scholarly journals VECTOR FOR THE DEVELOPMENT OF MEDICAL INSURANCE IN THE CONTEXT OF MODERN MEDICAL REFORM IN UKRAINE

2018 ◽  
pp. 148-156
Author(s):  
Olha KNEYSLER ◽  
Lesia SHUPA

Introduction. The current practice of functioning of the medical sector shows the existence of problems that impede the introduction of compulsory health insurance in Ukraine, the effective development of its voluntary form. At the same time, the problems of development of medical insurance under the influence of crisis phenomena of the national economy are deepening. The purpose of the article is to develop recommendations for improving medical reform in Ukraine. Results. The most controversial moment in the reform of health care was the rejection of free medicine, the right to which is enshrined in the Constitution of Ukraine. However, budget medicine in Ukraine will still remain, however, in what volumes and at what stages of provision of medical services or medical care is not yet defined in the Ministry of Health of Ukraine. The negative trend of the contracted health model is the creation of an authorized body that will not only implement health policy but, in fact, formulate this policy: to define state guarantees, needs for medical services and to check the quality of these services. And this is a huge threat, because Ukrainian medicine will be in a worse situation than it is now. We believe that the policy-making function should remain under the Ministry of Health of Ukraine. The negative aspect of modern medical reform in Ukraine is the lack of requirements for the formation of medical treatment protocols. This can be explained by the fact that patients will continue to prescribe treatment that is untrue. Instead, for the health insurance, the insurance company would monitor costs and control the appointment of treatment for the patient, the price of medical services. In this context, we propose to adopt the Law of Ukraine “On Compulsory Health Insurance”, which stipulates and clearly defines the rights and obligations of the insurer, the insurer, the list of services, their price, a single register of insured persons, the formation of the Social Health Insurance Fund and a differentiated approach to categories of the population. Conclusions. The experience of developed countries of the world proves that achieving this goal is possible through the introduction of insurance medicine. Insurance medicine is a real alternative to budget financing, which is no longer capable of ensuring the constitutional right of citizens to receive unpaid health care. The development of health insurance is an objective need, which is dictated by the need to ensure that healthcare receives funds. At the moment, the study of the question of the necessity of introducing compulsory health insurance is probably very relevant to all. Successful market reforms in Ukraine are impossible without the formation of an effectively organized health insurance market that can guarantee the preservation and strengthening of human health, improving the quality of medical services and the level of human life.

Author(s):  
Lilia Olegovna Avdeeva ◽  
Elena Igorevna Kozyrenko

The article touches upon the problem of financing health care in the world today, which is carried out mainly at the expense of budget funds, employers, population and enterprises in different proportions. The share of each of these sources in the total amount of funds allocated by society to health care determines the model of financing this economic sector. The budget model of financing the health care does not fully cover the needs of the population in the guaranteed volume of free medical care. In recent years, such sources as direct payment for medical services and voluntary health insurance programs have brought a certain amount of money to the Russian health care system. The conducted analysis of the financial support of the health care system in Russia proved that the cost of the program of state guarantees increases throughout the whole period. Means of compulsory medical insurance as well as budgetary allocations of the entities of the Russian Federation are used to finance the program of State guarantees. The volume of compulsory health insurance funds is increasing, the growth rate of compulsory health insurance in 2017 outpaced the rate assigned by the program. In 2016 revenue growth and spending cuts brought the Federal Fund of compulsory medical insurance to a deficit-free budget, but in 2017 the growth of spending outpaced revenue growth, which leads to a deficit. There can be seen the positive dynamics of growth rates of insurance premiums for voluntary health insurance. Currently, underfunding of territorial programs is compensated by the population independently through the use of voluntary health insurance and paid medical services. The main objective of the further transformation of compulsory medical insurance system is stated to increase the volume of financing of the system. In the process of adjusting state obligations the deficit of financial provision of territorial programs of state guarantees should be taken into account, which has already been redistributed due to its insecurity, but without legislative consolidation. The reserve of redistribution will be the increase in payments under contracts of voluntary medical insurance and funds received by medical organizations from the provision of paid medical services.


