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1
. Baltic Journal of Economic Studies Vol. 7 No. 4, 2021 -J--
DOI: https://doi.org/10.30525/2256-0742/2021-7-4-101-107
SYSTEM OF ECONOMIC MEANS OF STATE ADMINISTRATION OF THE RIGHTS OF PEOPLE WITH DISABILITIES TO HEALTHCARE
Liudmila Kozhura1, Svitlana Zadereiko2, Andrii Omelchenko3
Abstract. At the current stage of the development of society the problem of social protection and state support for people with disabilities is particularly relevant and requires reform and improvement. Ukraine, as a country aspiring to join the European Union, should take into account the best foreign experience of the leading countries of the world in the field of state policy to support people with disabilities and its implementation. The process of reforming the national healthcare system demonstrated the ineffective policy in this area, the high level of corruption and the inability to transform this system to the level of world standards of medical care, especially for people with disabilities. The problem of disability in Ukraine is becoming particularly acute. The goal of this article is to investigate the system of economic means of state administration of the rights of people with disabilities to healthcare, to identify the areas of budgetary management and the formation of a new mechanism of economic administration.
Scientific analysis was carried out by using the method of systematic approach and analysis, which enabled us to study theoretical aspects of economic methods of state administration of the right of people with disabilities to healthcare, formation of the budget management in Ukraine for the economic security of the rights to healthcare, and features of the new mechanism of the economic administration of the right of people with disabilities to health care. It has been researched that along with administrative methods of state management of the right to health protection of people with disabilities the economic group of methods is important. These include programs of economic development of health care, rehabilitation programs for people with disabilities, implementation of pilot projects to change the mechanism of financial support for operative treatment, etc.
Methods of regulating influence (indirect management) are becoming increasingly important, and economical methods of management belong to them. Implementation ensures that the financial and material interests of the management objects are satisfied through the activities of its subjects, which create favorable conditions for achieving the goals and objectives of management. For example, local self-government bodies, within the limits of their competence, can finance local programs for the development and support of community healthcare institutions.
In 2019, a new mechanism of rehabilitation support for children with disabilities was introduced based on the principle of "money follows the people', which should ensure targeting, transparency and improve the quality of rehabilitation services. Resources are divided vertically among regional bodies, which divide budgetary funds among local bodies in proportion to the number of children who require rehabilitation measures, according to the place of their residence (location).
The national legislation also reflects the norms that created the conditions for the implementation of the right to work of people with disabilities, as well as ratified Convention on the Rights of Persons with Disabilities and the ILO Convention on professional rehabilitation.
From the point of view of the Ministry of Healthcare of Ukraine, the funds allocated by the state are extremely insufficient for the uninterrupted functioning of the medical system. In its budget memorandum for 2021 the
Corresponding author:
1 Kyiv National Economic University named after Vadym Hetman, Ukraine. E-mail: lepel@ukr.net
ORCID: https://orcid.org/0000-0003-4100-9530
2 Kyiv National Economic University named after Vadym Hetman, Ukraine. E-mail: zadereikosvitlana@gmail.com
ORCID: https://orcid.org/0000-0002-0336-0023
3 Kyiv National Economic University named after Vadym Hetman, Ukraine. E-mail: a.omelchenko.kneu@gmail.com
ORCID: https://orcid.org/0000-0002-8407-8555
Baltic Journal of Economic Studies . , -J-- Vol. 7 No. 4, 2021
ministry has allocated twice as much - 296 billion UAH, 225 billion UAH of which for the implementation of the medical guarantee program (which is 5% of GDP, as required by the Law of Ukraine "On State Financial Guarantees of Medical Services to Population"). But the proposals of the Ministry of Health both at the time of formation of the state budget and at the time of its approval were not taken into account.
The requirement of the Law of Ukraine "On State Financial Guarantees of Medical Services to the Population" for the establishment of financing of the program of medical guarantees at the level of 5% of GDP was lengthened for one more year.
Key words: economical methods, public administration, rights of persons with disabilities, budget management, economic mechanism, social protection, healthcare.
