Organization of public health services & medical care

OrganizationOrganization
of public health servicesof public health services
and medical сareand medical сare

Public health services is a systemPublic health services is a system
of state, public, individual actionsof state, public, individual actions
and means which assist health,and means which assist health,
prevention of diseases and theprevention of diseases and the
prevention of premature death,prevention of premature death,
maintenance of persons activemaintenance of persons active
ability to live and work.ability to live and work.

Medical services – is a system ofMedical services – is a system of
special medical actions and meansspecial medical actions and means
which assist health, prevention ofwhich assist health, prevention of
diseases and the prevention ofdiseases and the prevention of
premature death, maintenance ofpremature death, maintenance of
persons active ability to live andpersons active ability to live and
work .work .

Main principles on which the publicMain principles on which the public
health services and medical care inhealth services and medical care in
Ukraine are based:Ukraine are based:
- The state character with equal rights for the- The state character with equal rights for the
existence of public and private ownership;existence of public and private ownership;
- Decentralization of management;- Decentralization of management;
- Socially focused availability;- Socially focused availability;
- Economic efficiency;- Economic efficiency;
- A preventive orientation;- A preventive orientation;
- A free choice of the doctor;- A free choice of the doctor;
- Scientific maintenance;- Scientific maintenance;
- Wide participation of the public in public health- Wide participation of the public in public health
services;services;
- The international cooperation;- The international cooperation;

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The right on public health servicesThe right on public health services
provides:provides:
1. High standard of life, including clothes, dwelling,1. High standard of life, including clothes, dwelling,
medical care both social service and the maintenance,medical care both social service and the maintenance,
necessary for health of the person;necessary for health of the person;
2. Environment safe for life and health ;2. Environment safe for life and health ;
3. Sanitary - epidemic well-being of territory and3. Sanitary - epidemic well-being of territory and
settlement where the citizen lives;settlement where the citizen lives;
4. Safe and healthy working conditions, life and rest;4. Safe and healthy working conditions, life and rest;
5. The qualified health care, including free choice of5. The qualified health care, including free choice of
the doctor and establishment of public health services;the doctor and establishment of public health services;
6. The authentic and up-to-date information about6. The authentic and up-to-date information about
the condition of the health of all people, includingthe condition of the health of all people, including
existing risk factors and their degree;existing risk factors and their degree;

7. Participation in discussion of projects of acts and7. Participation in discussion of projects of acts and
offers concerning formation of a state policy in the fieldoffers concerning formation of a state policy in the field
of public health services;of public health services;
8. Participation in management of public health8. Participation in management of public health
services and carrying out public examination on theseservices and carrying out public examination on these
questions in the order, stipulated by the legislation;questions in the order, stipulated by the legislation;
9. Opportunity of association in public organizations9. Opportunity of association in public organizations
with the purpose to assist public health services;with the purpose to assist public health services;
10. Legal protection from any illegal forms of10. Legal protection from any illegal forms of
discrimination connected with personal state of health;discrimination connected with personal state of health;
11. Compensation of the harm caused to health;11. Compensation of the harm caused to health;
12. The appeal of wrongful decisions and actions of12. The appeal of wrongful decisions and actions of
workers, establishments and bodies of public healthworkers, establishments and bodies of public health
services;services;
13. Opportunity of carrying out of independent medical13. Opportunity of carrying out of independent medical
examination in case of disagreement of the citizen withexamination in case of disagreement of the citizen with
conclusions of the state medical examination,conclusions of the state medical examination,
application to him of compulsory treatment and in otherapplication to him of compulsory treatment and in other
cases if actions of the worker of public health servicescases if actions of the worker of public health services
can be the humiliate of human and civil rights.can be the humiliate of human and civil rights.

At the same time, the law also regulatesAt the same time, the law also regulates
duties of citizens in the field of publicduties of citizens in the field of public
health services, namely:health services, namely:
1. Duty to take care of the health of children,1. Duty to take care of the health of children,
not to be harmful to health of other citizens;not to be harmful to health of other citizens;
2. In the cases stipulated by the legislation to2. In the cases stipulated by the legislation to
pass preventive medical examinations reviewspass preventive medical examinations reviews
and to do inoculations;and to do inoculations;
3. To live the emergency care to other citizens3. To live the emergency care to other citizens
who are in menacing for a life or health ;who are in menacing for a life or health ;
4. To execute other duties stipulated by the4. To execute other duties stipulated by the
legislation concerning public health services.legislation concerning public health services.

