THE NATIONAL MEDICAL RESEARCH CENTERS AS PARTICIPANTS OF IMPLEMENTATION OF SCIENTIFIC PLATFORMS OF MEDICAL SCIENCE

ABSOLUTE HUMAN RIGHTS IN THE FIELD OF HEALTHCARE: LEGAL GROUNDS FOR RESTRICTION

In 2005 the European Society for Philosophy of Medicine and Health Care (ESPMH) initiated an annual contest for young scholars. Every year an ESPMH prize is awarded to a scholar younger than 35 years of age for a scientific contribution on ethical, epistemological, or other philosophical topics relating to medicine and health care. The first paper in this issue, ‘On the relationship between individual and population health’, has been written by the winner of this prize in 2007, Onyebuchi A. Arah. Compared to the idea of individual health, ‘population health’ is a relatively new, rather fashionable term in the field of medicine and health care. The relationship between individual and population health is partially built on the dichotomization of medicine into clinical medicine and public health. Individual and population health are often seen as absolute and independent concepts. Onyebuchi A. Arah argues that the relationship between the two is largely relative and dynamic. His argument is based on an attempt to include a population perspective on health in definitions of health, particularly by emphasizing the role of the ‘context’ component of any notion of health. The second contribution in this issue, written by Shawn H. E. Harmon, also deals with public health, but this paper is more practical in nature. After having reminded us of the fact that public health is a multidisciplinary and complex phenomenon, the author argues that public health promotion is a moral duty and that, although multiple actors are relevant and necessary to fulfilling this duty, the role of international actors is paramount. The paper especially focuses on one of the most important international organizations in this field, that is, the World Health Organization (WHO). Shawn H. E. Harmon argues that better health can and must be better promoted through a more robust interpretation of the WHO’s role. Together with other international organizations, he argues, the WHO has not yet played its necessary part in promoting ‘health for all’. The third paper, written by Rui Nunes, Guilhermina Rego and Christina Brandao, leaves the difference between individual and public health for what it is. The authors evaluate the role of independent regulatory agencies in the field of health care, as compared to the role of traditional public regulations, with regard to a fair process of equal access to health care and of setting limits to health care. In their argument Norman Daniels’ and James Sabin’s theory of accountability for reasonableness plays a central role. The authors conclude that accountability for reasonableness should be regarded as a landmark of any health care reform. The rationale for limit-setting decisions must be clearly communicated toward the public. Karin Dahlberg, Les Todres and Kathleen Galvin focus on individual health care. They critically review the common standard of ‘patient-centred’ or ‘patient-led’ health care and argue that current patient-led approaches hinder a focus on a deeper understanding of what patient-led care could be. Based on various phenomenological and existential insights they present an alternative interpretation of patient-led care which they call ‘lifeworld-led care’. A philosophy of the person, a view of well-being, and a philosophy of care should be key elements in the further development of this ‘lifeworld-led care’. With the paper of Juha Raikka, ‘The ethical and political evaluation of biotechnology strategies’, we enter a new category of topics in this issue, that is, regulatory aspects of research and new biotechnologies. Juha Raikka focuses on W. Dekkers (&) B. Gordijn UMC St Radboud Nijmegen, 114 IQ Healthcare, Section Ethics, PO Box 9101, 6500 Nijmegen, HB, The Netherlands e-mail: w.dekkers@iq.umcn.nl

