




































AGORA International Journal of Economical Sciences, http://univagora.ro/jour/index.php/aijes 

ISSN 2067-3310, E-ISSN 2067-7669 

Vol. 19, No. 1 (2025), pp. 220-235 

 

220 
 

ECONOMIC BURDEN AND POLICY GAPS IN NONCOMMUNICABLE 

DISEASE MANAGEMENT IN GEORGIA: A HEALTH ECONOMICS 

PERSPECTIVE 
 

N. MIKAVA, S. GABRITCHIDZE 

 

Nino Mikava¹, Simon Gabritchidze² 

¹ Business and Technology University, Georgia 

https://orcid.org/0000-0002-9567-3958, E-mail:  nino.mikava@btu.edu.ge  

² University of Georgia, Georgia 

https://orcid.org/0009-0003-3043-7254, E-mail: s.gabritchidze@ug.edu.ge 
 

Abstract: Noncommunicable diseases (NCDs) present a significant economic challenge 

for healthcare systems, particularly in low- and middle-income countries such as Georgia. 

Beyond the health sector, the escalating burden of NCDs has substantial macroeconomic 

implications, including long-term fiscal pressure on public healthcare budgets, diminished 

labor market productivity, and increased poverty due to out-of-pocket healthcare expenditures. 

Collectively, these effects can impede national development and economic growth potential. 

This study employs a health economics perspective to examine the direct and indirect costs 

incurred by patients and caregivers, the economic inefficiencies of the current healthcare 

system, and the broader implications for labor productivity and national development. 

Utilizing a mixed-methods approach—comprising literature review, qualitative focus group 

discussions, and quantitative survey—the study identifies key financial barriers, caregiving 

burdens, infrastructure deficiencies, and policy inadequacies.  

The findings inform economic policy recommendations, including expanded public financing, 

improved cost-efficiency of NCD care, and enhanced integration of NCD prevention into 

national development strategies. The study advocates for urgent health system reforms that not 

only improve health outcomes but also mitigate the long-term economic impact of NCDs. 

Keywords: Noncommunicable disease management, economic burden of NCDs, 

efficient management of NCDs, healthcare policy gaps in LMICs. 

 

INTRODUCTION  
Noncommunicable diseases (NCDs), encompassing cardiovascular diseases, diabetes, 

cancers, and chronic respiratory conditions, constitute the predominant cause of global 

morbidity and mortality. As of 2023, these diseases account for 74% of global deaths (WHO, 

2024). Their chronic nature, coupled with associated socio-economic burdens and pronounced 

disparities in healthcare access, particularly impacts low- and middle-income countries 

(LMICs), where premature NCD mortality rates are over three times higher than in high-

income nations (Ferrana et al., 2023).  

The management of NCDs necessitates substantial healthcare resources, long-term 

treatment plans, and significant financial expenditures, often surpassing the capacities of both 

patients and national health systems. In LMICs, out-of-pocket spending is a prevalent and 

significant concern, contributing to poverty and diminished access to essential services. Studies 

from global and regional contexts underscore that effective NCD strategies require not only 

medical but also systemic responses, emphasizing the necessity for integrated health services, 

early intervention, and financial risk protection (Gheorghe et al., 2018). 

Mental health challenges, social stigma, and inadequate support systems exacerbate the 

difficulties encountered by individuals with NCDs. Stigma and social isolation can deteriorate 

clinical outcomes and diminish treatment adherence. Consequently, comprehensive, patient-

https://orcid.org/0000-0002-9567-3958
mailto:nino.mikava@btu.edu.ge
https://orcid.org/0009-0003-3043-7254
mailto:s.gabritchidze@ug.edu.ge


ECONOMIC BURDEN AND POLICY GAPS IN NONCOMMUNICABLE DISEASE 

MANAGEMENT IN GEORGIA: A HEALTH ECONOMICS PERSPECTIVE 

 

221 
 

centered approaches that incorporate mental and social support are imperative (Patel & 

Chatterji, 2015). Advocacy plays a crucial role in addressing policy gaps. Effective advocacy 

enhances awareness, promotes equitable policies, and encourages community engagement. The 

5A Model—Awareness, Acceptance, Action, Audit, and Advocacy—has been established as a 

framework to facilitate patient-centered reform (Kalra et al., 2023).  

Globally, advocacy efforts have increasingly focused on prevention, rights-based 

access to care, and the meaningful inclusion of patient voices in decision-making processes 

(Kiknadze & Beletsky, 2013). To inform this study, advocacy agendas from India, Tanzania, 

Rwanda, Malaysia, the Philippines, Kenya, Ghana, Mexico, and Malawi were analyzed. Across 

diverse contexts, common priorities emerged: the protection of human rights and dignity of 

NCD patients, comprehensive preventive measures, equitable access to healthcare, and the 

inclusion of patients in policy-making. 

Georgia bears one of the most significant burdens of NCDs within the European region, 

with NCDs responsible for 93–97% of all mortalities (Russell et al., 2019). According to the 

Institute for Health Metrics and Evaluation (IHME), the primary contributors to this burden are 

cardiovascular diseases, cancers, chronic respiratory diseases, and diabetes. The principal risk 

factors include high tobacco and alcohol consumption, inadequate diets, physical inactivity, 

and obesity. In 2013, Georgia introduced a universal healthcare system to enhance 

accessibility. Nevertheless, challenges remain, including unequal healthcare utilization, 

substantial out-of-pocket expenditures, underfunded outpatient care, and disparities in disease 

prevention. The prevalence of obesity, hypertension, and diabetes continues to escalate. As of 

2015, Georgia reported 630.7 NCD-related deaths per 100,000 population annually, with an 

escalating public health crisis attributed to lifestyle and socioeconomic factors (Russell et al., 

2019). 

