This current study by the Curatio International Foundation concerns the history and existing challenges of the Universal Healthcare Program.
In many countries, including Georgia, people still struggle to afford healthcare even though governments are working toward the universal health coverage (UHC). The idea behind universal coverage is simple: everyone should be able to get the care and medicines they need without falling into poverty. But in reality, this goal is hard to reach, especially when the biggest expenses—like medicines—must be paid out of pocket.
In Georgia, buying medicines has long been one of the main reasons families face financial hardship. For years, households have spent around 70% of their healthcare money on medicines alone, much higher than what is seen in most other countries. Poorer families have been hit the hardest, often having to choose between paying for treatment or meeting their basic needs. Recognizing this crisis, the Georgian government launched the Chronic Disease Medicine Program in 2017 to help people with long-term/chronic illnesses get the medicines they need at a lower cost.
The program was designed to make essential drugs for chronic diseases more affordable. These illnesses, such as diabetes, heart disease, asthma and chronic obstructive pulmonary disease (COPD), are long-lasting and require continuous treatment. Without regular access to medicines, patients’ health can worsen, and their families can face serious financial problems. In Georgia, chronic diseases are responsible for more than 90% of deaths, and this burden is expected to grow as the population ages.
This study looked at how the Chronic Disease Medicine Program (hereafter called CDMP), has evolved since its creation, what improvements it has brought, and what challenges it still faces.
As research showed, the program started modestly. In its first year, it offered discounted medicines for people suffering from heart disease, type 2 diabetes, and lung conditions like asthma. Over the next few years, the list expanded to include thyroid disease, epilepsy, Parkinson’s disease, and most recently, glaucoma. The program also broadened the number of people it helps. At first, only socially vulnerable families were eligible. Later, the coverage was extended to pensioners, people with disabilities, and others who faced financial or health challenges.
However, the way medicines were selected for the program created some difficulties. From the beginning, officials tried to keep costs as low as possible by choosing the cheapest available drugs, often focusing on single-ingredient medicines instead of more effective combination treatments. This cost-saving approach, while understandable in a country with limited resources, meant that some patients were not fully satisfied with the medicines they received. Doctors also reported that some patients dropped out of the program because they didn’t believe the drugs worked as well as the ones they could buy privately.
Another issue in the early years was the strict limit on how much medicine each person could get through government reimbursement. Once patients reached their yearly allowance, they had to pay full price for the rest of the year. These limits were not based on real patient needs and were often used up within months. Many patients complained that they had to wait until the following year for help again. After long discussions between the Ministry of Health and the Ministry of Finance, these restrictions were finally removed in 2024. This change was one of the most significant improvements in the program’s history, allowing patients to continue their treatments throughout the year without interruption.
Initially, the government handled the purchase and distribution of medicines through a small number of contracted pharmacies. This centralized system soon ran into logistical problems. Medicines were often out of stock, delivery was slow, and some drugs expired before reaching patients. In 2020, the government changed strategy and partnered with private pharmacy chains across the country. This move transformed how people accessed medicines. Now, patients can go to almost any pharmacy, show their electronic prescription, and receive the subsidized medicine. The pharmacy is later reimbursed by the state. This public-private partnership improved access dramatically, especially for people in rural areas, and solved most of the earlier problems with shortages and delays.
At the same time, the Ministry of Health introduced new digital systems to monitor how medicines move through the supply chain—from import to sale—and to track prices and availability. These systems made the process more transparent and efficient, though analyzing data still takes time and relies heavily on staff rather than automation.
The results of these reforms have been impressive. The number of people benefiting from the program has increased sharply. In 2024, about 390,000 people—around 14% of Georgia’s adult population—were receiving medicines through the CDMP. Government spending on the program grew from half a million GEL in 2017 to nearly 60 million GEL in 2024. More importantly, patients can now get their prescribed medicines all year round without worrying about exhausting their benefits early.
Despite these achievements, challenges remain. One major issue is that decision-making in the program is still heavily influenced by politics rather than technical evidence. The committee responsible for choosing medicines and setting priorities has limited independence, and there is still a shortage of specialists in health economics and evidence-based policy. Budgeting is often based on past spending rather than careful forecasting of future needs, which makes planning difficult and sometimes leads to inefficiencies.
Another challenge lies in awareness and trust. Surveys show that although public knowledge about the program has improved—from just 10% of the population in 2017 to nearly 47% in 2023—many people, especially in rural areas or among ethnic minorities, still don’t know they can benefit from it. Doctors and pharmacists could play a big role in spreading awareness, but not all of them do. Some may even discourage patients from using state-funded medicines because they earn more from selling commercial alternatives. The government has introduced electronic prescriptions to improve transparency and required pharmacists to offer patients the three cheapest options available, but enforcement remains uneven.
The lack of patient-centered thinking also persists. The program still tends to focus on cost control rather than on whether medicines best meet patients’ clinical needs. More attention to patient experience, as well as the use of international best practices like Health Technology Assessments (a way for governments and health systems to decide which medicines, medical tests, or treatments are worth paying for), could help ensure that resources are used effectively and that patients receive the most suitable treatments.
Comparing Georgia’s progress to other countries provides useful perspective. Many nearby countries, such as Armenia, Azerbaijan, Kyrgyzstan, and Moldova, still face serious problems with access to affordable outpatient medicines. In contrast, countries like Brazil, Thailand, and Ukraine have successfully expanded drug coverage and improved financial protection by combining strong governance, transparent pricing, and systematic evaluation of which medicines to cover. Georgia is on the right path but must continue strengthening its institutions and building expertise if it wants to achieve similar results.
For the program to reach its full potential, several steps are needed. The government should focus more on evidence-based decision-making when selecting medicines and setting prices. Roles and responsibilities between agencies must be clarified to reduce bureaucracy and political interference. Investing in training for health economists, data analysts, and primary healthcare providers would also strengthen the system. At the community level, targeted awareness campaigns—especially in non-Georgian languages—could help ensure that more people understand and use the benefits available to them.
The Georgian experience shows that achieving universal health coverage is not only about political commitment or money. It also requires efficient organization, transparency, good data, and the active involvement of healthcare providers and patients. The Chronic Disease Medicine Program has already made healthcare more affordable for hundreds of thousands of people. By continuing to address its weaknesses—especially in governance, awareness, and capacity—it could become a model for other countries working to make essential medicines accessible for all.
The progress we have witnessed in the past 8 years is real, though the work is far from over. If the government continues to invest in people, systems, and transparency, the program can evolve into a cornerstone of a fair and sustainable healthcare system—one where no one is left behind because they cannot afford their medicine.
Authors: Alisa Tsuladze, Akaki Zoidze, Nino Kotrikadze, Janina Stauke, Giorgi Gotsadze
