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Introduction Actuality of the topic. Since 1991 the Republic of Moldova made the transition to

market in terms of socio-economic crisis. One of the conditions necessary for normal functioning of all areas of life in society is to develop and implement practical methods of regulation and control in health. Reduction of budgetary resources, lack of material resources and high percentage of loans made to the budgetary policy of Moldova to be much tougher. One of the possible ways of restoring the health situation at the present stage is the implementation of health insurance as a form of activity which requires the implementation of the health care system of market relations with all laws characteristic of these relationships. Because health insurance is aimed at health, it acquire a very pronounced social aspect. The current situation in Moldova allows to highlight a number of problems related to human health and functioning health care system: 

Continuous deterioration of health status; 

Decreased population accessibility to health services;  Decreased quality of care that patients that does not meet the standards of

modern medical care; 
Ineffective use of resources allocated to the branch, etc.

The need to further improving the population's access to medical services, requires a careful study of the evolution of social health insurance system as a whole, its a permanent correction for the efficiency. But both the effectiveness and efficiency of health insurance are inevitably subordinated financial opportunit ies which provide financing system in return as mentioned previously, the population's health needs. Working from the insurance market lasting several forms of health insurance is confirmed to be the most appropriate format for organizing the health system . Competition occurred in these relationships requires medical institutions to provide

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quality services, determined by practice performance methods of investigation and treatment, as well as improving the quality and conditions of service. Health Care Reform is one of the major social changes in Moldova. Health care insurance is the most progressive and effective current method and has a wide application in many countries of the world market economy. With health care reform, shifts to the insurance model of medicine is to achieve goals including a special place it has higher quality medical services provided curative and preventive institutions of the Republic of Moldova. Thus, quality of service provided has become a theme frequently addressed in socio-economic studies within the industry because it is one of the factors that positively affects saving and material resources to raise effectiveness of medical institutions.
The aim of the study: to study the health insurance market and developing

technologies to improve organizational quality and volume of health care by health insurance.
Objectives of the study:

1. Analysis of the health insurance market in countries that practice mixed type of health insurance and in Moldova; 2. Studying the possibility of joining the mandatory medical insurance scheme with voluntary health insurance in the Republic of Moldova; 3. Developing technologies to increase the quality of organizational and volume of medical services to insured persons;
The originality of this work consists in tackling health care reform by passing the

security model, this creates additional financial resources for health care for the high quality health services to provide health professional s with a respectable income, which would meet the quality and social value their work.

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Chapter I. Place and role of health insurance in the context of social security 1.1. Health insurance and its role on the insurance market. During the existence and development of human society, man was preoccupied

with issues related to providing material and financial resources. Intensive development of society has led to opportunities for human intervention for preventing or reducing the negative consequences of d amage to generating phenomena. Of all ways and methods used by humans for the prevention of loss events, the most suitable was proved to be insurance. From this perspective, insurance has taken a fairly large scale in countries of the world, becoming, in r ecent years, a branch of the global and national economy. Appearance of insurance was determined by need of protecting themselves

against natural disasters, accidents, through the accumulation of livelihood in terms of loss or limitation of working ability after illness or old age. As the development of society, have enlarged effective means to limit the loss events and the methods and ways of ensuring the population. Factors that have led to insurance, are the economic and social. Among economic factors, the principal may be nominated: 1. changing economic conditions with the transition from one type to another type of economy and, correspondingly, the diversification of relations between people; 2. development of international relations and as a result, the need to guarantee the goods against risk. At present, increase the importance of social factors, among which occupies a special place: 
intense development of the phenomena of urbanization and, correspondingly,

the population concentration in large cities; 
increased risk of illness and traumare;  increasing number of factors and events producing damage;  organization in groups and guild members shall assist each other.

