadamxdels (Cvens SemTxvevaSi _ saxelmwifos).

2. anazRaureba, daavadebis TiToeuli SemTxvevidan gamomdinare _

gadasaxadebis Setana xdeba momsaxurebaTa kompleqsze an erTdroul

daxmarebaze. xdeba momsaxurebaTa saxeebis diferencireba, magram ar

xdeba maTi Sejameba, rogorc pirvel SemTxvevaSi. zogjer tarifs

adgenen ama Tu im pacientze, konkretul saavadmyofoSi gaweuli

samedicino momsaxurebis realuri Rirebulebis gauTvaliswineblad,

rogorc amas aqvs adgili diagnostikuri jgufebis mixedviT

anazRaurebisas.

3. sadReRamiso anazRaureba _ safasuris gadaxda xdeba stacionarSi

gatarebuli dReebis mixedviT.

4. anazRaureba erTiani ganakveTiT _ SeTanxmebiT ama Tu im saxis

momsaxurebis uSualo anazRaureba.

5. anazRaureba yovel avadmyofze _ fiqsirebuli gadasaxdeli

TiToeul pacientze, romlebic iricxebian ama Tu im eqimis

momsaxurebaTa CamonaTvalSi. amave dros aris gansxvavebebi

pacientTa kategoriebis mixedviT. calke kategorias miekuTvnebian

75-ze meti wlis asakis adamianebi.

6. anazRaureba sawol-dReebis mixedviT _ sawolebis profilis

mixedviT pacientis mier gatarebuli sawol-dReebis raodenobis

anazRaureba.

7. globaluri biujeti _ fiqsirebuli wliuri subsidia, romelic

moicavs danaxarjebis yvela mxares zRvruli Tanxis dadgeniT. am

biujetis farglebSi dawesebulebas aqvs sakuTari neba-surviliT

fondis gamoyenebis ufleba. danarT №1-Si mocemulia `wminda

saxiT~ anazRaurebis formebi. aqve mocemulia safasuris mimRebi,

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samedicino momsaxurebasa da calkeul momsaxurebebze an maT

kompleqsze, romlebzec dgindeba fasi.

unda aRiniSnos, rom anazRaurebis es formebi iSviaTad gamoiyeneba

cal-calke, Cveulebriv, iyeneben maT kombinirebul variants an xdeba

momsaxurebaTa gawevisa da maTi dafinansebis konkretuli viTarebisadmi

Segueba.

anazRaurebis meqanizmi gansazRvravs samedicino dawesebulebaTa,

samedicino personalis qcevas, maT mier warmodgenili momsaxurebebis

moculobasa da xarisxs, rac zegavlenas axdens gadamxdelebTan

(pacientTan an mesame pirTan) maT urTierTobaze. xolo es saSualebas

aZlevs mimwodebels reagireba moaxdinos ufro metad im stimulebze,

romlebic ZiriTadad emsaxurebian maT interesebs, vidre pacientTa

interesebs. Tu samedicino dawesebulebas uxdian romelime maCveneblis

anazRaurebis dadgenili sistemiT, maSin is yuradRebas amaxvilebs mxolod

am maCveneblebze. ase, Tu eqimi Rebulobs fiqsirebul xelfass, maSin is

gamoimuSavebs saaTebis dadgenil raodenobas da ar Seecdeba ufro

produqtiuli gaxados sakuTari samuSao dRe. da piriqiT, Tu eqims uxdian

gaweuli momsaxurebisaTvis, maSin vlindeba iseTi saxis momsaxurebis

SeTavazebis tendencia, romelic saSualebas miscems mas miiRos ufro

maRali Semosavali, pacientisaTvis raime damatebiTi sargeblis gareSe.

sadReRamiso anazRaurebis meTodis gamoyenebisas, samedicino

dawesebuleba dainteresebulia saavadmyofoSi pacientis yofnis

gaxangrZlivebisa da amrigad, sakuTari Semosavlis zrdaSi. anazRaurebis

ZiriTadi meqanizmiT gaTvaliswinebuli stimulebi naCvenebia danarTN 2-dan,

sadac naTlad Cans samedicino momsaxurebis anazRaurebis formaTa

naklovanebebi da Rirsebebi.

msoflio praqtikaSi ukanasknel aTwleulSi gamoyenebuli samedicino

momsaxurebis anazRaurebis formaTa nakrebi rCeba SedarebiT mudmivi.

daavadebis SemTxvevaSi erTaderT mniSvnelovan siaxles warmoadgens

anazRaurebis meqanizmi `diagnostikuri jgufebis~ mixedviT, romelic gaCnda

aSS-Si 70-iani wlebis bolos msoflioSi kargad cnobili saxelmwifo

programa `medikaer~-is (dazRvevis federaluri sistema, romelic moicavs

30,4 mln. xanSiSesulisa da 3,2 mln. invalidis momsaxurebas) CarCoebSi

142

stacionarul momsaxurebasTan dakavSirebiT. amis Semdeg, anazRaurebis am

formas gamouCnda mravali mimdevari evropis qveynebSi (irlandia da

Sveicaria). bolo dros aSS-Si SemoRebul iqna anazRaurebis sxva

analogiuri meqanizmi _ `SedarebiTi Skala resursebis mixedviT~, romlis

Tanaxmad safasuri samedicino momsaxurebisaTvis unda asaxavdes

resursebis Rirebulebas, romelic aucilebelia mis gasawevad. resursebis

RirebulebaSi asaxulia geografiuli gansxvavebebi samedicino

momsaxurebis gawevisas, radgan sistema SedarebiT axlaxans dainerga,

amdenad jerjerobiT naadrevia misi Sedegebis Sefaseba. bolo dros

saavadmyofoebis dafinansebis dros gansakuTrebiT farTo gavrceleba hpova

globalurma biujetma. globaluri biujeti warmoadgens winaswar

SeTanxmebuli samuSaoebis moculobis dafinansebis wess samedicino

dawesebulebebisTvis, dadgenili wesiT damtkicebuli saxelmwifo

standartebis, tarifebis, normativebisa da sakontrolo maCveneblebis

gamoyenebiT.

globaluri biujetis kalkulacia saxelmwifo programiTa da

programaSi monawile konkretuli dawesebulebis mixedviT xorcieldeba:

_ miTiTebuli programebiT gaTvaliswinebuli nozolgiebis mixedviT

gaweuli samedicino momsaxurebebis wliuri prognozirebadi raodenobiT;

_ samedicino momsaxurebis tarifisa da saxelmwifo standartis

garkveuli nozologiuri kodebiT (sirTulis indeqsi) gamoTvlili gaweuli

samedicino momsaxurebis saSualo Rirebulebis Sesabamisad. amave dros,

globaluri biujetis sakontrolo parametris saxiT gamoiyeneba, agreTve,

sawol-dReebis zogadi prognozirebadi raodenoba da sawol-dReebis

saSualo Rirebuleba, romlebic gansazRvrulia samedicino momsaxurebis

saxelmwifo standartebiT.

amJamad globaluri biujetis dafinansebis principi gamoiyeneba

kanadaSi, safrangeTsa da germaniaSi.

globaluri biujeti gamoiyeneba, agreTve, ambulatoruli daxmarebis

asanazRaureblad, kerZod, germaniaSi. Tumca ambulatoruli rgolis eqimebs

uxdian momsaxurebebis mixedviT, magram mis gawevaze momsaxurebis

Rirebuleba ucnobia, radgan igi ganisazRvreba saangariSo periodis

143

bolosTvis yvela eqimis mier gaweul momsaxurebaTa raodenobaze

globaluri biujetis Tanxis dayofis gziT.

globaluri biujetis saxesxvaobas warmoadgens suladobrivi

dafinanseba ambulatoruli daxmarebis pirobebSi, romelic amJamad

gamoiyeneba inglisSi, irlandiaSi, italiaSi, espaneTSi, aSS-Si,

avstraliaSi, axal zelandiaSi. xolo SveicariaSi ufro popularulia e.w.

diagnostikurad dakavSirebuli jgufebis sqema.

mocemul etapze saqarTvelos jandacvis dafinanseba xorcieldeba

programuli dafinansebis meTodiT (cxrili 28), samedicino

dawesebulebebis mier gaweul samedicino momsaxurebaTa Rirebulebis

anazRaureba xdeba gaweuli momsaxurebis moculobis adeqvaturad

samedicino standartebis safuZvelze gamoangariSebuli fasebis mixedviT.

dawesebulebis Sida standartis Sesabamisad samuSaos saxelmwifo

programiT gaTvaliswinebul standartze zeviT momsaxurebisTvis ixdis

TviT avadmyofi dawesebulebis mier damtkicebuli Rirebulebis

adeqvaturad.

daavadebaTa mkurnalobisa da diagnostikis standartebis SemuSaveba

(samedicino momsaxurebis moculoba da saxe) SeiZleba vaRiaroT

mniSvnelovan warmatebad. amJamad moqmedebs 1200 meti saxelmwifo

samedicino standarti. standartis msgavs formebze gadasvla pirvelad

daiwyo aSS-Si 1912 wels. faqtiurad isini amoqmedda 1952 wels, rodesac

aSS-s kongresma gasca sanqcia 197 oficialur profesiul standartze

kontrolis organizaciis Seqmnaze. amis Semdeg, samedicino daxmarebis

teqnologiaTa ganviTarebis mixedviT, Cndeba axali srulyofili

samedicino standartebi. gasuli (meoce) saukunis 20-iani wlebidan

unificirebuli mkurnalobis aseT modelebs eyrdnobian germaniis

savaldebulo sadazRvevo sistemebic (saavadmyofo-salaroebi). yofil ssrk-

Si iyo mkurnalobis unificirebis ganxorcielebis mcdelobebi klinikur-

statistikuri jgufebis mixedviT, magram samuSaoebi ar iqna dasrulebuli.

144

cxrili 28.

samedicino momsaxurebis anazRaurebis formebis

zogadi daxasiaTeba

meTodi #1 meTodi #2 meTodi #3 meTodi#4

definicia programuli

dafinanseba

(pirveladi

versia)

pirobiTi

standartebi

anazRaureba

sawol-

dReebis

mixedviT

globaluri

biujeti

tipologia anazRaureba

gaweuli

samedicino

momsaxurebis

moculobis

mixedviT

anazRaureba

gaweuli

samedicino

momsaxurebis

moculobis

mixedviT

anazRaureba

gaweuli

samedicino

momsaxurebis

moculobis

mixedviT

fiqsirebuli

wliuri

finansuri

limiti

anazRaurebis

pirobiTi

erTeuli

diagnozi

(standarti)

diagnoziT

(standartiT)

gaTvaliswine-

buli de-

faqtod

Sesrulebuli

samuSao

sawol-dRe

profilis

mixedviT

profili da

simZlavre

(sawolebis

an

registrireb

uli

pacientebis

raodenoba,

materialur-

teqnikuri

baza da a.S.)

anazRaurebis

wesebi

pirdapir

dawesebuleb-

as qviTris

wardgenis

Semdeg,

sadac

miTiTebulia

diagnozi

pirdapir

dawesebulebas

qviTris

wardgenis

Semdeg, sadac

miTiTebulia

diagnozi da

Sesrulebuli

pirdapir

dawesebuleb-

as qviTris

wardgenis

Semdeg,

sadac

miTiTebulia

profili da

adre

gansazRvru-

li

odenobiT

Tanxebis

perioduli

miwodeba

145

samuSao sawol-

dReebis

raodenoba

ganfasebis

principi

gadamxdelis

standartebi

(fiqsirebu-

li)

gadamxdelis

standartebi

(naxevradfiq-

sirebuli)

gadamxdelis

standartebi

(profilebis

mixedviT)

_

ucxouri

analogebi

`di-er-ji~

(mediqea

Medicare, aSS)

mediqeidi da

blu qrosi

(Medicade&Blue

Cross)

holandia,

nawilobriv

safrangeTi

yofili

ssrk, didi

britaneTi

(kunZulebze),

kanada,

Svecia,

TurqeTi

(mTian

zonebSi),

safrangeTi,

espaneTi

(baskeTsa da

gaskonSi),

aSS

(veteranTa

sistema da

kaizer

permanente)

146

samedicino standartebis Seqmnis gziT SesaZlebeli gaxda qveyanaSi

erTiani tarifebis SemoReba. sabazro fasebidan gamomdinare damuSavebis

saSualebiT operatiulad xdeba maTSi Sesabamisi cvlilebebis Setana.

jandacvis marTvis erovnuli centris eqspertTa jgufis mier 1996

wels Catarebul iqna eqspertiza saxelmwifos mier jandacvis saxelmwifo

programebis CarCoebSi samedicino momsaxurebis anazRaurebis formebidan

optimaluri variantis arCevaze. eqspertiziT SeTanxmebul iqna ramdenime

varianti: programuli dafinanseba (qviTrebiT gadaxda fiqsirebuli

standartebis mixedviT), pirobiTi standartebi (pirvelis modificirebuli

varianti); sawol-dReebiT gadaxdis principi; globaluri biujeti. am

formebis ufro vrceli daxasiaTeba teqnologiuri procesis CvenebiT

mocemulia cxrilH 28-Si.

eqspertiziT dadgenil iqna Sefasebis ZiriTadi kriteriumebi da am

kriteriumebiT Sefasebul iqna variantebi 3-quliani sistemiT (yvela

mniSvnelovan kriteriums mieca 3 qula, xolo yvelaze umniSvnelos ki _ 0

(danarTiN3).

Catarebulma eqspertizam gamoavlina is, rom samedicino momsaxurebis

safasuris gadaxdis formebidan prioriteti, makro-doneze ganxorcielebis

TvalsazrisiT, ZiriTadad eniWeba globalur biujets. Tumca, rac ufro

centralizebulia fasdebis procesi, miT ufro naklebia gadaxdis

adeqvaturoba resursebis danaxarjebisadmi.

xolo mikro-doneze yvelaze sasurvelia gadaxda pirobiTi

standartebiT, radgan igi yvelaze adeqvaturad asaxavs faqtiur

danaxarjebs samedicino momsaxurebis erTeulze. winaaRmdeg SemTxvevaSi

adgili aqvs e.w. `derefans~, romelic rCeba gadaxdil Tanxasa da

faqtiurad gaweul momsaxurebebs Soris, magram amave dros pirobiTi

standartebi teqnologiurad yvelaze rTulia, radgan isini

dakavSirebulni arian did administraciul xarjebTan, Tanac, maTTvis

damaxasiaTebelia gadaxdis Seyovneba. amave dros pirobiTi standartebisa

da programuli dafinansebis dros didia imis albaToba, rom samedicino

momsaxurebis moculoba ar iqneba pacientisTvis realurad saWiro

momsaxurebis adeqvaturi.