Persistent challenges within the country's healthcare system encompass several critical 

areas. Healthcare access remains limited and fragmented, particularly in rural regions 

(Gotsadze et al., 2017). Socioeconomic inequities are evident, with mortality rates 

disproportionately high among lower-income and less-educated individuals, especially women 

(Lomia et al., 2020). Furthermore, behavioral risks, including smoking, alcohol consumption, 

and poor dietary habits, are prevalent (Antia et al., 2022). There are significant implementation 

gaps, as health promotion programs suffer from a lack of coordination and funding. Informal 

caregivers, predominantly women, experience considerable stress, burnout, and income loss 

due to the absence of formal support structures. Despite the existence of state-run NCDs 

programs by the National Center for Disease Control and Public Health (NCDC), prevention 

efforts are under-resourced. Barriers include low public awareness, weak enforcement of health 

policies, inadequate screening programs, and insufficient investment in community-based 

interventions.  

In summary, Georgia faces a multifaceted NCD crisis. Although national programs are 

in place, their implementation remains weak, and the economic burden continues to escalate. 

This study is guided by the central research question: What are the economic and systemic 

challenges associated with NCD management in Georgia, and how can targeted policy reforms 

mitigate their impact? The working hypothesis posits that individuals living with NCDs and 

their caregivers in Georgia encounter significant financial and access-related barriers, 

contributing to avoidable economic losses and systemic inefficiencies. These challenges are 

exacerbated by insufficient policy attention to preventive care, psychological support, and 

inclusive decision-making. Furthermore, the present study investigates these challenges from 

an economic perspective to support evidence-based reforms aimed at improving health 

outcomes and economic resilience. 

 



Nino MIKAVA, Simon GABRITCHIDZE 

222 
 

Methodology  
This study utilized a mixed-methods approach to examine the economic and systemic 

challenges associated with NCDs in Georgia. The research design incorporated both qualitative 

and quantitative methodologies to ensure a comprehensive understanding of patient and 

caregiver experiences, healthcare access, financial burdens, and policy gaps. 

The initial phase involved an extensive review of international literature, including 

peer-reviewed academic publications, national health strategy documents, and advocacy 

reports. The countries analyzed included Armenia, Ukraine, Moldova, Estonia, as well as India, 

Tanzania, Rwanda, Malaysia, the Philippines, Kenya, Ghana, Mexico, and Malawi. The 

objective was to identify global best practices and recurring challenges in NCD management, 

particularly those related to healthcare financing, equity, and patient-centered advocacy. 

In the subsequent phase of the research, five focus group discussions (FGDs) were 

conducted, encompassing 55 participants, including individuals with NCDs and their 

caregivers. These sessions were convened in Tbilisi and various regional locations to ensure 

geographical diversity. A purposive sampling method was utilized to capture variations in 

gender, age, disease type, and urban-rural residence. The discussions focused on economic 

barriers, access to healthcare services, caregiving responsibilities, discrimination, and 

psychological stress. Data from these discussions were recorded, transcribed, and analyzed 

using content analysis to identify key economic and social themes. 

Subsequent to this, a quantitative survey was conducted. Building upon qualitative 

insights, a structured questionnaire was developed utilizing the NCD Global Alliance 

framework to quantify the prevalence and intensity of the identified issues. The instrument 

underwent pilot testing with seven respondents to ensure clarity and reliability. Data were 

collected from 197 participants, both online and in person. The survey gathered demographic 

information, disease status, healthcare access, insurance coverage, caregiving responsibilities, 

and indicators of financial burden. 

Quantitative data were analyzed utilizing Microsoft Excel. Descriptive statistics, 

including frequency distributions and percentage breakdowns, were employed to elucidate 

patterns in economic burden, service utilization, and the impact of caregiving on employment 

and income. Ethical approval was secured from the institutional review board, and all 

participants provided written or verbal informed consent. Anonymity and confidentiality were 

preserved by de-identifying all personal data and securely storing the dataset.  

Limitations: Although the study provides comprehensive insights, it is constrained by 

the modest sample size for qualitative analysis (55 participants), which may not fully represent 

the spectrum of NCD experiences in Georgia. The use of purposive sampling may introduce 

bias, and socioeconomic or ethnic diversity was not systematically assessed. While rural 

representation was included, it warrants further exploration given the unique challenges faced 

by non-urban populations. 

Moreover, this study predominantly utilized self-reported data, which may introduce 

recall bias, as well as the potential for underreporting or exaggeration of certain experiences, 

such as income loss, caregiving burden, or discrimination. Respondents might also have been 

subject to social desirability bias when responding to sensitive inquiries. While these 

limitations are prevalent in survey-based research, they underscore the necessity for 

triangulation with administrative health records or longitudinal data in future investigations. 

 

 

 

 

 

 



ECONOMIC BURDEN AND POLICY GAPS IN NONCOMMUNICABLE DISEASE 

MANAGEMENT IN GEORGIA: A HEALTH ECONOMICS PERSPECTIVE 

 

223 
 

Table 1. Overview of the Mixed-Methods Design 

Phase Description Key Output 

Literature 

Review 

Review of scientific articles, global and national 

NCD advocacy and economic impact 

frameworks 

Identified global themes and 

policy benchmarks 

FGDs 
5 focus groups with 55 participants in Tbilisi and 

regional centers 

Thematic insights on 

economic and social burden 

Survey 
Structured questionnaire to 197 NCD patients 

and caregivers (online and in-person) 

Quantitative evidence on 

financial and labor impact 

By integrating qualitative narratives and quantitative measurements, this methodology 

facilitated a comprehensive, multidimensional assessment of the economic and social impacts 

of NCDs in Georgia, thereby establishing a foundation for targeted health policy reforms. 

 

Literature Review  
According to the World Bank (2022), public health expenditure in Georgia remains 

below the regional average, with only approximately 2.7% of GDP allocated to healthcare, in 

contrast to the Eastern Europe and Central Asia regional average of 5%. The prevalence of 

high out-of-pocket payments, which constitute over 50% of health expenditures in Georgia, 

has been linked to financial hardship and decreased healthcare utilization among low-income 

households. The IMF (2022) underscores that underfunded health systems in LMICs frequently 

lead to fiscal inefficiencies and increased long-term costs due to delayed disease detection and 

unmanaged chronic illnesses (Cebotari et al., 2022). Moreover, investment in preventive NCD 

programs has demonstrated significant returns; estimates from the World Health Organization 

(WHO) suggest a return of USD 7 for every USD 1 invested in prevention-focused 

interventions. 