Cultural aspect of social health insurance is deeply rooted in the countries where they were generated and initially introduced. Germany is considered to be the source

Operating mechanisms were similar. After the Second World War and. reporting to the disease. nature programs. Most researchers in the field agree that the birth of health insurance in 1883 was signed by German Chancellor Otto von Bismarck. traditionally reluctant to any state intervention. despite constant opposition from business circles.has led to cover a more significant segment of the population. including health care. who introduced the first compulsory social insurance program nationwide. The economic crisis of the '30s determined even the U. In addition to insurance funds. made by contributing of employers and employees and which were intended to provide financial support not only the cost of medical care but subsistence workers during the disease a year later was introduced compulsory insurance against accidents. .S. especially. introduced in official state law structures social health insurance voluntarily. which may be mentioned: the level of economic development and socio -cultural. government to take a series of concrete measures in order to create a social se curity system. yet its precursors are more difficult to identify. as early twentieth century to be taken in Sweden and the Netherlands. traditions. Today we can say that the health insurance system is a result of the level of development and civil ization of the nation. and funds management system employers and employees. medical services and benefits. in 1883. a process which .along with their diversification . The manner in which this system is implemented in each country depends on a combination of factors. The merit of Chancellor Bismarck is one which has created a social insurance system. human resource requirements. character istics and evolution of family social life. retirement age. the economic growth has also contributed to the developm ent of adequate social security systems. by the mid70s. The German example was followed some years later by Austria and Italy.-6- of this approach to health insurance because she was the first Western European country which. being based on contributions.

In social terms. in 1883 in Germany. terms and conditions for their implementation are established by law. hospital care and pharmaceuticals. the Netherlands in 1941 and 1996 in Switzerland has evolved into a state -legislative. Relations between the insured and the insurer. the rights and obligations of each party. there are two forms of insurance: compulsory and voluntary (optional). The mandatory health insurance. Equally important is that the main concept of this form of social insurance has changed. the rights and obligations of each party. Administrative nature of social health insurance has changed over time. In Moldova's conditions. moving from wage replacement and the death benefit to pay for outpatient medical services. almost universal in Western Europe. this type of insurance is designed to maintain financial areas t hat fall behind in their socio economic development and not have opportunities to independently form the financial basis for payment of medical services required value. Also health insurance became an insurance product which provides profit for the insurance companies on the insurance market. Insurance. the relationship between the insured and the insurer. terms and conditions for their implementation are established by law.-7- Health insurance appeared in order to protect people on their day by day life. this section is called . is the culmination of a historical process of 700 years. The current system of social health insurance. After making mode. aims to match individual risks between group members and not allowed to enter the insurance group objects. During this period. as a type of business. starting with voluntary cooperatives and later. the number of people covered with health insurance grew from a small number of workers from the trade to all citizens or at least all citizens whose income is below a relatively high income. Mandatory health insurance is meant to ensure the unique standards (general) population social protection in health insurance. capable of refocusing the group risk category in the direction exceeded the average.

medical service and medical assistance beneficiaries) are provided with a n on-discriminatory treatment in respect of rights and obligations under the law. This limitation manifested commercial insurance. The need for compulsory medical insurance is in Moldova. b) the principle of equality. us e for this purpose compulsory insurance. then use the voluntary medical insurance. based on mandatory contributions of employers and the citizens themselves. . as the state confirms that the protection of people's health has a crucial importance for the success of market reforms. in turn. commercial health insurance in Moldova. However. If. payments from the revenues or profit enterprises. according to specific contracts. the size depends on the insurance contribu tion rates for those medical services that are required for the quota given. organizes and ensures that the state compulsory health insurance system based on the same rules of law. may be performed exclusively as voluntary.never social".-8- "discrimination". however. Voluntary health insurance is protection to ensure guaranteed supplies for all citizens who are insured by the individual or collective voluntary insurance of citizens' own account. Size of contribution. stabilization and further development of society and not having sufficient resources in its budget for this protection. the universality of participation is missing. is determined by the health insurer by each insured or group of policyholders. In addition. in our opinion. which may be a mechanism for financing public goods. in this case can be expressed by the words "always a group . whereby all participants in the mandatory health insurance (premium paying compulsory medical insurance. volume and cost of care and services offered under such a contract depends on the size of contributions. some members of society or some organizations are able to protect health at a higher level than that guaranteed. funding guaranteed level of health insurance. Compulsory health insurance system is organized and functions having the following principles: a) the principle of uniqueness. In this case. Therefore. The essence of insurance. a feature of compulsory health insurance.

