State of functioning of departmental medicine in Ukraine at the current stage of healthcare reform

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State of functioning of departmental medicine in Ukraine at the current stage of healthcare reform

Introduction

The creation of parallel health care systems can be considered as additional conditions or benefits of providing medical services to a special contingent of citizens, as well as the creation of a budget burden due to duplication of medical services. This has been and remains an indicator of the low quality of health services in the general health care system as a result of the inefficiency of public administration mechanisms.

Quite logically, the question arises of finding ways to solve the problem, which is impossible without an analysis of financial and structural-functional mechanisms of the functioning of departmental medicine in Ukraine.

There is researched the mechanisms of formation of state management of departmental medicine in Ukraine in this article.

The main material presenting

The process of reforming Ukraine's health care system has been stalled for several decades. One of the obstacles to the advancement of medical reform in Ukraine was the structural dispersion, disorder of the legal framework and unregulated relations in the field of departmental medicine.

All efforts are aimed at solving three aspects of high-quality and efficient functioning of the health care system in Ukraine:

- financing of the health care system.

- availability of medical care to the entire population of the state.

- quality and efficiency of medical care.

Health care financing consists of:

- household expenditures (out of pocket),

- state budget (taxes on health care),

- insurance premiums (private insurance, social insurance funds, disability insurance funds, etc.),

- international aid (international aid funds, international banks).

According to the results of the State Statistics Committee of Ukraine, the expenditures of households for medical services in 2019 are 4.8% of the total expenditures of each household [1]. At the same time, less than 1% of Ukrainian citizens have their own health insurance, and state insurance does not cover half of the cost of treatment.

In Ukraine, funding for the provision of medical services is regulated by a single state insurer and fund manager - the National Health Service of Ukraine (NHSU), which is the structure that forms the state policy of the public health system. The state finances the provided medical services within the framework of the implementation of the priority health care programs specified by the state. The implementation of state policy in the health care system is due to the formation of regulatory, financial, economic, and structural and organizational mechanisms of public administration.

Funding for medical care is growing from year to year. According to the official data of the National Health Insurance Fund, the financing of health care in 2020 amounted to UAH 113 billion. [2]. The health care budget of Ukraine for 2021 is UAH 153 billion [3]. However, public dissatisfaction with the quality and availability of health care is growing, which is the main sign of low efficiency of public administration of the health care system.

Many scientists have studied issues of public policy, public administration of the health care system, they include scientists in public administration: Ya.F. Radish, M.M. Bilynska, N.P. Kryzyna, I.P. Rozhkova, I.M. Solonenko, S. Pak, M.G. Prodanchuk, V.L. Koretsky, V.V. Utvenko, V.M. Lehan, K.M. Manshilina, V.M. Rudy, G.O. Weak; military medics of Ukraine: OG Шекера, В.О. Zhakhovsky, VG Livinsky; economists Z.R. Kostak, N.M. Ruschishin. Foreign scientists: Martin D., Merry M.D., Rachel Magnesi, Dr. Michael Tempel - researchers in the history of medicine in the formation of medicine as a science, the formation of mechanisms of public administration in Europe.

According to the reports of the Accounting Chamber in 2005, non-fulfillment of state health care programs by the medical service of the Ministry of Internal Affairs was revealed due to inefficient planning and use of budget resources by medical services of the Ministry of Internal Affairs and the Ministry of Emergencies [4].

According to the analytical note of the National Institute for Strategic Studies in 2012, the irrational use of budget funds as the main reason for non-compliance and deterioration of medical care in the pilot areas [5].

In 2018, research by the National Institute for Strategic Studies in an analytical report to the annual message of the President of Ukraine noted inconsistencies of the view on the model of the health care system and the lack of well-balanced approaches to changing the mechanisms of public health management, which makes this reform as a departmental-oriented reform [6].

In the analysis of health care reforms in Ukraine, V.M. Lehan also points to the fragmentation of reforms due to the political context and political commitment. [7]. Departmental medicine in the structure of the health care system of Ukraine is characterized by the fact that: this structure exists in the post-Soviet countries; there is no control over the activities of this structure by the Ministry of Health of Ukraine; this structure is quite branched; it is divided into military and civilian components. [8].

The question of a clear separation of the term departmental medicine remains open. Many legal and government documents mention the departmental nature of subordination of medical institutions. Thus, the practical manual on human rights in the field of health care states: "The health care system is managed by the Ministry of Health of Ukraine and other central executive bodies to which departmental health care institutions are subordinated..." [9].