147

Tbilisis centraluri klinikuri saavadmyofos reanimaciul

ganyofilebaSi eqsperimentis wesiT 1997 wlis 1 martidan amoqmedebul iqna

anazRaureba stacionarSi gatarebuli sawol-dReebis mixedviT. am meTodiT

dadgenil iqna programaSi Semaval daavadebaze stacionaluri mkurnalobis

zRvruli (standartuli) vada da gamoTvlil iqna erTi sawol-dRis

Rirebuleba.

jandacvis saxelmwifo fondSi 1996 wels Semavali qviTrebis

kompiuterul-statistikuri damuSavebis gziT dadgenil iqna sxvadasxva

profilebisa da nozologiebisTvis sawol-dReebis fiqsirebuli raodenoba,

Sesabamisad, gansazRvrul iqna erTi sawol-dRis Rirebuleba. miTiTebuli

monacemebi ganzogadebul iqna da maT safuZvelze gansazRvrul iqna 1997

wlis nozologiaTa CamonaTvali, sawolze yofnis xangrZlivobis

normativebi da erTi sawol-dRis Rirebuleba.

samedicino momsaxurebis asanazRaureblad biujetis formirebis dros

xelmZRvaneloben formuliT:

biujeti = registrirebuli avadmyofebis raodenoba X

X sawolze yofnis xangrZlivobis normativi X

X erTi sawol-dRis saSualo Rirebuleba.

avadmyofs uxdian mkurnalobis Rirebulebas faqtiurad gatarebuli

sawol-dReebis mixedviT, magram araumetes zRvruli vadisa. amJamad

anazRaurebis es meTodi gamoiyeneba ftiziatriul da fsiqiatriul

stacionerebSi da sicocxlisaTvis saSiSi mdgomareobebis dros

mosaxleobisTvis stacionaruli samedicino daxmarebis programis

CarCoebSi.

xolo mosaxleobisaTvis ambulatoruli samedicino daxmarebis

programis CarCoebSi gamoiyeneba dafinansebis kapitaciis modeli: gamoiyofa

fiqsirebuli Tanxa erT sul mosaxleze gaangariSebiT, danarCeni

programebis dafinanseba xorcieldeba calkeuli RonisZiebebis mixedviT

xelSekrulebis safuZvelze, xolo samkurnalo programebis dafinanseba _

manamde arsebuli wesiT, nozologiebisa da maTze dadgenili tarifebis

mixedviT.

eWvgareSea, sawol-dReebis mixedviT anazRaurebis princips gaaCnia

dadebiTi mxareebi da is savsebiT misaRebia da SeiZleba iTqvas, dRevandel

148

pirobebSi warmoadgens yvelaze optimalur variants, radgan am pirobebSi

samedicino dawesebuleba dainteresebulia imaSi, rom rentabeluri gaxados

Tavisi organizacia samedicino personalisa da sawolis fondis

optimizaciis, dawesebulebis datvirTvis, Tanamedrove maRalefeqturi

diagnostikuri da samkurnalo saSualebebis gamoyenebis gziT. am formis

upiratesobas warmoadgens, agreTve, gadamxdelTan urTierTangariSsworebis

formis simartive: arsebuli wesis nacvlad, rodesac TiToeul

registrirebul avadmyofze ivseba calke qviTari, samedicino

dawesebulebam yovelTviurad unda Seavsos erTi moTxovna SemuSavebuli

wesis mixedviT. Tumca, yuradRebas iqcevs am formis erTi principuli

nakli. samedicino dawesebulebebs aqvT SesaZlebloba miiRon damatebiTi

mogeba sawolze avadmyofTa yofnis xangrZlivobis Semcirebis xarjze. Cveni

azriT, samedicino dawesebulebas ar unda hqondes normatiul maCvenebelze

adre avadmyofis gamoweris ufleba, radgan aman SeiZleba tipiurad aqcios

es tendencia da masobrivad xels Seuwyobs vadaze adre ara srulad

gamojanmrTelebuli adamianis gamoweras. pacientis mdgomareobis

gauaresebis SemTxvevaSi, misi ganmeorebiTi hospitalizacia da mkurnaloba

gacilebiT Zviri dajdeba.

samedicino momsaxurebis moculobis optimizaciis mizniT msoflios

mraval qveyanaSi gamoiyeneba Tanadafinanseba mosaxleobis mxridan

momsaxurebis dafinansebis dros. 1996 wlis 20 Tebervlis saqarTvelos

ekonomikisa da jandacvis saministroebis #76/0-18 erTiani brZanebiT

SemoRebul iqna pacientebis tarifebi. 18 wlis asakamde mosaxleobisaTvis

Tanadafinanseba urgentul samedicino daxmarebaze damtkicebul iqna

tarifidan 30%-is odenobiT; 18 wlis zeda asakis mosaxleobisaTvis _ 50%.

2003 wlidan _ 18 wlamde _ 0%, 18 wlis zeviT 25%.

amJamad msoflioSi mwvave diskusia mimdinareobs Tanadafinansebis

principis gamoyenebis Taobaze. evropis zogierT qveyanaSi Tvlian, rom es

praqtika iwvevs samedicino momsaxurebaTa gamoyenebis moculobis

Semcirebas. aSS-Si samedicino dazRvevis centr `rend~-is mier Catarebuli

gamokvlevebiT dadginda, rom is pirebi, romlebzec vrceldeba

Tanadafinansebis principi, sul ufro naklebad mimarTaven ambulatorul

da stacionarul momsaxurebas. agreTve, dadgenil iqna, rom aSS-Si da sxva

149

qveynebSic, es praqtika mniSvnelovanwilad amcirebs gadaudebel samedicino

momsaxurebis miRebas, Tu avadmyofis mdgomareoba Zalze ar aris

gaerTianebuli. zogierT qveyanaSi am praqtikas socialuri dacvis ZiriTad

principebTan SeuTavseblad Tvlian.

saqarTveloSi, am etapze, Tanadafinansebis principis gamoyeneba, Cveni

azriT, ar aris gamarTlebuli, radgan es mniSvnelovanwilad auaresebs

samedicino daxmarebis misawvdomobas, Tumca, gasaTvaliswinebelia rom

jandacvis saxelmwifo dafinansebis SezRudulobis pirobebSi,

warmoadgens dafinansebis erT-erT ZiriTad damatebiT wyaros.

Tanagadaxdis dadgenis dros gaTvaliswinebul unda iqnes

ambulatoriuli mkurnalobisa da prevenciuli RonisZiebebis amocana.

amisaTvis mizanSewonilia davadginoT Tanagadaxda mxolod an ZiriTadad

stacionarul mkurnalobaze.

ambulatoriul daxmarebasTan mimarTebaSi unda aRiniSnos, rom:

_ eqimTan pirveli viziti unda iyos ufaso;

_ tarifebi unda iyos dabali da Seesabamebodes mosaxleobis

Semosavlis dones;

_ SemuSavebuli unda iqnes sistema, romelic yvelaze umweoebs

gaaTavisuflebs samedicino momsaxurebaze pirdapiri gadaxdebisagan.

amrigad, SeiZleba gavakeToT daskvna imis Sesaxeb, rom ar arsebobs

anazRaurebis idealuri varianti, arCevani anazRaurebis formebs Soris

damokidebulia gadawyvetilebis mimRebi pirisTvis SefasebiTi

kriteriumebis prioritetulobaze. rogorc ukve iTqva, msoflioSi

arsebuli samedicino momsaxurebis anazRaurebis formebidan, saqarTveloSi,

saxelmwifo programebis CarCoebSi momuSave samedicino dawesebulebebSi

gamoiyeneba anazRaureba samedicino standartebis (diagnozis) safuZvelze

gaweuli samedicino momsaxurebis moculobis adeqvaturad. es meTodiT

moiTxovs garkveul koreqtirebebs, rac ZiriTadad gamoixateba programebisa

da standartebis daxvewaSi.

Mmagram, `jandacvis sistemis programuli dafinansebis meTodis~

upiratesobis miuxedavad, qveynis biujetidan da saqarTveloSi arsebuli

socialur-ekonomikuri mdgomareobidan gamomdinare, es meTodi awydeba

problemebs da araadeqvaturi dafinansebis doneze ar SeuZlia gamoxatos

150

Tavisi institucionaluri upiratesoba dafinansebis sxva meTodebTan

SedarebiT (mas ueWvelad, eqneboda adgili sruli moculobiT dafinansebis

SemTxvevaSi). saxsrebis nakleboba, Cveulebriv warmoSobs Sav bazars,

pirdapir garigebas eqimsa da pacients Soris, rasac ziani moaqvs jandacvis

sistemisaTvis.

yovelive aqedan gamomdinare sasurvelia am etapze ganvaxorcieloT

qveynis jandacvis finansuri uzrunvelyofa `globaluri dafinansebis

meTodiT~, es meTodi ZiriTadad gamoiyeneba regionalur doneebze. saerTod,

SeiZleba iTqvas, rom jandacvis yvelaze efeqtur politikas warmoadgens

`realobaze agebuli politika~. `globaluri dafinansebis meTodi

gansakuTrebiT efeqtiani eqstremalur, cxovrebisaTvis rTul zonebSi, e.i.

iq, sadac sabazro ekonomikas, bunebrivi pirobebidan gamomdinare, ar

SeuZlia srulad warmoaCinos sakuTari Tavi, e.i. is ar asrulebs xalxis

gamdidrebis pirobas, am meTods mimarTaven daxmarebisTvis. aRsaniSnavia,

rom samedicino momsaxurebis modelis samuშao versiis mixedviT Sesyidvis

meqanizmiT pirveladi jandacvisaTvis rekomendebulia ”kapitaciuri”

meTodi, xolo saavadmyofoebisaTvis - “globaluri biujeti.”

samkurnalo-profilaqtikuri dawesebulebebis Semosavlebis gazrdis

erT-erT ZiriTad faqtors warmoadgens samedicino momsaxurebis

moculobisa da xarisxis amaRleba. samedicino personalis Sromis

anazRaurebis dabali done ara marto xels uSlis jandacvis ganviTarebas,

niWieri adamianebis mozidvasa da kadrebis profesiuli kvalificiuri

donis zrdas, aramed qmnis saqmianobis am socialurad mniSvnelovani

sferos degradaciis, erT wertilze gayinvis wanamZRvrebsac.

sxvadasxva qveynebis samedicino personalis Sromis anazRaurebis

organizaciis gamocdileba gviCvenebs, rom arsebobs Sromis anazRaurebis

mravali meTodi. TiToeul maTgans mivyavarT gansxvavebul Sedegebamde.

SesaZlebelia maTi Serwyma. msoflio praqtikaSi ZiriTadi meTodebia:

anazRaureba momsaxurebisTvis, anazRaureba SemTxvevisTvis, anazRaureba

TiToeuli dRisTvis, anazRaureba individualuri xarjTaRricxvis,

suladobrivi anazRaureba, premialuri anazRaureba, anazRaureba jamagiris

ganakveTiT, sabiujeto meTodi. praqtikulad yvela CamoTvlil meTods

gaaCnia naklovanebebi da sxvadasxva saxis mastimulirebeli saSualebebi.

151

mTel msoflioSi gamoiyeneba Sromis anazRaurebis Sereuli forma, sadac

1/3 aris garantirebuli minimumi, xolo 2/3 damokidebulia xarisxobriv da

raodenobriv maCveneblebze, aq gamoiyeneba Sromis droiTi da garigebiTi

anazRaurebis elementebi. Sereuli forma moicavs muSakebis damsaxurebaTa

mravaldonian Sefasebaze dafuZnebuli xelfasis mravalfaqtorul

sistemebs.

saqarTvelos jandacvis sabiujeto dawesebulebebSi xelfass

safuZvelad udevs erTiani satarifo sqema, romelic saboloo Sedegze ar

aris orientirebuli.

sabazro ekonomikis da medicinis komercializaciis pirobebSi

saWiroa ufro garkveuli kriteriumebi samedicino muSakebis Sromis

anazRaurebis diferencirebisTvis, radgan anazRaureba ganakveTebis

mixedviT araadeqvaturad asaxaves sxvaobas samedicino personalis SromiTi

danaxarjebis donesa da kvalifikaciaSi. cxadia, rom anazRaureba

damokidebuli unda iyos Sromis xarisxsa da mis raodenobaze. xarisxi

damokidebulia kvalifikaciaze, raodenoba ganisazRvreba pacientis

ricxviT, agreTve maTi mdgomareobis simZimiT. amJamad Sromis xarisxi da

namkurnalebi pacientebis raodenoba garkveulwilad gaTvaliswinebulia

xelfasis doneSi (SemoRebulia kvalificiuri kategoriebi samedicino

personalisTvis, SemuSavebulia normativebi Catarebuli procedurebis,

konsultaciebis, gasinjvebisa da a.S. raodenobis mixedviT erT ganakveTze

gaangariSebiT), magram praqtikulad aranairad ar xdeba avadmyofTa

mdgomareobis simZimis gaTvaliswineba.

jandacvis muSakebis Sromis anazRaurebis sistemebi unda moicavdnen

ara marto motivaciur elementebs, aramed SemoTavazebuli samedicino

momsaxurebebis xarisxis kontrolis zomebsac. metismetad mniSvnelovania

samedicino personalis mier misaRebi klinikuri gadawyvetilebebis

finansur SedegTa gagebis miRweva, radgan gadawyvetileba profilaqtikuri

RonisZiebebis, gamokvlevisa da mkurnalobis garkveuli gegmis Sesaxeb

ganapirobebs samedicino dawesebulebis aucilebel danaxarjTa

gansazRvrul moculobas.

stacionarSi avadmyofis mkurnalobis xarjebi yalibdeba samkurnalo

dawesebulebis faqtiurad daricxuli xarjebis yvela saxis mixedviT:

152

daricxuli xelfasis fondis, kvebis, medikamentebze xarjebis, sameurneo -

satransporto, komunaluri da sxva mimdinare xarjebis, agreTve, msubuqi

inventaris, mowyobilobis SeZenis, kapitaluri remontis xarjebis CaTvliT.

poliklinikaSi erTxel vizitis xarjebi yalibdeba daricxvebiT

mkurnali eqimis, samedicino personalis, damxmare qvedanayofebisa da sxva

samsaxurebis personalisa da eqimebis xelfasidan imave wiliT, romelsac

akuTvneben poliklinikis ganyofilebis momsaxurebas, agreTve,

poliklinikis sxva mimdinare xarjebs, mowyobilobis Sesyidvisa da

nagebobaTa kapitaluri remontis xarjebs, romlebic mikuTvnebulia

gansxvavebul periodSi eqimTan vizitTa raodenobisTvis.

