The Soviet system of health care, which embraced all the republics, included extensive networks of state-run hospitals, clinics, and emergency first aid stations. The huge government health bureaucracy in Moscow set basic policies for the entire country, then transmitted them to the health ministries of the republiÍÍÍÍcs. In the republics, programs were set up by regional and local health authorities. The emphasis was on meeting national standards and quotas for patient visits, treatments provided, and hospital beds occupied, with little consideration of regional differences or requirements.

Under this system, the average Georgian would go first to one of the polyclinics serving all the residents of a particular area. In the mid-1980s, polyclinics provided about 90 percent of medical care, offering very basic diagnostic services. In addition, most workplaces had their own clinics, which minimized time lost from work for medical reasons. The hospital system provided more complex diagnosis and treatment, although overcrowding often resulted from the admission of patients with minor complaints. Crowding was exacerbated by official standards requiring hospital treatment of a certain duration for every type of complaint.

The Soviet system placed special emphasis on treatment of women and children many specialized treatment, diagnostic, and advanced-study centers offered pediatric, obstetric, and gynecological care. Maternity services and prenatal care were readily accessible. Emergency first aid was provided by specialized ambulance teams, most of which had only very basic equipment. Severe cases went to special emergency hospitals because regular hospitals lacked emergency rooms. Although this system worked efficiently in urban centers such as Tbilisi, it did not reach remote areas. Most Georgians cared for elderly family members at home, and nursing care was generally mediocre. Georgian health spas were a vital part of the Soviet Union's well-known sanatorium system, access to which was a privilege of employment in most state enterprises.

When the Soviet Union dissolved, it left a legacy of health problems to the respective republics, which faced the necessity of organizating separate health systems under conditions of scarce resources. By 1990 the Soviet health system had become drastically underfunded, and the incidence of disease and accidents was increased by poor living standards and environmental hazards. Nominally equal availability of medical treatment and materials was undermined by the privileged status of elite groups that had access to the country's best medical facilities. In 1990 the former republics also differed substantially in health conditions and availability of care (see table 2, Appendix). Subsequent membership in the Commonwealth of Independent States, to which Georgia committed itself in late 1993, did not affect this inequality.

According to most standard indicators, in 1991 the health and medical care of the Georgian population were among the best in the Soviet Union. The rate at which tuberculosis was c85 diagnososed, 28.9 cases per 100,000 population in 1990, was third lowest, and Georgia's 140.9 cancer diagnoses per 100,000 population in 1990 was the lowest rate among the Soviet republics. Georgia also led in physicians per capita, with 59.2 per 10,000 population, and in dentists per capita. However, hospital bed availability, 110.7 per 10,000 population in 1990, placed Georgia in the bottom half among Soviet republics, and infant mortality, 15.9 per 1,000 live births in 1990, was at the average for republics outside Central Asia.

Although illegal drugs were available and Georgia increasingly found itself on the international drug-trading route in the early 1990s, the drug culture was confined to a small percentage of the population. The relatively high rate of delinquency among Georgian youth, however, was frequently associated with alcohol abuse.

In 1993 the Republic AIDS and Immunodeficiency Center in Tbilisi reported that sixteen cases of acquired immune deficiency syndrome (AIDS) had been detected five victims were nonGeorgians and were deported. Of the remaining eleven, two had contracted AIDS through drug use and one through a medical procedure. Despite the small number of cases, the AIDS epidemic has caused considerable alarm in the Georgian medical community, which formed a physicians' anti-AIDS association in 1993. The AIDS center, located in a makeshift facility in Tbilisi, conducts AIDS research and oversees testing in twenty-nine laboratories throughout Georgia, stressing efforts among high-risk groups.

Like other former Soviet republics, Georgia began devising health care reform strategies in 1992. Budget expenditures for health increased drastically once the Soviet welfare system collapsed. Theoretical elements of Georgian health reform were compulsory medical insurance, privatization and foreign investment in institutions providing health care, and stronger emphasis on preventive medicine. Little progress was made in the first two years of the reform process, however. In Georgia political instability and civil war have destroyed medical facilities while increasing the need for emergency care and creating a large-scale refugee problem (see Threats of Fragmentation , this ch.).

Data as of March 1994