Medical reform: in the focus of Constitutional law
At the heart of any reform is change. If this is a reform at the state level, then these changes must take place within the legal field, ie constitutional law. And this seemingly obvious axiom is aimed not only at regulating legal / illegal actions, but first and foremost at ensuring the rights and freedoms of citizens guaranteed by the Constitution of their country. In the Ukrainian media, the topic of medical law is a static-regular story in which both doctors and patients play chess in a game not only blindfolded, but also with constant changes in the rules of the game, at a time when the game has already begun. …
Thus, at the end of June, the National Academy of Medical Sciences of Ukraine and the National Bar Association of Ukraine jointly held a round table "Constitutional human right to health care through the prism of medical reform" within the walls of one of the capital’s news agencies.
- Many issues related to medical reform have come under my scientific and practical microscope, - says one of the participants of the round table Irina Senyuta, Doctor of Law, President of the Foundation "Medical Law and Bioethics of Ukraine" - In fact, there are several points "of medical reform and, first of all, it is:
Medical protocols. These documents are not adapted to modern Ukrainian realities. Today, standardization in health care is virtually bare. For example, caesareans are performed without a single national standard, so it is unclear how to check the quality of treatment in court cases.
Functioning of clinical bases of universities . Healthcare facilities are becoming non-profit utilities, so cooperation between clinical facilities and universities is of particular importance. The question of whether universities will pay for utilities and base deployment remains relevant (similar precedents have already been set).
Changing the system of continuous professional development of physicians. The issue of unregulated internship became acute. The draft of the new Regulations on internship was developed in 2014, but it has not yet been approved.
Free choice of doctor . The basis of the legislation of Ukraine on health care - the "medical Constitution" of the state - Article 6 provides for the right to qualified medical care, including the free choice of doctor and methods of treatment. And Article 38 guarantees the right to choose a doctor and a health care institution. These are fundamental things that concern the realization of human rights. As part of medical reform, the paradigm has changed: a person has the right to choose only a primary care physician.
Free medical care. The Constitutional Court of Ukraine has twice ruled on the State Guarantees Program: once on paid medical services, another on free medical care, which stated that all citizens receive full medical care free of charge, which cannot be a question of “guaranteed level". However, the Law of Ukraine "On State Financial Guarantees of Medical Care" still set a guaranteed level. Article 157 of the Constitution of Ukraine prohibits any changes that provide for the abolition or restriction of human rights and freedoms. Therefore, it is unequivocal and obvious: this law, which is lower in the hierarchy of normative acts, violated the Constitution of Ukraine.
Another Constitutional Violation was emphasized by a member of the Ukrainian Academy of Cyber Security, Ihor Kozachenko -Violations of personal data protection :
“Personal data (including medical secrets) may not be stored on commercial servers that do not have a certificate of compliance with information protection requirements. Medicine is a field of critical infrastructure. Interference in the information system of health care institutions can lead to fatal consequences: if you carry out a cyber attack on a hospital, it is possible to stop all equipment, " said the expert.
If we consider the Constitutional side of medical reform from a different angle - through the eyes of the patient, the violations, unfortunately, are also enough. This is clearly articulated in his blog by a public figure and a person with orphan disease Yuri Andreev : "Today the patient can feel:lack of an adequate vaccination program, which led to outbreaks of measles and other infectious diseases; untimely provision of medicines to patients due to international procurement, these are millions of cancer patients who lost their chance to live due to lack of medicines; the failure of the pilot project and the "Law on Transplantation" - millions abroad, hundreds of deaths in Ukraine; the reorganization of hospitals led to the collapse of the regions, due to the lack of developed infrastructure, the patient’s income to a remote hospital in some regions became physically impossible. The reduction and unification of hospitals in the oblasts has led to the closure of a hospital in Ternopil oblast, for example, and the village with the largest children in Ukraine now has no access to medical care just because there is no way to get to the hospital! The most painful topic for me personally is transplantation: the Ministry of Health has not developed regulations, registers and everything that is provided by the final provisions of the law on transplantation; ministry officials have inefficiently spent $ 112 million on the transplant. For example, $ 1 million was spent on the purchase of still non-functioning EDIST ( Unified State Information System ) and registers, while in neighboring Belarus it cost only $ 150,000; the replacement of the original immunosuppressive drugs with generics has led to a mass refusal of patients to take medication. As a result - the cost of purchasing normal drugs from local budgets, or from the pockets of patients themselves, and this - millions. According to experts who
participatedin the round table, almost the entire legal framework for the reform of the medical sector was adopted contrary to Ukrainian legislation, regulations and norms of general and sectoral agreements, with the authorities ignoring the procedure for approving regulations and proposals of the trade union. As for the financing of the industry, it is also not fully implemented - 5% of GDP is provided, and in fact - only 3.2%. And the last 3 reports of the Accounting Chamber are also not in favor of the Ministry of Health…
So, health care reform is really necessary, but it must be systematized, provided with adequate funding and in accordance with the law, including the Constitution of Ukraine.