Author(s):  
N. E. Popova ◽  
T. S. Sergienko

In the context of increasing concentration in the medical services market, one of the key areas of the industry's development is expanding the opportunities for private medical organizations to participate in the MHI and developing competition between medical organizations participating in the MHI system. In the work the analysis of the competitive environment in the market of mandatory medical insurance for 2015-20018 years, the reasons to reduce insurance companies on the market of OMS over the years, as well as the consequences of this event, considered leaders by revenues and shares in the market during 2016-2018, the identified indicators of the level of concentration in these regions, the analysis of market OMS of the SFD identified the problematic aspects and ways of increasing the effectiveness of competition between health insurance organizations, the built Matrix porter services OMS, identified obstacles (obstructions), faced by entities when entering into the market of medical services in the MHI system.


Author(s):  
D.S TISHKOV ◽  

Compulsory health insurance is an integral part of health care. Dental care is provided in two forms: private dental services and public dental services based on budget clinics. The purpose of this study is to study dental health in Russia by comparing the policy of compulsory medical insurance and private services in dental practice. During the study, dental health indicators were studied at three levels: indicators for monitoring the oral health of children and adolescents. In the second part, indicators for monitoring oral health in the General population were studied. In the third part, indicators for monitoring the quality of life of the oral cavity were studied. Statistical data processing included implementation of correlation analysis of the obtained data. The results show that social health insurance provides people with equal opportunities for dental services, and health care reforms have improved oral health. Thus, the data obtained indicate the need to Finance the health care system in view of improving the quality of dental care for children and adults, as well as through the introduction of primary and secondary prevention programs.


Author(s):  
Tetiana Zheliuk

The modern problems of formation of the market of medical services are analyzed. Attention is drawn to the resource provision of medical institutions, the provision of medical services and medicines in the context of medical reform. The effectiveness of the regulation of financial and price aspects of the provision of medical services through the program of state financial guarantees, the use of modern forms of procurement of medicines and medicines, the establishment of a tariff for medical services related to the provision of primary health care, quality assurance and availability of medicines has been analyzed. The approaches to improving the efficiency and quality of provision of medical services at the regional level are substantiated.


Author(s):  
S. O. Dzhundubaieva

<p>Introduction of ontological representations in insurance medicine is difficult due to lack of skilled professionals in this area of knowledge and ontology representation languages are complex and far from the knowledge of medical insurance. In addition, medical insurance is based on a large volume of procedural knowledge, which are also difficult to generalize and order. At the same time, harmonization of risk medical insurance and the desire of the population to purchase medical services urgently require a certain systematization. Outlines ways to create an ontology of health insurance are identified.</p>


Author(s):  
Olesia Dubovych ◽  
◽  
Nataliia Vasylieva ◽  
Iryna Drohomeretska ◽  
◽  
...  

The academic paper has analyzed the experience of implementing the reform of the health care system in Poland, taking into account the legal regulation of the measures taken.The attention is focused on the basic stages of the medical reform, as well as the features of each stage. The legal aspects of the process of reforming the health care system in Poland have been investigated; they determine the sources and methods of financing health services, the level of quality of health care and the functioning of the health care system in general. The individual components of the health care system related to compulsory health insurance have been described. Based on the analysis, it has been proved that in practice there is no single universal model of financing the health care system. The experience of the functioning of health care in Poland has shown that the experience of reforming the health care system in Poland can be successfully implemented in the practice of medical reform in Ukraine, provided that the historical, economic and cultural features of the country are taken into account. It has been concluded that in order to improve measures to reform the medical system of Ukraine it is necessary to develop and implement measures aimed at the development of health insurance and medical self-government. Introduction of health insurance in Ukraine will help improve medical services, improve the management of the entire health care system and its financing.