Rights and privilegesRights and privileges::
1) Occupation with medical and pharmaceutical1) Occupation with medical and pharmaceutical
activity according to a specialty andactivity according to a specialty and
qualifications;qualifications;
2) Appropriate conditions of professional work;2) Appropriate conditions of professional work;
3) Improvement of professional skills, retraining3) Improvement of professional skills, retraining
not less than once in five years in thenot less than once in five years in the
corresponding establishments;corresponding establishments;
4) Free choice of the approved forms, methods4) Free choice of the approved forms, methods
and means of activity, introduction of modernand means of activity, introduction of modern
achievements of a medical and pharmaceuticalachievements of a medical and pharmaceutical
science and practice;science and practice;
5) Gratuitous age of the social and special5) Gratuitous age of the social and special
medical information necessary for realization ofmedical information necessary for realization of
professional duties;professional duties;

66) Obligatory insurance at the expense of the) Obligatory insurance at the expense of the
proprietor of establishment of public health servicesproprietor of establishment of public health services
in case of causing harm to their life and health inin case of causing harm to their life and health in
connection with performance of professional dutiesconnection with performance of professional duties
in the cases stipulated by the legislation;in the cases stipulated by the legislation;
7) The social care of the state in case of disease,7) The social care of the state in case of disease,
invalidity or in other cases of disability which wereinvalidity or in other cases of disability which were
caused by performance of professional duties;caused by performance of professional duties;
8) To fix in official bodies of public health services8) To fix in official bodies of public health services
average rates and official salaries at the level, whichaverage rates and official salaries at the level, which
not lower from average wages of industry workers;not lower from average wages of industry workers;
9) The reduced working day and additional payment9) The reduced working day and additional payment
rest in the cases established y the legislation;rest in the cases established y the legislation;
10) Concessionary terms of a provision of pensions;10) Concessionary terms of a provision of pensions;

11) Preferential providing with dwelling and11) Preferential providing with dwelling and
phone;phone;
12) Gratuitous using an apartment with heating12) Gratuitous using an apartment with heating
and lighting by those who live in a countryside,and lighting by those who live in a countryside,
giving of privileges concerning payment of thegiving of privileges concerning payment of the
land tax, crediting, providing the a facilities andland tax, crediting, providing the a facilities and
construction of own house, purchase of autoconstruction of own house, purchase of auto
and motor-transport;and motor-transport;
13) Prime reception of the treatment-and-13) Prime reception of the treatment-and-
prophylactic care and provision with medicalprophylactic care and provision with medical
and orthopedic means;and orthopedic means;
14) Creation of scientific medical societies, trade14) Creation of scientific medical societies, trade
unions and other public organizations;unions and other public organizations;
15) Legal protection of the professional honor15) Legal protection of the professional honor
and dignity.and dignity.

Duties:Duties:
1)1) To assist protection and strengthening of health ofTo assist protection and strengthening of health of
people, prevention and treatment of the diseases, to givepeople, prevention and treatment of the diseases, to give
qualified medical care;qualified medical care;
2)2) Free-of-charge emergency call service to citizens inFree-of-charge emergency call service to citizens in
case of accident and other extreme situations;case of accident and other extreme situations;
3)3) To distribute scientific and medical knowledgeTo distribute scientific and medical knowledge
among the population, to propagandize, including ownamong the population, to propagandize, including own
example, a healthy way of life;example, a healthy way of life;
4)4) To keep the requirement of a professional etiquetteTo keep the requirement of a professional etiquette
and of a deontology, to save medical secret;and of a deontology, to save medical secret;
5)5) To raise constantly the level of a professionalTo raise constantly the level of a professional
knowledge and skills;knowledge and skills;
6)6) To live the advisory care to the colleagues and otherTo live the advisory care to the colleagues and other
workers of public health services.workers of public health services.

The first principle on which the publicThe first principle on which the public
medicine was created, was its availabilitymedicine was created, was its availability
to people. There was an idea to divideto people. There was an idea to divide
territory administrative unit (district,territory administrative unit (district,
province) on so-called districts and toprovince) on so-called districts and to
employ the doctor so that he gaveemploy the doctor so that he gave
inhabitants of that district accessibleinhabitants of that district accessible
medical service.medical service.

