HEALTH CARE

The health of the individual is an important pre-condition for sustainable human development. All fundamental changes affecting society and the individual during the transition period have influenced the health sector as well. Ukraine is confronted with the difficult task of reforming the health administration system, adapting it to the needs of market economy under circumstances of tight fiscal con-straint.

4.1% of Ukraine`s GNP is allocated to health care in comparison to 6.25% in Poland, 6.5% in Portugal, 6.8% in England, 9.2% in Germany, and 11% in Sweden.

The functioning network includes 661 city hospitals, 114 children`s hospitals(in urban areas), 131 specialized hospitals, 27 regional hospitals, 488 central district hospitals, 1293 district hospitals, 86 psychiatric as well as alcohol and drug clinics, 390 dispensaries, and 87 maternity clinics. In these institutions there are 551 350 beds in total.

The number of in-patient beds decreased from 130 per 10 000 population to 108.9 in 1996. Since 1996, the number has been steadily falling in connection with decrease in the financing of health care, which in turn is linked with the economic crisis on the one hand, and the rationalization of in-patient care on the other. In the oblasts the number of beds fluctuates from 96.0 to 138.0 per 10 000 inhabitants.

To reform the health care system it is necessary to consolidate the principles of state policy and develop a strategy for providing health care. It is also crucial to ensure plurality of social and economic structures, introduce multi-source funding together with medical insurance, guarantee accessibility of primary medical care, and develop family medicine.

Restructuring the financing of the health care system is the most urgent task. Mandatory medical insurance is to be the main non-budgetary source of funding. Introducing medical insurance will not only make it possible to mobilize additional funding, but will also contribute to the efficient and effective utilization of health care resources. Furthermore, its introduction will ensure equity in access to medical care in institutions of different forms of ownership, enhance the quality health care service, and guarantee a patient's right to choose a physician freely. It is envisaged that new methods of payment for medical care will be introduced. It has been proposed that medical institutions be financed according to their results and effectiveness, that material incentives for health care personnel be increased, and that favourable financial conditions for medical practice be created.

In resructuring the health care administration system, priority should be given to primary, secondary and tertiary medical care. In other words, those institutions most widely used by the population - out-patient and in-patient care on the basis of famaly medicine - should be reformed first and their services should be made affordable. In turn, the number of in patient beds needs to be rationalized while at the same time day hospitals, nursing institutions (for patient with chronic illnesses) should be developed.

The following are the main objectives of reform: improve forms and methods of health care administration; create the necessary legislation and an information system; centralize medical statistics, and prepare highly qualified specialists.

In reforming the health care system close collaboration is envisaged with World Health Organization, UNICEFF and other UN agencies, as is the coordination of the activity of all international organizations working in Ukraine to implement the s the strategy "Health for All", and fulfill the provisions of the Declaration of the Rights of the Child.