Organization Organization of public health services of public health services

and medical сareand medical сare

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

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

Main principles on which the public Main principles on which the public health services and medical care in health 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 services The 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 and 3. 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 of 5. 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 about 6. The authentic and up-to-date information about the condition of the health of all people, including the 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 and 7. Participation in discussion of projects of acts and offers concerning formation of a state policy in the field offers concerning formation of a state policy in the field of public health services;of public health services;8. Participation in management of public health 8. Participation in management of public health services and carrying out public examination on these services 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 organizations 9. 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 of 10. 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 of 12. The appeal of wrongful decisions and actions of workers, establishments and bodies of public health workers, establishments and bodies of public health services;services;13. Opportunity of carrying out of independent medical 13. Opportunity of carrying out of independent medical examination in case of disagreement of the citizen with examination 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 other application to him of compulsory treatment and in other cases if actions of the worker of public health services cases 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 regulates At the same time, the law also regulates duties of citizens in the field of public duties 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 to 2. In the cases stipulated by the legislation to pass preventive medical examinations reviews pass preventive medical examinations reviews and to do inoculations;and to do inoculations;

3. To live the emergency care to other citizens 3. 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 the 4. 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 pharmaceutical 1) Occupation with medical and pharmaceutical activity according to a specialty and activity according to a specialty and qualifications;qualifications;2) Appropriate conditions of professional work;2) Appropriate conditions of professional work;3) Improvement of professional skills, retraining 3) Improvement of professional skills, retraining not less than once in five years in the not less than once in five years in the corresponding establishments;corresponding establishments;4) Free choice of the approved forms, methods 4) Free choice of the approved forms, methods and means of activity, introduction of modern and means of activity, introduction of modern achievements of a medical and pharmaceutical achievements of a medical and pharmaceutical science and practice;science and practice;5) Gratuitous age of the social and special 5) Gratuitous age of the social and special medical information necessary for realization of medical 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 services proprietor of establishment of public health services in case of causing harm to their life and health in in case of causing harm to their life and health in connection with performance of professional duties connection 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 were invalidity 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 services 8) To fix in official bodies of public health services average rates and official salaries at the level, which average 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 payment 9) 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 and 11) Preferential providing with dwelling and phone;phone;12) Gratuitous using an apartment with heating 12) 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 the giving of privileges concerning payment of the land tax, crediting, providing the a facilities and land tax, crediting, providing the a facilities and construction of own house, purchase of auto construction 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 medical prophylactic care and provision with medical and orthopedic means;and orthopedic means;14) Creation of scientific medical societies, trade 14) Creation of scientific medical societies, trade unions and other public organizations;unions and other public organizations;15) Legal protection of the professional honor 15) Legal protection of the professional honor and dignity.and dignity.

Duties:Duties: 1)1) To assist protection and strengthening of health of To assist protection and strengthening of health of people, prevention and treatment of the diseases, to give people, prevention and treatment of the diseases, to give qualified medical care;qualified medical care;2)2) Free-of-charge emergency call service to citizens in Free-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 knowledge To distribute scientific and medical knowledge among the population, to propagandize, including own among 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 etiquette To 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 professional To raise constantly the level of a professional knowledge and skills;knowledge and skills;6)6) To live the advisory care to the colleagues and other To 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 public The first principle on which the public medicine was created, was its availability medicine was created, was its availability to people. There was an idea to divide to people. There was an idea to divide territory administrative unit (district, territory administrative unit (district, province) on so-called districts and to province) on so-called districts and to employ the doctor so that he gave employ the doctor so that he gave inhabitants of that district accessible inhabitants of that district accessible medical service.medical service.

The Soviet medicine has borrowed a The Soviet medicine has borrowed a district of the organization as the basic district of the organization as the basic and with the end of its existence has and with the end of its existence has finished normative parameters of districts finished normative parameters of districts to the following figures: a rural medical to the following figures: a rural medical district - radius of 7 km, number of district - radius of 7 km, number of inhabitants - 4 thousands. In city districts inhabitants - 4 thousands. In city districts became differentiated.became differentiated.

So-called therapeutic district for adult So-called therapeutic district for adult population, was limited to 1700 population, was limited to 1700 inhabitants, pediatric - to 800 infants. inhabitants, pediatric - to 800 infants.

Types of medical service Types of medical service according to the volume according to the volume

parameterparameter

primary - 60 %, primary - 60 %,

secondary - 30 %, secondary - 30 %,

tertiary – 10 %. tertiary – 10 %.

Bases parameters of system of medical Bases 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 family After long years of discussions family medicine in Ukraine began to medicine in Ukraine began to develop. In 2002 year there were develop. In 2002 year there were 1352 family doctors.1352 family doctors.