NCDs including cardiovascular disease, cancer, diabetes, and chronic respiratory 

illnesses, represent an escalating health and economic challenge in Georgia and other resource-

constrained countries. Evidence from Georgia indicates that the financial burden of managing 

chronic conditions is frequently prohibitive for individuals and places a significant strain on 

the healthcare system. A study on multiple sclerosis revealed that the annual direct medical 

costs exceeded $7,000 USD per patient receiving disease-modifying therapies, with 

medications constituting the primary cost driver (Gugutsidze et al., 2022). 

Furthermore, in cardiovascular care, quality improvement interventions in the Imereti 

region of Georgia—targeting both primary and secondary prevention—led to significant 

improvements in treatment adherence and outcomes. For instance, use of multi-drug therapy 

for secondary prevention of coronary artery disease increased from 6% to 91% in outpatient 

settings. The intervention also led to over $600,000 in savings by reducing unnecessary 

treatments and diagnostics (Chitashvili, 2015). 

Chronic respiratory diseases, such as COPD, are frequently underreported and likely 

underestimated in Georgia. A survey revealed that actual prevalence rates are five times higher 

than official statistics, indicating significant gaps in diagnosis and data collection (Chkhaidze 

et al., 2016). In resource-deficient countries, cardiovascular diseases represent one of the most 

substantial NCD-related costs. A global review indicated that the cost per episode of stroke or 

coronary heart disease can exceed $5,000, while even basic hypertension treatment averages 

$22 per month, which is disproportionately high relative to household incomes in many 

countries (Gheorghe et al., 2018). 

Similarly, diabetes presents an escalating financial challenge. While specific Georgian 

data on diabetes costs are limited, global models estimate that diabetes treatment and 

https://consensus.app/papers/rationale-for-improving-integrated-service-delivery-chitashvili/3c742dab12775a5a82f5734e62f91841/?utm_source=chatgpt


Nino MIKAVA, Simon GABRITCHIDZE 

224 
 

complications (e.g., kidney failure, cardiovascular events) substantially raise healthcare 

expenditures in LMICs. Indirect costs due to reduced productivity are often equal to or greater 

than direct medical costs, compounding the burden (Bloom et al., 2011). In Pakistan, for 

example, the economic burden of mental illness was found to be $4.3 billion annually, with 

59% attributed to lost productivity—a dynamic likely mirrored in other NCDs like diabetes 

and heart disease (Malik & Khan, 2016). 

In Georgia, the policy and legislative frameworks have encountered challenges in 

keeping pace with the escalating burden of NCDs. The existing health laws lack standardized 

definitions for essential terms such as medical malpractice and informed consent, resulting in 

ambiguity in the delivery of care and the protection of patient rights (Kiknadze & Beletsky, 

2013). Additionally, barriers persist in health financing and workforce structure. A study on 

mental health services identified inadequate funding mechanisms, geographic disparities in 

service availability, and significant out-of-pocket expenses for medications and transportation 

(Sulaberidze et al., 2018). These findings align with reports from the World Health 

Organization and the World Economic Forum, which highlight that weak primary healthcare 

and fragmented systems are central policy gaps in the NCD responses of resource-constrained 

countries (Bloom et al., 2011).  

To review comparative insights from regional Examining the management strategies 

for NCDs in resource-constrained countries and neighboring nations offers valuable insights 

into Georgia's healthcare landscape. For example, in Armenia, despite the accessibility of 

primary healthcare (PHC) facilities, utilization remains low, with only 4.1 visits per capita 

recorded in 2017. This underutilization is primarily due to concerns regarding the quality of 

care and associated costs. Furthermore, a substantial portion of healthcare financing is derived 

from out-of-pocket payments, resulting in fragmented funding and inefficiencies in service 

delivery (World Bank, 2024). Another country under review is Ukraine. Prior to the healthcare 

reforms initiated in 2017, Ukraine's system was characterized by high out-of-pocket expenses 

and inefficient hospital utilization. The reforms have sought to reduce dependence on hospital 

care, enhance PHC, and implement payment models that incentivize the effective use of 

resources (Swecare Foundation, 2022). 

NCDs are responsible for approximately 88% of annual deaths in Moldova. Efforts to 

address this significant health burden have included enhancing access to quality healthcare, 

reforming public health and primary healthcare (PHC), and improving health system financing. 

Despite these initiatives, challenges remain, particularly concerning the availability and quality 

of NCD services at the PHC level (Leon & Xu, 2023). In contrast, Estonia has implemented a 

comprehensive national strategy for cardiovascular disease prevention (2005–2020), which 

emphasizes risk factor management, health promotion, and the strengthening of PHC. These 

efforts have led to a substantial reduction in preventable mortality and serve as a model for 

integrating public health initiatives into national health plans (European Society of Cardiology, 

2020). 

The regional experiences highlight the critical importance of robust primary healthcare 

(PHC) systems, equitable financing mechanisms, and comprehensive national strategies in the 

effective management of NCDs. Georgia can derive valuable insights from these countries to 

guide its own healthcare reforms and policy development. Georgia's experience in managing 

NCDs such as cardiovascular disease, diabetes, and chronic respiratory illness mirrors broader 

trends observed in LMICs, characterized by a significant economic burden exacerbated by 

fragmented services and policy inertia. Nevertheless, evidence from both Georgia and other 

resource-constrained countries indicates that low-cost, evidence-based interventions and 

integrated care models can reduce costs and improve outcomes. To address these challenges, 

Georgia must strengthen legal frameworks, enhance financing strategies, and expand integrated 

prevention and treatment programs nationwide. 

https://consensus.app/papers/from-burden-to-best-buys-reducing-the-economic-impact-of-bloom-chisholm/19b26f3b54ae554ba201a13bd2e41899/?utm_source=chatgpt
https://consensus.app/papers/economic-burden-of-mental-illnesses-in-pakistan-malik-khan/76c0dae129ca54609cd62d266b208748/?utm_source=chatgpt


ECONOMIC BURDEN AND POLICY GAPS IN NONCOMMUNICABLE DISEASE 

MANAGEMENT IN GEORGIA: A HEALTH ECONOMICS PERSPECTIVE 

 

225 
 

Results  
Qualitative Findings: Key Challenges Faced by Patients with NCDs in Georgia  

Focus group discussions (FGDs) involving 55 participants elucidated a wide array of 

challenges encountered by individuals living with NCDs and their caregivers in Georgia. 