State and public health: rethinking value orientations

Introduction. The relevance of the topic lies in the fact that the problem of legal conflicts regarding the activities of public administration in the field of health care is extremely important for any legal democratic society that is in the process of building or reforming its state system. The issue of collisions becomes especially important in the context of the reform of the administrative system and public administration in Ukraine, which has been going on for ten years, as well as in the conditions of bringing the legal framework into compliance with the requirements of martial law and European integration processes. Legal disputes can lead to inconsistencies in legislation, delays in decision-making, and even legal confusion, which is unacceptable in wartime. Understanding how to overcome legal conflicts can lead to faster and more efficient governance, especially between authorities in different countries and regions. This ensures not only better coordination, but also protection of the rights of citizens who may suffer from unclear legislation. The aim of the study. Identify and characterize conflicting points in the current legislation that regulate the activities of public administration in the field of health care. Materials and methods. In the course of conducting an in-depth study on the regulatory and legal regulation of the activities of the public administration in the field of health care, as a result of which 250 workers in the field of health care were interviewed, which confirm the imperfection of the current legislation in the field of health care. The results showed that the majority of medical workers do not support making any amendments to the legislation – 86% of them, 2% – support the global change of the current legislation, 2% refrained from answering. Results and discussion. The authors comprehensively define legal disputes in the field of healthcare as legal contradictions that arise due to subjective or objective reasons or errors during the implementation by patients of their rights and obligations due to the adoption of legal acts containing conflicting norms. In addition, legal disputes have the following features. First, they depend on the national legal system and, accordingly, on the legal regulation in the field of health care. Secondly, the sphere of public medical legal relations, in which legal disputes most often arise, is the question of medical significance. Thirdly, legal disputes most often arise when regulating typical issues, such as establishing the quality and efficiency of the provision of medical services; management of medical teams; possession, use and disposal of communal property. Conclusions. the proposed reforms of public administration in the field of health care have the potential to further guarantee the realization of everyone's right to health care. Summarizing the key directions of solving legal conflicts in the field of health care, the following tasks can be identified: 1) state guarantees of free medical care for socially vulnerable population groups; 2) introduction of adequate health care financing and an effective system of mandatory health insurance; 3) creation of conditions for the free development of entrepreneurship in the field of health care and formation of the basis for competition between medical institutions and formation of the basis for fair competition between health care institutions; 4) improvement of the country's legislation in the field of health care in accordance with international legal standards; 5) create optimal conditions for healthy childbirth, primarily in terms of living conditions, education and nutrition; 6) implement an active demographic policy aimed at increasing the birth rate and reducing the mortality rate; 7) ensure the ability to meet the needs of the population, primarily in the sphere of health care, education and nutrition.

Relevance of the research topic. In the context of the COVID-19 pandemic, the health care financing system is an important tool for regulating social processes. Accordingly, the assessment of its institutional components, financial and economic risks in this area is an important condition for the formation and implementation of sound public policy in the field of health. Formulation of the problem. In the context of deteriorating trends in national economic development, important tasks are: substantiation of priority areas of state policy in the field of health care, in particular to strengthen the funding system in this area, ensuring an economically sound level of social standards. At the same time, the basis for the quality level of implementation of state policy in the field of health care is its coherence with the strategic directions of socio-economic development of the country in the short, medium and long term. Analysis of recent research and publications. The issue of formation and implementation of state policy in the field of health care, financing of health care is quite common in research. These are the works of foreign and domestic scientists: Barrow H., Bella P., Gupta S., Dali Eyu, Dzhigira I., Matnonnat J., Mainzyuk K., Sparkes S., Adamenko I., Lysyak L., Chugunova I. and others. Selection of unexplored parts of the general problem. The above issues are relevant in connection with the deteriorating trend of economic development, the pandemic COVID-19, which requires a number of specific tasks related to strengthening the health care financing system. Problem statement, research goals. The objectives of the study are: to reveal the role of the health care financing system in the regulation of socio-economic processes; substantiate the features of the system of financing the health care sector in modern conditions; to analyze and estimate health care expenditures of the State Budget of Ukraine. The purpose of the study is to reveal the directions of state policy on the development of the health care financing system. Method or methodology of the study. The article uses a set of research methods: a systematic approach, statistical analysis, structuring, synthesis, etc. Presentation of the main material (results of work). The role of the health care financing system in the regulation of socio-economic processes is revealed. The peculiarities of the system of financing the sphere of health care in modern conditions are substantiated. The analysis and assessment of health care expenditures of the State Budget of Ukraine was carried out. The directions of the state policy on the development of the system of financing the sphere of health care are substantiated. Field of application of results. The results of the study can be used in the process of forming and implementing public policy in the field of health care. Conclusions in accordance with the article. The validity of the implementation of state policy in the field of health care is an important condition for social development. In order to improve the quality of the health care financing system, at this stage, it is advisable to: take measures to reduce the risk of violation of the sustainability of the financial security system in the field of health care, which involves the modernization of system infrastructure. Stabilization of the level of financial support for health care involves improving budget policy in terms of planning budget expenditures for health care. An important condition for the formation of an effective state policy in the field of health care is to improve the interaction of public administration in terms of informatization of this area. Solving these problems will help create conditions for sustainable social development, the introduction of modern financial tools in the field of health.