For a clear understanding and separation of the term "departmental medicine" the authors studied the regulations and the work of scientists on this issue.

In the general provisions of the Fundamentals of the legislation of Ukraine on health care the following concepts are given:

"Health care - a system of measures aimed at preserving and restoring physiological and psychological functions, optimal performance and social activity of human at the maximum biologically possible individual life expectancy. Such measures are carried out by public authorities and local governments, their officials, health care institutions; natural persons - entrepreneurs who are registered in the manner prescribed by law and have received a license for the right to conduct business in medical practice; medical and pharmaceutical workers, rehabilitation specialists, public associations and citizens; "

"Medical care - the activities of professionally trained medical workers aimed at prevention, diagnosis and treatment in connection with diseases, injuries, poisonings and pathological conditions, as well as in connection with pregnancy and childbirth;"

"Medical service - the activities of health care institutions, rehabilitation institutions, departments, units and individuals - entrepreneurs who are registered and licensed in the manner prescribed by law, in the field of health care, which is not always limited to medical care and / or rehabilitation assistance, but directly related to their provision";

"Network of health care facilities - a set of health care facilities that meet the needs of the population in health care in the area"; [10]

Article 32 of the Law of Ukraine on Local Self-Government in Ukraine clearly defines both the formative and the governing functions of territorial communities in relation to medical institutions of their jurisdiction. [11] This gives grounds to allocate systems of medical services on a territorial basis.

These definitions will serve as a guide for us to determine the system of medical services in various structures. It can be concluded that regulations do not have a separate definition of this phenomenon.

Expert of the Department of Social Policy of the Institute for Strategic Studies of the Verkhovna Rada of Ukraine T. Popchenko in an analytical note for May 2011 also notes the inefficiency of budget funds due to duplication of services in departmental health care systems but does not define a clear concept and does not define which [12]. state management departmental medicine

Thus, Sidelkovsky O.L. also considers the integration of departmental medical institutions into the national health care system, but also does not define this concept [13].

Most researchers of various aspects of the health care system, such as B.O. Logvinenko, O.L. Sidelkovsky, O.V. Shinkarenko, I.V. Matyurin refers to departmental medicine only military medicine, or allocates, as a separate departmental health care system, only medicine of the Ministry of Internal Affairs of Ukraine, as S.G. Stetsenko and T.O. Tikhomirova.

The media and public and political figures often use terms such as "departmental medical facilities", "departmental medicine".

Against the background of the ongoing reform of the national health care system and territorial decentralization, hospital districts have been singled out.

By definition, capable network of the hospital district - a set of health care facilities that carry out in the manner prescribed by law economic activities in medical practice and have the functional capacity to provide quality, comprehensive, continuous and patient-centered care in accordance with socio-demographic characteristics, features of its settlement in the relevant territory. And as stated in the law on local self-government with the governing and rule-making functions of the governing bodies of territorial communities. But it should be noted that these networks of state and municipal medical institutions. [14].

The Ministry of Internal Affairs of Ukraine has a "Department of Health and Rehabilitation". Many structural subdivisions for the provision of medical care are directly subordinated to him [15].

The network of licensed medical institutions of the State Border Guard Service includes Medical and preventive institutions - the Main Military Medical Clinical Center and other medical units [16].

The Military Medical Department of the Security Service of Ukraine and the structure of the network of medical institutions of the Ministry of Defense are also specific and branched [17].

The Ukrainian Railways Health Center also has a network of medical facilities, which includes clinical hospitals by rail.

Thirty medical institutions belong to the network of the National Academy of Medical Sciences of Ukraine, according to the resolution of the Cabinet of Ministers of Ukraine of May 16, 2011, № 501 [18].

The study of the formation and reform of health care systems in Europe and the United States of America (USA) clearly indicates the distribution of the national health care system by territory. At the same time, a network of medical and preventive institutions of military departments is separated partially, which provide services to servicemen on the basis of insurance. Networks of military institutions partially serve civilians on the basis of insurance, due to which money is reimbursed to the budget of military medical institutions. Medical care is provided by staff military doctors and contracted civilian doctors [19].

Solidarity health systems in France, England and Germany show the heterogeneity of the structure of insurance companies (whether funds or health insurance funds), built on a sectoral or professional basis. The departmental nature of the network of insurance companies is traced, which does not restrict the access of citizens of any category of medical services and promotes competition between medical institutions and insurance companies, which affects the quality of medical care [20].