Several core themes emerged from the discussions. The foremost theme is stigma and 

discrimination. Participants reported pervasive stigma associated with obesity, diabetes, and 

cancer, manifesting in public, healthcare, and workplace environments. Notably, weight-

related stigma, misinformation regarding diabetes, and discrimination against cancer 

survivors—such as perceptions of their incapacity to work and employers and coworkers 

questioning their productivity—were particularly prevalent. Elderly patients were frequently 

perceived as burdens within healthcare facilities, and children with type-1 diabetes experienced 

bullying in school settings. The resultant social exclusion and emotional distress deterred many 

from seeking essential medical care. 

Another key challenge was - psychological and emotional burden. Patients frequently 

experienced emotional distress, including anxiety, depression, low motivation, and emotional 

eating behaviors. Cancer patients and caregivers reported limited access to mental health 

services and a lack of psycho-oncology support. Psychological care was virtually inaccessible 

in rural areas, and there was a widespread need for structured mental health integration within 

NCD care. 

Furthermore, geographic disparities in care access were widely reported, particularly in 

rural areas, where patients struggled to consult specialists like endocrinologists and 

cardiologists. Long waiting times, absence of local rehabilitation services, and a lack of 

structured follow-up care for post-operative and oncology patients were noted. Rehabilitation 

services for stroke, bariatric surgery, or cancer were especially scarce. 

Financial constraints were still another challenge regarding NCD management. 

Respondents frequently cited the high cost of diagnostics, medications, and rehabilitation 

services as barriers to continuous care. Out-of-pocket expenses for obesity, diabetes, and cancer 

treatments were often prohibitive. State-funded programs covered only a fraction of necessary 

interventions, and patients with low income were often forced to forgo treatments. Nutritional 

supplements, physiotherapy, and psychological support remained unaffordable for many. 

Distrust in healthcare providers was underscored by the respondents. Patients expressed 

skepticism about the effectiveness and empathy of healthcare professionals. Many reported 

generic, non-individualized treatment plans and poor communication. The perception of 

healthcare providers as dismissive or judgmental—especially towards obese patients—

contributed to a lack of engagement in care. 

Moreover, Georgia lacks peer support groups or patient advocacy platforms for 

individuals with NCDs. Many respondents expressed the need for environments where patients 

could share experiences, build motivation, and advocate for tailored policies. While online 

platforms exist, they are often commercialized and ineffective. 

One of the major problems in NCDs management in Georgia is a lack of 

multidisciplinary and holistic care. Respondents strongly emphasized the need for integrated 

care models involving nutritionists, psychologists, and physical activity experts. Patients often 

had to coordinate their care independently, and post-treatment rehabilitation was seldom 

available. School environments were reported as unsupportive of children with special dietary 

needs due to obesity or type-1 diabetes. 

Similarly, low public awareness and a lack of accessible screenings contributed to 

delayed diagnoses and late-stage interventions, particularly for cancers and cardiovascular 

conditions. Preventive health education in schools and public campaigns were largely absent. 

Barriers to healthy living included the high cost of nutritious food and fitness services. 



Nino MIKAVA, Simon GABRITCHIDZE 

226 
 

The qualitative analysis underscores the systemic, economic, and psychosocial burdens 

experienced by patients with NCDs in Georgia. These insights provide a foundation for 

evidence-based policy recommendations aimed at fostering equitable, person-centered, and 

economically sustainable NCD care. 

 

Quantitative Findings: 

To evaluate a degree of impact and importance of identified challenges and needs in 

the literature review and focus-group discussions, patients with NCDs and/or caregivers were 

surveyed using structured questionnaire. This article presents an analysis of survey data 

collected from 197 respondents, focusing on chronic diseases, healthcare challenges, and 

public perceptions regarding treatment accessibility and caregiving. The insights are based on 

demographic details, healthcare barriers, and disease types. 

To review main aspects of the demographics, gender distribution shows a mix of male 

and female participants, where 67% of them were female and 33% - male. The median age of 

respondents is 59 years, indicating that a majority of participants are from middle-aged and 

older populations (minimum age- 22 years; Maximum age -90 years; Standard Deviation – 

13.25 years). Among respondents of the survey, 75% were individuals having one or more 

NCD and 25% were caregivers of the chronic patients (Table 2). 

 

Table 2. Participants’ demographics table 

Variable Category Percentage (%) 

Gender Female 67% 

 Male 33% 

Age (Mean: 59, SD: 13.25) 22–39 14% 

 40–59 39% 

 60+ 47% 

Residence Tbilisi 27% 

 Imereti 22% 

 Shida Kartli 14% 

 Samegrelo-Zemo Svaneti 10% 

 Kvemo Kartli and other regions 27% 

Status Person living with NCD(s) 75% 

 Caregiver of person with NCD 25% 

Ethnicity Georgian 93% 

 Armenian 3% 

 Azerbaijanian 3% 

 Ossetian 1% 

Survey participants identified several areas of health protection and promotion that 

receive inadequate attention from national authorities. The most commonly cited issues 

include: 

1. Early Disease Prevention and Healthcare Access 



ECONOMIC BURDEN AND POLICY GAPS IN NONCOMMUNICABLE DISEASE 

MANAGEMENT IN GEORGIA: A HEALTH ECONOMICS PERSPECTIVE 

 

