Partial democratization and healthcare reforms in a hybrid regime: the case of Georgia

ABSTRACT

Democratization is often said to direct rulers’ attention to social services. Yet how strong is this relationship in countries that had to restructure previously universalistic but financially unsustainable welfare systems, such as the post-communist states following the collapse of the Soviet bloc? And what if political change stops short of full democratization leading to hybrid regimes in which elements of competitive politics and authoritarianism coexist? To address these questions, we analyse health care reforms in post-communist Georgia. We posit that, even when authoritarianism is not fully eradicated, elections and a partial liberalization of the political arena could elicit rulers’ responsiveness to social needs. The research highlights that the progress in political competition that followed the 2003 Rose Revolution has not made Georgia fully democratic, but has nonetheless shaped the health policy approach of the two successive governments, favouring a reconciliation between financial sustainability and citizen accessibility.

KEYWORDS:

• Democratization
• hybrid regimes
• competitive authoritarianism
• healthcare
• Georgia

Disclosure statement

No potential conflict of interest was reported by the author(s).

Notes

1. To be sure, healthcare is only one component of the welfare state, but arguably an important one. Access to health services has direct and concrete consequences on citizens’ lives.

2. In the post-communist region, government alternation under competitive authoritarianism occurred in countries such as Ukraine (2004), Georgia (2004, 2012), Kyrgyzstan (2005; 2011), Moldova (2010), and Armenia (2018).

3. The analysis stops before 2020 to avoid the risk that an ‘extra-ordinary’ event such as Covid-19 biases the findings of a research on health reforms.

4. Health expenditure data are only available from 2000 to 2018.

5. Georgia’s defeat in the war with Russia (August 2008) is another issue on which Saakashvili was heavily criticized.

6. Initially, the reform was suspected to be a stratagem for Saakashvili to elude presidential term limits and seek re-election as Prime Minister, but his UNM party eventually run with another candidate (Fairbanks and Gugushvili 2013).

7. For clarity, the political process that led Georgia to experience the second episode of electoral government alternation in its history formally completed in October 2013, when Saakashvili arrived at the end of his second and final term and GD’s candidate Giorgi Margvelashvili won the presidential election.

8. Giorgi Kvirikashvili, in office since 2015 (when he replaced Irakli Garibashvili, who in turn replaced Ivanishvili in 2013), was confirmed as prime minister.