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乌克兰在启动公共卫生保护措施方面的国际责任,以及地方当局在实施医疗保健政策方面的作用。

UKRAINE'S INTERNATIONAL LIABILITIES ON INITIATION OF MEASURES FOR PUBLIC HEALTH PROTECTION AND THE ROLE OF LOCAL AUTHORITIES IN IMPLEMENTATION OF HEALTH CARE POLICY.

机构信息

1Taras Shevchenko National University of Kyiv; Ukraine.

2Vasyl' Stus Donetsk National University; Ukraine.

出版信息

Georgian Med News. 2021 Mar(312):163-168.

Abstract

The article examines the international obligations of Ukraine to implement measures to protect public health and the role of local governments in implementation of health policy. Emphasis is placed on Ukraine's implementation of the Sustainable Development Goals being a member of the UN, the Association Agreement between Ukraine and the EU, and the commitment to develop cooperation in the field of health care undertaken by Ukraine, radical health care reform and decentralization reform in Ukraine. The purpose of the article is to determine the role of local governments in implementation of health policy in the context of decentralization reform and the second stage of health care reform in Ukraine, to identify shortcomings in Ukrainian legislation and the practice that lead to violations of regional communities residents' rights for health care and medical aid, as well as violations of the rights of medical personnel for labor. The object of the study is social relations that arise when the local authorities implement the health care policy. The methodological basis of the conducted research is the general methods of scientific cognitivism as well as concerning those used in legal science: formal logic, methods of analysis and synthesis, comparative law etc. The role of local governments on the implementation of health policy in the context of decentralization reform and the second stage of health care reform in Ukraine is defined: currently local governments are one of the key elements of the organizational and legal mechanism to ensure the rights of every resident for health care and medical aid. They develop and implement regional and local public health programs, directly influencing the state of the health care system. As a part of the decentralization reform, local self-government authorities have gained greater financial autonomy, and radical model of health care financing is being introduced as a part of radical reform of the health care system. Deficiencies in the legislation of Ukraine and the practice of its application, which lead to violations of the rights of residents of territorial communities to health care and medical aid, as well as violations of rights of medical personnel for labor: 1) inconsistency of Ukrainian legislation with the new system of administrative-territorial structure; 2) lack of clear delineation of powers, revenues and expenditures of local governments at the basic (regional), district and sub-regional levels, duplication of powers; 3) the absence of requirements to the content of regional plans for prevention and treatment of diseases that cause the greatest negative socio-demographic and economic impact within current legislation, as well as to the target programs of city councils, reports on their implementation. Emphasis is also placed onto inadequate and untimely funding for secondary link care facilities, existing barriers to the financial success of secondary health care facilities, and quality control of their medical services. Basing on the analysis of the case Law of the European Court of Human Rights, it is established that the stay of patients at medical institutions that are not supplied with the necessary equipment to ensure proper care, transfer of patients from one ward to another without an established diagnosis, failure to provide appropriate treatment because of difficult situation (lack of staff, malnutrition, poor living conditions in the hospital) is a violation of Article 2 of the Convention for the Protection of Human Rights and Fundamental Freedoms.

摘要

本文探讨了乌克兰作为联合国成员国、乌克兰与欧盟之间的《联系国协定》的签署国,履行保护公共健康的国际义务以及地方政府在实施卫生政策方面的作用,并强调了乌克兰在实施可持续发展目标方面的承诺,同时还探讨了乌克兰在卫生保健领域开展合作的情况、激进的医疗保健改革和权力下放改革。本文的目的是确定地方政府在乌克兰权力下放改革和医疗保健改革第二阶段背景下实施卫生政策的作用,确定乌克兰立法和实践中的不足导致侵犯地区社区居民的医疗保健和医疗援助权利,以及侵犯医务人员劳动权利的情况,以识别卫生保健系统中的缺陷。研究对象是地方当局在实施卫生保健政策时产生的社会关系。本文的研究方法基础是一般科学认知方法以及法律科学中使用的方法:形式逻辑、分析和综合方法、比较法等。在权力下放改革和乌克兰医疗保健改革第二阶段的背景下,确定了地方政府在实施卫生政策方面的作用:目前,地方政府是确保每个居民享有医疗保健和医疗援助权利的组织和法律机制的关键要素之一。它们制定和实施区域和地方公共卫生计划,直接影响医疗保健系统的状况。作为权力下放改革的一部分,地方自治政府获得了更大的财务自主权,并引入了激进的医疗保健融资模式,作为医疗保健系统激进改革的一部分。乌克兰立法和适用实践中的缺陷导致了以下问题:1)乌克兰立法与新的行政领土结构制度不一致;2)地方政府在基本(地区)、区和分区各级的权力、收入和支出划分不明确,权力重叠;3)目前立法没有要求制定区域预防和治疗疾病计划的内容,这些疾病对当前社会人口和经济造成最大负面影响,也没有要求市议会的目标方案、执行报告。还强调了二级保健设施的资金不足和不及时、二级保健设施取得财务成功的现有障碍,以及对其医疗服务的质量控制。基于对欧洲人权法院判例法的分析,确定了患者留在没有提供必要设备以确保适当护理的医疗机构、未经确诊将患者从一个病房转移到另一个病房、由于困难情况(人员不足、营养不良、医院生活条件差)而无法提供适当治疗的情况,这违反了《保护人权与基本自由公约》第 2 条。

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