Report on Conditions in Psychiatric Establishments in Georgia On the other hand, having finished short-term treatment course the patient may be moved in a long-term unit or other establishment without considering such re-placement as re-hospitalization. As stated by several directors, the establishments are manipulating with these artificial practices so to avoid sanctions of State Regulation Agency. As identified during the monitoring process, the funds allocated for one patient are not enough to cover expenses for somatic diseases management and purchase of means of hygiene. This is a rather serious issue especially in relation to patients whose family members or relatives cannot provide them with such treatment or items (the majority of chronic patients who actually live in the hospital face this problem). The problem is aggravated by the shortage of finances especially compared to short-term treatment. As a result of financing problems the establishments cannot afford hiring duly qualified personnel that affects the quality of patient treatment and care. In addition to that, the directors state that financing allocated for long-term medical treatment does not correspond with the needs of such patients. One director even told the Monitoring Group that he did not intend to participate in the next tender for placing disabled persons, as allocated government funds were not adequate to comply with the requirements of the Ministry of Labour, Health and Social Affairs. As noted by one of the directors, psychiatric program provides for patient/case-based financing. The Program precisely defines the items to be subjected to financing; it depends entirely upon good will of the financing authority to decide whether expenses were reasonable or not. For instance, the Program does not provide for financing neither for treatment of somatic diseases nor for the means of hygiene and clothes. Directors mention that despite the real needs of patients they cannot spend more funds than allocated, since, if they do so, the expenses won’t be reimbursed by the state notwithstanding reasonability of such expenditure. As stated by one of the directors, they refrain from openly discussing gaps and insufficiency of financing, as in such case they are considered to be bad managers unable to use funds appropriately and therefore they avoid raising this issue. There is one additional element not covered by voucher-linked (case-based) financing – refurbishment and rehabilitation works. This is a concern basically for old establishments; however the representatives of new ones also noted that even reimbursing expenses for basic refurbishment works is a problematic issue. Such an approach, first of all, adversely affects the patients’ interests, as only placement, food and psychotropic expenses are covered by the Psychiatric Assistance Program. The Program does not address other necessary expenses, especially for long-term patients. As stated by administrations, the quality of medicaments is no longer a priority. While observing state procurement rules the establishment have to purchase cheap (Indian) medicaments which, as the majority of doctors note, are not efficient due to the lack of active substances in the medicines.54 Accordingly such medicines are prescribed in bigger dosage and have adverse effects on patients’ health. As stated by the administration member of Rustavi establishment, despite their view on necessity of specific medicaments they are not entitled to purchase any medicament not included in the special prescribed list. While asked who makes such lists, the director was not able to answer the question. Directors informed the Monitoring Group that the Ministry of Labour, Health and Social Affairs plans to introduce obligatory rehabilitation services in every hospital, although financing of such services is not incorporated into financial plans. Nobody understands how this requirement might be implemented. 54 As a director clarified usage of low-quality medicament is directly linked with the decision of 2007 requiring Medicines Agency to use conclusions of drug-store net laboratories instead of independent laboratories for licensing medicines. NPM Report 2012 Furthermore, the majority of directors stated that the operation of psychiatric establishments has been burdened by the applicability of Law of Georgia on State Procurement since April 2010.