227 
 

o Limited early screening programs 

o Geographic disparities in access, especially in rural areas like Javakheti 

o Shortage of specialists for complex conditions 

o Inadequate support for people with disabilities 

2. Neglect of Healthy Lifestyle Promotion 

o Inadequate promotion of healthy diets and exercise among children 

o Widespread availability and advertising of unhealthy foods and beverages 

o Absence of structured programs for encouraging lifelong healthy behaviors 

3. Poverty and Health Inequities 

o Recognition of poverty as a root cause of chronic illness 

o Lack of national strategies to mitigate the health consequences of poverty 

4. Demand for Stricter Regulations 

o Public support for banning energy drinks, tobacco, and alcohol for youth 

o Calls to enhance safety and infrastructure for walking and cycling 

5. Overall Neglect of Public Health 

o Respondents perceive a lack of political will and priority given to prevention 

o Infrequent or ineffective public health campaigns (Diagram #1 & Diagram #2) 

 
Diagram 1. Health protection and promotion issues not receiving adequate attention from 

national decision-makers. 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Diagram 2. Challenges related to receiving care and support for the patients with NCDs. 



Nino MIKAVA, Simon GABRITCHIDZE 

228 
 

It needs to be emphasized, that - when asked if their NCDs could be prevented at earlier 

stage- 71% of respondents gave positive answer (Diagram #3).  

Those participants who answered, that NCDs would have been possible to prevent, 

were asked further to select reason for not seeking medical care earlier. Financial difficulties, 

as a reason for seeking medical care late, when NCD had already worsened – was chosen by 

36% of respondents; 17% selected option – “Due to travel difficulties and long distances, I 

sought medical care late, when my NCD had already worsened”; 15% answered – “I have little 

trust in my local family doctor and medical facility, so I delayed seeking medical help in other 

cities until my disease had already progressed” and 32% answered “Other”. It should be 

emphasized that common topics in the comments of respondents, while explaining “other 

reasons” for not seeking medical care earlier were – lack of education about these conditions / 

low health literacy and lack of qualification of local, regional doctors (Diagram #4): 

 
Diagram 3. Respondents’ views regarding possibility of prevention of NCDs. 

 

 
Diagram 4. Reasons why prevention of NCDs was not possible 



ECONOMIC BURDEN AND POLICY GAPS IN NONCOMMUNICABLE DISEASE 

MANAGEMENT IN GEORGIA: A HEALTH ECONOMICS PERSPECTIVE 

 

229 
 

 

Another topic of inquiry was public engagement in reducing NCD burden.  
Participants were also asked how they would like to be involved in NCD prevention 

and care efforts. According to the results, 61% would share experiences with peers; 41% 

supported engaging in discussions with policymakers; 21% - favored contributing to awareness 

with healthcare providers and community organizations and 20% proposed founding new peer 

support networks (Diagram 5). 

When asked what they needed to become more engaged in community-level NCD 

response, top responses included access to reliable information, support platforms, 

opportunities to connect with others, and structured engagement mechanisms. 

 
Diagram 5. Opinions of respondents how they would become more actively involved in 

reducing the negative impact of NCDs in the country. 

 

Diagram 6. Challenges related to caring for individuals living with NCDs. 

 

To review caregiving challenges for patients with NCDs. Caregivers reported a broad 

array of difficulties related to providing care for individuals with NCDs.  



Nino MIKAVA, Simon GABRITCHIDZE 

230 
 

The top-rated challenges were - financial burden, burnout, and transportation logistics. 

Additional concerns included: 

o High cost and difficulty of hiring professional caregivers 

o Inflexible workplace policies 

o Caregivers quitting jobs to provide full-time support 

o Lack of caregiver training and resources 

o Emotional exhaustion and mental health strain 

o Perceived indifference and dismissiveness from healthcare providers (Diagram 6). 

 

Furthermore, when asked which caregiver-related issues were most neglected by 

government policy - 62% highlighted the lack of caregiver training, consultation, and 

informational support; 57% of the respondents called for better access to respite care; 42% 

demanded protected leave policies and 29% emphasized the need for accessible infrastructure 

and transport for disabled individuals (Diagram 7). 

Diagram 7. Issues related to the role of caregivers for individuals with NCDs do not receiving 

adequate attention from national decision-makers. 

 

These responses confirm that caregivers, like patients, face systemic, emotional, and 

financial burdens—and are currently underserved in Georgia’s NCD response framework. 

Together, these findings further illustrate the broad scope of challenges faced by NCD patients 

and caregivers, emphasizing the urgent need for equity-based, multi-level health system 

reform.  

 

Discussions  
Studies in comparable resource-constrained countries have shown that investments in 

NCD prevention and primary care yield high returns on investment (ROI). For example, the 

WHO estimates that every dollar invested in strategic NCD interventions generates a return of 

at least seven dollars in economic benefits due to avoided treatment costs and productivity 

losses. A cost-effectiveness analysis from India demonstrated that community-based 

hypertension and diabetes screening programs saved $2–3 for every $1 spent by reducing 



ECONOMIC BURDEN AND POLICY GAPS IN NONCOMMUNICABLE DISEASE 

MANAGEMENT IN GEORGIA: A HEALTH ECONOMICS PERSPECTIVE 

 

231 
 

complications and hospitalizations. Similar outcomes were observed in Mexico and Kenya, 

where front-loaded investments in lifestyle interventions led to reductions in future healthcare 

expenditures and improved workforce stability. 

In Georgia’s context, delayed detection of NCDs and limited access to affordable care 

increase reliance on high-cost hospital services, which are financially unsustainable and less 

effective. This inefficiency in spending not only affects individual health outcomes but also 

places a long-term fiscal burden on the national healthcare budget. 

From a macroeconomic perspective, failure to address NCDs effectively could have 

severe implications for national development. Chronic illnesses disproportionately affect 

working-age adults, leading to increased absenteeism, early retirement, and reduced labor 

market participation. This trend can undermine Georgia’s human capital, decrease 

productivity, and reduce tax revenue, thereby slowing economic growth. Additionally, 

households facing catastrophic health expenditures are at greater risk of falling into poverty, 

further exacerbating socioeconomic disparities and weakening the consumer base needed for 

domestic economic resilience. 