JEL Classification: H11, H30, H61, I38, R50, D72
Introduction
At the present stage of the development of society the problem of social protection and state support for persons with disabilities is particularly relevant and requires reform and improvement. Ukraine, as a country aspiring to join the European Union, should take into account the best foreign experience of the leading countries of the world in the sphere of state policy of support for people with disabilities and its implementation. This will enable to solve problems related to education, employment, integration of people with disabilities into the environment and the realization of their abilities and skills.
Today the world does not have one thorough, stable and efficient system of healthcare administration. Every country in the world faces different problems in ensuring the realization of the right to healthcare, in providing access to quality medical care and treatment.
Ukraine's healthcare system lags behind the world's developed countries by various indicators, including life expectancy, mortality, and the fight against chronic and infectious diseases. Despite the low indicators of healthcare provision, Ukraine spends a significant part of its gross domestic product on medical services, but in general it has little impact on the healthcare system. The process of reforming the national healthcare system demonstrated the ineffective policy in this area, the high level of corruption and the inability to transform this system to the level of world standards of medical care, especially for people with disabilities. The problem of disability in Ukraine is becoming particularly acute. The number of people who were injured or maimed in connection with the recent events in the country is increasing. That is why creation of favorable living conditions for people with disabilities is one of the main priorities of social policy of the state.
The goal of this article is to investigate the system of economic means of state administration of the rights of persons with disabilities to healthcare, to identify the areas of budgetary management and the formation of a new mechanism of economic administration.
1. Methodology of research
1.1. Theoretical aspects of the definition of economic methods of state administration of the right of people with disabilities to health care
Significant contribution to the development of theoretical and practical foundations for the implementation of the state policy of support for persons with disabilities has been made by such well-known domestic scientists as M. Avramenko, S. Bohdanova, N. Boretska, I. Bezsonova, T. Voitchak, N. Hauzner, I. Hryshova, N. Dementieva, O. Diachenko, K. Myched, S. Leonova, A. Ipatova. However, despite the numerous efforts and achievements of domestic scientists, the study of experience in the sphere of realization of the state policy of support for people with disabilities and its implementation in Ukraine requires additional research.
In addition to administrative methods of state administration of the right to healthcare for people with disabilities another group of methods is important - the adoption of programs of economic development of healthcare, the acceptance and funding of rehabilitation programs for people with disabilities, ensuring the implementation of medical activities of individual state programs and comprehensive program activities, implementation of pilot projects to change the mechanism of financial support for surgical treatment of organ transplants and other anatomical materials, etc. The main purpose of economic methods of activity of the public administration in ensuring the right to healthcare for people with disabilities is to create such economic conditions, which cause interest in the performance of certain work, in increasing the productivity of work and, accordingly, the provision of financial support. During the application of economic management methods, the subject of control achieves the desired behavior of the managers by influencing their material interests. For this purpose, both the prospects of material benefits and the threat of material sanctions can be used (Kolpakov, 1999). These methods
are suitable for regulating the activities of the so-called non-profit organizations, taking into account, for example, how rationally they spend their own material resources received from the provision of paid services, the lease of state property and real estate.
It should be noted that in the process of implementing administrative and, in the future, medical reforms, methods of regulatory influence (indirect administration) become very important, among which the leading place is taken by economic methods of management. Implementation ensures that the financial and material interests of the management objects are satisfied through the activities of its subjects, which create favorable conditions for achieving the goals and objectives of management. For example, local self-government bodies, within the limits of their competence, can finance local programs of development and support of communal healthcare institutions. In particular, they are responsible for renovation of material and technical basis, major repairs, reconstruction, increasing wages for health workers (local incentives programs), as well as local programs for providing health services to the population, local public health programs and other programs in healthcare. Economic methods can also include measures of material incentives through a system of specially created funds that accumulate and distribute budgetary funds for health care together with private capital; identify priority areas of funding and support for the development of medical care for people with disabilities; provide funding for programs to improve the qualifications and retraining of specialists who provide medical care for people with disabilities; carry out redistribution of funds from state, local and other sources for the treatment of certain types of diseases; establish a system of grants and target funds and to use various mechanisms of control over the use of resources, etc.