It is still not enough if to take into It is still not enough if to take into account, that the number of medical account, that the number of medical districts in Ukraine exceeds 35 districts 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 also besides doubtless positive advantages, has also the essential lacks. the essential lacks.

First,First, always it is not sufficiently provided always it is not sufficiently provided with means. with means.

According to recommendations of WHO (the According to recommendations of WHO (the World Health Organization ), on medical care the World Health Organization ), on medical care the state can allocate not less than 6,5 % of the total state can allocate not less than 6,5 % of the total internal product.internal product.

If it is less allocated it will inevitable resulted in If 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 means lack is that the means are irrationally spent. It has lead to are irrationally spent. It has lead to upset of the display ratio of factors of upset of the display ratio of factors of medical care :a lot of medical workers medical care :a lot of medical workers were trained but medical technologies were trained but medical technologies were not developed . were not developed .

The basic method of work of ambulance The basic method of work of ambulance stations and polyclinics became stations and polyclinics became dispensary, which essence has consisted dispensary, which essence has consisted in active revealing of patients and their in active revealing of patients and their active improvement . Complex and target active improvement . Complex and target routine examinations of the population routine examinations of the population have been introduced.have been introduced.

Rationality dispensary method did not Rationality dispensary method did not cause doubt and due to them cause doubt and due to them indisputable successes in revealing a lot indisputable successes in revealing a lot of diseases, first of all infectious, a of 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 giving The basic organizational form of giving medical care to the population in city is medical care to the population in city is versatile city hospital. It consists of the versatile 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 city The primary goals of city hospital are the following:hospital are the following:

1.1. Giving of the inhabitants of the fixed district Giving of the inhabitants of the fixed district the primary health care.the primary health care.2. 2. Giving to inhabitants the specialized medical Giving 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 – epidemiological Maintenance 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 for 7. The organization of the public activity for participation in business and improvement of participation in business and improvement of medical care.medical care.

Besides district doctors, narrow specialists Besides district doctors, narrow specialists work in the structure of polyclinics. Their work in the structure of polyclinics. Their number is determined in each polyclinic number is determined in each polyclinic according to the needs ,but the total according to the needs ,but the total number does not exceed the limits of the number does not exceed the limits of the specification authorized by store specification authorized by store department of Ministry of public health department of Ministry of public health services (services (MPHs)MPHs) of Ukraine. of Ukraine.

The modern city polyclinic, as a rule, gives The modern city polyclinic, as a rule, gives the specialized out-patient care of 15-35 the specialized out-patient care of 15-35 specialties.specialties.

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

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

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

4) Monetary payments to mothers (parents) occupied 4) Monetary payments to mothers (parents) occupied care with three and more infant by age till 16 years; are care with three and more infant by age till 16 years; are appointed at a rate of the minimal wages at presence of appointed at a rate of the minimal wages at presence of three infant and double minimal wages at presence of three infant and double minimal wages at presence of four and more infant;four and more infant;5) Monetary payments of the child - invalid till his 5) Monetary payments of the child - invalid till his reaching 16-years old age (him) at a rate of the minimal reaching 16-years old age (him) at a rate of the minimal wages;wages;6) Monetary payments on temporary disablement in 6) Monetary payments on temporary disablement in connection with care of the ill child till the age of 14 connection with care of the ill child till the age of 14 years.years.7) Monetary payments on infant in the age till 16 years 7) 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 average minimal wages on each child if the monthly average cumulative income on each member of family for cumulative income on each member of family for previous year does not exceed the triple number of the previous year does not exceed the triple number of the minimal wages;minimal wages;

8) Monetary payments on infant to single -unmarried 8) Monetary payments on infant to single -unmarried mothers, in number half or complete minimal wages on mothers, 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 of 9) Monetary payments on infant of military men of emergency service is given at a rate of the minimal emergency service is given at a rate of the minimal wages on each child;wages on each child;10) Monetary payments on infant who are under 10) 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 infant 11) The temporary monetary payments for minor infant under age whose parents evade from payment of the under 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 on it is given at a rate of 50 % of the minimal wages on each child.each child.

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

Especially medical actions Especially medical actions maternity care and childhood are maternity 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-prophylactic The treatment-and-prophylactic infant care.infant care.

Regular prophylactic and medical Regular prophylactic and medical attendance is aimed at:attendance is aimed at:

1.1. Helping pregnant women in Helping pregnant women in observance of the existing legislation observance of the existing legislation concerning protection of their health and concerning protection of their health and other rights;other rights;2.2. Examination of the general state of the Examination of the general state of the pregnant woman, control over her way of pregnant 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 hygiene Training the rules of personal hygiene and care of newborns.and care of newborns.

The delivery hospital consists of The 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) obstetrical Observational (second) obstetrical department;department;

4.4. The department of pathologies of The 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 for for children is independent children children is independent children hospital or children departments in hospital or children departments in structure of big hospitals.structure of big hospitals.

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

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