jandacvis reformebis mocemul etapze finansuri da materialuri

resursebis gamoyenebis srulyofis ZiriTadi mimarTulebebia:

_ poliklinikaSi vizitisa da namkurnalebi avadmyofis xarjebis

Semcireba sawolebis raodenobis Semcirebisa da restruqturizaciis,

hospitalizaciis vadebis Semcirebis, ufro iaffasiani wamlebisa da

mkurnalobis teqnologiaTa gamoyenebis xarjze da sxv;

_ samkurnalo dawesebulebaTa momsaxurebebiT mosargeble

mosaxleobis kontingentis gafarToeba;

_ efeqti SeiZleba miRebul iqnes rogorc zomebis romelime jgufis

ganxorcielebis xarjze, ise mocemuli momentisaTvis yvela SesaZlo

RonisZiebebis kompleqsuri danergvis xarjze, romlebsac ar unda axldes

Tan samedicino daxmarebis xarisxis gauareseba.

sawolTa fondis restruqturizaciisadmi da Semcirebisadmi

tendenciis miuxedavad, ZviradRirebuli stacionaruli daxmareba

winandeliviT ikavebs mniSvnelovan adgils mosaxleobisaTvis samedicino

daxmarebis gawevis struqturaSi, hospitalizaciisa da sawolze dayovnebis

saSualo xangrZlivobis maCveneblebi uwindeburad gadidebulia.

sawolebisa da mkurnalobis vadebis Semcirebis Senelebuli tempis

ZiriTad mizans warmoadgens aRdgeniTi mkurnalobis

stacionarSenacvlebiTi teqnologiebisa da qvedanayofebis ganviTarebaSi

samedicino dawesebulebebis ekonomikuri dainteresebis arseboba.

mkurnalobis xangrZlivobis Semcireba iZleva yvela saxis mimdinare

xarjebis danazogs erT avadmyofze gaangariSebiT. am SemTxvevaSi efeqti

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SeiZleba miRebul iqnes mkurnalobis intensiuri meTodebis gamoyenebis,

winasadResaswaulo da dasvenebis dReebSi avadmyofis Semosvlis

SemTxvevaSi stacionarSi dayovnebis arasawarmoo dReebis Semcirebis,

poliklinikasa da stacionarSi diagnostikuri da laboratoriuli

kvlevebis dublirebis gamoricxvis xarjze. ekonomikuri efeqti SeiZleba

miRebul iqnes maTi muSaobis normatiul SromatevadobasTan SesabamisobaSi

eqimebisa da samedicino personalis raodenobis moyvanis xarjze.

garda amisa, avadmyofis mkurnalobaze danaxarjebis Semcirebas

SeiZleba mivaRwioT im xarjebis SemcirebiT, romlebic ar miekuTvnebian

sakuTriv mkurnalobas, saxeldobr im xarjebisa, romlebic dakavSirebulni

arian Senobebis, komunikaciebis, inventaris momsaxurebasTan, agreTve

samivlinebo xarjebisa, saTavsebis SekeTebis xarjebis SemcirebiT.

aseTi xarjebis xvedriTi wilis Semcireba saSualebas mogvcems

SefardebiTi gaangariSebiT da absoluturad gavzardoT xarjebis odenoba

sxva muxlebze da, upirveles yovlisa, gavzardoT samedicino

dawesebulebebis personalis Sromis anazRaurebis fondi.

damatebiTi mogebis miRebis sxva mimarTulebas warmoadgens im pirTa

wris gafarToeba, romlebic sargebloben mocemuli samkurnalo

dawesebulebis momsaxurebiT. moTxovna momsaxurebebze, Tu ar CavTvliT

pacientis mier eqimTan pirvelad vizits, SeiZleba regulirebul iqnes

eqimebis mier. moTxovnis gazrda realuria, radgan samedicino

momsaxurebebis bazari moqalaqeebs saSualebas aZlevs airCion mkurnali

eqimi da samkurnalo dawesebuleba. ukanasknelis maRali reitingi

moizidavs mosaxleobis damatebiT kontingents, maSasadame, gazrdis

samkurnalo-profilaqtikuri dawesebulebebis mogebas.

amasTan erTad, samedicino momsaxurebebis bazris Camoyalibebisas

aqcenti unda gakeTdes eqimebs Soris dawesebulebis Sida konkurenciaze.

eqimebs Soris konkurenciis ganviTarebis mamoZravebel Zalas,

upirveles yovlisa, warmoadgens xelfasi. sxvaobam muSaobis odenobasa da

xarisxSi Tavisi asaxva unda hpovos Sesabamis waxalisebaSi, mxolod maSin

gauCndeba samedicino personals maRalefeqtiani Sromis motivacia.

sabazro ekonomikis dros jandacvis sistemis subieqtebs Soris

urTierTobebis Camoyalibebis procesis warmateba damokidebulia imaze, Tu

154

ramdenad efeqtianad iqneba gamoyenebuli jandacvis muSakebis Sromis

anazRaurebis meqanizmi, romelic iZleva ara marto stimuls SromisaTvis,

aramed aumjobesebs klinikuri saqmianobis finansuri Sedegebis. samedicino

personalis farTo Cabma muSaobaSi finansuri da materialuri resursebis

gamoyeneba, samedicino daxmarebis gawevaze danaxarjebis Semcireba,

saSualebas mogvcems realurad miviRoT damatebiTi saxsrebi Sromis

saTanado anazRaurebisTvis. dRes unda gaZlierdes jandacvis

dawesebulebebis poliklinika-ambulatoriebis rgolis ekonomikurad

efeqtiani saqmianoba, radgan poliklinikis eqimi Tavisi saqmianobiT

(magaliTad, hospitalizaciaze gagzavniT, stacionaris arCeviT da a.S.)

gansazRvravs mkurnalobis rogorc samedicino, aseve ekonomikur efeqts.

jandacvis reformebis mocemul etapze arsebuli, zemoT

Camoyalibebuli problemebis Suqze sakmaod mniSvnelovnad gvesaxeba

xelfasis axali modelis agebis principebis swori formireba, miT umetes,

rom dRes jandacvis dawesebulebebs ufleba aqvT SeimuSaon xelfasis

sakuTari sistemebi.

erTiani satarifo sistemis da xelfasis fondis gazrdis safuZvelze

Sromis anazRaurebis moqmedi sistemis srulyofis sakiTxTa gadaWra

SemoTavazebulia Semdegi mimarTulebebiT:

_ minimaluri xelfasis, damatebiT gadaxdebisa da wanamatebis gazrda

imave TanafardobiT;

_ samedicino dawesebulebis saerTo danaxarjebSi xelfasis xvedriTi

wilis gazrda;

_ Sromis anazRaurebis fondis gazrda mosaxleobis uzrunvelyofili

fenebisaTvis fasiani momsaxurebebis sistemis ganviTarebis xarjze,

Crdilovani ekonomikis legalizacia;

_ samkurnalo-profilaqtikuri dawesebulebis dafinansebis

moculobaTa SenarCunebis dros mkurnalobasTan daukavSirebeli

samkurnalo-profilaqtikur dawesebulebaTa danaxarjebis Semcireba.

_ samedicino dawesebulebaTa sruli dafinansebis saxelmwifo

garantiebis sakanonmdeblo gaZliereba.

amrigad, SromiT SemosavlebSi gaumarTlebeli diferenciaciisa da

samuSao Zalis gaufasurebis daZleva unda iqces jandacvaSi xelfasis

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etapobrivi reformirebis umniSvnelovanes amocanebad, sadac ZiriTad

mimarTulebas warmoadgens Sromis anazRaurebis fondis formirebisa da

ganawilebis meqanizmis srulyofa.

jandacvaSi Sromis anazRaurebis reformebis problemis gadaWris

gzebis ZiebaSi sakmaod mkafiod gamoiyofa ori mimarTuleba. erTi moicavs

makroekonomikuri xasiaTis sakiTxebis gadaWras da exeba iseT sakiTxebs,

rogorebicaa xelfasis Taobaze damokidebulebaTa sabazro regulirebis

Camoyalibeba., xelfasisa da inflaciis urTierTkavSiri, tendenciebi

muSakTa jgufebis mixedviT xelfasis diferenciaciaSi, garkveuli

politikis SemuSaveba Sromis anazRaurebis sferoSi da sxv.

meore mimarTuleba exeba mikroekonomikur dones da moicavs arsebul

da saWiro mikroekonomikur gadawyvetilebaTa CarCoebSi xelfasis

organizaciis sakiTxTa gadaWris Ziebebs. es, upirveles yovlisa, xelfasis

sistemebis da formebis, maTi struqturuli Semadgenlobis: satarifo

gadaxdebis, waxalisebebis, damatebiT gadaxdebis, fasdanamatebis,

garantiebisa da kompensaciebis da a.S. agebis problemebs.

samedicino muSakebis Sromis anazRaurebis srulyofis RonisZiebaTa

konkretuli sistema unda moicavdes:

_ minimaluri xelfasis mudmivi indeqsaciis Catarebas samomxmareblo

kalaTis Rirebulebis gaZvirebis gaTvaliswinebiT;

_ xelfasis fondis gazrdas samkurnalo-profilaqtikuri

dawesebulebis danaxarjebis Semcirebis xarjze, romlebic ar aris

dakavSirebuli mkurnalobasTan;

_ maRalkvalificiuri TanamSromlebis damatebiT stimulirebas;

_ premirebis fondisa da samedicino muSakebisTvis mastimulirebeli

xasiaTis sxva gadaxdebis ganawilebis srulyofas.

minimaluri xelfasi (ZiriTadi sargo) gaicema muSakze moculobiTi

normatiuli maCveneblebis Sesrulebis pirobisas. Cveni azriT, damatebiTi

xelfasis moculobam unda gansazRvros faqtorTa nakrebi, romlebsac

miekuTvneba miRweuli Sedegebi da Sromis xarisxi, muSakis profesiul-

pirovnuli potenciali da mimarTuleba, Zalisxmeva konkretuli

profesiuli saqmianobisTvis, romlebic `muSaoben~ Sedegze, aseve unda

ganvaxorcieloT mastimulirebeli damatebiTi anazRaureba.

156

unda aRiniSnos, rom samkurnalo-profilaqtikuri dawesebulebis

personalis materialur anazRaurebaze mimarTuli fuladi saxsrebis

naklebobam da samedicino Sromis satarifo gadasaxdelis dabal dones ar

SeuZlia srulad aamaRlos samedicino muSakebis motivirebuli sakuTari

valdebulebebis maRalefeqtiani Sesruleba. maSasadame, saWiroa

samkurnalo-profilaqtikuri dawesebulebis ZiriTadi personalis

motivaciis marTvis sxva meTodebis gamoyeneba, romlebsac ZaluZT

TanamSromlebSi Camoayalibon Sidapirovnuli daintereseba sruli

profesiul-pirovnuli TviTrealizacia mocemul dawesebulebaSi.

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III.3. samedicino momsaxurebis bazrisa da fasebis saxelmwifo

regulireba da finansuri resursebis gamoyenebis

efeqtianobis amaRlebis sxva mimarTulebebi

praqtikam gviCvena, rom jandacvaze xarjebis zrda yovelTvis ar iwvevs

mis efeqtianobis zrdas, xolo saxelmwifo jandacvis sruli usasyidlobis

principi, Tavisi socialuri mimzidvelobis miuxedavad, yvelaze mdidari

qveynebisTvisac ki fufunebas warmoadgens (yvelaze naTeli magaliTi _

didi britaneTi) [91, gv.60]. amitom mraval qveyanaSi ukanaskneli wlebis erT-

erT gamoxatul tendencias warmoadgens jandacvis funqciis realizaciaSi

saxelmwifos an sxva struqturebis monopolizmis daZleva. xdeba

sazRvrebis waSla jandacvis finansuri uzrunvelyofis sxvadasxva

sistemebs Soris, romlis Sedegad yalibdeba sistemebi, TiToeul qveyanaSi

specifikuri, romlebic uTanxmeben erTmaneTs sabiujeto, sadazRvevo da

fasian sawyisebs dargis resursebis formirebaSi.

rogorc mravali eqsperti aRniSnavs, nebismier saxelmwifoSi,

politikuri da ekonomikuri wyobis miuxedavad, sadac moqmedebs

saxelmwifo jandacvis erTiani centralizebuli sistema, adre Tu gvian es

sfero aRmoCndeba araxelsayrel mdgomareobaSi. es ganpirobebulia Semdegi

mizezebiT:

_ erTaderTi finansuri wyaros arseboba mniSvnelovnad zRudavs

saqmianobis saxeTa arCevanis SesaZleblobebs, aZlierebs monopoliur

damokidebulebas da xSirad mivyavarT gamoyofili saxsrebis

araracionalur gamoyenebamde;

_ sabiujeto dafinansebisas romelime axali obieqtis, meTodis an sxva

siaxlis SemoReba xSirad gvaiZulebs uari vTqvaT ama Tu im ara marto

moZvelebul, aramed jer kidev sasargeblo SenaZenzec;

_ ufaso medicinis dros araadeqvaturad matulobs mimarTva

samedicino daxmarebisTvis samkurnalo-profilaqtikur dawesebulebebSi

normalur donesTan SedarebiT.;

_ samedicino momsaxurebaze moculobis matebis paralelurad izrdeba

eqimebis raodenobac, Sesabamisad, izrdeba gamoyofili saxsrebic. amave

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dros momsaxurebis Rirebuleba da moculoba xSirad izrdeba daCqarebuli

tempebiT.

