National Preventive Mechanism Medical service is provided by private insurance companies according to territorial principle, within the limits of insurance policies. The packages of different insurance companies are almost identical; They fail to take into account the age-related aspects of diseases, possible special needs of children with such common diagnoses as hydrocephaly, pediatric cerebral palsy, management and rehabilitation of its secondary condition, and different inborn defects and abnormalities. At the time of the monitoring, several beneficiaries of the Tbilisi Infant House, including a brother and a sister diagnosed with diabetes mellitus and Down’s syndrome, did not have an insurance policy, despite several requests. For almost a month and a half, it was impossible to provide them with insurance policies, despite the fact that notifications were made upon their admission to the Infant House (4/05/2012). Insurance packages often fail to meet the health needs of beneficiaries of infant houses. There were cases when children diagnosed with pneumonia were transferred from the Tbilisi Infant House to a hospital to provide them with inpatient treatment. The Forms #100140 indicated that the children required a consultation of a neurosurgeon and an otolaryngologist, which was possible to provide in the same pediatric clinic (in which the children were hospitalized to receive treatment for pneumonia), though the children were returned from the clinic without providing them with the consultation, because the code of the illness (primary illness) did not envisage the aforementioned types of consultation. There are also cases when as soon as the sum covered by the code of the concrete disease is spent, children are returned to the Tbilisi Infant House, which has no resources to invite narrow specialists and provide consultations. The pediatrician of the Tbilisi Infant House has to address the insurance company again to substantiate the need of an examination or a consultation. Due to this, the process of setting a diagnosis and providing corresponding medical assistance gets protracted. Children with Hydrocephaly 141 – Lifespan Determined by Infant House In his speech given on June 11, 2010, Regional Representative of the UN High Commissioner for Human Rights, Jan Jařab, noted: “Children born with spina bifida [spinal hernia] or hydrocephaly are human beings and they have human rights. If properly treated, a human being born with spina bifida should not develop hydrocephaly at all. We should never see images of small children with enormous heads who have become blind and intellectually impaired; children who suffer terrible pain before they die a slow, excruciating death, because they do not receive adequate treatment.” 142 It is still very important location, where such a child is born. In some countries, doctors advise parents to leave their child in a children’s home immediately, because such a child has no future – due to non-performance of surgical intervention at a.b) Electrocardiographic, echoscopic, and X ray examinations, and laboratory and instrumental examinations connected with planned surgery hospitalization based on a doctor’s prescription; a.c) Clinical-laboratory outpatient examinations with a doctor’s prescription: general blood test, general urine test and creatinine, peripheral blood glucose, pregnancy test, hemoglobin, analysis of faeces for concealed bleeding; a.d) Examinations required for the social assessment of persons with disabilities, specifically, examinations required for the assignment of the disability status, expect for highly technological examinations (computer tomography and nuclear magnetic resonance examinations); a.e) Issuance of all types of medical certificates and prescriptions at the outpatient level (except for Form NIV-100/A connected with starting a job, a driver’s license in LEPL Service Agency of the MIA, and certificates required for receiving the right to keep/bear arms); b) Reimbursement of expenses of inpatient services: b.a) Urgent inpatient services, including hospitalization connected with complicated pregnancy, childbirth, and post-natal period; b.b) Planned surgeries (including daytime inpatient unit) – annual insurance limit – GEL 15,000; b.c) Expenses of chemotherapy and radiation therapy – annual insurance limit – GEL 12,000; c) Expenses connected with childbirth – GEL 400; d) Expenses of medical products – according to the list of medical products. The insurer shall reimburse these expenses within the annual insurance limit of the policy, GEL 50, with a 50% co-payment, while from September 1, 2012, for women aged 60 and above and men aged 65 and above (population of pension age) as determined by Paragraphs a and a1 of the terms of the voucher, the annual insurance limit shall be set at GEL 200, with a 50% co-payment. 140 A health certificate 141 Hydrocephaly –a medical condition in which there is an abnormal accumulation of cerebrospinal fluid in the cavity of the brain 142 http://www.europe.ohchr.org/Documents/Speeches/RightsForPersonsWithSpinaBifida.pdf www.ombudsman.ge NPM Report