The stages of the evolution of public administration in the field of health care are considered. The processes of world history and the practice of forming management in the field of medicine are updated. It was found that domestic scientists did not pay enough attention to the issues of the evolution of the management of the health care system, the study of which is important for public management for several reasons: the possibility of identifying successful and unsuccessful practices of past periods, which will help to improve the system of medical services; the opportunity to understand the development trends of domestic medicine in the context of demographic changes, technological progress and social transformations; an opportunity to identify the most effective methods of using resources in the field of health care. The stages of the evolution of public administration in the field of health care, which took place over many centuries from ancient civilizations to the present, are analyzed. It is emphasized that a thorough analysis of the evolution of the management of the medical industry helps to improve and optimize modern approaches to management, contributing to increasing the efficiency of the system. The analysis is also important for the science of public administration, as it provides an opportunity for scientific research and evaluation of various approaches to the justification of management strategies and policies, identification of shifts that influenced the development of the health care system, helps to understand how the health care system has adapted to changes in the socio-economic and political environment in order to better understand how to effectively respond to modern challenges and changes. It is concluded that the historical review of the evolution of public management in the health care system reflects complex dynamics that were determined by various social, political, economic and technological factors over the centuries. In ancient civilizations, the first attempts to organize medical care were observed, the need for management of the industry increased in the era of industrialization and mass migration of the population, and the modern period is characterized by a constant process of modernization to introduce the latest technologies, improve access to medical care and ensure the quality of services.

The article proves that modern transformations in the field of health care, reforming and improvement of digital tools and methods require improvement of the elements of the government mechanism for the development of e-health to ensure the effective functioning of the health care sector. The purpose of the article is to determine the priorities for the development of tools of the government mechanism for the development of e-health in Ukraine for the effective implementation of strategic plans for reforming the health care sector. Based on the analysis of the tools of the government mechanism for the development of electronic health care (dashboards, electronic documents and electronic document flow, eMalyatko, electronic prescription, electronic referral), the specifics of the implementation of each of the tools in Ukraine were determined. It has been proven that mental health programs are vital for society and a priority in the process of implementing strategic tasks of government policy in the field of health care of Ukraine. Priority projects in the field of mental health care of Ukraine have been identified. The study of initiatives in the field of telemedicine for the implementation of the government mechanism for the development of e-health and the functionality of chatbots in the field of health care made it possible to highlight the advantages of the specified tools of the government mechanism for the development of e-health. Popular electronic services in the field of health care of Ukraine as part of the implementation of the government mechanism for the development of e-health are highlighted. It is justified that well-functioning electronic health care tools can help increase attention to preventive care and self-monitoring, improve the relationship between the doctor and the patient. The advantages of using the tools of the government mechanism for the development of e-health for medical workers and patients are highlighted (expanding and improving citizens' access to medical services, ensuring personalized, more advanced medical care for citizens).