The Soviet medicine has borrowed aThe Soviet medicine has borrowed a
district of the organization as the basicdistrict of the organization as the basic
and with the end of its existence hasand with the end of its existence has
finished normative parameters of districtsfinished normative parameters of districts
to the following figures: a rural medicalto the following figures: a rural medical
district - radius of 7 km, number ofdistrict - radius of 7 km, number of
inhabitants - 4 thousands. In city districtsinhabitants - 4 thousands. In city districts
became differentiated.became differentiated.
So-called therapeutic district for adultSo-called therapeutic district for adult
population, was limited to 1700population, was limited to 1700
inhabitants, pediatric - to 800 infants.inhabitants, pediatric - to 800 infants.

Types of medical serviceTypes of medical service
according to the volumeaccording to the volume
parameterparameter
primary - 60 %,primary - 60 %,
secondary - 30 %,secondary - 30 %,
tertiary – 10 %.tertiary – 10 %.

Bases parameters of system of medicalBases parameters of system of medical
care in Ukraine, 1999care in Ukraine, 1999
1. Number of hospital establishments 3122
2. Number of establishments which give the out-patient – polyclinic help 6429
3. The general number of hospital beds 444495
4. Total number of doctors (including dental) 205759
5. Total number of nurses 498845
6. Number of doctors on 10 thousands people 41,6
7. Number of nurses on 10 thousands people 100,9
8. Number of hospital beds on 10 thousand people 89,9
9. Average capacity of hospital establishments:
Areal hospital 837
City hospital 190
Regional hospital 230
District hospital 73
Local hospital 16

After long years of discussions familyAfter long years of discussions family
medicine in Ukraine began tomedicine in Ukraine began to
develop. In 2002 year there weredevelop. In 2002 year there were
1352 family doctors.1352 family doctors.
It is still not enough if to take intoIt is still not enough if to take into
account, that the number of medicalaccount, that the number of medical
districts in Ukraine exceeds 35districts in Ukraine exceeds 35
thousands (2002).thousands (2002).

However the state maintenance of medicine,However the state maintenance of medicine,
besides doubtless positive advantages, has alsobesides doubtless positive advantages, has also
the essential lacks.the essential lacks.
First,First, always it is not sufficiently providedalways it is not sufficiently provided
with means.with means.
According to recommendations of WHO (theAccording to recommendations of WHO (the
World Health Organization ), on medical care theWorld Health Organization ), on medical care the
state can allocate not less than 6,5 % of the totalstate can allocate not less than 6,5 % of the total
internal product.internal product.
If it is less allocated it will inevitable resulted inIf it is less allocated it will inevitable resulted in
an impoverishment and backlogs of medicine.an impoverishment and backlogs of medicine.

The secondThe second lack is that the meanslack is that the means
are irrationally spent. It has lead toare irrationally spent. It has lead to
upset of the display ratio of factors ofupset of the display ratio of factors of
medical care :a lot of medical workersmedical care :a lot of medical workers
were trained but medical technologieswere trained but medical technologies
were not developed .were not developed .

The basic method of work of ambulanceThe basic method of work of ambulance
stations and polyclinics becamestations and polyclinics became
dispensary, which essence has consisteddispensary, which essence has consisted
in active revealing of patients and theirin active revealing of patients and their
active improvement . Complex and targetactive improvement . Complex and target
routine examinations of the populationroutine examinations of the population
have been introduced.have been introduced.
Rationality dispensary method did notRationality dispensary method did not
cause doubt and due to themcause doubt and due to them
indisputable successes in revealing a lotindisputable successes in revealing a lot
of diseases, first of all infectious, aof diseases, first of all infectious, a
tuberculosis, venereal, malignant, etc.tuberculosis, venereal, malignant, etc.
have been achieved.have been achieved.

The basic organizational form of givingThe basic organizational form of giving
medical care to the population in city ismedical care to the population in city is
versatile city hospital. It consists of theversatile city hospital. It consists of the
following departments:following departments:
polyclinics,polyclinics,
hospital,hospital,
auxiliary diagnostic-medical serviceauxiliary diagnostic-medical service
administrative service.administrative service.

