The document discusses reforms to Ukraine's healthcare system in market conditions. It proposes dividing healthcare into three subsystems: state, public, and private. The state subsystem would provide a basic level of care for all citizens. Those dissatisfied could use the public or private options. Factors like costs, pricing, competition between providers, and the economic roles of medical workers are discussed at different levels of the system. Budgets for medical institutions would be divided into accounts for salaries, current expenses, capital expenses, and other costs. The social, medical, and economic effectiveness of the healthcare system are also addressed.

1. Bases and features ofBases and features of
organization of treat-organization of treat-
prophylactic aid inprophylactic aid in
reformation of healthreformation of health
guard in the marketguard in the market
conditions.conditions.

2. The reform of economy and social sphere
in our country conditions the definite
changes in the system of health service.
The conception of its development in the
conditions of market economy expressly
orients society on perception of medicine
not only as a moral, legal, but above all
things as socio-economic category based on
the adequate economic providing
according to volume and quality of
actually executed medical services.

3. About objective nature of necessity of their
development in the home system of health
service testify:
awareness by the population of economic
conditionality of their health;
commercialization of health service;
increase volume of requiring payment
medical services;
development of marketing operations;
introduction of various forms of enterprise
and others like that.

4. The economic environment of medical
workers changes and firstly it is - practical
doctor who can be:
wageworker in the state establishment or
medical enterprise;
co-operator, tenant, shareholder,
specialist, that attends to the individual
private medical practice;
to connect that and other forms of
economic activity.

5. The economic science divides the charges of
production to constant and variables.
To constant ones in medicine it is necessary to
concern apartments, their amortization,
insurance payments.
To variables - ones labour force, equipment,
medicines, communication facilities,
transport, bank's services and others like that.

6. It is necessary to divide the present system
into three parts or subsystems: state,
public, private. About subsystem which the
state can maintain , the speech was held
higher. It will give to citizens of Ukraine so
called assured volume of medicare. All,
who will be dissatisfied with this
subsystem (medical workers, patients
ones), will be able to realize themselves
,and other will be able to get help in the
public and private medical establishments.

7. Directions of reorganization of the Ukrainian medicareDirections of reorganization of the Ukrainian medicare
№ Problem Reorganization directions
1. Forms of own State, public, private
2. Contents State - for facilities of state and local budgets, other
sources. Public and private - for facilities of
communities and citizens, other sources.
3. Medicare volume assured
by state
Spreads by all populousness, on all types of medicare
4. Competition Between forms of own, free choice of doctor, self-
supporting basis between establishments
5. Makes of norms State establishments - orientation on scientifically
based norms on the level state, region, city
7. Pricing Sole methodology and method in the state
establishments, in private - free.
8. Social stratification in the
medical environment.
Moderate.
9. Moral aspect Every patient has a right to medicare free of charge

8. An economic mechanism of modern
market's economy is the aggregate of public
relations based on:
* the full relative production and economic
apartness of producers by various goods and
services;
* equality rights of all types of ownership;
* free pricing and competition;
* on the real co-operation of economic laws
of market: cost law, competition, demand and
supply, income law etc.

9. The notion of market economy engulfs the
economic system in which the process of
acceptance of decisions concerning
production and allocation of resources is
based on the basis of prices, created by the
voluntary exchange between producers,
buyers, workers and proprietors of other
factors of production. At the acceptance of
decisions in the conditions of economic
relations of such nature is carried out
decentralizedly. The market system
foresees also equal in rights existence of
different forms of property - private,
public, state.

10. Basic laws of the market system are
confirmed to a few major aspects:
 - firstly, determination of basic principles of
functioning separately taken markets and their
intercommunication;
 - secondly, establishment of dynamic development
of basic elements of the market system - objects and
volumes of production, facilities of production,
subjects of consumption of production results;
 - thirdly, determination of regulative role of the
state;
 - the fourth aspect foresees achievement of the
highest level of national welfare.

11. It is possible to divide the economic
aspects of medicare functioning in the
market conditions into two levels:
grate- (state and regional),
micro- (patient, medical staff, medical
establishment, joint medical
establishments).

12. The volume of assignations which the state
must select on medicare, and their part, that
goes to the small level; creation of benefits
and encouragements for bringing in
additional facilities outside the industrial
enterprises and some citizens; grant of
investments in development of medicare
factors; development of methodology and
method of pricing in the medicare system;
establishment of correlation of medicare
factors, estimation from economic positions
of the organizational systems of medicare are
determined at the grateveled.

13. Processes of functioning of medical service
market are explored on microlevel, definite
economic layouts metric within the limits of
medical establishment, in particular
correlation of medical service factors,
correlation of wages and other charges on
medicare, pricing, changes of populousness
demand level on the medical services, and
others like that. The main purpose at this
level there is a satisfaction of optimum
necessity of people in medicare depending
from the public possibilities and own spiritual
necessities and values.

14. The social efficiency of health
service consists in that role which it
plays in achievement of the primary
purpose to which the man aspires -
longevity, active vital activity, high
quality of life.

15. Criteria of social efficiency of health
service are death rate and ordinary
duration of expected life.
Then lower is death rate and higher
duration of people life, more
effective is social function of health
service.

16. The medical efficiency of health service
consists in diminishment of morbidity of
people and consequences of illnesses. It is
conditioned by the positive action of the
special medical measures directed to
achievement of this aim. Consequently
decline of people morbidity and relapses
and complications of illnesses is the index
of medical efficiency of health service.

17. The economic effectivity of health
service consists in achievement of
economic effect and additional
production of national product
through the recreation and
strengthening of health of the main
factor of production labour force.