provided and updated by authorized institutions.-9- c) solidarity principle. . b) lists the nominal record of insured persons at state expense. For the uninsured. under which payers of insurance premiums paid mandatory healthcare contributions according to income and healthcare benefits insured as required. in the established policy of mandatory health insurance. e) contributiveness principle according to which the health insurance funds are based on insurance premiums paid by the payers established by law. f) distribution principle. according to law. under law. d) mandatory principle according to which natural and legal persons under the law have the obligation to participate in compulsory health insurance system and health insurance rights shall be exercised in correlation with the obligations. pre-hospital emergency health care costs for primary care and specialized medical care and hospital outpatient care for socially conditioned diseases with major impact on public health. according to the list established by the Ministry of Health. The insurance policy is a document of strict accounting and issued by the insurer based on: a) lists the nominal record of insured persons employed by employers l isted and updated. are covered from the compulsory health insurance funds means care. g) principle of autonomy. under which compulsory healthcare system is administered independently. The quality of the insured person is confirmed through the issuance by the insurer. which states that funds made mandatory health insurance is redistributed to pay obligations of mandatory health ins urance system. and health care providers providing care in this system works on principles of self-financing and profit. under which the full amount insured person receiving medical assistance provided in the program and granted the unique health care providers.

First approach. In it is described that care received by the insured in case of occurrence of insurance case. This approach is much more expensive just as the insurer receives for managing this product. In this case the insurance products of voluntary health insurance has medico technological nature. The second approach. the rights and obligations of each party is determined by the insurance contract. Voluntary health insurance is complementary to the mandatory. This type of insurance plays an important role in the context of lack of funding from the budget. Let us compare the insurance products that underlie them. Unfortunately. in accordance with the laws and regulations of the Supervisory Authority. unlike the universal compulsory. Following insurance protection under the voluntary medical insurance contracts is not basic social protection. but not only that part which relates to the . These actually are the same paid medical services received by the contribution (payment) of the insurer. maintaining and protecting health. Voluntary health insurance can be both collective and individual. For individual insurance. the insurer conclude the contract not with a particular person.10 - c) identity documents and other documents certifying the right to obtain policy by persons obliged by law to provide indivi dually. but not mass. the insurer concluded insurance contract with each customer individually. Optional health insurance is based on the principles of health insurance.. There are two approaches. In the case of collective insurance (group). because he gives the best idea (views) of the Law on compulsory health insurance. but with staff representatives of workers (government and trade union committee). The voluntary health insurance. The purpose is to ensure all interest related medical issues. the relationship between the insured and the insurer. Insurance is based solely on risk-related expenses for medical aid. we can not omit this fact. but add the element of social protection guaranteed by the mandatory health insurance. The conditions of voluntary insurance are set by the insurer.

Differentiation by the volume of maintenance programs. Activity in base of laws in force. Adaptation . Basic principles: 1. Unlike the mandatory insurance. 2. Establishing principles and rules of insurance products With the advent of health insurance requirements for implementation of voluntary health insurance appears the necessity of establishing insurance programs. All have a f inancial expression and placed under the grading of risks can be transferred to insurance. Insurers take a number of risks of expenses that arise from the use of ineffective methods of treatment. 8. but in such a way. voluntary medical activity is an important form of commercial finance and insurance is a part of persons insurance(Table 1 . Problematic situation for voluntary health insurance can be determinate by the following case: it is necessary for the insurer to form an attractive package of services. 6. loss of body parts or its function. We choose the latter approach and all subsequent exposures will be d isplayed in this key. 5. . given that the package will not stimulate the increase of medical services. Strict division of fields of activity for setting correct programs. Implementation.1. Of those exposed to conclude that compu lsory health insurance and voluntary health insurance can not be merged into a single insurance company health insurance practice by the principles and approach second accident insurance. 4. Forecasting. 7. decreased work capacity. Liability insured under these risks can suddenly increase the attractiveness of the insurance product to potential customers.. Using statistical methods in the formation of insurance programs. Findings of the necessary volume of medical services rendered on a program in correlation with the cost of medical services.1). 3.11 - provision of healthcare.

3. Prices for services provided by medical institutions are established by agreement between the subjects. 1 2. 1 0. The volume of medical services is limited by financial ability of medical institutions. Terms of assurance shall be determined by the CNAM.1 The main distinctions between mandatory health insurance and voluntary health insurance N r. It has a voluntary character. Is carried out by insurance companies with different forms of ownership. 2. It is regulated by the Law on Insurance and other government ordinance refers to entrepreneurial activity. are individuals and 7. Terms of assurance shall be determined by insurance companies.. It covers only the law on mandatory health insurance. The volume of medical services is limited by the amount of insurance. Form of insurance with financialcommercial activity. Voluntary health insurance 1. in coordination with the compulsory subjects. Insurers businesses. state. Revenues may only be used for developing the core business . 9. Revenues can be used in any commercial activity commercial. 4. 6. . Is binding. Is done individually. local administrative bodies. Mandatory health insurance A compartment in the social security system. Insurers are employers and employees. Prices are set by contract. Universal Is performed. 1 1. Assurance program is established under the contract between the insurer and the insured.insurance required. Prices are set by law. usually by insurance companies with non-profit. in groups or families.1. which refers to personal insurance. 5. The unique program is approved by the state. Prices for services provided by medical institutions are established by bilateral agreement. 8.12 - Table 1. based on actuarial mathematics.

