改善乌克兰医疗实践、医疗活动和医疗自治法律监管的当前问题

I. Selivanova
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Among recent studies, the collective monograph “The Unified Medical Space of Ukraine: Legal Dimension” of 2022 should be singled out [22]. This work examines various issues of the functioning of the medical system of Ukraine after the beginning of its reform in 2017. However, the problems of legal regulation of medical practice, medical activity and medical self-governance are not considered in the monograph P. Mazur, M. M. Tyshchuk [6], S. Ternova [7] dealt with issues of medical self-governance, but they did not connect the success of its implementation in Ukraine with the liberalization of legal regulation of medical practice and the status of a doctor. Article’s main body. Medical care is an integral part of the concept of medical practice. When defining the concept of medical care, the legislator unites all persons who directly provide it into a general group of medical workers, without dividing into professional groups (doctor, nurse / medical brother, etc.). As a result, the subjectivity of these persons is nullified, their status is not defined. The current legislation does not contain the concepts of medical activity, activity of medical nurses/medical brothers. On the other hand, in connection with the active work on the preparation of national legislation on self-governance in the field of health care, the question of the need to separate subjects involved in the provision of medical care is acutely emerging. After all, world experience shows that states develop self-government in accordance with the professional division of medical workers medical, nursing, pharmaceutical. Real effective medical self-government in Ukraine is impossible without giving doctors more freedom for their own professional realization. In the entire democratic world, a doctor is a representative of a free profession, has various options for his own professional realization, determines his own workload and level of income, can carry out activities on the basis of a professional license without additional formalities and attachment to workplaces. On the other hand, in Ukraine, the majority of doctors are salaried employees with state-regulated workload and wages. The conclusion is substantiated that the medical community can be prepared for the introduction of medical selfgovernment only in case of simplification of state regulation of medical practice and provision of economic freedom to the doctor, i.e. the opportunity to work not only as an employee or self-employed person (as today), but also on the basis of civil law contract (subcontract) or as a self-employed person. 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引用次数: 0