18. Bed necessity is determined in suchBed necessity is determined in such
formula:formula:
 Lc - number of necessary beds;
 N - number of population on which the hospital
waits;
 P - percent of population which heads for
hospitalization;
 С - middle duration of stay of one sick on bed
in the permanent establishment.
100
340
×
××
=
СPN
Lс

19. Market - is a method of labor distribution.
For the rational organization of production its
planning is necessary. It is up to medicare
too.
Plan is a foresight of future and substituation
of its achievement.
In the conditions of the market economy the
medical institutions are acquiring much more
of the independence in comparison with the
times of administrative-commanding system
of management.

20. The salary tariff is a document, which fixes
the number of the establishment’s staff and
the salary every employee receives in
accordance with his qualification, category,
post held, the state of work, etc.
The staff list is a document, which shows the
division of the number of doctors, senior,
junior and another personnel in accordance
with the number of people living on the
territory of the establishment’s activities.
The estimate is a budget given in separate
clauses. It is the main planning financial
document. First its draft is drawn up on the
basis of the execution of the previous year
plan, changes in the salary tariff and the staff
list.

21. Revenues of the budget are divided between the followingRevenues of the budget are divided between the following
accounts of the estimate:accounts of the estimate:
 1. Salary account. The means for paying the employees’
salaries are put down to it including:
a. Collection to the obligatory state pension insurance
(provision);
b. Collection to the obligatory social insurance.
 2. Current account, which accumulates money for
economical, municipal, medicine needs, etc.3. Account
for special means (leasing expenditures, paid services).
 4. Commission sums (this account accumulates sponsors’
and charitable contributions). Spending this account’s means
is based on “Establishment Regulations”. “Regulations” is a
yearly-confirmed document, which defines the expenditures
the means of this account can be spent on. As a rule, the
establishment has the opportunity to spend this money on
salaries, food, medicines, repairs, etc.
 5. Chornobyl’ account. The means of this account for the
employees of the establishment, who took part in the
elimination of the consequences of the breakdown at the
Chernobyl’ nuclear power station, is given from the state
budget.

22. The expenditures’ part of the estimate includes theThe expenditures’ part of the estimate includes the
following points:following points:
1. Current expenses:
a) Payment for the work of the budget establishments’ employees;
b) Setting down to the salary;
c) Purchase of the provision things and materials, keeping the
budget establishments;
d) Payment for the municipal services, electricity, etc.;
2. Capital expenses:
a) Capital reconstruction (purchase);
b) Capital repairs, reconstruction;
c) Purchase of equipment and objects of the long-term usage, etc.
3. Undivided expenses.
4. Crediting including the percentage rate.
5. Budget payments:
a) Taxes and obligatory payments (except the income tax and the
added value tax);
b) Income tax;
c) Added value tax.

23. Consequently, the reform of the healthConsequently, the reform of the health
care system in Ukraine must be based oncare system in Ukraine must be based on
these main theoretical principles:these main theoretical principles:
The state nature with the equal existence
of public and private forms of ownership;
Economical and social effectiveness;
Prohpylactic direction;
Scientific provision;
Adoption suitable for Ukraine
achievements of the world theory and
practice of the medical aid organization
and management.

24. The state is responsible for providing all its
citizens with the guaranteed amount of
medical aid in spite of the parallel existence
of the public and private medicine.
It is determined by:
 The existing level of illnesses of the population and
the need of realization of appropriate diagnostic,
treating, rehabilitating and prophylactic measures;
 The amount of the gross national product and the
share given to the medical help;
 Salaries of the medical staff and its share in
concerning all expenditures on the medical aid.

25. Eliminating in new conditions one of the most significant shortcomings of the
existing fundamental medical education - insufficient preparation of medical
institutions’ graduates to the independent practical activities - requires the goal-
oriented steps to be taken, precisely:
 Reconsidering curricula in the direction of radical
reduction in them, first of all, those subjects, which are
studied at school, and teaching them only in the volume
that will be necessary for a future doctor in his practical
activitys;
 Increasing the number of clinical subjects and helping
students acquire practical skills during their studies;
 Radical changes of the method of teaching social medicine
as science, which belongs to the sphere of activities of all
future doctors;
 Change of the methods of internship studies in the
direction of paying particular attention not to the theory
but to the maximum acquiring practical skills by future
doctors-specialists;
 Introduction of learning a foreign language during the
whole period of study at the educational institution.

26. Out of the state health care system,
which meets the modern requirements
and recourses of Ukraine, there remain a
considerable number of medical staff
and hospital beds. Public and private
medicine is to be created on the basis of
these resources in the health care
system. This makes a new task, which in
the scales of its solving has had no
precedents in history of native medicine.

27. The succession of carrying out thisThe succession of carrying out this
task must be the following:task must be the following:
 1. Realization of accrediting and licensing
the medical institutions;
 2. Selection of the best ones, which remain
in the state ownership;
 3. Privatization of the medical institutions,
which have not received the state status via
the open sharing;
 4. Introduction of the mechanism of
funding private and public establishments
via voluntary medical insurance or medical
banks.

28. For the reform’s legislative provision thereFor the reform’s legislative provision there
must be drawn up and presented in themust be drawn up and presented in the
Supreme Rada the drafts of such vital laws:Supreme Rada the drafts of such vital laws:
1. About the public and private ownership and
practice in the health care system.
2. About the mechanism of funding of the state
health care system.
3. About the voluntary medical insurance.
4. About the organization of the family medicine.
5. About the mechanism of the health protection
management.
6. About hospitals’ activities.
7. About the patients’ rights.

29. Thank you!Thank you!