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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
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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.
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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.
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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
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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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181
87.Котлер Ф. Маркетинг Менеджмент, ( Пер.с. англ.) l., 2001
88. Кузьменко М.М., БарановВ.В., Финансовый менеджмент в Здравоохранении
России.,М.,1995 89. låä"åäå" b.̀ . - nK?å“2"å……%å "%C!%,ƒ"%ä“2"% , “-å!= 3“ë3ã. l.: }*%…%ì,*=, 1968.
90. må“2å!%" k.h. - ) åë%"å÷å“*,L C%2å…ö,=ë , p%““,L“*= tåäå!=ö, /b%C!%“/
“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
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veb-gverdebi:
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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
Seferxeba
1 0 2 3
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
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