Objective: development of a unified system and classification of indicators for an integral assessment of performance and effectiveness of the organization of medical care (MC) at the regional level in the Russian Federation (RF).Material and methods. A systematic search for domestic and foreign scientific publications and a comprehensive analysis of the current regulatory legal acts in the field of health care for the presence of indicators characterizing the effectiveness of MC organization in the RF regions were performed. The search for indicators of effectiveness was carried out in analytical reports based on the results of field events of national medical research centers (NMRC) in the constituent entities of the RF for 2019, 2020 and 2021 in various profiles of MC. In total, 3019 analytical reports on the results of field events and 97 annual public reports on the results of the NMRC activities were analyzed.Results. Three options for classifying indicators were formed: according to the method of obtaining (primary, calculated, secondary qualitative); in relation to the final result (resulting, process (surrogate)); classification of parameters that determine the MC system, including in the context of profiles, forms, types, conditions of MC (18 positions). The proposed unified system and classification of indicators has a number of advantages compared with the Organisation for Economic Cooperation and Development, Centers for Medicare & Medicaid Services and Commonwealth Fund indicators adopted in a number of countries. It was established that international systems use mainly resulting indicators, while the domestic health care system uses exclusively process indicators that are not combined into a single system and are monitored by various departments.Conclusion. The presented approach to a unified system and classification of indicators for an integrated assessment of performance and effectiveness of MC organization allows to determine the priorities for the development of a monitoring system. At the same time, it should be noted that this approach requires further discussion and improvement.

Problem setting. The issue of powers of subjects of public control in the field of health care is insufficiently developed in the scientific literature. Therefore, in the conditions of growing importance of public control in all spheres of public life, including in the field of health care, this issue becomes especially relevant. After all, the quality of such control in the field that is investigated in this scientific work directly depends on the effectiveness of the activities of these subjects. The scientific article is devoted to the scientific and theoretical analysis of subjects of public control in the field of health care. Analysis of recent researches and publications. Regarding the scientific approach to the definition of subjects of public control, it should be noted such scientists as O.O. Borbunyuk, A.S. Krupnyk, O.I. Nevmerzhynskyi, S.A. Kosinov, who made a significant scientific contribution. They included individual citizens and their associations (organized and unorganized), public councils/colleges, political parties, trade unions, public organizations, etc. as subjects of public control. We separate these approaches and take them into account in the further research of scientific work. Purpose of the research is to study and analyze different approaches and legislation regarding the definition of a subject of public control, and to provide a legal characterization of all types of subjects of public control in order to prove how important a role they play in achieving a single goal: to ensure the effective protection of legal rights and human and citizen interests in the sphere of health care of Ukraine. Article’s main body. The author of the article analyzed the views of scientists who devoted their works to the subjects of public control and derived his own definition, according to which the subjects of public control in the field of health care should be understood as natural or legal persons who, in accordance with the norms of current legislation of Ukraine are endowed with a certain set of rights and obligations regarding the exercise of control in the specified sphere and may be participants in the relevant legal relations. In addition, each subject of public control in the field of health care is characterized, namely: powers of citizens, subjects of organized public (Public Councils), political parties, mass media, trade unions and self-organization bodies of the population. Each considered subject of public control in the field of health care plays its own, special role in ensuring the effective functioning of the health care industry of Ukraine, which is reflected in the powers granted to them in accordance with the norms of current legislation. However, it would be fair to note that the control activities of these entities are aimed at achieving a single goal: ensuring effective protection of the legal rights and interests of people and citizens in the field of health care of Ukraine. We consider it necessary to note that the powers of subjects of public control in the field of health care are not directly enshrined in any normative legal act, which negatively affects its quality and effectiveness. In addition, the mechanism for taking public opinion into account in the activities of health care entities needs additional legislative clarification. In the opposite case, a completely logical question arises about the real practical value of such control, if its results do not have significant consequences for those for whom it is carried out. Conclusions and prospects for the development. We consider it necessary to enshrine at the legislative level in the future Law of Ukraine «On Public Control» the powers and legal status of subjects of public control in the field of health care, so that they carry out their activities on a legal basis and the results of their activities have consequences for whom they are carried out.