the main objective of social policy. Individual and . housing. For this reason. Taking the political science concept of cyclical political process.in fact . as it is presented in Figure 1..2. which is . known as social policy. They are not limited to a simple analysis of society and its problems (poverty. unemployment). Figure. discrimination.1. 2. Social bases of health insurance Health insurance is part of a broader context. are envisaged and arrangements based on specific actions that each area can be achieved at as high a level of efficiency and effectiveness. resulting in decisions and actions welfare to be achieved. unemployment and imprisonment. in addition to actions directed towards achieving public welfare. a concept known as collective welfare.1. inequality. generate and review of social policy can be described as an interactive model. Policy cycle Identify social problems Evaluation of policies and effects Implementing Political proposals All these features are associated with the concept of welfare. but have in mind and mechanisms to address the problems in question. 1. together with human health. education. aim to improve quality of life by providing community members a decent living. The measures undertaken.2.13 - 1. Everything is analyzed in the context of social policies and the institutional architecture that implements programs and providing welfare support. having as main object of study social services and which. marginalization. as well as areas of reference include: social security. both economically and from a social perspective.

For this reason. but also their families. disability. related to mechanisms of resource allocation and income and the redistributive nature of the transfer mechanisms. reduction and elimination of consequences of events considered "social risks" that have a bearing on the level living and the quality of life. maternity and child care increase. In the process of operationalization of social policies can make a record of their focus to an object generically called social security. poverty are considered to be fundamental risks human which may generate each other or may become centers generating new ones. . in which case we are dealing with a primary distribution. One can see easily that social security programs are designed not only to protect individuals. Meanwhile. the withdrawal of active life). ignorance. Disease. in situations where loss of income or insufficient income. Linking financial support of medical treatment and / or medical care. income maintenance measures in case of involuntary loss (in whole or in part) of ability to work in a manner in which to include family financial problems. unemployment. the ultimate organization of the International Labor Organization (ILO) uses three criteria for defining social security: 1. involved enough large spending that may put population at risk. loss of spouse. exceptionally. Social security can be defined as a set of mea sures laid down by law. Social Security can provide financial resources people in need from different cases (illness. Social protection system is a set of programs that are designed to protect individuals from the situation interruption or loss of earning capacity. representing all actions taken by the society for the prevention.14 - collective welfare can be achieved both by direct mechanisms arising from the functioning.. aiming to maintain income individual or family concerned to provide an income if all sources of income have disappeared or when.

Transfer risk (for example. that health insurance is not just a way of managing these risks.15 - 2. . because of unemployment). 3. avoiding s moking. by practicing a proper diet. in general the contributions and rights of those who are receiving them. y y Establishing personal reserve for medical expenses not covered by the public. Health insurance differs significantly from other forms of public aid or support. the costs of long-term treatment. or reduction in income during incapacity for work. A marked demographic reality of the aging population. private. proscribing certain dangerous sports).. Another concept is the basic social security. but also because this sector consume appreciable amounts of resources. however. among which we mention: y Control. They are collected in special funds that provide financial support to beneficiaries. Appropriateness of mechanisms for security management system principles specific to each component. not only becau se it covers a distinct category of risk. by clause of the contract of employment that employers provide accountability for certain medical costs of employees). which may add other methods or techniques. excess alcohol products. due to technological development in the field. It must be said. from employers and in some cases. y y Avoiding risk (for example. Contributions come from individuals emplo yed. a program of exercise. public-private partnership). makes the demand for health services to provide a strong dynamics. Health care services and health insurance benefits from an increased interest in social insurance. from state budget. The benefits depend. representing a special form of protection that society attaches to its members support one way to counteract the effects of various economic risks (loss of income due to illness. due to reduced working capacity in old age. Voluntary private insurance system to cover medical expenses. The existence of legal provisions concerning rights and obligations of individuals in relation to each of the components of the system (public.

