National medical services market participants in Ukraine

Размещено на http://www.allbest.ru/

Размещено на http://www.allbest.ru/

National medical services market participants in Ukraine

Национальные участники рынка медицинских услуг в Украине

Barzylovych A.D.

PhD in Medical Sciences Director mc KinderKlinik Kiev

Summary

The article focuses on functional activities of the national medical services market participants in Ukraine, which is an element in the mechanism of public administration of healthcare sector. Four principal levels of participants are singled out: entities that execute public regulation and outline strategies for the sector's development; entities that perform administration, supervision, and control; entities that are service contractors or providers; entities that are service recipients (patients). Development of the medical services market in Ukraine resulted in emergence of medical entities that are service producers and simultaneously, of autonomous municipal non-profit enterprises. Entities ensuring financial support to medical services provision in reformation conditions are medical institutions, National Health Service of Ukraine, insurance companies, and charitable foundations. The article determines local-level control and administration entities: entities controlling a medical institution's operations (supervisory and monitoring boards which will include representatives of the medical institution, local self-governance bodies); charitable foundations and organizations, insurance companies, international companies and organizations working in the field of medical services and modernization of medicine administration systems. It is ascertained that in Ukraine, an electronic healthcare system is being formed, which leads to formation of market interconnection mechanisms and relations of the following principal participants in the medical sector: private medical institutions; telemedicine entities; insurance agents and companies; pharmacies; diagnostic laboratories; private hospitals; academic medical centers, etc.

Keywords: medical services, affordability of medical services, public regulation entities, entities - medical service recipients, medical service contractors.

Аннотация

Статья посвящена функциональной деятельности участников национального рынка медицинских услуг в Украине, которая является элементом механизма государственного управления сектором здравоохранения. Выделены четыре основных уровня участников: организации, осуществляющие государственное регулирование и намечающие стратегии развития сектора; субъекты, которые осуществляют администрирование, надзор и контроль; юридические лица, которые являются подрядчиками или поставщиками услуг; лица, являющиеся получателями услуг (пациенты). Развитие рынка медицинских услуг в Украине привело к появлению медицинских организаций, которые являются производителями услуг и одновременно автономными муниципальными некоммерческими предприятиями. Субъектами, обеспечивающими финансовую поддержку оказания медицинских услуг в условиях реформирования, являются медицинские учреждения, Национальная служба здравоохранения Украины, страховые компании и благотворительные фонды. В статье определяются органы контроля и управления на местном уровне: субъекты, контролирующие деятельность медицинского учреждения (наблюдательные и наблюдательные советы, в состав которых войдут представители медицинского учреждения, органов местного самоуправления); благотворительные фонды и организации, страховые компании, международные компании и организации, работающие в сфере медицинских услуг и модернизации систем управления медициной. Установлено, что в Украине формируется электронная система здравоохранения, что приводит к формированию рыночных механизмов взаимосвязи и взаимоотношений следующих основных участников медицинского сектора: частных медицинских учреждений; телемедицинские организации; страховые агенты и компании; аптеки; диагностические лаборатории; частные больницы; академические медицинские центры и др.

Ключевые слова: медицинские услуги, доступность медицинских услуг, субъекты государственного регулирования, субъекты - получатели медицинских услуг, подрядчики медицинских услуг.

Setting the problem in general and its connection with important practical tasks

Due to reforms in the healthcare sector, changed model of functioning and financing of medical institutions and entities providing medical services, there emerge new groups of the national medical services market participants, the existing forms of relations are developing and new ones are being introduced. In fact, a market of medical services is being formed, which is characterized by signs of competitiveness, and this causes changes in approaches to all the market participants functioning. The above requires that a more detailed research is done into modern-day features of the participants operations on the medical services market.

Analysis of the latest research and publications

The article's objective is to study operations of the national medical services market participants in Ukraine in conditions of reforming the healthcare system.

Presentation of the basic material

Mechanism of public regulation in the healthcare sector consists of the following basic elements: participant, object, purpose, goals, and principles, as well as instruments of the mechanism implementation. The state, local authorities, legislative, executive and judicial bodies, non-governmental and political organizations are also considered public regulation actors in the healthcare sector [10, p. 47].

All healthcare institutions should be regarded medical sector objects regulated by the state. The principal body ensuring formation and fulfillment of the healthcare public policy is the Ministry of Healthcare of Ukraine. The Ukrainian Government and Ministry of Healthcare develop instruments for the medical sector to function effectively, carry out planning and forecasting, establish state standards, develop governmental order programs aimed at procuring the sector with necessary resources, and monitor activities in the sector [11, p. 277].

Medical service contractors are companies, institutions, and organizations irrespective of their ownership and incorporation form, and also sole traders pursuing medical practice or performing medical activities under a license obtained [2, p. 114].

medical service market

The healthcare system reform strategy makes it possible to determine the public administration actors in this field, which are responsible for various stages of their formation and implementation, namely: the Verkhovna Rada of Ukraine, Cabinet of Ministers of Ukraine, Ministry of Healthcare of Ukraine, and other authorities, institutions, companies, non-governmental organizations, and law-enforcement agencies [21, p. 67].