Tanac ukanaskneli garemoeba Rrmavdeba imiT, rom ufaso medicina

mniSvnelovan wilad asustebs sakuTari janmrTelobis SenarCunebasa da

gaumjobesebaSi mosaxleobis ekonomikur dainteresebasa da mis

gauaresebaze ekonomikur pasuxismgeblobas. gansakuTrebiT naTlad es

vlindeboda Cveni qveynis arsebobis sabWour periodSi, rodesac

saxelmwifo paternalizmis batonoba moqalaqeTa Soris warmoSobda

kmayofaze yofnis tendenciebs, umravles SemTxvevaSi, upasuxismgeblo

damokidebulebas sakuTari janmrTelobisadmi, imeds saxelmwifos

usazRvro SesaZleblobebisadmi. aseTi damokidebuleba, saboloo jamSi

sxva uaryofiTi momentebis garda, aqveiTebs janmrTelobis dones, amcirebs

sicocxlis xangrZlivobas.

msoflios umravlesi qveynebis praqtika cxadad gviCvenebs, rom

samedicino momsaxurebisTvis gadaxdis (srulad an nawilobriv)

aucilebloba mraval adamians aiZulebs pasuxismgeblobiT moekidon am

momsaxurebis gamoyenebas. amave dros fasiani samedicino momsaxurebis

ganviTareba gamodis faqtorad, romelic amcirebs samedicino momsaxurebis

misawvdomobas da maSasadame, SeuZlia negatiuri zegavlena moaxdinos

adamianis janmrTelobasa da sazogadoebaze [91, gv.62]. am tendenciis

dasaZlevad TiToeul calkeul qveyanaSi saWiroa samedicino ufaso da

fasiani momsaxurebis optimaluri Sexamebis povna. ismeba kiTxvebi: ras

warmoadgens samedicino momsaxurebis Rirebuleba da fasi, rogorc

ekonomikuri kategoriebi; rogoria saqonlis _ `samedicino momsaxurebis~

faswarmoqmnis meqanizmi; ra xarisxiTa da ra viTarebaSi SeuZliaT

sasaqonlo warmoebis mocemul kategoriebs gadaWran calkeuli pirovnebisa

da sazogadoebis janmrTelobis uzrunvelyofis sakiTxebi da rodis _ ara?

jandacvis ekonomikis mocemuli problemis gadaWris Ziebisas gverds

ver avuvliT ekonomikuri Teoriis fundamentur debulebebs, radgan

jandacvaSi ekonomikuri urTierTobebi warmoadgenen ekonomikuri

urTierTobebis erTiani sistemis organul nawils, romlebic ekonomikuri

Teoriis kvlevis sagania. amitom mniSvnelovania gavaanalizoT, Tu rogor

159

wydeba zogadTeoriuli kuTxiT zemoT mocemuli problemebi da ra

xarisxiTaa maTi gadaWra misaRebi medicinisTvis.

ekonomikur TeoriaSi resurswarmoqmnis problemebisadmi midgomisas

mkafiod aRiniSneboda Semdegi ZiriTadi mimarTulebebi: moTxovnisa da

miwodebis Teoria, sargeblianobis Teoria, warmoebis danaxarjebis Teoria,

zRvruli sargeblianobis Teoria da sxv. miTiTebuli Teoriebidan

TiToeuli Taviseburad xsnis resurswarmoqmnis meqanizms. sargeblianobis

Teoria da misi zRvruli sargeblianobis Tanamedrove variantebi ar

SeiZleba gamoyenebuli iqnes medicinisTvis. rasTanaa es dakavSirebuli?

vswavlobT ra faswarmoqmnis procesebs, Cven vxedavT, rom fasebi saqonelze

pirdapir damokidebulebaSia moTxovnasa da miwodebaze. jer kidev XVII s-Si

ekonomistebis mier Camoyalibebul iqna moTxovnisa da miwodebis kanoni,

romlis arsi gamoixateba SemdegSi: saqonelze fasi mocemul saqonelze

moTxovnis proporciuli da misi warmoebis ukuproporciulia. sxva

redaqciiT kanoni JRerda ase: saqonlis fasi myidvelTa raodenobis

proporciuli da gamyidvelTa raodenobebis ukuproporciulia. am Teoriis

momxreebi amtkiceben, rom saqoneli Rirs zustad imdeni, ramden Tanxasac

iZlevian masze an sxva saqonelze moTxovnisa da miwodebis mocemuli

Tanafardobis dros da rom fasTa cvlileba mTlianadaa damokidebuli

moTxovnisa da miwodebis Tanafardobaze. moTxovnisa da miwodebis Teoriis

logikis Sesabamisad, rac ufro maRalia sargeblianoba, miT ufro meti

unda iyos samedicino momsaxurebis fasi. es niSnavs, rom fasebis avardna

unda SeiniSnebodes epidemiebis dros, rodesac moTxovna samedicino

momsaxurebaze mniSvnelovnad aRemateba miwodebas. Tumca eqimTa Semosavlis

done ar unda iyos dakavSirebuli avadobis saxeobebTan da ar unda iyos

damokidebuli mkurnalobis cvalebadobaze. Tu eqimTa Semosavlebi

Semcirdeba samedicino momsaxurebaze moTxovnis SemcirebasTan erTad, rac

zianis miyenebs maT socialur-ekonomikur keTildReobas, maSin isini

iZulebulni iqnebian ASeinarCunon avadobis maRali done. marketingis

kanonebis mixedviT, sakuTari socialur-ekonomikuri interesebis dasacavad

medikosebs mouwevT imuSaon maTTvis araxelsayrel sabazro situaciaSi.

adridanve unda moaxdinon maTTvis sasurveli sabazro koniunqturis

modelireba. es niSnavs, rom avadmyofobis gamovlineba da zrda ar unda

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iyos dakavSirebuli eqimis SemosavlebTan. es mimRebebs pacientebiT

stabilurad Seavsebs samedicino momsaxurebaSi. ekonomikuri interesis

aseTi gaRviveba Slis humanur arss, eqimTa funqciebis profesionalur

daniSnulebas da amitom SeuTavsebelia medicinasTan. Tavisi mediko-

socialuri SedegebiT adamianisaTvis saSiSi, moTxovnisa da miwodebis

kanonis sabazro diqtatisagan sakuTari Tavisa da eqimis dacvis mizniT,

sazogadoeba ormagi obieqturi aucileblobis winaSea: jer erTi, sabazro

damokidebulebisagan samedicino saqmianobis ganTavisufleba; meorec,

medikosebisTvis samedicino saqmianobis aRdgenisa da warmoebis

profesiuli, sazogadoebrivad normaluri pirobebis Seqmnis

valdebulebebis sakuTar Tavze aReba, agreTve samedicino muSakebis

sazogadoebrivad normaluri cxovrebis mowyoba. eqimi yvela

sazogadoebriv-ekonomikur sistemaSi _ socialuri, arasabazro figuraa.

amrigad, moTxovnisa da miwodebis Teoriam ver SeZlo aexsna iseT

specifikur saqonelze faswarmoqmnis kanonzomierebebi, rogorebicaa

samedicino momsaxureba da ar ZaluZs gansazRvros samedicino saqmianobis

urTierTgacvlis RirebulebiTi proporciebi TviT medicinis sxvadasxva

struqturul rgolebs Soris.

moTxovnisa da miwodebis Teoriis safuZvelze fasTa formirebis

axsnis SeuZleblobam Seaguliana ekonomistebi daewyoT fasebis obieqturi

safuZvlis Zieba uSualod TviT saqonlis TvisebebSi. zogma ekonomistma

daiwyo saganTa sargeblianobaSi fasebis obieqturi safuZvlis Zieba,

sxvebma _ maT warmoebaze daxarjuli Sromis raodenobaSi. pirveli

Sexedulebis ganviTarebam migviyvana sargeblianobis Teoriamde, xolo

meores ganviTarebam _ SromiTi Rirebulebis Teoriamde.

sargeblianobis Teoriis momxreebi Tvlian, rom rac ufro

sasargebloa produqti adamianisTvis, miT ufro maRali unda iyos misi

Rirebuleba da fasi. maT mier Sedgenili moTxovnilebaTa skalis Tanaxmad,

yvelaze maRali Rirebuleba unda hqondeT sakveb produqtebs, xolo

yvelaze dabali _ fufunebis sagnebs. amave dros realuri sinamdvile

sapirispiros mowmobda. sazogadoebrivi faqtebisadmi sargeblianobis

Teoriis aSkara Seusabamobis gamo mravali ekonomisti mivida daskvnamde,

rom sagnebisa da momsaxureobebis sargeblianoba ar SeiZleba iyos is

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zogadi, rac saqonels aqcevs Tanazomvadad da gansazRvravs fasTa

moZraobis kanons. mocemuli Teoriis usafuZvloba yvelaze mkafiod

vlindeba medicinaSi. ar SeiZleba avxsnaT ufro maRali fasi kuWis

operaciaze imiT, rom is ufro sasargebloa, vidre kbilebis mkurnaloba.

naTelia, rom samedicino momsaxurebebi Tvisobrivad gansxvavebulni,

araTanazomvadni da araurTierTCanacvlebadni arian. am rigad,

sargeblianobis Teoriis safuZvelze ver moxerxda fasTa moZraobis kanonis

aRmoCena samedicino momsaxurebisTvis, romelic warmoadgens

zogadsocialur momsaxurebas.

samedicino momsaxurebis fasisa da Rirebulebis Sinaarsis arsis

gamokvlevisas, vlindeba jandacvis ekonomikaSi sasaqonlo warmoebis

kategoriaTa formirebis araordinaluroba. samedicino momsaxurebas

gansakuTrebuli adgili ukavia Cveulebrivi saqonlis samyaroSi.

SevaTavsebT ra Rirebulebis Sinaarsis cnebas, mis faqtorwarmomqmnel

elementebs samedicino momsaxurebaTa Rirebulebis formirebis procesTan,

aRvniSnavT Semdegs: jer erTi, Sromis danaxarjebi jandacvis sferoSic

unda iyos sazogadoebrivad aucilebeli, sazogadoebis mier aRiarebuli.

meorec, sazogadoebrivi aRiareba unda gamoixatebodes sazogadoebis

TanxmobaSi _ sazogadoebisa da pirovnebisTvis SeTavazebuli samedicino

momsaxurebis sanacvlod uzrunvelyos normaluri warmoebisa da

kvlavwarmoebis SesaZlebloba sazogadoebrivad normalur doneze. Tumca,

mesamec, vavlenT, rom bazari ar SeiZleba iyos samedicino daxmarebaSi

sazogadoebis moTxovnilebis sazomi da, maSasadame, mas ar SeuZlia

daareguliros samedicino warmoebis funqcionireba. erT-erTi axsna

mdgomareobs imaSi, rom bazars saqme aqvs mxolod gadaxdisunarian

myidvelTan. gadaxdisuunaroebs is gamoricxavs sabazro moxmarebidan.

amitom sabazro moTxovna ar asaxavs ama Tu im saqonelsa da momsaxurebaze

sazogadoebis srul, WeSmarit moTxovnas.

samedicino warmoebidan samedicino momsaxurebaTa gadaxdisuunaro

myidvelebis gamoricxvas SeiZleba mohyves saSiSi mediko-socialuri

Sedegebi ara marto gadaxdisuunaroebisTvis, aramed

gadaxdisunarianebisTvisac. e.i. gadaxdisunarianebma angariSi unda gauwion

aragadaxdisunarianebs da sakuTari janmrTelobisa da jansaRi

162

Sromisunariani Zalis warmoebis uzrunvelsayofad dauSvan isini

medicinasTan. Tanac ara marto humanitaruli daxmarebis formiT, aramed

janmrTelobis dacvis sazogadoebriv struqturebis organizaciebSic,

romlebic ar jdebian sabazro kanonzomierebebSi. samedicino warmoeba _ es

nebismieri adamianis sicocxlis uzrunvelyofis zogadsocialuri

elementia. kavSiri sazogadoebriv warmoebasa da samedicino

keTildReobaTa gamoyenebas Soris SeiZleba iyos mxolod pirdapiri da ara

iribi da damyarebuli unda iqnes sabazro gaSualedebis, sabazro

regulirebis gareSe. amitom warmoebis zogadi sabazro orientaciis dros

eris dacvis mizniT medicina obieqtur safuZvelze gamoyofil unda iqnes

komerciuli interesebis sistemidan. am obieqturi winaswar gansazRvris

Sesabamisad, jandacvis ekonomikis sferoSi sasaqonlo warmoebis

ekonomikuri kategoriebidan, agreTve, obieqturad gamoiricxeba

Rirebulebis sabazro maxasiaTeblebi, momsaxurebis fasebi, warmoebis

fasebi da a.S. amitom jandacvis ekonomikis Teoriasa da praqtikaSi

aRniSnuli kategoriebis `bazrianobis~ gamoyeneba arakoreqtulia. amas

mivyavarT iqamde, rom Rirebulebis faqtorwarmomqmneli komponentebidan

gamoiricxeba sabazro zegavlena. samedicino momsaxurebis Rirebulebac

ganisazRvreba sazogadoebisTvis sazogadoebrivad normalur doneze

samedicino daxmarebis warmoebisa da kvlavwarmoebisTvis sazogadoebrivad

saWiro danaxarjebiT. bazris mier maTi sazogadoebrivi sargeblianobis

aRiarebaSi gasaSualebiTebis gareSe. sabazro faqtoris adgili, romelic

zegavlenas axdens Cveulebrivi saqonlis Rirebulebis formirebaze, ukavia

socialur faqtors, romelic asaxavs sazogadoebis zogadsocialur

moTxovnas sazogadoebis yvela wevris janmrTelobis SenarCunebis

aucileblobaSi maTi arsebobis materialuri wyaroebisagan damoukideblad.

es ar jdeba sabazro kanonzomierebaTa moTxovnebSi, magram Seesabameba

sazogadoebis sicocxlis uzrunvelyofis Sinagan moTxovnilebebs. amitom

sazogadoeba valdebulia, gansakuTrebiT sabazro ekonomikis pirobebSi,

moaqcios saxelmwifo mzrunvelobis qveS samedicino warmoebisa da

kvlavwarmoebis moZraobis yvela faza, mTeli procesi da daicvas jandacva,

misi organizacia da funqcionireba sabazro urTierTobaTa agresiisgan.

163

es, upirveles yovlisa, SesaZlebelia jandacvis dafinansebaSi

saxelmwifo monawileobis, agreTve fasiani jandacvisTvis mkafio

samarTlebrivi da ekonomikuri bazis dadgenis saSualebiT.

jandacvaSi sabazro urTierTobaTa gamoyenebis SezRuduli

SesaZlebloba, samedicino saqonlisa da momsaxurebis bazris

gaZlierebuli saxelmwifo regulirebis aucilebloba, agreTve,

gamomdinareobs jandacvis, rogorc socialuri sferos gansakuTrebuli

segmentis, dargobrivi Taviseburebebidan.

jer erTi, samedicino momsaxurebaTa gaweva moiTxovs momsaxurebis

mwarmoeblisa da momxmareblis pirad kontaqtebs, xasiaTdeba

pacientebisadmi saeqimo midgomis maRali individualobiTa da

arastandartulobiT. am situaciaSi bazrisTvis tipiur Suamavlobas

SeuZlia negatiuri zegavlenis moxdena samkurnalo procesze.

meorec, socialuri sferos sxva seqtorebisgan gansxvavebiT,

jandacvaSi mwarmoebelsa da momxmarebelSi (pacientSi) ufro metad

vlindeba samedicino momsaxurebaTa samomxmareblo Tvisebebis Sesaxeb

informaciis asimetriuloba. pacientebisTvis ara marto momsaxurebaTa

araxelSesaxeboba, aramed maTi didi sainformacio da samecniero tevadoba

qmnian obieqtur sirTuleebs mediko-socialuri kompleqsis sxvadasxva

samsaxurebis mier warmoebuli produqciis arCevanis dros. amasTan

dakavSirebiT, momsaxurebaTa mwarmoebeli da momxmarebeli (pacienti da

eqimi) aRmoCndebian araTanabar mdgomareobaSi, radgan samedicino

momsaxurebaTa bazarze pacientis namdvili suvereniteti SeuZlebelia misi

arasakmarisi samedicino informirebulobis gamo. pacienti unda endos

eqimis rCevebs, profesionalur kvalifikaciasa da eTikur-moralur

Tvisebebs.

mesamec, mediko-sanitaruli daxmarebis moTxovnileba _ es

moTxovnilebaa, romelic dakavSirebulia uSualod fasdaudebel

keTildReobasTan _ adamianis janmrTelobasTan da TviT sicocxlesTan.

rogorc ukve ganvixileT, samedicino daxmarebis maRali socialuri

prioritetuloba winaswar gansazRvravs, masze moTxovnisa da miwodebis

formirebis Taviseburebebs.