mandatory health insurance. 3. 2. medical insurance for a certain area. Insurance on certain groups or diseases:  medical insurance for certain groups of states or diseases. health. 3. Complex:  advanced medical insurance. Each principle is part and other principles of classification.3. So health insurance can be classified as follows: According the law: 1.  complex insurances for diseases.  complex health insurance. 2. . international medical insurance. As mentioned in previous chapters. According the territorial principle: 1. voluntary medical insurance. According to the number of insured persons: 1. 2.Principles of classification of health insurance. family medical insurance. These concepts are not s ynonymous and its information content is very different. 4. it is necessary to classify the concepts of medical insurance. medical expenses for illness.. According to the volume of coverage: 1. individual health insurance. also the principles of classification are only principles and are not defining in classification.16 - 1. 2. medical insurance for the entire population.  complex medical expenses insurance. medical insurance for the entire population. collective medical insurance.  health insurance for certain groups of conditions or diseases . Medical insurance are classified by the same principles as other types of insurance. It allows to easily understand the co ntents of each medical insurance.

 insurance for long .  insured.one year or less. based on the number of insured persons attached to the service. According to the manner of payment by the insured person:  full payment . only after which the coverage becomes effective.  insurance average . According to the period of insurance:  insurance for short period .  cash.17 -  health insurance costs on certain groups of states or diseases.  service provider. As in other types of health insurance contracts. According to the manner of payment of service providers:  actual expenses payment. it establishes a waiting period.  according to the norms for treating a case of insurance.  pay a share of the amount of insurance or expenses. the cost of medical treatment as a result of illness or injuries in insured or compensation coverage for illness or income during illness. .  by transfer. Insurance premiums are different for men and women. Health insurance is a form of insurance designed to cover all or partial hospitalization costs if hospitalized exceeds a certain number of consecutive days (usually 3 or 5). it can be 3 -6 months.  paying the cost of day / bed.1-5 years.  by paying the annual budget.  health insurance for whole life. The risk of death is not insured..65.  with overlapping claims.  payment by applying various reliefs.

are much cheaper and easily subject to calculation.  surgery. oncology).). A major application of preventive methods have collective contracts. diagnosis and / or fees to specialists (radiology. The concept of cumulative risk is understood all the risks that accumulates the likelihood of a case and the same insurance. Lump. 2. 1.  treatment at home after discharge. especially in adverse conditions where persist the teams work.  of convalescence. This action occurs in case of the force majeure (natural disasters).  consultation.  repatriation costs.. . representing a daily allowance of a fixed amount for hospitalization or surgery.the cumulative risk.  private ambulance services.  advice from a family doctor.  maternity allowances. Reimbursement of expenses of hospitalization in the form of allowances for private hospital services.3. compared with other medical services related to treatment of diseases. Level premium insurance is calculated according to the occupational categories. medical / surgical .18 - Costs covered include:  hospital. In the papers devoted to insurance risk assessment is a new concept . and others.2. due to various risks. It is possible to finance preventive services at the expense of the employer and insurer (Figure. Methods of prevention. ultrasound. Insured amounts paid may take the following forms: 1.  rental of a wheelchair.

poisoning Deepening the risk of chronic and acute diseases The risk of chronic diseases Risks of second order Expenses for medical services Damage from medical technology The damage from the ineffective treatment Insurance Cases Medical services under contract Loss of employment Loss of a body part Death ..19 - Fi 3 The purpose and risks of oluntary health insurance Material interest regarding health maintenance and recovery Insurance object Risks of the first order Risk of loss of health from illness Risk of loss of health as a result of trauma.