Thus, economic methods are manifested in the creation of such conditions for the development of the ordered objects, for which they under the influence of certain material and financial incentives can independently choose a variant of behavior. However, as before, this choice is made on the basis of the traditional "surplus" principle of state funding of healthcare, which, unfortunately, cannot be solved in the near future. Economical methods can be used on a limited scale. That is why it is necessary to look for new methods of complex investment in the field of healthcare, including sources of funding of medical care for people with disabilities through the use of the possibilities of different levels of budgets, recruitment of charitable contributions (development of philanthropy and patronage), expansion of the scope and sphere of use of business activities in the surveyed sphere of administration. It is worth noting that the
use of economic methods of state administration of the right to health care for persons with disabilities requires the search for specific indicators of activity of the authorized entities, as well as specific criteria for evaluating its effectiveness.
Therefore, economic methods of public administration of the right of people with disability to healthcare - the totality of means and methods, which are used by the authorized subjects of public administration in order to create such economic conditions, which contribute to improving the health level of individuals with disabilities, ensuring an accessible and safe environment, improving the professional qualities of medical personnel providing medical care for those with disabilities, implementation of rehabilitation measures, as well as the creation of other necessary conditions for the integration of such people.
2. Results and discussion
2.1. Budgetary management of economic security of healthcare rights
Economic methods of state management of the right of people with disabilities to healthcare are implemented by:
1. planning in the state and local budgets to allocate funds to ensure the right to healthcare;
2. development, approval of comprehensive social protection and support and rehabilitation programs;
3. elaboration and implementation of rehabilitative measures;
4. development of state-private partnership mechanisms to ensure the right to healthcare for people with disabilities;
5. financing from the state and local budgets for the development of healthcare institutions, as well as for the construction and commissioning of new rehabilitation centers, etc.
Thus, in the state budget of Ukraine for 2018 the expenditures for the functional classification of expenditures and budget crediting for healthcare and social protection, including for people with disabilities, are as follows (Law of Ukraine of 23.11.2018):
- measures for rehabilitation of children with cerebral palsy - 14 154 000,00 UAH;
- implementation of the pilot project to change the mechanism of financial support for surgical treatment for organ and other anatomical materials transplantation - 112 015 300,00 UAH;
- providing primary medical care to the population -8 054 517 600,00 UAH;
- subventions from the state budget to local budgets for the purchase of expensive materials for health care
institutions and pharmaceutical products for inhalation anesthesia - 18 972 600,00 UAH;
- subsidy from the state budget to local budgets to cover the cost of medicines for the treatment of certain diseases - 1 000 000 000,00 UAH;
- specialized prosthetic-orthopedic and medical-rehabilitation assistance to incapacitated person at the clinic of the Scientific and Research Institute of Prosthetics, Prosthetic Construction and Rehabilitation - 23 384 300,00 UAH;
- measures for social protection of children, families, women and other most vulnerable categories of the population - 100 789 900,00 UAH;
- provision of one-time financial assistance to family members of persons who died (passed away) during the participation in the anti-terrorist operation, and to persons who received a disability during the participation in the specified operation -48 748 700,00 UAH;
- providing one-time financial assistance to a member of the volunteer's family who died while providing volunteer assistance in the area of an anti-terrorist operation, and to a volunteer who became disabled as a result of an injury sustained while providing assistance - 815 700,00 UAH.