164

meoTxec, jandacvaSi Zalze gaurkveveli da bundovania kavSiri

samedicino personalis Sromis danaxarjebsa da mis saboloo Sedegs, e.i.

adamianis janmrTelobis mdgomareobas Soris.

samedicino daxmareba _ gansakuTrebuli saxis sazogadoebrivi sikeTea.

jandacvis muSakebis Sromis saboloo efeqti aRiniSneba aSkarad

gamoxatuli socialuri xasiaTiT. amave dros, rogorc ukve aRiniSna, misi

socialuri Sedegianoba yovelTvis ar eqvemdebareba zust raodenobriv

Sefasebas, maSasadame, RirebulebiT gamosaxulebas.

mexuTec, jandacvaSi meurneobis marTvis gansakuTrebuli meqanizmis

gamoyeneba nakarnaxebia socialuri samarTlianobisa da ekonomikuri

efeqtianobis Serwymis aucileblobiT. socialuri samarTlianoba aris

upirveles yovlisa, samedicino momsaxurebaTa sayovelTao misawvdomoba,

rac uzrunveliyofa jandacvis sistemis funqcionirebiT, romelic

dafuZnebulia saxelmwifos, sazogadoebis xarjze samedicino daxmarebis

mosaxleobisTvis ufasod miwodebis principze da socialuri solidarobis

principebzec, romelic gulisxmobs, rom janmrTelebi ixdian

avadmyofebisTvis, axalgazrdebi _ moxucebisTvis, mosaxleobis srulad

uzrunvelyofili fenebi _ naklebad uzrunvelyofilebisTvis, saxelmwifo,

samedicino dazRvevis instrumentebis gamoyenebiT.

upiratesoba, romelic eniWeba an ekonomikur efeqtianobas, an

socialur samarTlianobas, bevrad gansazRvravs jandacvaSi meurneobis

marTvisa da dafinansebis models.

moyvanili mosazrebebi mowmoben im movlenis niSnebis aSkara

arsebobaze, romelsac ekonomikur TeoriaSi ewodeba bazris uunaroba.

samedicino momsaxurebaTa bazris socialuri uunaroba mdgomareobs

imaSi, rom moTxovnis, miwodebis, faswarmoqmnis sabazro meqanizmi, axdens

ra socialuri faqtorebis ignorirebas da xelsayrel mdgomareobaSi

ayenebs mosaxleobis materialurad uzrunvelyofil fenebs, arTmevs ra

sasicocxlod aucilebeli dovlaTis xelmisawvdomobis SesaZleblobebs

dabalSemosavlian, socialurad daucvel moqalaqeebs.

samedicino momsaxurebaTa bazris ekonomikuri uunaroba

ganpirobebulia im tipis konkurenciuli bazrebis Seqmnis sirTuliT,

romlebzec warmodgenilia erTgvarovani saqonlis mravali myidveli da

165

gamyidveli, romlebic Tavisuflad Sedian da gamodian bazridan, gaaCniaT

sruli informacia bazarze warmodgenili saqonlis Sesaxeb, romlebic

ayalibeben gasayidi dovlaTis fass vaWrobis, moTxovnisa da miwodebis

odenobaTa gaTanabrebis saSualebiT. realurad maRalkonkurentunariani

bazris es moTxovnebi ar SeiZleba Sesrulebul iqnas samedicino

momsaxurebasTan mimarTebaSi.

samedicino momsaxurebaTa bazrisTvis organulad, bunebrivad

damaxasiaTebeli uunaroba warmoSobs rogorc minimum, aseTi bazris

saxelmwifo regulirebis aucileblobas, Semdegi RonisZiebebis

saSualebiT:

_ calkeuli saxis produqciis warmoebasa da realizaciaze

saxelmwifo monopoliis damyareba, rac SeZlebs sabazro fasebze

Semakavebeli zegavlenis moxdenas, saxelmwifoebrivad dadgenili fasebis

cirkulaciiT;

_ fiqsirebuli an maqsimalurad dasaSvebi fasebis dadgena, rac

SezRudavs gamyidvelis SesaZleblobas gazardos fasi gansazRvrul doneze

maRla;

_ sagadasaxado regulireba, romelic gavlenas axdens fasebze,

dadgenil gadasaxadebTan dakavSirebuli danaxarjebisa da mogebis

saSualebiT;

_ antimonopoliuri regulireba, romelic zRudavs mewarme-

monopolistebis mier saqonlis warmoebisa da gayidvis SesaZleblobebs;

_ saxelmwifos mier biujetis saxsrebidan im samedicino momsaxurebis

mwarmoeblebis zaralis kompensacia, romlebic axdenen produqtis

realizacias dabali fasebiT.

166

daskvna

sadisertacio kvlevis Sedegad SeiZleba gavakeToT Semdegi daskvnebi:

(1) safinanso politika ganisazRvreba, rogorc saxelmwifos saqmianoba

finansebis ganviTarebis mecnierulad dasabuTebuli koncefciis

SemuSavebaze, misi ZiriTadi mimarTulebebis gamoyofiT, dasaxuli miznebisa

da amocanebis misaRwevad, upirveles yovlisa, qveynis moqalaqeTa cxovrebis

donis asamaRleblad, Sesabamisi finansuri meqanizmis Seqmnis gziT;

(2) safinanso politika jandacvis sferoSi gansazRvrulia, rogorc

saxelmwifos mecnierulad dasabuTebuli saqmianoba sabiujeto finansuri

resursebis formirebaze, ganawilebasa da gamoyenebaze, mosaxleobis

cxovrebis donis amaRlebis mizniT, qveyanaSi demografiuli maCveneblebis

gaumjobesebis saSualebiT, mosaxleobis avadobis Semcirebis,

diagnostikuri samkurnalo-profilaqtikuri da samedicino-sareabilitacio

RonisZiebebis Catarebis gziT.

(3) dadgenilia da sqematuradaa ilustrirebuli pirdapiri

damokidebuleba ekonomikis ganviTarebis donesa da jandacvis finansur

resursebs Soris;

(4) dazustebulia `jandacvis finansuri meqanizmis~ Sinaarsi. avtoris

ganmartebiT, `jandacvis finansuri meqanizmi _ saTanado samarTlebrivi da

normatiuli uzrunvelyofis, finansuri meTodebisa da instrumentebis

safuZvelze ganxorcielebuli finansuri marTvis urTierTdakavSirebul

elementTa sistemaa, romelTa saSualebiTac warmoebs jandacvis finansuri

resursebis efeqtiani formireba da gamoyeneba~;

(5) gaanalizebulia ZiriTad saprogramo dokumentebSi arsebuli

saxelmwifo safinanso politikis mimarTulebebi jandacvis dargSi, dargis

dafinansebis wyaroebTan mimarTebaSi;

(6) saqarTveloSi mediko-demografiuli situaciisa da TviT jandacvis

sistemis mdgomareobis analizis safuZvelze Cven mier gakeTebul iqna

Semdegi daskvnebi:

_ saqarTveloSi Seqmnili negatiuri demografiuli situacia, garda

sxva faqtorebisa, ganisazRvreba agreTve mosaxleobis janmrTelobis

167

mdgomareobis faqtoriTac. saqarTvelos mosaxleobis avadobis donis

maCveneblebis mixedviT is win uswrebs evropis yvela qveyanas.

sazRvargareTis qveynebSi ubnis eqimebis mier pacientebis specialistebTan

gagzavnis sixSire Seadgens pirveladi vizitebis raodenobis 4-10%-s

saqarTveloSi 30%-Tan SedarebiT, rac mowmobs miSvebulobasa da eqimisadmi

mimarTvianobis dagvianebas; prevenciuli da pirveladi mediko-sanitaruli

daxmarebis ganuviTareblobas, `ojaxis eqimis~ samsaxuris organizaciisadmi

didi yuradRebis daTmobis aucileblobas. Seqmnili situaciis Secvla

SesaZlebelia jandacvis struqturuli gardaqmniT, romelic gulisxmobs

prevenciuli da pirveladi mediko-sanitaruli daxmarebis prioritetul

ganviTarebas stacionarul daxmarebasTan SedarebiT, samedicino

momsaxurebaTa xarisxis gazrdiT.

amJamad saqarTveloSi erT sawolze eqimebis saSualo raodenoba erTs

aRemateba, rac saSualo evropul maCvenebelTan SedarebiT TiTqmis orjer

metia (sawolze 0,6 eqimi). saqarTvelos regionebSi eqimebis gadanawileba

araTanabaria. darRveulia eqimebisa da eqTnebis Tanafardoba (1 : 1-Tan),

maSin, rodesac samedicino momsaxurebis efeqturobisa da efeqtianobis

uzrunvelsayofad rekomendirebuli Tanafardobaa 4 eqTani da 1 eqimi.

aucilebelia qveyanaSi jandacvis dargSi sakadro politikis

SemuSaveba, romlis ZiriTadi principebi iqneba:

_ jandacvis specialistebisa da profesionalebis raodenobis

dagegmvis meTodologiis SemuSaveba;

_ aucileblad migvaCnia dadgenili samedicino specialobebis nusxis

Sesabamisad TiToeuli specialobis mixedviT samedicino personalis

saWiro raodenobis gansazRvra demografiuli, epidemiologiuri,

teqnologiuri da organizaciuli faqtorebis safuZvelze;

_ samedicino momsaxurebis Tanabari geografiuli xelmisawvdomobis

uzrunvelyofa samedicino kadrebis racionaluri, optimaluri ganawilebis

meSveobiT;

_ eqimebsa da eqTnebs Soris optimaluri Tanafardobis uzrunvelyofa

(2 : 1), grZelvadian perspeqtivaSi ki eqTnebis raodenobis Semdgomi zrda

3 : 1 Tanafardobis misaRwevad.

168

_ saeqTno specialobebis ganmsazRvreli da maregulirebeli garemos

Seqmna (saeqTno specialobebis samarTlebrivi aRiareba, profesiuli

kompetenciebis, saswavlo programebis, saqmianobis uflebis miniWebis

meqanizmebis Seqmna).

_ samedicino kadrebis ganaTlebis xarisxis gazrda msoflio

standartebis Sesabamisad.

jandacvis seqtorSi sakadro politikis gansazRvrisas samedicino

personalis garda, mniSvnelovania arasamedicino personalis, m.S.

menejerebis, farmacevtebis, socialuri muSakebis da a.S. saWiro

raodenobis gansazRvra da profesiuli kompetenciebis Sesabamisad

saswavlo programebis SemuSaveba. samarTlebrivi aRiareba da maTi

profesiuli kompetenciebis sazRvrebis dadgena. arasamedicino

personalisTvis unda SemuSavdes saswavlo programebi da gegmebi.

(7) Sefasebulia sabiujeto saxsrebis wili qveynis mosaxleobis

samedicino momsaxurebaze danaxarjebis dafinansebaSi.

saxelmwifo pasuxismgebloba jandacvis sferoSi iyofa or jgufad:

_ pirvel SemTxvevaSi saxelmwifo pasuxismgebelia mTeli mosaxleobis

winaSe saxelmwifo (sabiujeto) saxsrebiT uzrunvelyos saWiro jandacviTi

RonisZiebebis organizeba da ganxorcieleba; daicvas da gaaumjobesos

mosaxleobis koleqtiuri janmrTelobis mdgomareoba; amave dros

saqarTvelos teritoriaze saWiroebis SemTxvevaSi nebismier pirovnebas

anazRaurebis gareSe miawodos kanoniT gansazRvruli prevenciuli,

samkurnalo da reabilitaciuri momsaxureba;

_ meore SemTxvevaSi saxelmwifo pasuxismgeblobas iRebs mosaxleobis

araRaribi nawilisaTvis uzrunvelyos misi finansuri da geografiuli

xelmisawvdomoba, xolo siRaribis zRvars qvemoT myofi mosaxleobisTvis

saxelmwifo (sazogadoebrivi) saxsrebiT daufaravs Sesabamis xarjebs.

amasTan dakavSirebiT rigi RonisZiebebis gatareba jandacvis sferoSi

moiTxovs dafinansebis principebis gadaxedvas. saWiroa damatebiTi

saxsrebis gamoyofa dargisTvis.

mTlian Sida produqtTan jandacvis seqtorze danaxarjebi sxvadasxva

qveynebSi 7-14 procentamde meryeobs, xolo am moculobaSi saxelmwifo

169

danaxarjebis wili 30-80 procentamde. miuxedavad imisa, rom wlidan wlamde

izrdeba sabiujeto saxsrebis moculoba jandacvis seqtoris

dafinansebisTvis, igi ver uzrunvelyofsY jandacvis sferoSi arsebuli

mZime situaciidan gamomdinare moTxovnebs.

bolo wlebSi mTlian Sida produqtTan mimarTebaSi jandacvis seqtorSi

danaxarjebi 8,0-8,5 procents Seadgenda, aqedan saxelmwifo danaxarjebi

mTlian danaxarjebTan mimarTebaSi 20-25% ar aRemateboda. jandacvis

seqtoris dafinansebaSi, analogiurad sxva qveynebisa mniSvnelovnad, unda

gaizardos saxelmwifos wili. rac SesaZlebelia miRweuli iqnas

samedicino miznobrivi gadasaxadebis SemoRebiT da sabiujeto dafinansebis

gazrdiT.