European Experience In Ireland. In contrast. the insurers were not impose restrictions regarding the c overage of health care providers. Every system of health insurance is different. the hospital costs for personal expenses is limited. In the following we intend to emphasize the structure and content of the basic package of several developed and developing countries.20 - Chapter II. Plans with the lowest coverage level support accommodation. Over time. however. Although it represents only a fraction of the total cost. which represents the largest part of private health insurance market. Studying the health insurance market in the Republic of Moldova and in countries with highly developed economy.. or an equivalent level of coverage in privat e hospitals. . so that over two thirds of the population supports the individual costs for this type of medical services. private health insurance market has not proposed to cover these costs but to provide protection for medical costs in case of disaster. selected from different geographical regions in order to highlight the main factors of influence to be taken into account in this respect. and all plans must provide coverage complementary to the contributions paid by those who seek th e services of public hospitals. coverage for primary care is less comprehensive. We are not dealing with a list of priorities in terms of medical services but with an implicit approach to the basic package. while more comprehensive plans bear the full cost of treatment in any private hospital.1. meals and semi-private care in public hospitals. There are. even if they do not work in isolation. Virtually all health plans cover both services in public hospitals and in private. used for both hospitalized patients and for those who are not hospitalized. Existing medical insurance forms in countries with developed economy. 1. 2. so that basic health services package definition is directly and indirectly influenced by the particular systems of each country. the requirement to establish a minimum level of benefits to cover all health services and offers insurance plans should cover care in public hospitals.

the increasing incidence of . accommodation and food. supervision. special regulations are applied for child care and for treatment with substances that generate addiction. however. fertilization "in vitro". An exception to the usual rules of health services is a specialized psychiatric care in the area. Insurers may cover. medicines represent less than 9% of total health budget. Rights of patients with such disorders include tr eatment. a very expensive part of the cost of drugs prescribed during hospitalization. In the Netherlands. in addition. sterilization. In recent years. without specifying in detail what are the rights of the insured. Outpatient psychotherapy is covered financially within certain limits and only if there is a reference to the general practitioner or psychiatrist. pharmaceutical. by establishing broad categories of services. stipulating which of the categories of transplant are covered and that access to a range of other medical services is allowed only under certain conditions. whic h can be explained partly by the increase of elderly population. Through such regulations of some services are excluded as well as reconstructing eyelids. the basic package of health services is defined mainly by the Central Government. in general. the cost of spending on medicines significantly increased. and circumcision. The introduction of mental health care in the basic package is an objective of future legislation on the matter. whose coverage is provided by a special law. Basically. pharmaceutical costs are relatively low compared with other European countries. Policy on fertilization "in vitro" has changed several times. insurers now cover only those medical procedures after a first attempt at fertilization (paid directly by the insured) has failed.) specifying the areas of care covered by the insurance scheme. it established a list of categories of service that every patient has the right (the nature of the medical.21 - In the Netherlands. body sculpting. Nomination excluded from the basic package of services is a government decision to regulate medical care. Pharmaceutical prescriptions during hospitalization is a part of the right to medica l care. they are funded. This excludes a number of transplants and plastic surgery procedures.. by the hospital budget.

Determining factors in the evaluation process are the therapeutic effect of the products concerned and that they do not exceed the cost of similar drugs from the basic package. in collaboration with the Government of universities and research centers. Basically..22 - chronic diseases and medical prescriptions. while others go through an evaluation procedure and analysis before taking a decision in this regard. If the price of a particular drug is higher than the group average. In an effort to preserve public access to pharmaceutical products. government actions aimed at boosting the role of the market on a competitive basis in order to maintain prices at a level as low as possible. The purpose of these programs is to sustain and increase the number of interdisciplinary studies pharmaco -economic field. the additional cost will be borne by the consumer. The settlement system determines the compensation for medicines. more expensive than those used previously or replace them. as well as compensation for drugs for which there is a proprietary alternative. . there are enough alternatives available to allow selection of a drug completely compensated. Programs to support pharmaceutical research is subsidized by the governmen t. government took a series of measures to control drug costs for patients not hospitalized. Approved drugs do not automatically qualify for settlement in the basic package. some of which are only partially compensated. so that patients can buy medicines wit hout having to pay extra. In addition. by a law dedicated to this purpose. Government is the settlement system which adopts the basic package of drugs and he also sets maximum prices. based on the average cost of drugs with similar effect that can be replaced and which are considered as a group of substitute products. an additional factor in this regard is the emergence of new drugs. Ministry of Health intends to lower the cost of medicines are not patented. They were initiated by the pharmaceutical industry. the Health Ministry is responsible for deciding whether a new drug will enter or not in the package and also it decides which to remove from the package of medicines made from a therapeutic standpoint.