Author Kateryna Stebelska
Other materials of the author: Self-auditor: how to check the originality of medicines yourself?
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Thus, at the end of June, the National Academy of Medical Sciences of Ukraine and the National Bar Association of Ukraine jointly held a round table "Constitutional human right to health care through the prism of medical reform" within the walls of one of the capital’s news agencies.
- Many issues related to medical reform have come under my scientific and practical microscope, - says one of the participants of the round table Irina Senyuta, Doctor of Law, President of the Foundation "Medical Law and Bioethics of Ukraine" - In fact, there are several points "of medical reform and, first of all, it is:
Medical protocols. These documents are not adapted to modern Ukrainian realities. Today, standardization in health care is virtually bare. For example, caesareans are performed without a single national standard, so it is unclear how to check the quality of treatment in court cases.
Functioning of clinical bases of universities . Healthcare facilities are becoming non-profit utilities, so cooperation between clinical facilities and universities is of particular importance. The question of whether universities will pay for utilities and base deployment remains relevant (similar precedents have already been set).
Changing the system of continuous professional development of physicians. The issue of unregulated internship became acute. The draft of the new Regulations on internship was developed in 2014, but it has not yet been approved.
Free choice of doctor . The basis of the legislation of Ukraine on health care - the "medical Constitution" of the state - Article 6 provides for the right to qualified medical care, including the free choice of doctor and methods of treatment. And Article 38 guarantees the right to choose a doctor and a health care institution. These are fundamental things that concern the realization of human rights. As part of medical reform, the paradigm has changed: a person has the right to choose only a primary care physician.
Free medical care. The Constitutional Court of Ukraine has twice ruled on the State Guarantees Program: once on paid medical services, another on free medical care, which stated that all citizens receive full medical care free of charge, which cannot be a question of “guaranteed level". However, the Law of Ukraine "On State Financial Guarantees of Medical Care" still set a guaranteed level. Article 157 of the Constitution of Ukraine prohibits any changes that provide for the abolition or restriction of human rights and freedoms. Therefore, it is unequivocal and obvious: this law, which is lower in the hierarchy of normative acts, violated the Constitution of Ukraine. Another Constitutional Violation was emphasized by a member of the Ukrainian Academy of Cyber Security, Ihor Kozachenko -Violations of personal data protection :
“Personal data (including medical secrets) may not be stored on commercial servers that do not have a certificate of compliance with information protection requirements. Medicine is a field of critical infrastructure. Interference in the information system of health care institutions can lead to fatal consequences: if you carry out a cyber attack on a hospital, it is possible to stop all equipment, " said the expert. If we consider the Constitutional side of medical reform from a different angle - through the eyes of the patient, the violations, unfortunately, are also enough. This is clearly articulated in his blog by a public figure and a person with orphan disease Yuri Andreev : "Today the patient can feel:lack of an adequate vaccination program, which led to outbreaks of measles and other infectious diseases; untimely provision of medicines to patients due to international procurement, these are millions of cancer patients who lost their chance to live due to lack of medicines; the failure of the pilot project and the "Law on Transplantation" - millions abroad, hundreds of deaths in Ukraine; the reorganization of hospitals led to the collapse of the regions, due to the lack of developed infrastructure, the patient’s income to a remote hospital in some regions became physically impossible. The reduction and unification of hospitals in the oblasts has led to the closure of a hospital in Ternopil oblast, for example, and the village with the largest children in Ukraine now has no access to medical care just because there is no way to get to the hospital! The most painful topic for me personally is transplantation: the Ministry of Health has not developed regulations, registers and everything that is provided by the final provisions of the law on transplantation; ministry officials have inefficiently spent $ 112 million on the transplant. For example, $ 1 million was spent on the purchase of still non-functioning EDIST ( Unified State Information System ) and registers, while in neighboring Belarus it cost only $ 150,000; the replacement of the original immunosuppressive drugs with generics has led to a mass refusal of patients to take medication. As a result - the cost of purchasing normal drugs from local budgets, or from the pockets of patients themselves, and this - millions. According to experts who
participatedin the round table, almost the entire legal framework for the reform of the medical sector was adopted contrary to Ukrainian legislation, regulations and norms of general and sectoral agreements, with the authorities ignoring the procedure for approving regulations and proposals of the trade union. As for the financing of the industry, it is also not fully implemented - 5% of GDP is provided, and in fact - only 3.2%. And the last 3 reports of the Accounting Chamber are also not in favor of the Ministry of Health…
So, health care reform is really necessary, but it must be systematized, provided with adequate funding and in accordance with the law, including the Constitution of Ukraine.
Author Kateryna Stebelska
Other materials of the author: Self-auditor: how to check the originality of medicines yourself?
SUPPORT PROJECTS AND SUBSIDIARY FUNDS