摘要

问题设置。乌克兰最高拉达于1992年11月19日通过的乌克兰保健立法的基础奠定了国家医疗系统运作的法律机制的基础。目前,医疗系统正在经历一个复杂的转型过程,这需要在医疗实践、医疗活动和医疗自治等问题上做出新的立法决定。Тarget研究的目的是分析乌克兰目前规范医疗实践和医疗活动的立法,并提出解决其当前问题的建议。分析最近的研究和出版物。乌克兰科学家研究了乌克兰医疗系统运作的各种问题。在最近的研究中,应该挑出2022年的集体专著“乌克兰统一的医疗空间:法律维度”。这项工作考察了2017年改革开始后乌克兰医疗系统运作的各种问题。然而,P. Mazur、M. M. Tyshchuk[6]、S. Ternova[7]专著在论述医疗自治问题时没有考虑到医疗实践、医疗活动和医疗自治的法律管制问题,但他们没有将其在乌克兰的成功实施与医疗实践法律管制的自由化和医生地位联系起来。文章的主体。医疗保健是医疗实践概念的一个组成部分。在界定医疗保健的概念时,立法者将所有直接提供医疗保健的人统一为一个总的医务工作者群体,而不划分专业群体(医生、护士/医务兄弟等)。结果,这些人的主体性被否定了,他们的地位没有被确定。目前的立法没有包含医疗活动、医务护士/医务兄弟活动的概念。另一方面,在积极拟订关于保健领域自治的国家立法的工作中,迫切需要将提供医疗保健所涉及的主体分开的问题正在出现。毕竟,世界经验表明,国家根据医务人员的专业分工发展自治医疗,护理,制药。如果不给予医生更多的自由来实现自己的专业目标,乌克兰就不可能实现真正有效的医疗自治。在整个民主世界,医生是一种自由职业的代表,有自己实现职业的各种选择,决定自己的工作量和收入水平,可以根据专业执照开展活动,而不需要额外的手续和对工作场所的依附。另一方面,在乌克兰,大多数医生是受国家规定工作量和工资的受薪雇员。结论证明,只有在简化国家对医疗实践的管制和向医生提供经济自由的情况下,即不仅有机会作为雇员或个体经营者(如今天)工作,而且有机会作为民法合同(分包合同)或个体经营者工作,医学界才能为引入医疗自治做好准备。医疗执业许可的法律机制不是监测医疗质量和将违反国家规定的实体绳之以法的有效工具。结论证明,以诉讼程序声明取代医疗执业许可应成为医疗执业管理的一般规则。结论及发展展望。向医疗实践申报的过渡,医生专业实施的法律机会的增加,引入医疗自治和行医权的个人证书,将有力地推动国内医疗体系朝着欧洲医疗实践和医疗活动标准的方向发展。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Current Issues of Improving the Legal Regulation of Medica l Practice, Medica l Activities and Medica l Self-Government in Ukraine
Problem setting. The foundations of Ukrainian legislation on health care, adopted by the Verkhovna Rada of Ukraine on November 19, 1992, laid the foundations of the legal mechanism for the functioning of the national medical system. Currently, the medical system is going through a complex process of transformation, and this requires new legislative decisions on the issues of medical practice, medical activity, and medical self-governance. Тarget of the research is to analyze the current legislation regulating medical practice and medical activity in Ukraine and to develop proposals for solving its current problems. Analysis of recent researches and publications. Ukrainian scientists studied various issues of the functioning of the medical system of Ukraine. Among recent studies, the collective monograph “The Unified Medical Space of Ukraine: Legal Dimension” of 2022 should be singled out [22]. This work examines various issues of the functioning of the medical system of Ukraine after the beginning of its reform in 2017. However, the problems of legal regulation of medical practice, medical activity and medical self-governance are not considered in the monograph P. Mazur, M. M. Tyshchuk [6], S. Ternova [7] dealt with issues of medical self-governance, but they did not connect the success of its implementation in Ukraine with the liberalization of legal regulation of medical practice and the status of a doctor. Article’s main body. Medical care is an integral part of the concept of medical practice. When defining the concept of medical care, the legislator unites all persons who directly provide it into a general group of medical workers, without dividing into professional groups (doctor, nurse / medical brother, etc.). As a result, the subjectivity of these persons is nullified, their status is not defined. The current legislation does not contain the concepts of medical activity, activity of medical nurses/medical brothers. On the other hand, in connection with the active work on the preparation of national legislation on self-governance in the field of health care, the question of the need to separate subjects involved in the provision of medical care is acutely emerging. After all, world experience shows that states develop self-government in accordance with the professional division of medical workers medical, nursing, pharmaceutical. Real effective medical self-government in Ukraine is impossible without giving doctors more freedom for their own professional realization. In the entire democratic world, a doctor is a representative of a free profession, has various options for his own professional realization, determines his own workload and level of income, can carry out activities on the basis of a professional license without additional formalities and attachment to workplaces. On the other hand, in Ukraine, the majority of doctors are salaried employees with state-regulated workload and wages. The conclusion is substantiated that the medical community can be prepared for the introduction of medical selfgovernment only in case of simplification of state regulation of medical practice and provision of economic freedom to the doctor, i.e. the opportunity to work not only as an employee or self-employed person (as today), but also on the basis of civil law contract (subcontract) or as a self-employed person. The legal mechanism for licensing medical practice is not an effective tool for monitoring the quality of medical care and bringing to justice entities that violate the requirements established by the state. The conclusion is substantiated that replacing the licensing of medical practice with the declaration of its proceedings should become a general rule of regulation of medical practice. Conclusions and prospects for the development. The transition to the declaration of medical practice, the increase of legal opportunities for the professional implementation of doctors, the introduction of medical self-government and the individual certificate for the right to practice medicine will be a powerful impetus for the development of the domestic medical system in the direction of European standards of medical practice and medical activity.
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