Primary care provided by general practitioners is regulated by legislation on health insurance. each type of care is covered by a specific treatment plan. In the Netherlands. some of them based on economic coordinates. c. are part of health care rights and settlement system are covered by the insurance system. The new hospital financing system would change that decision makers in the field and will require hospitals to regulate the supply of more expensive drugs. There are many such disciplinary and interdisciplinary guides. both for primary and for the secondary care. fluoride treatment. the Dutch government programs were .. pharmaceutical prescriptions. They are published in a restricted list of medicines qualified for compensation. fillings. according to professional standards. The regulations in this regard stating that they are entitled to such care to all persons aged 18 years. This involves home visits. Between 1998 and 2002. Such an approach has led to some variation in terms of availability of certain categories of drugs (usually more expensive) in hospitals and in directing costly patients to specialized treatme nt centers. From the above results that there is a difference between medicines to patients in hospitals and those of patients who are hospitalized. The rights to these services are explicitly defined. Adults are entitled to medical care only in certain circumstances set forth in documents on conditions for granting special dental services for people with mental or physical disabilities. consultation. An important method of influencing the amounts allocated to medical services is the practice guidelines. wh ile the drugs prescribed in hospitals follow a liberal policy. including regular consultants. primary care services. Dental treatment includes 14 types of services. Medications distributed in hospitals. dental care and curative benefits covered by insurance system covers the following aspects: a. long ago. referrals to specialized physicians and other less important activities. Rights relating to the nature of dental health care have been specified explicitly.23 - Distributed drugs outside hospitals are covered by a special law. Settlement of the prescriptions made by community pharmacists is regulated at the central level. b.

according to clinical diagnosis. Germany currently consumes approximately 8. Health insurance is divided into three main categories: social. Policy is withdrawn by the doctor when addressing.1% of gross domestic product. such the person . curative and ergo -therapy treatment are covered partially. self-regulated. On these policies most patients receive also free medication. In Germany there is no law on compulsory health insurance.. 15% through state allocations and 15% of citizens through their own sources. Almost 90% of the population engages in mandatory health insurance and 10% receiving medical ser vices through voluntary health insurance judgments.24 - structured in terms of practice development. Health insurance funds are accumulated from three sources: state budget. the first employer and employee premiums. Average premium is 13% paid equally by employer and employee. speech therapy services. 10% through voluntary health insurance. Policies (one for GP and one for the dentist) are remitted to the insured person in each quarter. in a more comfortable and in full volum to the doctor or health care institution preferred. The financing of medical institutions in Germany are divided as follows: 60% by health insurance funds. by law and voluntary: 1) Social Insurance It is a supplement to Social Security that allows to obtain health services in ambulatory and stationary conditions and the dentist. Paramedical care such as physiotherapy. which led to the appearance of 31 therapeutic guides. For this policy the insured person does not pay anything. are used by doctors as a rule of practice in the field. All costs are incurred by local government policy where the insured person lives. both within and outside their hospitals. These guides therapeutic. They serve as a landmark in defining the best standards of care. Germany has the richest practice of health insurance and decentralized system of compulsory health insurance. 3% of the population full fill compulsory health insurance policies through voluntary health policy to higher quality health services. which refers to the 23 disorders in some groups of diseases.

homes of farmers. If the insured person has a higher income than he established he covers a part of the cost of medicines. Compensation paid by health insurance can be divided as follows: 1. It is mandatory for all employees with lower income levels than established (currently this income is about 6000 ¼ / month). The monthly premium for a student is about 80 ¼. but if necessary. Evidence of accumulated resources and other necessary information are entered on magnetic cards. Insurance premiums are paid by the insured person a percentage of her/his salary in half and is paid by the employee and the employer. miners. compensation for maintaining health . These houses are organized on the principle of ter ritorial or special guild houses seamen. So even people who have no income and access to qualified medical assistance. the GP sends a patient to any specialist who patient needs. specialists in preventive measures. 2. compensation related to prevention of dental diseases (including schools and kindergartens).. curative and auxiliary supplies as well as preventive measures for women. federal homes. including supply of medicines.25 - which have social policy of carrying health insurance can not appeal to another doctor than the designated by policy. There in a free choice of doctor in Germany. Persons who are under the protection of social assistance (homeless people . from 9 to 14% from salary.health enlightenment and methods of disease prevention. and if revenues are lower than the level set the person is exempt from payment of a part of premium. Insurance is carried by hospital houses. Students are re quired to ensure admission to the institution. . However. the person is free to choose their own insurance fund. Each house has insurance that different percentage value. 2) Ensure by law This type of insurance covers 80% of the population of Germany. The insured person may receive medical services a t any medical facility in Germany. dressing materials.people without residence visa and other categories) do not benefit from these policies.