(8) saxelmwifom unda gansazRvros da daareguliros ara marto

sazogadoebrivi saxsrebis xarjvis prioritetebi, aramed Seqmnas iseTi

dafinansebis sistema, romelic axdens mosaxleobis kerZo danaxarjebis

mniSvnelovani nawilis mobilizebas organizebul finansur nakadebSi

sadazRvevo sistemis ganviTarebis gziT. amave dros saxelmwifom unda

SeimuSaos da ganaviTaros iseTi regulirebis meqanizmebi, romelic

mimarTuli iqneba mosaxleobis araformaluri danaxarjebis xvedriTi

wilis Semcirebaze jandacvis erovnul danaxarjebSi.

aRsaniSnavia sazRvargareTis qveynebis gamocdileba, sadac SemoaqvT

Tanagadaxdis sxvadasxva sqemebi da axdenen misi ganakveTebis varirebas

garkveuli kriteriumebis Sesabamisad:

_ mosaxleobis kategoriebis mixedviT;

_ wamlebis tipis mixedviT.

mosaxleobis kategoriaze damokidebuli Tanagadaxdis done

dadgenilia umweoTa, an maT dasacavad, vinc daavadebulia mZime qronikuli

daavadebebiT. qronikuli daavadebebis samkurnalo wamlebis safasurs

srulad ixdis saxelmwifo.

Tanagadaxdis dadgenis dros gaTvaliswinebul unda iqnes

ambulatoriuli mkurnalobisa da prevenciuli RonisZiebebis amocana.

amisaTvis mizanSewonilia davadginoT Tanagadaxda mxolod an ZiriTadad

stacionarul mkurnalobaze.

ambulatoriul daxmarebasTan mimarTebaSi unda aRiniSnos, rom:

170

_ eqimTan pirveli viziti unda iyos ufaso;

_ tarifebi unda iyos dabali da Seesabamebodes mosaxleobis

Semosavlis dones;

_ SemuSavebuli unda iqnes sistema, romelic yvelaze umweoebs

gaaTavisuflebs samedicino momsaxurebaze pirdapiri gadaxdebisagan.

(9) samedicino programebis finansuri uzrunvelyofis analizis

Sedegad gakeTebul iqna daskvnebi imis Sesaxeb, rom arsebuli dafinansebis

formis pirobebSi, saWiroa:

_ tarifebis gadaxedva;

_ `erTian saSualo tarifze~ TandaTanobiTi gadasvla samedicino

momsaxurebis Rirebulebis gaangariSebisas, rac gaamartivebs

angariSsworebas SemkveTsa da Semsrulebels Soris nozologiebis

mixedviT, agreTve Semoitans erTian ekonomikur wess da gaweul samedicino

momsaxurebisTvis organizaciebTan angariSsworebis pirobebs

(gansakuTrebiT ZviradRirebuli teqnologiebisa da aRWurvilobis mqone

klinikebis gamoklebiT).

_ finansurad dabalansebuli programebis ritmuli da drouli

dafinanseba. droulad miuRebeli saxsrebi davamatoT yoveli momdevno

wlis samedicino programebis biujets;

(10) Catarda monacemebis analizi ramodenime saxelmwifo

dawesebulebis, romlebic profiliT, zomiT da a.S. gansxvavdebian

erTmaneTisagan, magram mTlianobaSi warmoadgenen hospitalur seqtorSi

dawesebulebaTa finansuri marTvis arsebul suraTs:

1. umravlesoba ganxiluli samedicino dawesebuleba wamgebiania, da

Sesabamisad arc erTSi ar xorcieldeba aqtivebis efeqturi gamoyeneba;

2. samSobiaro saxlebSi da pediatriul klinikebSi sxva profilis

klinikebTan SedarebiT ukeTesi maCveneblebia, rac ZiriTadaT ukeTesi dafinansebis

reJimisa da Sida standartebiT meti gayidvebis moculobis Sedegia;

3. samedicino dawesebulebebSi ar mimdinareobs gadauxdeli momsaxurebis

wilis gaangariSeba, rac sakmaod mniSvnelovani informaciaa analizisTvis

prognozirebisTvis da swori gadawyvetilebis miRebisTvis mmarTvelobis yvela

doneze ;

171

4. umetes SemTxvevaSi dawesebulebaTa miznebi araa Tavsebadi maT xelT

arsebul finansur resursebTan. xSirad samedicino dawesebulebebi

iReben monawileobas iseT programebSi, romelTa Sesrulebac

gacilebiT aRemateba maT SesaZleblobebs;

5. samedicino dawesebulebebi ar zrunaven kapitalis reinvestirebaze,

rac gulisxmobs samedicino momsaxurebebidan miRebul TiToeul

larSi Semdgomi ganviTarebisTvis gankuTvnili danazogis Seqmnas;

6. samedicino dawesebulebebis umetesoba faqtiurad aranair finansur

saSualebebs ar mimarTavs uaxlesi teqnologiebis dasanergad da

personalis motivirebisTvis;

7. sabuRaltro aRricxvisa da finansuri angariSgebis

mouwesrigeblobis gamo, xSir SemTxvevebSi SeuZlebeli xdeba

dawesebulebebis Sefaseba raime zogadi maCveneblebiT;

8. arcerT samedicino dawesebulebaSi ar xorcieldeba finansuri

menejmentis Sefaseba raime indikatoruli sistemiT.

samedicino dawesebulebebis marTvis arcerT doneze ar aris miRebuli

finansuri efeqturobis Sefasebis standartuli da obieqturi

indikatorebis nakrebi, romelic miscemda rogorc calkeuli

dawesebulebis menejersa, ise saministrosa da gadamxdelebs finansuri

aqtivebis obieqtur suraTs da daexmareboda maT calkeuli

gadawyvetilebebis arCevasa da miRebaSi;

9. sxvadasxva dawesebulebebis finansuri marTvis efeqturobis

Sedarebisas mniSvnelovania gamoviyenoT indikatorebis nakrebi, rac

saSualebas gvaZlevs gamovricxoT calkeuli garegani faqtorebi da

uSualod SevafasoT xelmZRvanelTa menejeruli aRricxvis

SesaZleblobebi.

Yyovelive zemod aRniSnuli kidev erTxel adasturebs saxelmwifo

sakuTrebaSi arsebuli samedicino infrastruqturis optimizaciis da

reabilitaciis aucileblobas.

Aam mimarTulebiT, reformis farglebSi, ganxorcielebuli

RonisZiebebis Sedegad saqarTvelos sxva da sxva regionSi gaixsna axali

tipis, evropuli standartebis saavadmyofo, kerZod:

172

Tbilisis o. RuduSauris saxelobis erovnuli samedicino centri,

quTaisis regionuli saavadmyofo, zugdidis mravalprofiluri saavadmyofo

da sxva.

sadisertacio naSromSi gakeTda axali tipis klinikis Mmenejmentis, da

kerZod finansuri menejmentis analizi o. RuduSauris saxelobis

mravalprofiliani erovnuli samedicino centris magaliTze. gamovlenili

iqna varaudebi da riskebi, maTi mosalodneli gavlena da kontr-

RonisZiebebi arasasurveli gamosavalis asacileblad.

(11) sadisertacio naSromSi Seswavlilia msoflio praqtikaSi arsebuli da

saqarTvelos samkurnalo-profilaqtikur dawesebulebebSi gamoyenebuli

samedicino momsaxurebebis anazRaurebaTa formebi .

unda aRiniSnos rom `programuli dafinansebis meTodis~ upiratesobis

miuxedavad, saqarTveloSi arsebuli socialur-ekonomikuri mdgomareobidan

da qveynis biujetidan gamomdinare, es meTodi awydeba problemebs da

araadeqvaturi dafinansebis fonze ar SeuZlia gamoxatos Tavisi

institucionaluri upiratesoba dafinansebis sxva meTodebze (am

upiratesobas ueWvelad eqneboda adgili sruli moculobiT dafinansebis

SemTxvevaSi). Cveulebriv, saxsrebis nakleboba warmoSobs Sav bazars,

pirdapiri garigeba eqimsa da pacients Soris zians ayenebs jandacvis

sistemas. yovelive aqedan gamomdinare, sasurvelia am etapze ganvixiloT

jandacvis finansuri uzrunvelyofa `globaluri biujetis~ meTodiT, raTa

samedicino dawesebulebebma SeZlon TavianTi neba-surviliT gamoiyenon

fondebi fiqsirebuli wliuri subsidiis farglebSi.

(12) saerTo bazrisagan gansxvavebiT, sadac momxmareblebi kargad arian

informirebulebi, jandacvaSi moqmedebs informaciis asimetriis principi.

eqimi samedicino momsaxurebaTa bazarze ayalibebs moTxovnas samedicino

daxmarebaze, rodesac avadmyofma arc icis misi aucileblobis Sesaxeb. es

da mravali sxva Tavisebureba mkveTrad ganasxvavebs mas nebismieri sxva

momsaxurebisagan. unda aRiniSnos, rom samedicino-profilaqtikuri

dawesebulebis personalis materialur gasamrjeloze mimarTuli fuladi

173

saxsrebis naklebobasa da samedicino Sromis satarifo gadasaxdelis

dabal dones ar SeuZlia srulad gazardos samedicino muSakebis motivacia

sakuTari valdebulebebis maRalefeqturi Sesrulebisadmi. SromiT

SemosavlebSi gaumarTlebeli diferenciaciisa da samuSao Zalis

gaufasurebis daZleva unda iqces jandacvaSi xelfasis etapobrivi

reformirebis umniSvnelovanes amocanad. arsebuli dafinansebis formis

pirobebSi, ZiriTad mimarTulebas warmoadgens Sromis anazRaurebis fondis

ganawilebisa da formirebis meqanizmis srulyofa.

xelfasis fondis odenobis gazrdisa da erTiani satarifo sistemis

safuZvelze Sromis anazRaurebis moqmedi sistemis srulyofis sakiTxTa

gadaWra SemoTavazebulia Semdegi mimarTulebebiT:

_ minimaluri xelfasis gazrda da imave TanafardobiT danamatebisa

zrda;

_ samedicino dawesebulebis saerTo danaxarjebSi xelfasis xvedriTi

wilis gazrda;

_ mosaxleobis uzrunvelyofili fenebisTvis fasiani momsaxurebebis

sistemis ganviTarebis xarjze Sromis anazRaurebis fondis gazrda,

Crdilovani ekonomikis legalizacia;

_ samkurnalo-profilaqtikuri dawesebulebebis arasamkurnalo

nawilis danaxarjebis Semcireba, dafinansebis moculobis SenarCunebiT;

_ samedicino dawesebulebaTa sruli dafinansebis saxelmwifo

garantiis sakanonmdeblo gaZliereba.

(13) samedicino momsaxurebaTa SeTavazebis arsebuli praqtika tovebs

pacientebis uflebaTa Selaxvis SesaZleblobas, rac SeiZleba gamowveuli

iyos ramdenime faqtoriT:

_ samedicino programebis moculoba da Sinaarsi sakmaod xSirad

icvleba; mosaxleoba, pacientebi srulad ar arian informirebulebi

maTTvis samedicino programebiT gaTvaliswinebuli SeRavaTebis, sakuTari

uflebebis Taobaze;

_ mZime finansur mdgomareobaSi arsebuli samedicino dawesebuleba

cdilobs Tavidan aicilos sruli moculobiT saxelmwifo standartiT

gaTvaliswinebuli samedicino momsaxureobebis SeTavazeba; xSirad pacienti

174

ixdis momsaxurebisTvis, romelic mas ekuTvnis samedicino programiT, e.i.

erTi da igive momsaxurebaze is orjer ixdis.

mosaxleobis informirebulobis mizniT saWirod vTvliT:

_ Catardes im saxelmwifo programebis Sesaxeb mosaxleobis

informirebulobis intensiuri kampania, romlebic srulad an nawilobriv

faraven samedicino momsaxurebis Rirebulebas;

_ samedicino dawesebulebebSi gavrceldes sainformacio xasiaTis

broSurebi.

(14) samedicino momsaxurebebis fasisa da Rirebulebis, rogorc

ekonomikuri kategoriebis kvlevis safuZvelze gakeTebul iqna daskvna

saxelmwifos mxridan samedicino momsaxurebaTa gawevis sferoze sabazro

zegavlenis SezRudvis aucileblobis Sesaxeb Semdegi RonisZiebebis

saSualebiT:

_ calkeuli saxis produqciis warmoebasa da realizaciaze

saxelmwifo monopoliis damyareba, rac SeZlebs sabazro fasebze

Semakavebeli zegavlenis moxdenas, saxelmwifoebrivad dadgenili fasebis

cirkulaciiT;

_ fiqsirebuli an maqsimalurad dasaSvebi fasebis dadgena, rac

SezRudavs gamyidvelis SesaZleblobas gazardos fasi gansazRvrul doneze

maRla;

_ sagadasaxado regulireba, romelic gavlenas axdens fasebze,

dadgenil gadasaxadebTan dakavSirebuli danaxarjebisa da mogebis

saSualebiT;

_ antimonopoliuri regulireba, romelic zRudavs mewarme-

monopolistebis mier saqonlis warmoebisa da gayidvis SesaZleblobebs;

_ saxelmwifos mier biujetis saxsrebidan im samedicino momsaxurebis

mwarmoeblebis zaralis kompensacia, romlebic axdenen produqtis

realizacias dabali fasebiT.

(15) jandacvis organizaciuli sistemis sazRvargareTis gamocdilebidan

saqarTvelosTan mimarTebaSi sayuradRebod migvaCnia:

- iaponiaSi arsebuli jandacvis organizaciis sistema, jandacvis

dafinansebasTan dakavSirebuli riskis gadanawilebis efeqtiani meqanizmiT;

175

- didi britaneTis , kanadis, SvedeTis, TurqeTis , safrangeTis, espaneTis

jandacvis globaluri biujetiT dafinansebis sistema;

- kanadur sistemaSi centralizebuli da decentralizebuli marTvis

Serwymis gamocdileba, sadac jandacvis obieqtebis mimdinare operatiuli

saqmianobis sakiTxebis gadaWra jandacvis marTvis adgilobrivi organoebis

kompetenciaSia;

- britanuli sistemis jandacvis organizacia, romelsac safuZvlad

udevs pirveladi mediko-sanitaruli daxmarebis prioriteti;

- aSS-s jandacvis organizaciuli sistema, maRalkvalificiuri

samedicino daxmarebaiT, romelsac safuZvlad udevs xarisxis federaluri

standartebi, maRalkvalificiuri samedicino kadrebis momzadebis

daxvewili programiT, pacientebis maRali samarTlebrivi daculobiT.

unda aRiniSnos, rom msoflioSi arsad ar arsebobs mxolod

biujetidan dafinansebis sistema, sadazRvevo an mxolod kerZo. yvelaze

gavrcelebulia sxvadasxva wyaroebidan dafinansebis Sereuli sistema.

magaliTad, did britaneTSi, sadac arsebobs sabiujeto dafinansebis

klasikuri modeli, daaxloebiT 10% Seadgenen socialuri dazRvevidan

miRebuli saxsrebi, romelTa gadaricxva xdeba socialuri dazRvevis

fondidan. xolo klasikuri sadazRvevo sistemis mqone qveynebSi saxsrebis

nawili Semodis biujetidan, magram ZiriTad wyaros warmoadgenen gadaxdebi

dazRvevaze.

jandacvis saxelmwifo dafinansebis prioritetulobasa da amave dros

SezRudulobis gaTvaliswinebiT, vTvliT, rom ar aris saWiro xelovnurad

vTqvaT uari damatebiT wyaroebze.

saqarTvelos jandacva, analogiurad sxva qveynebisa , unda iyos Sereuli,

mravalkomponentiani sistema.