While this study does not calculate precise monetary figures for indirect costs, it does 

identify and contextualize them within the framework of health economics. For example, 

survey data revealed that many caregivers—especially women—reported job loss, reduced 

working hours, or inability to work due to caregiving responsibilities. These effects translate 

into significant productivity losses at the household and national level. Additionally, delays in 

seeking care due to cost or travel costs increase the long-term economic burden of NCDs 

through complications and hospitalizations that could have been prevented. 

The findings of this study illuminate a significant economic load and structural 

inefficiencies within Georgia’s response to NCDs, resonating with broader concerns in health 

economics and public finance. The combination of inadequate funding for outpatient and 

preventive care, inequitable access to services, and high out-of-pocket expenditures 

underscores the urgent need for more cost-effective health system designs. These issues 

directly impact economic productivity, with working-age individuals and caregivers bearing 

financial and psychological strain that translates to lost labor hours and reduced workforce 

participation. 

According to World Bank data, Georgia’s public expenditure on health stood at 

approximately 2.7% of GDP in recent years, which is below the average for Eastern Europe 

and Central Asia, whereas OECD countries spend an average of around 8.8% of GDP on 

healthcare, according to OECD Health Statistics (2022). This underinvestment is reflected in 

gaps in primary care, prevention, and chronic disease management—areas critical to NCD 

control. Additionally, over 50% of health expenditures in Georgia come from out-of-pocket 

payments, posing a substantial financial burden on households and leading to care delays or 

avoidance. The disproportionate burden on low-income and rural populations reflects not only 

health disparities but also economic exclusion—hindering equitable economic growth. 

Investment in early detection, preventive health education, and the integration of cost-

effective digital tools like telemedicine and remote monitoring are not merely health-sector 

improvements but economic imperatives. International evidence shows that investing in 

prevention and chronic care coordination can reduce long-term healthcare costs and enhance 

human capital outcomes. Georgia’s current underinvestment in such services is a missed 

opportunity to mitigate future fiscal strain and social costs. 

Moreover, the study’s findings on the invisibility of caregivers within national policy 

echo economic studies highlighting unpaid labor's hidden contribution to healthcare and 

welfare systems. Providing financial and legal support to informal caregivers not only 



Nino MIKAVA, Simon GABRITCHIDZE 

232 
 

addresses social justice concerns but also strengthens labor market resilience by reducing 

premature workforce exit, especially among women. 

The observed lack of patient and caregiver inclusion in policymaking also reflects a 

governance deficit with economic implications. Stakeholder engagement in healthcare 

decision-making is associated with higher system efficiency, improved outcomes, and greater 

social return on investment. 

Ultimately, the Georgian case demonstrates the need for a comprehensive economic 

strategy that integrates health sector reform with broader social protection, gender equity, and 

labor policy. Such an approach would move beyond siloed budgeting to a model where health 

investment is seen as a lever for national productivity and inclusive growth. 

 

Conclusions and Policy Recommendations 

Present study highlights the complex and interrelated challenges faced by individuals 

living with NCDs and their caregivers, in Georgia. Key issues identified include inadequate 

healthcare access, systemic inefficiencies, high financial burden, stigma and discrimination, 

lack of psychological support, and insufficient caregiver assistance. 

Healthcare Accessibility and Infrastructure problems are one of the central findings. 

Patients—especially in rural areas—face prolonged waiting times and limited access to 

specialized care. Rehabilitation services for post-treatment recovery are underdeveloped, and 

the absence of a multidisciplinary approach results in fragmented and ineffective care 

pathways. 

Financial Barriers should be emphasized as key challenge hindering seeking earlier care 

and prevention for the individuals living with NCDs. State health programs provide limited 

coverage for medications, diagnostics, and post-treatment support. Many patients face 

prohibitive out-of-pocket costs that delay or prevent access to timely care. Preventive services 

are similarly underfunded, deterring early intervention. 

Widespread Social and Mental Health stigma, especially for obesity, cancer, and 

diabetes, impairs treatment-seeking behavior and worsens mental health outcomes. 

Psychological services are largely inaccessible, particularly in non-urban settings. 

Lack of Prevention and Education is a common cause of delayed diagnosis. Poor public 

awareness and low engagement with preventive health services emerged as major barrier for 

the prevention and early treatment of NCDs. Schools and workplaces lack robust health 

promotion programs. To reduce long-term economic strain and prevent avoidable mortality, 

Georgia must prioritize equitable funding mechanisms and scalable preventive services at the 

PHC level. 

Caregivers face emotional exhaustion, job loss, and lack of formal support mechanisms. 

Protected/paid caregiver leaves, financial aid, and respite services are currently absent from 

policy frameworks. 

Exclusion from Policy Making. There is little to no formal involvement of patients or 

caregivers in the creation of health policies. Peer support networks and advocacy groups are 

scarce, limiting public engagement. 

According to the revealed challenges and situational analysis, as well as on the basis of 

reviewed best practices, Policy Recommendations are as follows: 

In order to enhance healthcare access and infrastructure - expansion of telemedicine 

services is highly recommended, as well as, implementing structured follow-up and 

rehabilitation plans. 

Financial Support needs to be strengthened. Broadening state coverage of diagnostics, 

medications, and rehabilitation, provision of subsidies for lifestyle interventions and healthy 

food and creation of financial aid programs for low-income patients and caregivers is advised. 



ECONOMIC BURDEN AND POLICY GAPS IN NONCOMMUNICABLE DISEASE 

MANAGEMENT IN GEORGIA: A HEALTH ECONOMICS PERSPECTIVE 

 

233 
 

To Combat Stigma and Expand Mental Health Support, launching national campaigns 

is recommended, to normalize NCDs and reduce stigma. Moreover, it is crucial to train 

healthcare providers in empathy and patient-centered care and to integrate psycho-oncology 

and general psychological counseling into NCD programs. 

