Bobkova S.A., Kazinina E.N.

SI “Crimea State Medical University named after S. I. Georgievsky”

Insurance medicine in Ukraine and its problems

Before1989 the Soviet health system was based on a curative approach and provided services to the entire population. It was regarded as generally effective, as measured, for example, by reductions in infant mortality from the 1950s and high immunisation rates. Now, barely a third of Ukraine's infants are vaccinated. Large reductions in expenditureon health care and in access to services followed economic transition and have seriously degraded the health system. Private purchase of health care exists alongside a state funded system. Ukraine is currently seeking international assistance to develop a system based on a combination of tax and insurance. The article is devoted to the actual problems of introduction of insurance ofprofessional responsibility of medical workers in the system of the Ministry of Internal Affairs of Ukraine. There have been determined the key-tasks resolving of which is possible if such an insurance is introduced. A list of circumstances that are not considered by an insurer as insurance occassions which can’t be subjected to indemnification is defined.

Public awareness of HIV risk is low, a consequence of the government's neglect of public health. Lack of investment, widespread poverty, social and judicial constraints on decriminalisation of drug use, drug trafficking, and government corruption have been key influencing factors.

Cultural attitudes toward injecting drug users, sex workers, same sex relationships, immigrants, and people with communicable diseases remain punitive. At the same time, the country has experienced steep rises in injecting drug use, the initial transmission route for HIV. Corrupt border controls and drug trafficking have been internationally recognised features in Ukraine until recently.

What is insurance medicine?

Treatment, even in the developed countries, is quite expensive and not everyone can pay for it. In order to make it more accessible institute of insurance medicine has been created.

The insurance medicine is a form of public health services organization, which provides obligatory state insurance upon illnesses in combination to private medical practice and private medical institutions. Such system of the organization of medicine allows putting a payment of medical staff and incomes of medical establishments in direct dependence on quality of treatment and diagnostics. And thus, from the financial point of view, reception of qualitative medical aid is accessible to the majority of citizens.

The insurance medicine means medical insurance which, in turn, can be obligatory or voluntary. The world practice confirms that a basis of insurance medicine is obligatory medical insurance. Its purpose is to guarantee reception of medical service due to the saved up means in the insurance case.

Insurance fund is the main attribute of insurance medicine. It is formed due to obligatory deductions of wages working, deductions of employers’ profit, state grants and welfare funds.

The previous Minister of Health of Ukraine has come out with the assumption, that 2-3 years will be required for introduction of insurance medicine in Ukraine. It is planned, that in a year 15,573 billion UAH will be spent on maintenance of medical insurance.

In Ukraine already the first experiences of application of insurance medicine appear. Hospital cash departments may be considered as one of its prototypes. They quite successfully work in many cities of Ukraine. But it is the form of voluntary medical insurance. If to speak about obligatory medical insurance, it is worth of mentioning that talks on its necessity have started already in the beginning of 1990 – so long before occurrence of 49-th clause of the Constitution, Ukraine guaranteeing to all citizens free-of-charge health services. In 2002 the first bill about the state social medical insurance has appeared. Later six more bills, offering to enter obligatory medical insurance, have been submitted. But all of them have remained just projects. Next, these days already the eighth bill On obligatory state social medical insurance has been registered. On the basis of Fund of social insurance on time loss of working capacity the project offers to carry out services of obligatory medical insurance. Introduction of an innovation was planned for January, 1st, 2009. Expenses for rendering of medical services will be guaranteed by the employer (4,2 % from fund of a payment) and local enforcement authorities, and clients will pay insurance payments regarding a covering of expenses for material maintenance and social services of the Fund.

Reinsurance is one of insurance kinds and the major mechanism on risks redistribution. Reinsurance allows to compensate fluctuations and to reduce damage potential. It is a system of economic relations according to which the insurer, accepting to insurance on them (in view of the financial opportunities), transfers risks, a part of the responsibility on the coordinated conditions to other insurers with the purpose of creation of whenever possible balanced insurance portfolio, financial stability maintenance and insurance operations profitability.

The Ukrainian parliament passed a law in 1997 whereby all visitors to Ukraine are required to obtain Ukrainian health insurance. The cost of this insurance depends on how long you are in Ukraine. This required insurance can be purchased after arrival and covers only the costs of basic medical care inside Ukraine; it does not cover medical evacuation.