176

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России.,М.,1995 89. låä"åäå" b.̀ . - nK?å“2"å……%å "%C!%,ƒ"%ä“2"% , “-å!= 3“ë3ã. l.: }*%…%ì,*=, 1968.

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“2=2,“2,*,. 1999, Š 2/.

91. o=…,÷*,… b.l. - q%ö,=ëü…%- .*%…%ì,÷å“*,å ã!=…,ö/ !/ …%÷…/ . %2…%øå…,L "

ƒä!="%%.!=…å…,, /j=…ä. ä,““. - qoa, 1998/.

92. o%*!%"“*%ã% b.h., o%C3ë !…= ìåä,ö,…“*= .…ö,*ë%Cåä, . 5- å,ƒä. l.: n…,*“, 1998.

93. o!%“*3! *%" b.l., q=ì!3*,… `.h. - }*%…%ì,÷å“*,L C%2å…ö,=ë “%ö,=ëü…%L

“-å!/ . l.: }*%…%ì,*=, 1991

94. p=L“ q., d›åLì“ `. - qìåø=……= .*%…%ì,*= " ƒä!="%%.!=…å…,,: C!%Këåì/ ,

Cå!“Cå*2,"/ . , ( Пер.с. англ.) - l.: n“2%›üå, 1996.

95. p K*%" l.j. q%-,…=…“,!%"=…,å , 2å…å"%å “%-,…=…“,!%"=…,å " ƒä!="%%.!=…å…,,:

k%ã,*= ä,“*3“,,. f3!…. " }*%…%ì,*= ƒä!="%%.!=…å…, ", l., 2001 ã. N 7- 8 (56).

96. p%ä,%…%"%L b.l. , l.: t,…=…“/ . r÷åK…,* t,…=…“/ , “2=2,“2,*= 1995.

97 .Стоянова Е.С., Финансовый менеджмент: теория и практика. l., 1996.

98. qå…÷=ã%" b.j. t,…=…“/ , äå…å›…%å %K!=?å…,å, *!åä,2. r÷åK…,*.l., 2001

99. Семенов В.Ю. Опыт реформ здравоохранения зарубежных стран, М., 1996

100. Фишер С.и др., Економика, М., 1993.

101.Хедоури.Ф, Маскони М., Алберт М. Основы менеджмента.,( Пер.с. англ.)qoa,1998

102. ХелфертЭ.,Техника финансового анализа, М., 1995

103. Щепин О.П., Комаров Ю.М., Здравоохранение зарубежных стран. М., Медицина,2001

104. Эрхард Л., Благосостояние для всех.,1991

105.~!üå"= c.b. måC!,K/ ëü…/ L “å*2%! " !/ …%÷…%ì .%ƒ L“2"å /p%““,L“*,L

.*%…%ì,÷å“*,L ›3!…=ë. 1994. N 4

106.. Kapencky L.S “ Understanding Health Care Financial Management.” Michigan1993

107 . McConnell,StenleyL.Brue, Macroeconomics (sixteenth edition),2006

108. Todaro M.P., SmithS.C., Economic Development (ninth edition),2006.

109. William O.Cleverley, Essentials of Health Care Finance (fourth edition),1997.

110. Richard L.Sandhusen Marketing (fourth edition),2000.

111. GroppelliA.A and Ehsan Nikbakht, Finance, capital budgeting and management. (fourth

edition),2000

112. P. Jacobs, J. Rapoport , The Economics of Health and Medical care (fifth edition),2002.

113. Hospital Accreditation Standards, Joint commission resources, 2001

182

183

114. Bruce A.& . Langdon K, Project management, 2002

115. . Bruce A.& . Langdon K, Strategic thinking, 2003

116 Blanchard. K. , Johnson S. , The one minute manager, 2006

117. Heller R., Motivating people , 2006.

veb-gverdebi:

1. www.economy.gov.ge

2. www.moh.gov.ge

3. www.medportal.ge

4. www.reforms.ge

5. www.statistics.ge

6. www.parlament. gov.ge

7. www.worldbank.org

9. www.iet.ru

1

d a n a r T i

2danarTi.1.

samedicino momsaxurebis anazRaurebis meqanizmebi

da maTi gamoyenebis ZiriTadi sfero

mimRebi anazRaurebis principi anazRaurebul

momsaxurebaTa saxeebi samed.

dawes.

kerZo

praqtikis

eqimi

safasuri samedicino

momsaxurebis

calkeul saxeebze

calkeuli procedura an

mimarTva

+

+

safasuri daavadebis

TiToeul SemTxvevaSi

sxvadasxva SemTxvevebi,

tarifis Sesabamisad

+

dRe-Ramuri

anazRaureba

TiToeuli pacientis

mixedviT dRe-Rameebis

ganmavlobaSi

+

erTiani ganakveTi momsaxurebis specifikuri

saxeebi, magaliTad,

profilaqtikuri

RonisZiebebi

+

+

anazRaureba

TiToeuli pacientis

mixedviT

gansazRvruli periodis

ganmavlobaSi pacientisTvis

potenciuri daxmarebis

yvela saxe

+

sawol-dReebis

mixedviT

profilis mixedviT

avadmyofis mier

stacionarSi gatarebuli

sawol-dReebis raodenoba

+

globaluri biujeti samedicino momsaxurebis

yvela saxe, romelTac uwevs

dawesebuleba mocemul

periodSi

+

3danarTi.2

samedicino momsaxurebis mastimulirebeli formebi, principebi

# anazRaurebis

principebi

momsaxurebaTa raodenoba momsaxurebis struqturuli

xasiaTi

pacientebis

raodenoba

momsaxurebis procedurebis

raodenoba

erTxel

mimarTvis

dros

procedurebis

raodenobis

cvlileba

fasis

matebiT

1. safasuri

momsaxurebaze

+ + + +

2. anazRaureba

daavadebis

TiToeul

SemTxvevaze

0 + _ +

3. dRe-Ramuri

anazRaureba

+ + _ +

4. erTiani

ganakveTi

+ 0 _ 00

5. safasuri

TiToeuli

pacientis

momsaxurebaze

+ 0 _ _

6. anazRaureba

sawol-dReebis

raodenobis

mixedviT

+ _ 0 0

7. globaluri

biujeti

_ 0 _ _

sadac: `+~ _ samedicino momsaxurebis momwodebeli dainteresebulia maqsimalurad

gazardos momsaxurebis xarisxi (struqturuli elementebi);

`_~ _ samedicino momsaxurebis momwodebeli dainteresebulia maqsimalurad

Seamciros momsaxurebaTa raodenoba (struqturuli elementebi);

0 _ indikatori ar aris damaxasiaTebeli mocemuli formisTvis; Sedegebi ucnobia.

4danarTi.3. samedicino momsaxurebisa da anazRaurebis formaTa

Sefaseba kriteriumebis mixedviT3

kriteriumebi progra-

muli

dafinan-

seba

pirobiTi

standar-

tebi

sawol-

dReebis

mixedviT

globalu-

ri

biujeti

ganxorcielebadoba

makrostruqtura

mikrostruqtura

kadrebi

teqnikuri saSualebebi

teqnologiuri procesis

simartive

1

3

1

1

1

0

3

1

0

0

2

2

2

1

2

3

0

3

2

3

ekonomikuri maxasiaTeblebi

danaxarjebi samedicino

momsaxurebis erTeulze

2

3

1

0

administraciuli da

operaciuli danaxarjebis

Tanafardoba

1 0 2 2

anazRaurebis saSualo

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anazRaurebis (fasdebis)

adeqvaturoba

2 3 1 0

mikroekonomikuri efeqturobis

stimulireba

3 1 2 0

konceptualuri adeqvaturoba

reorganizaciis ZiriTad

mizanTan Sesabamisobaze

3

2

2

0

resursTa ekonomiis amocanis

uzrunveyofa

1 1 2 2

mosaxleobis (momxmareblebis)

dakmayofileba

1 1 2 3

medpersonalis dakmayofileba 1 0 2 3

samedicino momsaxurebis

xarisxisTvis xelSewyoba

3 2 1 0

3 d. gziriSvili, l. kobalaZe. samedicino momsaxurebis anazRaurebis formaTa SedarebiTi analizi. Tb., 1996, gv.6.

5

akad. o. RuduSauris saxelobis erovnul samedicino

centrSi registrirebul pacientTa raodenoba da Sesrulebuli

samuSaos moculoba 2004-2005 wlebis ganmavlobaSi

stacionari danarTi 4

# perinataruli samsaxuri registrirebuli

avadmyofebis raodenoba

gatarebuli sawo-dReebis

raodenoba

2004 2005 2004 2005

1 maT Soris sul sul sul sul

2.

3.

a) meanoba

b) ginekologia

g) neonatologia

saxelmwifo programiT

a) meanobis programiT

b) referaluri programiT

g) umweoTa programiT

Sida standartiT

a) sagarantio werilebiT

sul (2+3)

1189

101

188

1410

1189

200

21

68

47

1478

2084

91

393

2533

2084

400

49

35

20

2568

6594

455

2575

9326

6594

2575

157

298

210

9824

12298

503

7043

19684

12298

7081

305

160

88

19844

qirurgiuli samsaxuri

1. maT Soris 2004 2005 2004 2005

2.

3.

a) zogadi qirurgia

b) angioqirurgia

g) neiroqirurgia

d) urologia

saxelmwifo programiT

a)referaluri programiT

b)umweoTa programiT

Sida standartiT

a) sagarantio werilebiT

sul (2+3)

416

45

105

57

308

181

127

315

230

623

609

43

145

65

691

539

152

171

70

862

2240

167

1493

286

2722

1954

1207

1464

883

4186

4326

288

1431

446

5895

4548

1347

596

279

6491

Terapiuli samsaxuri 2004 2005 2004 2005

maT Soris sul sul sul sul

1. a) Terapia

saxelmwifo programiT

a) referaluri programiT

b) umweoTa programiT

Sida standartiT

sagarantio werilebiT

sul (2+3)

136

80

46

34

56

15

136

160

137

49

88

23

11

160

875

550

234

316

325

120

875

1224

1112

349

763

112

54

1224

6

tramvatologiur-orTopediuli samsaxuri 2004 2005 2004 2005

sul sul sul sul

1.

a

b

g

2.

3.

saxelmwifo programiT

0-dan 3 wlamde bavSvebis programiT

a) bavSvTa orTopedia

b) mozrdilTa orTopedia

g) bavSvTa tramva

d) mozrdilTa tramva

e) arTrologia

3-dan 15 wlamde bavSVebis programiT

a) bavSvTa orTopedia

b) mozrdilTa orTopedia

g) bavSvTa tramva

d) mozrdilTa tramva

e) arTrologia

umweoTa programiT

a) bavSvTa orTopedia

b) mozrdilTa orTopedia

g) bavSvTa tramva

d) mozrdilTa tramva

e) arTrologia

Sida standarti

a) bavSvTa orTopedia

b) mozrdilTa orTopedia

g) bavSvTa tramva

d) mozrdilTa tramva

e) arTrologia

Sida standartiT registrirebul pacientTa

sagarantio werilebiT

170

25

134

11

599

334

481

48

339

94

633

402

3453

218

3075

160

1318

438

4045

421

3043

581

1932

1320

sul (1+2) 769 1114 4771 5977

wyaro: ak. o. RuduSauris saxelobis erovnuli samedicino centris arqivi

7 danarTi 5

akademikos o. RuduSauris saxelobis erovnuli samedicino centris

biujeti 2004-2005 ww.

faqtiuri aRiarebuli anazRaurebuli

E2004 2005 2004 2005 2004 2005

Semosavali XII XII XII XII XII XII

1. socialuri

dazRvevis erTiani

fondi

4724804,00 8016638,00 2130619,00 3620358,00 2253597,00 3067913,00

maT Soris _

referaluri

programa

941252,00 1005672,00 807100,00 983515,00 874049,00 887596,00

urgentuli

programa

1775466,00 2218253,00 223894,00 809885,00 252839,00 679845,00

xelmokleTa

daxmarebis

programa

383510,00 677446,00 383510,00 548067,00 410209,00 407872,00

meanobis programa

1284497,00 2921058,00 400000,00 750966,00 400000,00 641474,00

bavSvTa daxmarebis

programa

313964,00 1183702,00 300000,00 517868,00 300000,00 442868,00

2115,00 10507,00 2115,00 10057,00 2500,00 8258,00

24000,00 _ 14000,00 _ 14000,00 _

2.

axalwveulTa

programa 2488439,00 2299196,00 2488439,00 2299196,00 1917239,00 2371279,00

8

saxelmwifo

programa

Sida standartebiT

Sesrulebuli

samuSaoebi

maT Soris

xelmokleTa

daxmarebis

programis

damatebiTi

komponenti

1223903,00

959794,00

1223903,00

959794,00

1254064,00

778481,00

salaroSi Setanili

Tanxebi:

(ambulatoria,

poliklinika,

diagnostika)

426028,00

1148794,00

429028,00

1148794,00

429028,00

1156467,00

individebi

761354,00 158264,00 761354,00 158264,00 159993,00 137208,00

sxva organizaciebi

74154,00 32344,00 74154,00 32344,00 74154,00 299123,00

3. salaroSi Setanili

Tanxebi:

(ambulatoris,

politka,

diagnostika)

39573,00

35941,00

39573,00

35941,00

34798,00

20406,00

4. uwyveti swavlebis

programebisTvis

425104,00 290609,00 _ 290609,00 201000,00 _

sul Semosavlebi

7677920,00 10642384,00 4658631,00 6246104,00 4406634,00 5459598,00

faqtiuri aRiarebuli anazRaurebeli

2004 2005 2004 2005 2004 2005

xarjebi XII XII XII XII XII XII

1. operaciuli

xarjebi

4311309,00 4925161,06 4311309,00 4925161,06 2405985,00 3994974,80

med.