The primary goals of cityThe primary goals of city
hospital are the following:hospital are the following:
1.1. Giving of the inhabitants of the fixed districtGiving of the inhabitants of the fixed district
the primary health care.the primary health care.
2.2. Giving to inhabitants the specialized medicalGiving to inhabitants the specialized medical
care from the basic structures.care from the basic structures.
3.3. Preventive services of the population.Preventive services of the population.
4.4. Expertise of temporary disablement.Expertise of temporary disablement.
5.5. Maintenance of sanitary – epidemiologicalMaintenance of sanitary – epidemiological
well-being in area of activity.well-being in area of activity.
6.6. Educative activities.Educative activities.
7. The organization of the public activity for7. The organization of the public activity for
participation in business and improvement ofparticipation in business and improvement of
medical care.medical care.

Besides district doctors, narrow specialistsBesides district doctors, narrow specialists
work in the structure of polyclinics. Theirwork in the structure of polyclinics. Their
number is determined in each polyclinicnumber is determined in each polyclinic
according to the needs ,but the totalaccording to the needs ,but the total
number does not exceed the limits of thenumber does not exceed the limits of the
specification authorized by storespecification authorized by store
department of Ministry of public healthdepartment of Ministry of public health
services (services (MPHs)MPHs) of Ukraine.of Ukraine.
The modern city polyclinic, as a rule, givesThe modern city polyclinic, as a rule, gives
the specialized out-patient care of 15-35the specialized out-patient care of 15-35
specialties.specialties.

For optimization of streams of patients thatFor optimization of streams of patients that
go to a polyclinic, departments of preventivego to a polyclinic, departments of preventive
maintenance are organized. They consist ofmaintenance are organized. They consist of
such subdivisions: a room of pre-medicalsuch subdivisions: a room of pre-medical
reception, rooms of the therapist and thereception, rooms of the therapist and the
basic specialists (the neurologist, the oculist,basic specialists (the neurologist, the oculist,
the otholaryngologist, the surgeon), athe otholaryngologist, the surgeon), a
fluorographic room, clinical laboratory. In thefluorographic room, clinical laboratory. In the
room of premedical reception medicalroom of premedical reception medical
workers work.workers work.

In cities the care to inhabitants isIn cities the care to inhabitants is
organized not only by territorial, butorganized not only by territorial, but
also by an industrial principle. Thealso by an industrial principle. The
essence of last the one is, that at theessence of last the one is, that at the
enterprises medical care centres (MCC)enterprises medical care centres (MCC)
are developed .If there are more than 4are developed .If there are more than 4
thousand workers on the enterprise,thousand workers on the enterprise,
MCC consists of a polyclinic and aMCC consists of a polyclinic and a
hospital. Besides it may include dietaryhospital. Besides it may include dietary
dining room and dispensaries.dining room and dispensaries.

The following kinds of the state help areThe following kinds of the state help are
stipulated:stipulated:
1) Monetary payments on pregnancy and child birth.1) Monetary payments on pregnancy and child birth.
The size of the care makes, as a rule, 100 % ofThe size of the care makes, as a rule, 100 % of
earnings;earnings;
2) A lump sum allowance at a birth of the child. This2) A lump sum allowance at a birth of the child. This
care is given to families in the quadruple number of thecare is given to families in the quadruple number of the
minimal wages. To mothers, who was registered inminimal wages. To mothers, who was registered in
medical institution in early terms of pregnancy (till 12medical institution in early terms of pregnancy (till 12
weeks), on a regular basis of attendance and carried outweeks), on a regular basis of attendance and carried out
the recommendation of doctors, at a birth of the child thethe recommendation of doctors, at a birth of the child the
additional care in the double size of the minimal wagesadditional care in the double size of the minimal wages
is given;is given;
3) Monetary payments of the child till his three-year3) Monetary payments of the child till his three-year
old age is given to working women (or to other membersold age is given to working women (or to other members
of family) at a rate of the minimal wages irrespective ofof family) at a rate of the minimal wages irrespective of
work experience;work experience;