For the purpose of improving Preventive Healthcare, national health education and 

early screening campaigns need further promotion. Furthermore, to enforce regulations on 

alcohol, tobacco, and unhealthy food marketing and to incorporate NCD education into school 

curricula should be considered. 

To Support Caregivers, introducing respite care services, and policies for paid caregiver 

leave should be thought. Moreover, workplace flexibility and provision of caregiver training 

and informational support are strongly recommended. 

Still another important area of focus is Facilitation of Patient Advocacy and 

Participation. For this purpose, creating formal mechanisms for patients and caregivers to shape 

policy and to support the development of peer-led support and advocacy groups should be 

considered, ensuring the inclusion of individuals with lived experiences in national planning. 

 

Table 3. Summary of key challenges, impacts and recommended policy responses for NCD 

management in Georgia 

Challenge Observed Impact Policy Recommendation 

High out-of-pocket 

(OOP) 

expenditures 

Delayed care-seeking; financial 

hardship; increased disease burden 

Expand state insurance coverage; 

subsidize essential NCD 

medications 

Rural access gaps 
Inequitable access to diagnosis and 

treatment; geographic disparities 

Strengthen PHC infrastructure in 

rural areas; deploy 

mobile/telemedicine units 

Weak preventive 

service delivery 

Late-stage disease detection; 

avoidable complications 

Integrate NCD screening into 

routine PHC; fund public awareness 

campaigns 

Caregiver burden 

and lack of 

protections 

Income loss, burnout, 

informal/uncompensated care 

Introduce caregiver leave policies 

and social protection mechanisms 

Fragmented health 

information 

systems 

Poor continuity of care; 

inefficiencies in tracking and 

planning 

Implement interoperable electronic 

health records (EHR) systems 

Low provider 

incentives for 

prevention 

Overemphasis on treatment rather 

than prevention 

Reform provider payment models 

to reward preventive care and early 

intervention 

 

To enhance strategic planning and resource allocation, the following recommendations 

were analyzed and organized by timeframe and scope: short-term vs. long-term and low-cost 

vs. systemic reform. 

Short-Term and Low-Cost Recommendations consist of: 

o Launching national awareness campaigns to reduce stigma and promote early detection. 

o Training healthcare providers in delivering empathetic, patient-centered care. 

o Providing informational support and virtual peer platforms for patients and caregivers. 

o Expansion of telemedicine services, particularly for rural communities. 

o Strengthen school-based health education and prevention programs. 



Nino MIKAVA, Simon GABRITCHIDZE 

234 
 

The following three reforms were prioritized based on their scope of feasibility and 

immediate impact: 

1. Increasing funding for outpatient care and essential medications, particularly targeting 

low-income and rural populations; 

2. Establishing structured caregiver support programs to address growing informal care 

burdens; 

3. Expansion of telemedicine and digital health services to bridge access gaps and 

improve cost-efficiency. 

Moreover, other recommendations concerning Medium to Long-Term Systemic Reforms 

include: 

o Investing in rehabilitation services and multidisciplinary chronic disease management 

centers 

o Formalizing patient and caregiver inclusion in policy development and health 

governance 

o Implementing national NCD prevention and care strategy with integrated financing 

mechanisms 

o Developing national NCD registry and digital health information system to enable 

better surveillance, outcome tracking, and policy evaluation. Robust data infrastructure 

is critical for designing effective interventions, monitoring program performance, and 

informing equitable health financing decisions. 

By implementing these recommendations, Georgia can strengthen its response to the 

growing burden of NCDs, enhance system-wide efficiency, and significantly improve the 

health and wellbeing of patients and caregivers. 

 

REFERENCES 
1. Antia, N., Berg, C. J., Sturua, L., Gagnidze, N., Lomidze, G., & Goodman, M. (2022). Research 

capacity training on environmental health and noncommunicable diseases in the country of 

Georgia: Challenges and lessons learned during the COVID-19 pandemic. International 

Journal of Environmental Research and Public Health, 19(13), 8154. 

https://doi.org/10.3390/ijerph19138154 

2. Bloom, D. E., Cafiero, E. T., Jané-Llopis, E., Abrahams-Gessel, S., Bloom, L. R., Fathima, S., 

& Weiss, J. (2011). The global economic burden of noncommunicable diseases. World 

Economic Forum. https://www.weforum.org 

3. Cebotari, A., Garrido, L., Kangur, A., Tiffin, A., & Vtyurina, S. (2022). Financing vaccine 

equity: Funding for day zero of the next pandemic (IMF Working Paper No. 2022/099). 

International Monetary Fund. https://www.imf.org/-

/media/Files/Publications/WP/2022/English/wpiea2022099-print-pdf.ashx 

4. Chkhaidze, I., Maglakelidze, T., & Mirtskhulava, V. (2016). Chronic respiratory diseases at 

primary health care level in Georgia: Results of survey and spirometry testing. Public Health 

of Georgia, 3(1), 20–25. 

5. Chitashvili, T. (2015). Rationale for improving integrated service delivery: reduced cost and 

improved care in Georgia / Justificación de la mejora en la prestación de servicios integrados: 

reducción de costos y mejora en la atención en Georgia. International Journal of Integrated 

Care,15. https://doi.org/10.5334/IJIC.2333. 