personalis

xelfasi

2320745,00 2865652,18 2320745,00 2865652,18 1257360,00 2294780,45

9

gadaxdebi

xelfasidan

719431,00 888352,18 719431,00 888352,18 239769,00 192120,67

medikamentebi,

erTjeradi

moxmarebis

sagnebi

1271133,00 1171156,70 1271133,00 1171156,70

908856,00

1208073,68

2. sil

administraciuli

Semosavlebi

2010444,00 2000349,69 2010444,00 2000349,69 1967113,00 1651241,22

sul

administracii

xelfasi

686754,00 640605,13 686754,00 640605,13 481846,00 577295,79

gadaxdebi

xelfasidan

212894,00 198587,59 212894,00 198587,59 82544,00 48331,63

komunikaciebi

26494,00 20097,87 26494,00 20097,87 21323,00 20097,87

eleqtroenergia

121002,00 163939,60 121002,00 163939,60 96275,00 145950,00

wyali

18862,00 51892,00 18862,00 51892,00 96456,00 97000,00

gaTboba

28505,00 84253,46 28505,00 84253,46 _ 47000,00

sawvavi

131353,00 149211,84 131353,00 149211,84 109606,00 145611,84

sakancelario

xarjebi

45829,00 36260,57 45829,00 36260,57 35242,00 25931,46

kompiuteruli

xarjebi

13004,00 13081,80 13004,00 13081,80 13004,00 13081,80

utilizacia

1571,00 3101,00 1571,00 3101,00 1571,00 3101,00

spec tansacmeli

_ _ _ _ _ _

sasterilizacio

xarjebi

2500,00 9057,38 2500,00 9057,38 2500,00 9057,38

10

saxanZro

usafrTxoeba

51376,00 146624,30 51376,00 146624,30 _ _

xarjebi

dezinfeqciaze

2000,00 2000,00 2000,00 2000,00 2000,00 2000,00

warmomadgenlobiTi

xarjebi

2150,00 200,00 2150,00 200,00 2150,00 200,00

masalebi uwyveti

swavlebisaTvis

3500,00 8946,11 3500,00 8946,11 3500,00 8946,11

TeTreuli

9000,00 _ 9000,00 _ 9000,00 _

xarjebi SekeTebaze

234993,00 107952,66 234993,00 107952,66 225433,00 104257,36

liftze

4383,00 1721,00 4383,00 1721,00 4383,00 1721,00

auditze

23000,00 24890,00 23000,00 24890,00 11000,00 3230,00

sxva

3911271,00 337927,38 391274,00 337927,38 769280,00 398427,98

3. amortozacia 395135,00 3911978,08 395135,00 3911978,08 _ _

samedicino

aparatura:

266647,00 2585987,51 266647,00 2585987,51 _ _

msoflio banki

_ 858456,05 _ 858456,05 _ _

iaponia

_ 1585433,58 _ 1585433,58 _ _

o. RuduSauris sax.

klinika

266647,00 142097,88 266647,00 142097,88 _ _

Senoba-nagebobebi

128488,00 1325990,57 128488,00 1325990,57 _ _

4. gadasaxadebi 187221,00 _ 187221,00 _ 56914,00 27787,84

gadasaxadebi

qonebaze

29184,00 _ 29184,00 _ 35139,00 _

11 gadasaxdelebi

miwaze

11250,00 _ 11250,00 _ 10900,00 _

satransporto

gadasaxdelebi

70953,00 _ 70953,00 _ 6180,00 _

saSemosavlo

gadasaxadi

3491,00 _ 3491,00 _ 4695,00 _

gadasaxadi mogebaze 72343,00 _ 72343,00 _ _ 27787,84

sul xarjebi

muxlebis

mixedviT

6904109,00

10837488,83

6904109,00

10837488,83

4430012,00

5374003,86

wyaro: ak. o. RuduSauris saxelobis erovnuli samedicino centris arqivi

12 danarTi 6

RuduSauris sax. esc-Si medikamentebis xarjvis maCveneblebi

2004-2005 wlebSi

ganyofilebebi sawolebi sawol-dReebi medikamenti

dReSi

medikamenti

weliwadSi

2004 2005 2004 2005 2004 2005

zogadi qirurgia 70 4 181 6 491 31,44 11,81 131 544,96 76 675,98

travmatologia da

orTopedia

40 4 767 5 977 49,85 53,55 237 634,95 320

051,60

Terapia 10 875 1 224 26,21 8,83 22 933,75 10 809,80

ginekologia 15 455 503 15,71 9,21 7 148,05 4 632,85

meanoba 45 6 594 12 298 8,15 5,75 53 741,10 70 689,99

neonatalogia 10 2 575 7 043 30,55 10,29 78 666,25 72 463,27

reanimacia 6 1 501 1 922 315,97 182,00 474 270,97 349

794,54

anesTezia-

intensiuri Terapia

0 0 2 239 0 21,96 _ 49 167,86

saoperacio 0 1 650 2 239 45,12 35,75 74 448,00 80 038,08

196 22

601,00

39936,00 1080388,03 1034323,98

misaRebi

katastrofa

ambulatoria

diagnostika (lab)

sisxlis banki

reabilitacia

2987

3219

7927

41387

587

283

5173

3523

8313

74170

820

654

10,63

8,01

2,28

2,62

8,34

6,38

5,19

4,88

1,22

1,05

5,16

0,71

31 751,81

25 784,19

18 073,56

108 433,94

4 895,58

1 805,54

29

841,04

17 195,44

10 181,21

77 918,21

4 233,43

4 62,82

sul medikamentebisa da damxmare masalebis danaxarji

1271132,65

1171156,75

wyaro: ak. o. RuduSauris saxelobis erovnuli samedicino centris arqivi

13danarTi 7

saaqcio sazogadoeba `akademikos o. RuduSauris saxelobis erovnuli

samedicino centris~ wliuri danaxarjebis uwyisi 2004-2005 ww.

2004 2005

xelfasebi

1,01 samedicino personali

1,02 zogadadministraciuli

1,03 xelfasis anaricxebi

2 320 745,24

686 754,86

932 325,03

2 865 652,18

640 605,13

1 086 939,77

1

Tanxa 1 271 132,65 4 593 197,08

sasaqonlo-materialuri

maragi

2,01 maragebi 1 271 132,65 1 171 156,73

2

Tanxa 1 271 132,65 1 171 156,70

sxvadasxva

1.01 komunikaciebi

1.02 eleqtroenergia

1.03 wyali

1.04 gaTboba

1.05 sawvavi

1.06 sakancelario xarjebi

1.07 kompiuteruli xarji

1.08 utilizacia

1.09 spectansacmeli

1.10 sarecxi sasterilizacio

saSualebebi

1.11 saxanZro usafrTxoeba

1.12 deratizacia/dezinseqsacia

1.13 warmomadgenlobiTi xarji

1.14 masalebi uwyveti

ganaTlebisTvis

1.15 TeTreuli

1.16 xarjebi SekeTebaze

1.17 lifti

1.18 xarjebi auditis momsaxurebaze

1.19 sxvadasxva

24 101,00

121 002,00

18 862,00

28 505,00

131 353,00

45 829,00

13 004,00

1 571,00

2 500,00

51 376,00

2 000,00

2 150,00

3 500,00

9 000,00

234 993,00

4 383,00

23 000,00

466 010,00

20 097,87

163 939,60

51 892,00

84 253,46

149 211,84

36 260,57

13 081,80

3 101,00

9 057,38

146 624,30

2 000,00

200,00

8 946,11

_

107 952,66

1 721,00

24,890,00

337 927,38

3

Tanxa 1 183 139,00 1 161 156,97

sul xarjebi 6394096,78 6925510,75

wyaro: ak. o. RuduSauris saxelobis erovnuli samedicino centris arqivi

14danarTi #8

saaqcio sazogadoeba `akademikos o. RuduSauris saxelobis erovnuli

samedicino centris wliuri mogeba-zaralis uwyisi 2004-2005 ww.

2004 2005

stacionari 5805566,37 8150981,22

ambulatoriuli operaciebi 8143,00 9700,00

ambulatoria/poliklinika

(diagnostika/paraklinika/reabilitacia)

372160,00 1040760,00

katastrofa da gadaudebeli medicina 341252,00 1005672,00

saerTaSoriso wiTeli jvris programa 24000,00 _

axalwveulTa program 2500,00 10507,00

sxva Semosavlebi 101694,00 134155,00

arasaoperacio Semosavlebi 422605,00

290609,00

realizaciis moculoba 7677920,37 10642384,22

saoperacio xarjebi

samedicino personali 2320745,24

xelfasis anaricxebi 719431,02

medikamenti/samedicino daniSnulebis

erTjeradi gamoyenebis sagnebi

1271132,65

sul saoperacio xarjebi 4311308,91 62,45% 45,45%

zogadadministraciuli xarjebi

zogadadministraciuli xelfasi 686754,86 640605,13

xelfasis anaricxebi 212894,01 1985887,59

komunikaciebi 24101,00 20097,87

eleqtroenergia 121002,00 163939,60

wyali 18862,00 51892,00

gaTboba 28505,00 84253,46

sawvavi 131353,00 149211,84

sakancelario xarjebi 45829,00 36260,57

kompiuteruli xarji 13004,0 13081,80

utilizacia 1571,00 3101,00

spectansacmeli _ _

sarecxi sasterilizacio saSualebebi 2500,00 9057,38

saxanZro usafrTxoeba 51376,00 146624,30

deratizacia/dezinseqsacia 2000,00 2000,00

warmomadgenlobiTi xarji 2150,00 200,00

masalebi uwyveti ganaTlebisTvis 3500,00 8946,11

TeTreuli 9000,00 _

xarjebi SekeTebaze, 234993,00 107952,66

lifti 4383,00 1721,00

xarjebi auditis momsaxurebaze 23000,00

24890,00

15sxvadasxva 466010,00 337927,38

sul zogadadministraciuli

xarjebi

2082787,87 30,17% 2000349,69 18,46%

amortizacia

samedicino aparatura, maT Soris 266646,66 2585987,51

saerTaSoriso banki _ 858456,05

iaponia _ 1585433,58

RuduSauris saxelobis klinika 266646,66 142097,88

Senoba-nagebobebi 128488,28

1325990,57

sul amortizacia 395134,94 5,72% 3911978,08 36,10%

gadasaxadebi

gadasaxadi qonebaze 29184,00 _

miwis gadasaxadi 11150,00 _

sagzao 70953,00 _

samewarmeo 3491,00

_

sul gadasaxadebi 114878,00 1,66% 0,00%

sul xarjviTi nawili 6 904 109,72 10 837 488,83

mogeba 773810,65 (195104,61)

wyaro: ak. o. RuduSauris saxelobis erovnuli samedicino centris arqivi

16

danarTi #9

angariSebis fuladi saSualebebis moZraobis Sesaxeb

sawarmos daxaxeleba: ss `erovnuli samedicino centri~

saqmianobis dargi: samedicino momsaxureba

angariSebis fuladi saSualebebis moZraobis Sesaxeb( pirdapiri meTodiT).

2004w. 2005w.

saoperacio saqmianobidan miRebuli

fuladi saSualebebis moZraoba

miRebuli fuladi saSualebebi 4406634,0 5365256,0

TanamSromlebsa da momwodeblebze

gacemuli fuli -3584293,0 -5432016,0

gadaxdili gadasaxadebi -597015,0 -56109,0

gadaxdili sakomisioebi -6808,0 0,0

saoperacio saqmianobidan miRebuli wminda fuladi saSualebebi 218518,00 -

122869,00

sainvesticio saqmianobidan miRebuli

fuladi saSualebebis moZraoba

aramaterialuri aqtivebis SeZena -10238,0 0,0

ZiriTadi saSualebebis SeZena -231656,0 -36442,0

sainvesticio saqmianobidan miRebuli wminda fuladi saSualebebi –241894,00 -

36442,00

finansuri saqmianobidan miRebuli

fuladi saSualebebis moZraoba

miRebuli sesxebi 0,0 250000,0

anazRaurebuli dividendebi 0,0 -5000,0

sainvesticio saqmianobidan miRebuli wminda fuladi saSualebebi 0,00

245000,00

fuladi saSualebebis wminda namati/Semcireba -23376,0 85689,0

fuladi saSualebebi da eqvivalentebi saangariSo

wlis dasawyisisTvis 31354,0 7978,0

fuladi saSualebebi da eqvivalentebi saangariSo

wlis dasawyisisTvis 7978,0 93667,0

17 b a l a n s i danarTi #10

2005 wlis 31 dekembris mdgomareobiT

sawarmos dasaxeleba: ss "akad.Oo. RuduSauris sax. erovnuli samedicino centri"

organizaciul samarTlebrivi forma: s/s

misamarTi: Tbilisi, lublianas q. #18/20

saqmianobis dargi: samedicino momsaxureba

zomis erTeuli: 1 lari

aqtivebi 31,12,2005 31,12,2004 grZelvadiani aqtivebi

ZiriTadi saSualebebi 26 951 519 3 361 571 aramaterialuri aqtivi 8 761 9 738 gadavadebuli sagadasaxado aqtivi sul grZelvadiani aqtivebi 26 960 280 3 371 309 mimdinare aqtivebi sasaqonlo-materialuri faseulobebi 660 804 540 795 savaWro da sxva moTxovnebi 6 154 244 3 701 149 fuladi saxsrebi da eqvivalentebi 93 666 7 978 sul mimdinare aqtivebi: 6 908 714 4 249 922 sul aqtivebi: 33 868 994 7 621 231 sakuTari kapitali da valdebulebebi kapitali da rezervebi gamoSvebuli saaqcio kapitali 28 356 850 3 636 830 akumulirebuli mogeba-zarali -327 751 rezervebi - - Mimdinare wlis mogeba -195 105 618 360 sul kapitali da rezervebi 28 161 745 3 927 439 grZelvadiani valdebulebebi gadavadebuli mogebis gadasaxdi 5 507 2 233,0 sul grZelvadiani valdebulebebi 5 507 2 233 moklevadiani valdebulebebi savaWro da sxva valdebulebebi 2 596 417 2 206 271 sagasaxado valdebulebebi 2 715 725 1 485 288 sxva moklevadiani valdebulebebi 389 600 sul moklevadiani valdebulebebi 5 701 742 3 691 559 sul sakuTari kapitali da valdebulebebi 33 868 994 7 621 231