2018 ◽  
pp. 168-171
Author(s):  
Lesia Shupa

Introduction. At the current stage, the state should pay considerable attention to the development of the social sphere, including health care. Ensuring sustainable and sufficient funding for development of health care is a guarantee of the normal functioning of the economy in any country. In addition, the establishment of effective public health institutions is one of the priority tasks of any state. This is due not only to the fact that the health of the nation is important for the sustainable social and cultural development of society. It is an important determinant of the country's economic development. Purpose. The article aims to characterize and identify the key features of the functioning of the health insurance system in Estonia and to introduce Estonian experience in compulsory health insurance in Ukraine. Results. The medical insurance in Estonia and in Ukraine have been described. The effectiveness of compulsory health insurance depends on the accepted concept of insurance medicine in the country. Currently, a mixed healthcare system operates in Ukraine, with a predominant source of budget funding. At the same time, nowadays there is a private health insurance takes a negligible share in the health care system. The public health insurance of Estonia covers the cost of treatment and disease prevention, finances the purchase of a wide range of medicines and medical devices, compensates for the income not received due to temporary disability, covers the cost of treatment and prosthetics of teeth. The article reveals positive and negative tendencies in the introduction of obligatory forms of health insurance. The benefit of the Estonian health insurance system has become the following fact: the health insurance system really works and its economic efficiency. The disadvantages of the Estonian health insurance system include queues and financial vulnerabilities. It is noted that the priority task for Ukraine is the adoption of the Law of Ukraine "On Compulsory Social Health Insurance", which will be supplemented by voluntary medical insurance. It will promote the increase of social standards, improvement of the health of the nation, the living standards of each citizen and achievement of the country's economic well-being.


2021 ◽  
Vol 2 (1) ◽  
pp. 76-88
Author(s):  
Vadym Aleksandrov ◽  
Pavlo Rubanov ◽  
Madi Mazhed Eisa

This article summarizes the arguments and counterarguments within the scientific discussion on health care financing by introducing compulsory health insurance in Ukraine and improving voluntary one. The study’s primary purpose is to theorize and determine the main directions and recommendations for implementing compulsory health insurance in Ukraine. Systematization of scientific background concerning the study problem showed that Ukrainian national and municipal health care institutions didn’t provide free medical care in the amount and quality guaranteed by the Constitution of Ukraine. Therefore, the relevance of solving this scientific issue is the necessity of comprehensive health care reforming (especially funding) considering compulsory health insurance. To achieve this goal, the study was conducted in the following logical sequence: analyzing models, historical experience, and a hybrid budget insurance system of health care financing; identifying the Ukrainian health insurance features during the pandemic in 2020; clarifying the problems of health insurance development in Ukraine and the world; analyzing and considering the theoretical base on solving health insurance issues; retrospective analysis of the three-level insurance model; developing the practical recommendations for improving the mechanisms of compulsory health insurance implementation. The methodological tools of the study were the methods of dialectical scientific knowledge, systematic approach, statistical and comparative analysis, a review of scientific background, regulatory framework, and insurance companies’ reports. The study involves data for 2002-2021. The object of the study is the health insurance system and state mechanisms for regulating compulsory and voluntary health insurance in Ukraine. The obtained results showed that the introduction of compulsory health insurance in Ukraine addressed the expanding availability of medical services to the general population and attracting additional resources in health care. The study empirically confirms and theoretically proves that the Ukrainian government should determine the main health services provided and the insurance premium amount, coordinate the interaction between insurance parties, resolve conflict situations, provide the legal basis for the system functioning, control financial flows and activity insurance fund. The study results can be helpful for insurance market professionals, financiers, and economists in the health care industry, researchers, and students of economic specialties.


Author(s):  
M. V. Sochinskaya ◽  

The article examines the models of health insurance in Western countries. A comparative analysis of forms of social insurance and sources of financing payments for four models of medical insurance is carried out. The practical aspects of the functioning of compulsory health insurance in Germany are investigated, its positive features are revealed. Attention is paid to medical insurance, which provides insurance in case of loss of health for any reason. It provides greater accessibility, quality and completeness to meet the diverse needs of the population in the provision of medical services, and is more effective than government funding of the health care system. In addition, the social and economic efficiency of health insurance related to reimbursement of citizens' expenses related to receiving medical care, as well as other expenses aimed at maintaining health, depends on how comprehensively the concept of developing insurance medicine in the country has been worked out. The positive and negative aspects of health insurance are analyzed. The forms of health insurance are considered: compulsory health insurance and voluntary health insurance. It was found that one of the first countries where health insurance was introduced was Germany. There are two types of health insurance in Germany: public and private. Germany's state health insurance is compulsory. That is, every employee, as well as persons trained in production (Auszubildende), are subject to compulsory state health insurance and must be members of one of their freely chosen state health insurance funds. At the same time, if a person wishes to receive medical services that are not included in the list of compulsory health insurance, he can conclude a supplementary health insurance contract with the insurance company. Voluntary health insurance allows you to choose an inpatient medical institution and the conditions of stay in it, special services of a personal physician.


Sign in / Sign up

Export Citation Format

Share Document