The document discusses reforms needed for Ukraine's public health service system. It identifies issues like low accessibility and quality of care, high personal costs for citizens, and dissatisfaction among the population and doctors. The aims of reform are improving health outcomes, ensuring equal access to quality care, and increasing government financing. Reform strategies include reorganizing medical institutions, changing the financial mechanism, introducing quality controls, and promoting healthy lifestyles. The prospective results are decreased mortality and increased access and quality of care. International cooperation and experience sharing are emphasized as ways to support reforms.

1. EUROPEAN APPROACH TO PUBLIC HEALTH
SERVICE REFORMATION.
REFORMS IN UKRAINE.
SHEKERA Oleg Grygorovych
MD, Master of public administration
The International Association for "HEALTH OF SOCIETY“

2. The international association for "HEALTH OF SOCIETY“
International public organization that was created
in 2011.
Implementing of legally guaranteed right of the
general public to participate in health care and
education.
Main area of activity:
• satisfaction and protection of the following interests guaranteed
by law:
• social
• medical
• ecological
• national
• cultural
• sporting and other
• assistance to strengthening of friendship development between
different folks

3. •OLEG SHEKERA, MD, PhD, Master of Public Administration
•highest category doctor; specialty - general practice / family medicine, Health
Management; colonel of medical service supply
•PRESIDENT OF THE INTERNATIONAL ORGANIZATION – ASSOCIATION FOR
“HEALTH OF SOCIETY”
•Author and co-author of over 150 scientific publications, among them 2 monographs
and 1 information-analytical collection.
•Currently working at the National Medical University
•EDUCATION
Higher medical and military education, higher education in Public
Administration
2001-2004: National Academy of Public Administration of Ukraine, Kyiv
2001: Institute of International Humanitarian Law, San Remo, Italy
1999-2000: National Academy of Defense of Ukraine, Kyiv
1989-1991: the Military Medical Academy, Leningrad
1976-1978: a military medical faculty at Kuybyshev Medical Institute, Kuibyshev
•1972-1976: the Kharkov Medical Institute, Kharkov

4. Development of public health service
•Development strategies should be based on local conditions and
comprehensive principles.
•Significant amount of problems go far beyond the potential of
particular state and require global institutes accountable to
democracy.
•The deep analysis of dramatically weak interaction between
economic growth and improvement in public health service and
education
•More careful analysis of multidimensional purposes of
development.

5. The priority of public policy
•The direct correlation between the level of socio-economic
development and health care system efficiency is established all
around the world long ago.
•We consider that conservation and promotion of public health on
the ground of the formation of healthy life-style and rise in
accessibility and quality of medical aid must be the one of main
priorities of public policy.

6. The following items must become the main
purposes of conceptual bases of development of
public health service in the world:
• Increase of population and life expectancy of
population;
• Decrease of infant and maternity mortality;
• Formation of public healthy life-style;
• Rise in the quality and accessibility of guaranteed
medical aid for public.

7. In our opinion, the main purposes of health
care system development are the next:
•Creating the conditions, opportunities and motivation for public for a
healthy life-style;
• Improvement of medical aid organization;
• Concretization of government guarantees in rendering free of charge
medical aid to population;
• Improvement of medicinal assuring in outpatients’ clinics including
the system of compulsory hospital insurance;
• Creating of effective model of management by financial resources
of the program of state guarantees;
• Raising of medical officers qualification and creating the system of
their motivation for work of high quality;
• Development of medical science and innovations in health care
system;
•Informatization of public health service.

8. Disparity of existing health care system to
modern society needs
Causes
•Low accessibility to medical aid;
•Low quality of medical aid;
•Personal costs of medical services of population are equal to the
governmental ones (1/2 of general financing);
•Dissatisfaction with the functioning of system among 68 % of
population .

9. Disparity of existing health care system
to modern society needs (2)
Effects
•Life expectancy of population of Ukraine is 69,3 years (10 years
less than in EU)
•Untimely death rate in Ukraine is 3 times higher than in EU.
•Tuberculosis mortality in Ukraine is 20 times (!) higher than in
EU.
Existing system of medical aid is not sufficient for
PATIENTS

10. Disparity of existing health care system
to modern society needs (3)
Causes
Absence of doctors’ motivation to rendering of the good quality
service
Excessive workload of general practitioners
Outdated equipment and inadequate working conditions
Existing system of medical aid is not sufficient for
DOCTORS

11. Disparity of existing health care system
to modern society needs (4)
Effects
The doctor’s salary is 33 % lower than average
The number of general practice doctors is 6,3 per 10000 people
(in EU – 9,4)
Wearing-out of medical equipment is 80 %
Existing system of medical aid is not sufficient for
DOCTORS

12. Disparity of existing health care
system to modern society needs (5)
Causes
•Financing of beds but not the volume of medical aid
•Redundant number of stationary health care
establishments leads up to functions dublication
Existing system of medical aid is not sufficient for
GOVERNMENT

13. Disparity of existing health care system
to modern society needs (6)
Effects
•The financing of health care is $5, 2 billion from budget and it’s
less than $0,13 per sick person in hospital.
•The number of beds per 10 thousand of population is twice less
than in EU.
Existing system of medical aid is not sufficient for
GOVERNMENT

14. Aim and tasks of medical service
reform:
Aim:
Improvement of the public health, providing with equal and fair
access to medical service of proper quality for all people.
•To raise the quality of medical services.
•To raise the accessibility to medical services
•To improve the governmental financing in this area.
•Create the incentives for healthy life-style among population
and healthy work conditions.

15. Instruments of reformation of medical service
system:
1. Reorganization of medical institutions system;
2. Change of the financial mechanism;
3. Introduction of the system controlling the quality
of medical service;
4. Assistance to healthy life-style.

16. Prospective results of reformation –
indicators of success
Decrease of:
general rate of infant mortality to 6,5 ‰
maternity mortality rate to 13 ‰
untimely death rate by 25%
tuberculosis mortality rate by 30%
number of households in which one of the members has not got medical aid
or purchase medicine or medical accessories when needed (from 20 % (2009)
to 3%)
hidden payments in medical service from 10-15 % up to 5-7 %
Increase of percentage of general practitioners from 4 % to 8-10 %.

17. Experience exchange
Experience exchange is an effective way of knowledge
acquisition.
Widespread involvement of grants ensures a close cooperation
with foreign specialists.

18. Cooperation
We are ready for cooperation with governmental, non-
governmental and private organizations in Spain.
The main point for us is high scientific and practical result of
research that can be used for management decision-
making, development of the politics and strategies of
formation, preservation and promotion of health.

19. I wish big time and good health to the
participants of the Congress!
Thank you, miss and gentlemen both, many
times for your attention!