In accordance with the Law of Ukraine "On the State Budget for 2019" the following allocations were planned in the field of healthcare as well as indirectly to ensure the implementation of the right to healthcare for people with disabilities (Law of Ukraine of 14.11.2019):
- subventions from the state budget to local budgets for the purchase of medicines and medical products for the provision of emergency medical care -137 992,3 UAH;
- appropriation from the state budget to local budgets for the purchase of angiographic equipment -150 000,0 UAH;
- subsidium from the state budget to local budgets for the reimbursement of the cost of medicines for the treatment of certain diseases - 250 000,0 UAH;
- subsidy from the state budget to the district budget of Valkivsk District of Kharkiv region for the purchase of a computer tomograph for the communal health institution Valkivska Central District Hospital -12 500,0 UAH;
- advanced training of social security workers -644,1 UAH;
- specialized prosthetic-orthopedic and medical-rehabilitation assistance to persons with disabilities in the hospital of the Scientific and Research Institute of Prosthetics, Prosthetic Construction and Restoration of Functioning - 26 768,9 UAH;
- social protection measures for children, families, women and other most vulnerable categories of the population - 95 570,3 UAH;
- recuperation and recreation of children who require special attention and support in the children's
health centers of the International Children's Center "Artek" and Children's Center "Young Guard" -217 192,1 UAH;
- health resort treatment for war veterans, persons covered by the laws "On the status of war veterans, guarantees of their social protection", "On victims of Nazi persecution" and people with disabilities -193 165,9 UAH;
- actions for psychological rehabilitation, social and professional adaptation, provision of health resort treatment to victims of the 2013-14 Ukrainian revolution, participants of the anti-terrorist operation and persons who carried out measures to ensure national security and defense, repulse and deter armed aggression of the Russian Federation in Donetsk and Luhansk regions - 110 905,6 UAH;
- financial support for public associations of people with disabilities with the status of nationwide -89 362,4 UAH, Including the financial support of the National Assembly of the Disabled of Ukraine, enterprises and organizations of the nonprofit sector of the Ukrainian Association of the Disabled and the Ukrainian Association of the Deaf, and the Union of organizations of persons with disabilities of Ukraine -76 025,9 UAH;
- efforts for social, labor and professional rehabilitation of people with disabilities - 1 335 591,0 UAH;
- maintenance of activities of the Social Security Fund for Invalids - 85 678,0 UAH;
- rehabilitation of children with disabilities as a result of child cerebral palsy - 130 022,6 UAH;
- subventions from the state budget to local budgets for the payment of cash compensation for the necessary accommodation for the families of persons listed in paragraphs 5-8 of clause 1 of Article 10 of the Law of Ukraine "On the Status of Veterans of the War, guarantees of their social protection", for people with disability of groups I-II resulting from injuries, contusions, casualties or illnesses sustained during direct participation in the anti-terrorist operation, implementation of activities aimed at ensuring national security and defense, and the withdrawal and destruction of the military aggression of the Russian Federation in Donetsk and Luhansk oblasts, and to ensure that these measures are implemented, In accordance with paragraphs 11-14 of part two of article 7 of the Law of Ukraine "On the Status of Veterans ofthe war, guarantees oftheir social protection", and which require improvement of living conditions -305 145,3 UAH;
- subvention from the state budget to local budgets for the payment of monetary compensation for housing to internally displaced persons who defended the independence, sovereignty and territorial integrity of Ukraine and participated directly in the anti-terrorist operation, ensuring its execution, being in the areas of the anti-terrorist operation during its implementation,
in the performance of actions aimed at ensuring national security and defense, fighting and disrupting the military aggression of the Russian Federation in Donetsk and Luhansk regions, providing its fulfillment, residing indirectly in the areas and during the period of implementation of the mentioned measures, and recognized as people with disability as a result of the war of the II group according to paragraphs 11-14 of part two of article 7 or participants in the fighting according to paragraphs 19-20 of part one of article 6 of the Law of Ukraine "On the Status of Veterans of the War, Guarantees of their social protection," which require improvement of living conditions -25 000,0 UAH (Law of Ukraine from 23.11. 2018).
At the same time, according to the State Budget of Ukraine for 2020, the cost of healthcare for people with disabilities is as follows::
- public health and fight against epidemics -2 121 032,8 UAH;
- creation of a modern clinical base for the treatment of oncological diseases at the National Cancer Institute - 700 000 UAH;
- realization of the state investment project "Improvement of molecular genetic diagnostics of oncological diseases in Ukraine" - 100 000 UAH;
- health resort treatment for tuberculosis patients and children and adolescents with somatic diseases -573 390,4 UAH;
- specialized prosthetic-orthopedic and medical-rehabilitation assistance to people with disabilities at the clinic of the Scientific and Research Institute of Prosthetics, Prosthetic Construction and Restoration of Employment - 34 500,7 UAH;
- social protection activities for children, families, women and other most vulnerable categories of the population - 66 019,8 UAH;
- the annual one-time assistance to war veterans and victims of Nazi persecutions and social assistance to
persons who have special labor services to Ukraine -1 382 540,6 UAH;
- Social support for people who suffered as a result of the Chernobyl disaster - 2 570 195,0 UAH (Law of Ukraine of 14.11. 2019).
