DOI kodi: 10.52340/ekonomisti.2026.03.01

Extended Summary 

Rare neurological diseases comprise a heterogeneous group of genetic, degenerative, autoimmune, and neuromuscular disorders that frequently result in progressive limitations in mobility, balance, communication, swallowing, cognition, self-care, and participation in everyday life. Although each condition affects a relatively small number of people, patients often require long-term, continuous, and multidisciplinary rehabilitation. Depending on the disease and the individual’s functional status, rehabilitation may include physical therapy, occupational therapy, speech and swallowing therapy, psychological and neuropsychological support, assistive technologies, patient and caregiver education, and social support.

In progressive neurological conditions, the purpose of rehabilitation is not always the complete restoration of lost function. Clinically meaningful outcomes may include maintaining existing abilities, slowing functional decline, preventing secondary complications, prolonging independence, supporting participation in family and community life, and reducing the burden of care placed on relatives. Consequently, rehabilitation for rare neurological diseases should be organised as a flexible and continuing service rather than as a limited course provided only after an acute medical event.

This study aimed to evaluate the accessibility, financing, and organisation of rehabilitation services for patients with rare neurological diseases in Georgia. It also sought to identify the principal policy gaps in the existing rehabilitation system and to determine which elements of international experience could be adapted to Georgia’s economic, institutional, and workforce context.

The study used a narrative literature review, documentary policy analysis, and country case-study approach. Scientific literature was reviewed through PubMed/MEDLINE, Scopus, and Google Scholar using combinations of terms related to rare neurological diseases, neurological rehabilitation, access to rehabilitation, health financing, geographical inequalities, rehabilitation workforce, multidisciplinary care, telerehabilitation, and Georgia. Peer-reviewed studies, international guidelines, health-system reports, official statistics, and relevant policy documents were included.

The Georgian case analysis covered national legal and programme documents, government regulations, rehabilitation financing arrangements, official health workforce statistics, and reports issued by international organisations. Particular attention was given to the publicly financed rehabilitation programme for patients with conditions resulting from stroke and traumatic brain and spinal cord injuries, as well as to the development of Georgia’s first rehabilitation service package. Georgia’s experience was compared with selected organisational and financing mechanisms in Germany, France, and Sweden.

The analysis indicates that Georgia has made important progress towards recognising rehabilitation as an essential component of healthcare. The introduction of a publicly financed multidisciplinary rehabilitation programme represents a significant policy development. The programme includes functional assessment, individual rehabilitation planning, medical supervision, physical therapy, occupational therapy, psychological support, speech and swallowing therapy, patient and caregiver education, and assistance with the selection and use of assistive devices.

However, the existing programme is primarily designed for rehabilitation following stroke and traumatic brain or spinal cord injury. Its eligibility criteria do not adequately reflect the long-term needs of patients with rare genetic, degenerative, and neuromuscular diseases. Many patients with progressive conditions remain outside the publicly funded package because their diagnoses are not explicitly included or because their rehabilitation needs do not fit a model designed around recovery after an acute event.

Diagnosis-based eligibility is particularly problematic for rare diseases. Because the number of rare neurological conditions is large, it is not feasible to include every diagnosis in a closed administrative list. Furthermore, patients with different diagnoses may experience comparable levels of functional limitation and require similar rehabilitation interventions. Eligibility should therefore be based not only on diagnosis but also on the severity of functional impairment, the risk of deterioration, the need for ongoing multidisciplinary intervention, and the expected benefit in terms of maintaining independence and preventing complications.

Time restrictions linked to the date of diagnosis or injury also require reconsideration. Such limitations may be justified in early post-acute rehabilitation, when rapid intervention can improve functional recovery. However, they are less appropriate for chronic and progressive neurological diseases, in which rehabilitation may remain necessary for many years. In these cases, a clinically successful outcome may be functional stability rather than measurable improvement.