Conclusions

After analyzing the situation in Ukraine, we can draw the following conclusions:

1. Departmental health care system can be considered a network of health care institutions with separate subordination, financing, goal-setting, which provide medical services in full (preventive, sanitary-anti-epidemic, medical, restorative) to certain contingents of citizens whose activities are directed to individual department.

2. In Ukraine, both civilian public authorities and state structures of the security and defense sector have their own networks of health care facilities. Therefore, by belonging to such structures, we have parallel civilian and military departmental health care systems.

3. In the countries of Europe and the United States of America, there is a network of health care facilities of military agencies that provide services to servicemen based on insurance. These institutions partially serve civilians based on insurance, due to which there is a reimbursement of money to the budget of military medical institutions.

4. In France, England and Germany, there is a departmental nature of the network of insurance companies, rather than the health care system, which does not restrict access of citizens of any category to medical services and promotes competition between medical institutions and insurance companies, which improves the quality of health care.

References

1. “Expenditures and resources of Ukrainian households in 2019”. Kyiv 2020: State Statistics Service of Ukraine, Statistical Collection Part I C 63

2. NSZU report for 2019 C 8.

3. Conclusions based on the results of the examination of the draft Law of Ukraine “On the State Budget of Ukraine for 2021.

4. On the use of state budget funds for departmental medicine / Prepared based on inspections by the Department of State Security and Law Enforcement and the Department of Science and Humanities / - Kyiv. Accounting Chamber of Ukraine, 2005. - Issue 4. On the use of state budget funds for departmental medicine. Kyiv 2005

5. Analytical note - National Institute for Strategic Studies on the current state and further directions of reform of financing and management of the health care system in Ukraine". (2012, January)

6. Analytical report to the Annual Address of the President of Ukraine to the Verkhovna Rada of Ukraine "On the Internal and External Situation of Ukraine in 2017". - К.: НІСД, 2017. C388-398.

7. Lekhan V.M., Kryachkova L.V., Zayarsky M.I. (2018). Analysis of health care reforms in Ukraine: from independence to modernity. Dnipropetrovsk Medical Academy of the Ministry of Health of Ukraine. Health of the nation. 4 (52).

8. Krizina N. Sukhanova Y., (2021). Legislative and regulatory governance of departmental medicine in Ukraine. International Journal of Innovative Technologies in Social Science, 1 (29), 1-9pages.

9. Bern I., Ezer T., Cohen J., Overal J., Senyuta I. (2012). Human rights in health care: a practical guide / For science. ed. I. Senyuta: LOBF "Medicine and Law" (552 p.) Lviv: Publishing House.

10. LAW OF UKRAINE Fundamentals of the legislation of Ukraine on health care 2801-XII (2021, April 23) Vidomosti Verkhovnoi Rady Ukrainy. Kyiv: Parlam. vyd-vo1993, №4

11. Закон України про місцеве самоврядування в Україні №280/97-ВР: (1997, 21 травня) Відомості Верховної Ради України, 1997, №24, с.

12. Popchenko T. (2011). On the priority areas for improving the domestic health sector. Analytical note of the National Institute for Strategic Studies of the Verkhovna Rada of Ukraine.

13. Sidelkovsky O.L. (2019). Departmental health care institutions in the system of a single medical space: organizational and legal principles. South Ukrainian Law Journal. Current issues of historical and legal and international law science. (2019) Ch.- 3. P.160-164.

14. Cabinet of ministers of Ukraine resolution on Amendments to the Resolution of the Cabinet of Ministers of Ukraine № 589 (2020, June 19). Government courier official publication 134 [in Ukrainian].

15. Department of Health and Rehabilitation of the Ministry of Internal Affairs

16. State Border Guard Service. Official site.

17. Medical Service of the Armed Forces of Ukraine.

18. Resolution of the Cabinet of Ministers of Ukraine on approval of the list of health care institutions and programs in the field of health care that ensure the performance of national functions, expenditures for which are made from the state budget, and recognition as invalid of some resolutions of the Cabinet of Ministers of Ukraine. №501 (2011, May 16) Kyiv Government Courier official publication 1, 2011 - №98 [in Ukrainian].

19. Golovan V., International experience of creation and functioning of military medical forces (experience of France, Germany, and the USA) Information reference prepared by the European Information and Research Center at the request of the Committee of the Verkhovna Rada of Ukraine.

20. Parshikova A. International experience in reforming the health care system (experience of the European Union) Information reference prepared by the European Information and Research Center at the request of the People's Deputy of Ukraine. Kiev. 2017

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