2.1. Formation of a new mechanism of economic administration of the right of persons with disabilities to healthcare
Note that in 2019 a new mechanism of providing rehabilitation services for children with disabilities due to cerebral palsy was introduced based on the principle "money follows the people". This mechanism will ensure targeting, oversight and improve the quality of rehabilitation services. For compliance with the Law of Ukraine "On the State Budget of Ukraine for
2019," which provides for payments under the budget program 2507100 "Rehabilitation of Children with Disabilities due to Cerebral Palsy" was approved by the Cabinet of Ministers of Ukraine Decree of 27. 03.03.2019 № 309 "On Approval of the Order of the Ministry of Social Policy (2019) for use in 2019 of the funds provided by the state budget for the rehabilitation of children with disability due to cerebral palsy.
The state budget for 2021 provides funds for the Ministry of Healthcare of Ukraine, including the financing of the Ministry Apparatus (35,2 billion UAH), the State Service of Ukraine for Medicines and Drugs Control (116,2 million UAH) and the National Health Service of Ukraine (NHSU) (123,8 billion UAH). The lion's share of funding of the NHSU is directed to the continuation of the implementation of the program of state guarantees of medical care for the population, which was launched in full scope from 1 quarter of
2020. The state budget for 2021 allocated 123.5 billion UAH for the Program of Medical Guarantees (PMG) (Figure 1). The final edition of Law No. 1082-IX increases spending on this budget program (as
Development of the system of emergency medical aid
Performing a COVID-19 vaccination | 2,6 Public health and anti-epidemic measures
2,6
Training of specialists in the field of health ^ 71 and refresher courses
Centralized purchasing of medicines 10, 3
Realization of PMG 123,5
0 20 40 60 80 100 120 140
Figure 1. The biggest expenses ofthe Ministry of Healthcare of Ukraine for 2021 (billion UAH)
Source: Health care spending in 2021. Health care spending in 2021: when expectations are shattered by a harsh reality. №1 (1272) https://www.apteka.ua/article/579552
compared to the first edition of the draft budget) by 56 million UAH (for treatment of patients in the posttransplantation period) (Health care spending in 2021).
In 2021 the PMG provides funding for first medical aid (taking into account the number of people who have signed a declaration with a physician); secondary (specialized) and tertiary(highly specialized) outpatient and hospital medical care (based on priority services and conditions); reimbursement; palliative medical care and medical rehabilitation; as well as emergency medical care (according to a new organizational model). It should be noted that according to the Cabinet of Ministers of Ukraine Decree of 16.12.2020. No. 1271 "On the standard of arrival of emergency (ambulance) medical aid teams to the site of the event" now the target time of emergency medical aid team travel is determined not by the territorial relevance, but by the priority of the patient's condition.
The Ministry of Social Policy is the main holder of the budget funds allocated in the state budget for rehabilitation of children with infant cerebral palsy in 2019. The coordinators of budgetary funds of the lower level are: Fund for Social Protection of Invalids -responsible for implementing the budget program; Body of legislative power in the Autonomous Republic of Crimea on social care of population, structural divisions on welfare of the regional residents, Kyiv City State Administration; structural subdivisions on social protection of the district inhabitans in Kyiv, as well as state administrations, executive bodies of city, district and city councils (local organizations (if created)).
Resources are vertically distributed among regional bodies, which, in their turn, allocate budgetary funds among local bodies in proportion to the number of children, who require rehabilitation measures at the place of their residence (staying) in accordance with the individual treatment programs. It should be noted that funds allocated for the implementation of rehabilitation measures may be redistributed on the basis of appeals from these subjects.
These program-targeted economic methods of state management of the right of people with disabilities to healthcare are applied to relevant institutions of any form of ownership and organizational-legal form, which provide medical care for people with disabilities and (or) their rehabilitation on the basis of a corresponding license and professional activities of medical (pharmaceutical) workers, who have a license to conduct business activities in the medical practice for the purpose of covering the cost of rehabilitation activities for children in need.