On the medical services market, there are three participants of crucial importance for the healthcare system, which take part in the process of communicative interaction with the medical service consumers and set out specialties of such interaction. They are:

- patient (participant consuming medical services);

- medical institution (participant providing medical services);

- payer (participant financing medical services) [22].

As the market relationship elements evolved, there emerged a category of medical entity - producer of medical services. Medical entity producing medical services is a registered and duly licensed treatment and prevention institution of any form of incorporation and ownership, which provides medical services [1, p. 418]. Production and consumption of medical aid (service) occurs simultaneously. There is a provider of medical aid (or service) and its consumer - patient (client), and economic operators: owner (producer and provider) of medical service (seller) and its buyer (client). Funding can be provided at the expense of: reimbursements from insurance companies; payments from employers and employees; budgetary tax reallocation toward medicine; investment measures to improve public health; charitable foundations and donations; payments from the enterprise, firm, company (where employees are working); at the cost of a natural person, etc. [15].

The healthcare system reform in Ukraine envisages that function of the medical service client will be vested upon an organization that should allocate financial resources to be replenished by patients through the insurance medicine or taxation. Medical institutions are defined as service providers and patients - as medical service consumers. In compliance with the reform, they provide for forming an autonomous client of services, autonomous providers that will sell medical services to the client under concluded contracts. Prospectively, a controlling body or supervisory board will be established. Thus, all actions of the state should be aimed at creating a single market of medical services (medical space) which will unite all providers (healthcare institutions and establishments), including private medical centers, pharmacies, etc. [23, p. 118].

Network of healthcare institutions is a complex of healthcare institutions that satisfy public needs of medical service in a corresponding territory [14]. Healthcare institutions are contractors, providers of medical services to the population.

Within a healthcare institution, entities can be classified as follows:

1) administration of the medical institution;

2) employees of the medical institution (doctors);

3) persons organizing procurement of the medical institution with various resources;

4) patients.

In Ukraine, medical services payer is the National Health Service of Ukraine (NHSU), a central executive power agency pursuing governmental policy in the field of public financial guarantees of medical services for the people. NHSU operations are instructed and coordinated by the Cabinet of Ministers of Ukraine through the Minister of Healthcare [18]. Thus, NHSU operations can be regarded effective, because as at April 1, 2019, 1238 medical institutions entered into contracts with the NHSU (including 117 private clinics and 110 sole traders), 97% of municipal institutions adopted a new model of medical services financing, and 92% of institutions have computerized work stations. In 2018 and early 2019, NHSU effected payments amounting to over UAH 7 billion. What is more, one can see a steady growth in payments under contracts with municipal non-commercial companies [12].

Effective operations of the entities is also proved by the electronic healthcare system being introduced jointly by the Ministry of Healthcare (regulation) and NHSU (contracting the service providers, analyzing the data and public needs, developing a medical guarantees program, paying for medical services).

Thus, formation of the electronic healthcare system will ensure transparent funding, a gradual transition to electronic records, formation of a new business environment with quality services, create preconditions for implementing innovations such as telemedicine, and facilitate development of the medical IT-market. Due to development of the electronic healthcare system, key roles are played by the following entities:

1) Ministry of Healthcare of Ukraine ensures formation and realization of policy in the field of healthcare and is responsible for reforms implementation;

2) National Health Service of Ukraine analyzes and applies the data to forecast public needs of medical services, develop the medical guarantees program, and make payments to the institutions for medical services;

Elektronne Zdorovya [electronic health] State Enterprise (eZdorovya) administers eHealth central database and monitors development of the electronic healthcare system in Ukraine;

4) business entities introduce electronic medical information systems (MIS) which enable automated work of medical institutions from the centralized database.

Formation of the electronic healthcare system results in establishment of market interconnection mechanisms and relationships of the following principal actors in the medical sector:

- private medical institutions;

- telemedicine entities;

- insurance agents and companies;

- pharmacies;

- diagnostic laboratories;

- private hospitals;

- academic medical centers.

All the mentioned entities will have access to the central database of medical information systems, which will considerably simplify access to medical services for patients. Currently, 1,854 medical institutions, 28.41 million patients, 25,244 doctors, 1,230 pharmacies, and 12,014 pharmacists have joined the electronic healthcare system. The above ensures formation of a unified medical eco-space in Ukraine [15, p. 119].

An important role in the healthcare system is played by economic operators that produce goods and products of medical purpose, innovative medical technologies, etc. These are pharmaceutical companies, technology parks, innovation clusters, small high-tech enterprises, private scientific medical companies, medical and technical centers and institutes, and other innovative infrastructure entities [23, p. 119].

Table 1 displays authorities of principal participants of the national medical services market in Ukraine as in 2019.

Table 1

Functions and authorities of principal participants of the national medical services market in Ukraine as in 2019*.