The article examines theoretical and practical issues of administrative and legal regulation of the implementation of administrative procedures in the field of health care. Administrative and legal regulation of the implementation of administrative procedures in the field of health care is considered as a system of legal norms, mechanisms and actions aimed at the organization and control of administrative activities in the health care system. This model involves the application of administrative law principles to ensure that health care-related processes such as licensure, facility accreditation, and patient registration are conducted in accordance with legal standards, ethical norms, and public health priorities. The components of the administrative and legal regulation of the implementation of administrative procedures in the field of health care are determined: 1) legislative norms and acts, 2) administrative mechanisms, 3) institutional structure, 4) rights and obligations of participants, 5) accountability and supervision. A theoretical and practical analysis of the most important administrative procedures in the field of health care related to a) licensing and accreditation of medical institutions, b) regulation of the activities of medical personnel and c) registration and access to medical services of citizens is carried out. The main problems in the administrative and legal regulation of the implementation of administrative procedures in the field of health care are highlighted: institutional problems and problems of legal uncertainty. To increase the level of administrative and legal regulation of administrative procedures in the field of health care, the following recommendations are offered: 1) simplification and standardization of administrative procedures, 2) digitalization of administrative procedures, 3) attraction of investments in the training of administrative personnel and equipping regulatory bodies with the necessary resources, 4 ) consideration of adaptive international experience, 5) optimization of legislation on administrative and legal regulation of administrative procedures in the field of health care.

In 1920s - late 1980s, active cooperation between the USSR and Mongolia in the field of medicine and health care had been occurred. The Mongolian People's Republic was the first country to which the USSR exported its organization of health care system, using it as a means of geopolitical influence and instrument of the socialist transformation of traditional nomadic society. At the same time, assistance to Mongolia began when the USSR itself had not yet completed the organization of new health care system, including needed medical personnel and resources, receiving assistance from Germany and other European countries. The article discusses the reasons of the Soviet leadership's hasty decision to force assistance to the Mongolian People's Republic in the field of medicine and health care. Two approaches to its implementation are singled out and explained: the evolutionary one, when experienced Soviet doctors were selected and sent to the Mongolian Department of Health care, and the forced one - through organization of expeditions of the People's Commissariat of Health of the RSFSR, which simultaneously studied the medical and sanitary situation in the country and organized medical institutions where the assistance was needed the most.

In Ukraine today, the implementation of reforms in the field of public health services and health care in general, including during the training of specialists in the field of public health services. That is why the whole sphere of medical care should be intensified and follow the established directions of activity, which determine and form certain legal consequences. The purpose of the article is to study the process of professional training in the field of health care, which determines the solution of a number of tasks, namely: the study of health care, which is at the crossroads of the reform process, identifying basic ways and mechanisms to improve this process. Scientific novelty. Actual directions of activity of the sphere of medical service of the population in the country are such as: digitalization in the sphere of medical service of the population; development of educational and research activities during the training of specialists in the field of medical care; improving the proper financing of the field of medical care; implementation of quality personnel policy in the field of medical care; improving the sanitary and epidemiological well-being of the population; development of transplantology. It is in the article that the direction of development of educational and research activities during the training of specialists in the field of medical care is described; improving the proper financing of the field of medical care. Conclusion. The following steps are proposed: introduction of the latest achievements of medicine in general practice in the field of medical care; development, improvement and implementation in practice of the latest standards to provide quality and effective medical care to the population in the treatment of cardiovascular diseases, treatment of infectious diseases, pediatric pathology, cancer, etc .; introduction of effective new methods of early prevention and diagnostic of various diseases at the appropriate stages of providing medical care to the population (during emergency medical care; during primary, secondary and tertiary medical care); determining the cause, prevention, diagnosis and treatment of pulmonary hypertension and the introduction of scientific trends in the professional activities of pulmonologists, phthisiologists and family physicians; introduction of modern programs for rehabilitation of patients with therapeutic diseases; creation of training centers where modern methods and technologies will be introduced for the purpose of multidisciplinary rehabilitation for internships; development of the latest methods of prevention, diagnosis and treatment of unexplored infectious diseases; implementation of modern measures to ensure the sanitary and epidemiological well-being of the population. Keywords: medical care; population; health care; digitalization; scientific and legal principles; methodical principles; reforming.