Therefore, the use by territorial communities of the funds allocated in the state budget for the rehabilitation of children with disabilities due to cerebral palsy is a valid method of public administration of the right to healthcare of people with disabilities.
Another effective economic method of public administration of the right to healthcare for people with disabilities is the development of a mechanism of using the funds allocated in the state budget by territorial communities to purchase specially equipped vehicles for transportation of people and children with disabilities, who have impairments of the musculoskeletal system. The use of this method will be able to stimulate territorial communities to create transportation services for people with disabilities, especially for people in wheelchairs. The fulfillment of these actions will positively contribute to the elimination of barriers in the life activity of people with disabilities.
Implementation mechanism of the mentioned economic method of public administration of the right to healthcare for people with disabilities was approved in the Decree of the Cabinet of Ministers of Ukraine of 14 February 2018. No. 189 "Some issues of using the funds provided in the state budget for the purchase of specially equipped cars for the transportation of people and children with disabilities who have musculoskeletal disorders" (Resolution of the Cabinet of Ministers of Ukraine of 14.03.2018 № 189). It should be mentioned that according to the budgetary program 2507030 "Social, Labor and Professional Rehabilitation of Disabled Persons" for 2019, 30 000 UAH are allocated for this sphere.
We also note that the economic methods of state administration of the right to healthcare for people with disabilities, in our opinion, also include: targeted approach to ensuring technical and other means of rehabilitation of persons with disabilities; providing such persons on the principle of "money follows the person"; payment of cost compensation for self-purchased rehabilitation equipment, etc.
Conclusions
Today the world does not have perfect, stable and efficient system of healthcare administration. Every country in the world faces different problems in ensuring the realization of the right to healthcare, as well as in providing access to quality medical care and treatment.
In addition to the administrative methods of state management of the right to healthcare for people with disabilities, an important group of methods ensures this right. For example, programs of economic development of healthcare, rehabilitation programs for people with disabilities, the implementation of pilot projects to change the mechanism of financial support for operative treatment, etc.
It is worth noting that in the process of implementing administrative and, in the future,
medical reforms, methods of regulatory influence (indirect management) become very important, among which the leading place is taken by economic management methods. Implementation ensures that the financial and material interests of the administration objects are satisfied through the activities of its subjects, which create favorable conditions for achieving the goals and objectives of management, for example, local self-government bodies, within the limits of their competence, can finance local programs for the development and support of community healthcare institutions.
Economic methods find their manifestation in the creation of such conditions for the development of dependent entities, for which they can independently choose an individual variant of behavior under the influence of certain material and financial incentives. However, this choice is made on the basis of the traditional "surplus" principle of state funding in the field of healthcare, which cannot be solved in the near future.
It is important to point out that in 2019 a new mechanism was introduced to provide rehabilitation measures for children with disabilities due to cerebral palsy on the principle of "money follows people" principle was introduced, which should ensure targeting, oversight and improve the quality of rehabilitation services.
References:
The national legislation reflects norms that created conditions for the realization of the right to work of people with disabilities, as well as ratified Convention on the Rights of Persons with Disabilities and the ILO Convention on vocational rehabilitation. From the point of view of the Ministry of Healthcare of Ukraine, the funds allocated by the state are extremely insufficient for the uninterrupted functioning of the medical system. In its budget memorandum for 2021 the ministry has allocated twice as much -296 billion UAH, 225 billion UAH for the implementation of the program of medical guarantees (which is 5% of GDP, as required by the Law of Ukraine "On State Financial Guarantees of Medical Services to the Population"). But the suggestions of the Ministry of Healthcare of Ukraine both at the time of formation of the state budget and at the time of its approval were not taken into account.
The requirement of the Law of Ukraine "On State Financial Guarantees of Medical Services to the Population" for the establishment of financing of the program of medical guarantees at the level of 5% of GDP was suspended for one more year.
When formulating policy regarding people with disabilities in Ukraine it is necessary to take into account not only the experience of our own country, but also the current trends in international practice, which are more innovative.
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