Financial barriers remain another major concern. Even when rehabilitation services are partially funded, co-payments may be unaffordable for patients requiring repeated or prolonged care. The cost of rehabilitation also extends beyond the price of therapy sessions. Patients and families may have to pay for transportation, temporary accommodation, food, assistive technologies, and the presence of an accompanying caregiver. These additional costs disproportionately affect people living outside major cities and households with limited financial resources.

Geographical inequality is closely linked to financial access. Specialised multidisciplinary rehabilitation services are concentrated mainly in large urban centres. Patients living in other regions may need to travel long distances for assessment and treatment. For people with serious mobility limitations, travel may be physically difficult and may require assistance from a family member. As a result, formally available or publicly funded services may remain practically inaccessible.

The analysis also identified workforce limitations. Effective neurological rehabilitation requires coordinated input from rehabilitation physicians, neurologists, physical therapists, occupational therapists, speech and swallowing therapists, psychologists, neuropsychologists, social workers, and other professionals. In Georgia, these professional groups are limited in number and unevenly distributed. Services may therefore be focused predominantly on physical therapy, while communication, cognition, occupational functioning, psychological well-being, and social participation receive insufficient attention.

International experience offers several relevant policy lessons. Germany demonstrates the importance of integrating rehabilitation into broader health and social protection systems and linking it to the preservation of independence and working capacity. France provides an example of flexible financial protection for severe chronic conditions, including mechanisms for patients whose diseases are not included in a predetermined diagnostic list. Sweden illustrates the potential of combining specialised regional expertise with community-based and locally delivered rehabilitation services.

These systems cannot be transferred directly to Georgia because they operate in different economic and institutional environments. Nevertheless, several principles are adaptable. These include eligibility based on functional need, multidisciplinary assessment, individual rehabilitation planning, continued funding for progressive conditions, stronger financial protection, regional service networks, and coordination between specialised centres and local healthcare providers.

Telerehabilitation may contribute to reducing geographical barriers. A hybrid model could combine initial and periodic in-person assessments with remotely delivered exercise supervision, patient education, psychological support, caregiver consultation, and functional monitoring. Telerehabilitation should not replace all face-to-face services, particularly interventions requiring physical assistance, complex assessment, or the fitting of assistive devices. However, it could reduce travel, support continuity of care, and enable specialised teams to assist regional professionals.

For Georgia, the most realistic policy option is the gradual expansion of the existing rehabilitation programme rather than the creation of a separate parallel system. A pilot programme could initially include selected groups of patients with rare and progressive neurological diseases. Eligibility should be determined by a multidisciplinary team using standardised functional assessment. Each patient should receive an individual rehabilitation plan specifying goals, interventions, frequency, mode of delivery, and outcome indicators.

Programme outcomes should include not only functional improvement but also functional maintenance, delayed deterioration, prevention of complications, preservation of self-care and mobility, participation in daily life, and reduction of caregiver burden. Vulnerable patients may also require support for transportation, assistive devices, home-based services, or accommodation when specialised care is unavailable locally.

The expansion of rehabilitation services should be accompanied by workforce development, professional training, regional capacity building, patient registries, and systematic monitoring. Evaluation should assess service utilisation, completion of rehabilitation programmes, functional and social outcomes, patient experience, regional equity, safety, and budget impact.

In conclusion, Georgia has established an important foundation for the public financing of multidisciplinary rehabilitation, but the current model does not sufficiently address the needs of patients with rare, chronic, and progressive neurological diseases. A gradual transition from diagnosis-based eligibility to a function- and needs-based model would improve equity and continuity of care. Integrating specialised centres, regional services, primary healthcare, home-based care, and telerehabilitation could create a more accessible and sustainable rehabilitation system. Such reforms would support not only clinical outcomes but also patient independence, social participation, financial protection, and the long-term sustainability of health and social care.

Keywords: rare neurological diseases; neurological rehabilitation; access to healthcare; health financing; health policy; multidisciplinary care; telerehabilitation; Georgia.