The article deals with the issue of social work in the field of health care. An attempt was made to comprehensively analyze the peculiarities of social work concerning health care in Canada. The purpose of the work is to identify the basics of social work related to health care in Canada and to outline ways of implanting experience in Ukraine. It is noted that the United Nations identifies Canada as "the best country in the world to live in", where the health of citizens is considered a social indicator. It was found that now in Canada social work has become an integral component of the field of health care. The results of the analysis of the current state of social work in health care in Canada indicate that the system of social work in the field of health care in the studied country meets the requirements of the time and follows global trends in the development of the industry. It is positioned as a unique type of professional activity to create social conditions for the health of an individual and increase the well-being of the population in general. It has been studied that the basis of social work in the field of health care in Canada is the system of social protection of the population, education, health care, social services for young people, specialized institutions, and institutions. It was revealed that one of the most important trends in the state of social work regarding health care in Canada is an emphasis on the concept of a new vision of health, which involves the creation of appropriate conditions in society, the promotion of the development of necessary life skills, the participation of communities, the development of the system of providing services in the field of health care health, etc. It was found that there are professional organizations of social work in the studied country, which determine the standards of the industry and the main vectors of training and development of relevant specialists in the field of health care. It has been established that the prevailing idea in Canada is that health is a broader concept than is traditionally believed. It was determined that the greatest focus should be on lifestyle, given that the greatest potential for improving health lies in engaging Canadians in healthy lifestyles. As a result, it was established that the experience of the functioning of the Canadian social work system regarding health care is very useful for Ukraine and can be applied after its appropriate adaptation to Ukrainian realities.

It is indicated, taking into account the multi-vector nature of factors that have a meaningful, technical, legal, informational influence on the formation of the image of a person, it is appropriate to ascertain the presence of various types of image of a person in the field of health care, the identification and characterization of which will have an important legal significance from the point of view of protection and protection of rights on him. In the scientific article, the author focuses attention on the relevance and scientific and practical demands of conducting research on issues related to the need to analyze the types of human images in the field of health care. The expediency of conducting a study of the types of images of a person in the field of health care is proven, which is justified by the peculiarity of this field, where bioethical, moral, religious, legal and social aspects intersect, the center of which is definitely a person, his rights, freedoms and interests. Therefore, the research and analysis of various concepts and scientific views on this issue will make it possible to find out the specifics of the image of a person in the field of health care as a special legal phenomenon. It has been proven that the issue of classification of human images in the field of health care is an urgent theoretical and practical necessity. It is substantiated that the proper level of classification will ensure the necessary level of legal protection and protection of human images in the field of health care, will determine at the legal level the order and limits of access to human images, as well as certain restrictions on the use of certain types of human images. It will provide a certain level of control over the use and access to images of legal subjects, etc. Attention is drawn to the author’s approach to distinguishing classification criteria and, in accordance with them, the types of human images in the field of health care. It is concluded that the classification of the image of a person in the field of health care (medical field) is an important tool for ensuring a balance between human rights to privacy protection and the development of medical science, thus contributing to the further well-being of society.

The scientific article focuses on factors that indicate the relevance of the study of state and public control in the field of health care as an object of legal regulation. Such factors include the unsatisfactory state of health of the population, the observance of human rights in the field of health care, the quality and efficiency of the medical reform, the quality of the provision of medical services, etc. Therefore, the study of the characteristics of the relationship and legal regulation of state and public control in the field of health care is extremely relevant. In order to thoroughly reveal the purpose of the scientific article, the concept of the category "control" in various spheres of social existence was investigated and the peculiarities of control were considered through the prism of the opinions of experts in legal scientific research. The existing legislative provisions and the established practice of state and public control in the field of health care are analyzed. The existing regulatory and legal basis for monitoring compliance with legislation in the field of health care in Ukraine by the state and public organizations is characterized. The activity of subjects of state and public control and supervision in the field of health care is characterized. The competence and powers, the order of formation and regulation of the performance of their functions by the bodies of state and public control of the supervisory boards at health care institutions and management bodies of the health care system were studied. The procedure for public control by members of observation and public councils is determined. Issues within the competence of the specified councils were considered. It was found that their main authority is to control compliance with the legislation in the activities of a certain authority or health care institution.