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

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.