6. European Society of Cardiology. (2020). EAPC Country of the Month – Estonia. Retrieved 

from https://www.escardio.org/Sub-specialty-communities/European-Association-of-

Preventive-Cardiology-(EAPC)/Advocacy/Prevention-in-your-country/Country-of-the-

Month-Estonia 

7. Ferranna, M., Cadarette, D., Varghese, B., & Bloom, D. E. (2023). The macroeconomic burden 

of noncommunicable diseases and mental health conditions in South America: A modelling 

study. PLOS ONE, 18(6), e0285267. https://doi.org/10.1371/journal.pone.0285267 

https://www.weforum.org/
https://doi.org/10.5334/IJIC.2333
https://www.escardio.org/Sub-specialty-communities/European-Association-of-Preventive-Cardiology-%28EAPC%29/Advocacy/Prevention-in-your-country/Country-of-the-Month-Estonia
https://www.escardio.org/Sub-specialty-communities/European-Association-of-Preventive-Cardiology-%28EAPC%29/Advocacy/Prevention-in-your-country/Country-of-the-Month-Estonia
https://www.escardio.org/Sub-specialty-communities/European-Association-of-Preventive-Cardiology-%28EAPC%29/Advocacy/Prevention-in-your-country/Country-of-the-Month-Estonia


ECONOMIC BURDEN AND POLICY GAPS IN NONCOMMUNICABLE DISEASE 

MANAGEMENT IN GEORGIA: A HEALTH ECONOMICS PERSPECTIVE 

 

235 
 

8. Gheorghe, A., Griffiths, U., Murphy, A., Legido-Quigley, H., Lamptey, P., & Perel, P. (2018). 

The economic burden of cardiovascular disease and hypertension in low- and middle-income 

countries: A systematic review. BMC Public Health, 18, 975. https://doi.org/10.1186/s12889-

018-5806-x 

9. Gotsadze, G., Tang, W., Shengelia, N., & Zoidze, A. (2017). Determinants analysis of 

outpatient service utilisation in Georgia: Can the approach help inform benefit package design? 

Health Research Policy and Systems, 15, Article 36. https://doi.org/10.1186/s12961-017-0197-

5 

10. Gugutsidze, T., Gigineishvili, D., & Kutateladze, T. (2022). Economic burden of multiple 

sclerosis in Georgia. Health Economics and Policy, 4(1), 55–64. 

11. Kalra, S., Verma, M., & Sahay, R. (2023). The 5A model for non-communicable disease 

advocacy. JPMA: The Journal of the Pakistan Medical Association, 73(5), 1132–1133. 

https://doi.org/10.47391/jpma.23-35 

12. Kiknadze, N., & Beletsky, L. (2013). Overview of the gaps in the health care legislation in 

Georgia. Georgian Journal of Public Health Policy, 2(1), 14–19. 

https://consensus.app/papers/overview-of-the-gaps-in-the-health-care-legislation-in-kiknadze-

beletsky/3d4868e3770e5beabdc74487beb707ae/?utm_source=chatgpt 

13. Leon, N., & Xu, H. (2023). Implementation considerations for non-communicable disease-

related integration in primary health care: a rapid review of qualitative evidence. BMC Health 

Services Research, 23, 169. https://doi.org/10.1186/s12913-023-09151-x 

14. Lomia, N., Berdzuli, N., Pestvenidze, E., Sturua, L., Sharashidze, N., Kereselidze, M., & Stray-

Pedersen, A. (2020). Socio-demographic determinants of mortality from chronic 

noncommunicable diseases in women of reproductive age in the Republic of Georgia: Evidence 

from the National Reproductive Age Mortality Study (2014). International Journal of Women’s 

Health, 12, 89–105. https://doi.org/10.2147/IJWH.S235755 

15. Malik, M. A., & Khan, M. M. (2016). Economic burden of mental illnesses in Pakistan. Journal 

of Mental Health Policy and Economics, 19(4), 193–200.  

16. Organisation for Economic Co-operation and Development (OECD). (2022). OECD Health 

Statistics 2022. OECD Publishing. Retrieved from 

https://www.oecd.org/en/data/datasets/oecd-health-statistics.html 

17. Patel, V., & Chatterji, S. (2015). Integrating mental health in care for noncommunicable 

diseases: An imperative for person-centered care. Health Affairs, 34(9), 1498–1505. 

https://doi.org/10.1377/hlthaff.2015.0791 

18. Russell, S., Sturua, L., Li, C., Morgan, J., Topuridze, M., Blanton, C., Hagan, L., & Salyer, S. 

(2019). The burden of non-communicable diseases and their related risk factors in the country 

of Georgia, 2015. BMC Public Health, 19, Article 6785. https://doi.org/10.1186/s12889-019-

6785-2 

19. Sulaberidze, L., Green, J., Chikovani, I., Uchaneishvili, M., & Gotsadze, G. (2018). Barriers to 

delivering mental health services in Georgia: A qualitative study. BMC Health Services 

Research, 18, 350. https://doi.org/10.1186/s12913-018-3161-2 

20. Swecare Foundation. (2022). The digital transformation of healthcare – Health by Sweden. 

Stockholm: Swecare. https://www.swecare.se/healthbysweden/the-digital-transformation-of-

healthcare/ 

21. World Bank. (2022). Georgia Human Capital Review. Washington, DC: World Bank Group. 

https://documents1.worldbank.org/curated/en/099435008172221325/pdf/P1735300c417d202

6096d50dd8d8218cd90.pdf 

22. World Health Organization. (2024). Progress on the prevention and control of non-

communicable diseases and the promotion of mental health and well-being: Report of the 

Secretary-General. United Nations General Assembly Document A/79/762. 

https://cdn.who.int/media/docs/default-source/ncds/unsg-report-on-ncds-2025.pdf 

 

 

 

https://doi.org/10.1186/s12889-018-5806-x
https://doi.org/10.1186/s12889-018-5806-x
https://consensus.app/papers/overview-of-the-gaps-in-the-health-care-legislation-in-kiknadze-beletsky/3d4868e3770e5beabdc74487beb707ae/?utm_source=chatgpt
https://consensus.app/papers/overview-of-the-gaps-in-the-health-care-legislation-in-kiknadze-beletsky/3d4868e3770e5beabdc74487beb707ae/?utm_source=chatgpt
https://doi.org/10.1186/s12913-023-09151-x
https://www.oecd.org/en/data/datasets/oecd-health-statistics.html
https://doi.org/10.1186/s12913-018-3161-2
https://documents1.worldbank.org/curated/en/099435008172221325/pdf/P1735300c417d2026096d50dd8d8218cd90.pdf
https://documents1.worldbank.org/curated/en/099435008172221325/pdf/P1735300c417d2026096d50dd8d8218cd90.pdf
https://cdn.who.int/media/docs/default-source/ncds/unsg-report-on-ncds-2025.pdf