4) Monetary payments to mothers (parents) occupied4) Monetary payments to mothers (parents) occupied
care with three and more infant by age till 16 years; arecare with three and more infant by age till 16 years; are
appointed at a rate of the minimal wages at presence ofappointed at a rate of the minimal wages at presence of
three infant and double minimal wages at presence ofthree infant and double minimal wages at presence of
four and more infant;four and more infant;
5) Monetary payments of the child - invalid till his5) Monetary payments of the child - invalid till his
reaching 16-years old age (him) at a rate of the minimalreaching 16-years old age (him) at a rate of the minimal
wages;wages;
6) Monetary payments on temporary disablement in6) Monetary payments on temporary disablement in
connection with care of the ill child till the age of 14connection with care of the ill child till the age of 14
years.years.
7) Monetary payments on infant in the age till 16 years7) Monetary payments on infant in the age till 16 years
(pupils - till 18 years) is given at a rate of 50 % of the(pupils - till 18 years) is given at a rate of 50 % of the
minimal wages on each child if the monthly averageminimal wages on each child if the monthly average
cumulative income on each member of family forcumulative income on each member of family for
previous year does not exceed the triple number of theprevious year does not exceed the triple number of the
minimal wages;minimal wages;

8) Monetary payments on infant to single -unmarried8) Monetary payments on infant to single -unmarried
mothers, in number half or complete minimal wages onmothers, in number half or complete minimal wages on
each child age till 16 years (pupils - till 18 years);each child age till 16 years (pupils - till 18 years);
9) Monetary payments on infant of military men of9) Monetary payments on infant of military men of
emergency service is given at a rate of the minimalemergency service is given at a rate of the minimal
wages on each child;wages on each child;
10) Monetary payments on infant who are under10) Monetary payments on infant who are under
somebody’ s guardianshipsomebody’ s guardianship
( trusteeship) or care; is given at a rate of double( trusteeship) or care; is given at a rate of double
minimal wages on each child;minimal wages on each child;
11) The temporary monetary payments for minor infant11) The temporary monetary payments for minor infant
under age whose parents evade from payment of theunder age whose parents evade from payment of the
alimony or if collecting of the alimony is impossible;alimony or if collecting of the alimony is impossible;
it is given at a rate of 50 % of the minimal wages onit is given at a rate of 50 % of the minimal wages on
each child.each child.

The program "Children of Ukraine" shouldThe program "Children of Ukraine" should
be a reference point for taking measuresbe a reference point for taking measures
concerning improvement of infant health. Inconcerning improvement of infant health. In
particular, the question is in prophylaxis ofparticular, the question is in prophylaxis of
disease and providing infant most with thedisease and providing infant most with the
effective medical care, means of treatmenteffective medical care, means of treatment
and restoration; carrying out radical actionsand restoration; carrying out radical actions
on prevention of infectious and parasiticon prevention of infectious and parasitic
diseases; introduction of the scientificdiseases; introduction of the scientific
inventions aimed at on the solution of actualinventions aimed at on the solution of actual
problems of the childhood.problems of the childhood.

Especially medical actionsEspecially medical actions
maternity care and childhood arematernity care and childhood are
covered two basic units:covered two basic units:
1.1. The obstetrical - gynecologic care;The obstetrical - gynecologic care;
2.2. The treatment-and-prophylacticThe treatment-and-prophylactic
infant care.infant care.

Regular prophylactic and medicalRegular prophylactic and medical
attendance is aimed at:attendance is aimed at:
1.1. Helping pregnant women inHelping pregnant women in
observance of the existing legislationobservance of the existing legislation
concerning protection of their health andconcerning protection of their health and
other rights;other rights;
2.2. Examination of the general state of theExamination of the general state of the
pregnant woman, control over her way ofpregnant woman, control over her way of
life, regular attendance of the hospital;life, regular attendance of the hospital;
3.3. Training the rules of personal hygieneTraining the rules of personal hygiene
and care of newborns.and care of newborns.

The delivery hospital consists ofThe delivery hospital consists of
the following structural parts:the following structural parts:
1.1. The casualty ward;The casualty ward;
2.2. Physiological obstetrical department;Physiological obstetrical department;
3.3. Observational (second) obstetricalObservational (second) obstetrical
department;department;
4.4. The department of pathologies ofThe department of pathologies of
pregnancy;pregnancy;
5.5. The department for newborn;The department for newborn;
6.6. Gynecologic department.Gynecologic department.

The typical treatment-and-The typical treatment-and-
prophylactic establishmentprophylactic establishment forfor
children is independent childrenchildren is independent children
hospital or children departments inhospital or children departments in
structure of big hospitals.structure of big hospitals.

A district pediatrist - servicesA district pediatrist - services
800 children in the cities and 800800 children in the cities and 800
children in the villageschildren in the villages..

Organization of public health services & medical care

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