 free supply of hearing.  medical expenses and other additional expenses related to medical rehabilitation.  free supply of the standard package of medicines and dressing materials Note: additional costs related to procurement of drugs and dressing materials are more expensive and higher quality are incurred by the insured. orthopedic and if these devices have a fixed price. annual inspections of cancer prevention for women aged over 20 years and men aged over 45 years. provided a room for him individually and curing by the head of the c linic. including prosthetics. and hearing aids. compensation for treatments that are divided into:  dental care. Until the contract the person is subject of a medical examination as t he insurance premium depends on health status. starting in the seventh week of incapacity for work because of illness. with payment of 10% for insured adults. Holder of voluntary health insurance policy benefits from increased attention from health . Insurance policies provide that policyholders aged over 35 years every two years have to pass a rigorous medical examination. Also are given care and housekeeping help if the policyholder can not meet household obligations and the in family are children up to 8 years old or disabled persons dependent on help of the third per son. 4. Under existing requirements can be insured people who have an income less than ¼ 6. 3) Optional Insurance Voluntary health insurance in Germany is a luxury service. In case of hospitalization of the insured. Free Issue of medicines through voluntary health insurance is not provided. 5. but it can not be done.  patient care by a qualified home if hospitalization is indicated. This compensation constitutes 80% of the total amount of income after paying all taxes.26 - 3. compensation for early diagnosis of diseases..  auxiliary material supply. age and other causes. compensation for incapacity.000.

As in other countries. the remaining 25% pays the person independently or by contracting voluntary health insurance. Compulsory health insurance in France covers the majority (70-90%) the cost of drugs purchased. and this time. compulsory health insurance is carried out centrally by law. The only downside of voluntary health insurance is that (and this is legislated). employers and transfers from state budget allocations. and. mainly. Mandatory health insurance is made centrally. regardless of ownership. to raise them. regardless of ownership. Large and small collectives and free professional people. Over 80% of the population engages in social health insurance. health insurance funds in France consist of financial accumulation of individuals. Mandatory health insurance pays only 75% of the cost of medical expenses. Prices are reviewed twice a year periodicity. negotiations between state.. French insurance companies offer to the popul ation a much wider spectrum of medical services than those included in the package of medical services required and mandatory health insurance system of France compensates in some cases and certain expenses incurred by the insured. An important feature of state activity in the social insurance is the management of prices for medical services and cost of drugs domestically. In Great Britain the negotiations between state and society on the organization of health care continues over 50 years . In France. by law. society and the patient does not cease. One of the features of the French system is franchising of insurance payments. In 1948 in England was nationalized health care. conclude mandatory health insurance contracts.27 - workers. Collaboration continues to build a model tends to the optimal functioning of the public health care system and a fruitful collaboration between the three participants in this system. Special interest in British health care system is the work of two organizations defending the rights of the patient: . if the person was denied social security office or by law for ensuri ng the voluntary return to traditional social insurance is not allowed.

The purpose of this service is independent assessment of the state health service and helping patients. The purpose of this movement is to protect. This service is represented by expert groups in three regions of Great Britain: England. or where it is impossible to minimize them. patient or family should receive compensation concerned. This service specializes in handling complaints about the shortcomings in the work of national health care (and government departments the medical staff and outpatient. ophthalmologists. for the need to improve public health system. Supplemental health problems delegate of Parliament was held in 1973. Scotland and Wels. as far as possible. This service is a service department of the delegate of the Parliamentary Human Rights (Parliamentary Ombudsman). through its legal representative as Parliament in health problems (Health Service Ombudsman).AVMA (Action for Victims of Medical Accidents). with medical and legal studies.. it is also necessary that the moment of appearance of deficiency in treatment does not exceed one year. It should be noted that the legal settlement of the case and medical expertise are free. Movement in defending victims of medical errors on the position of the company cautions health care system that believes that the adverse effects of treatment are an inevitable result of insufficient funding and medical s taff overload. Preliminary. The work of this movement in England has . dentists. patients of medical errors.28 - a) a state organization. is compulsory the defendant to file a complaint to the county health and wait for an answer. Conclusions of the parliamentary delegate are presented for hearings and decision making. Movement in defending victims of medical errors was born in 1982 as a charitable movement in support of patients who suffered from various incorrect treatments. As a result . A staff from 80 people is filled with experts specifically trained. family physicians). In case if could not avoid medical error. Authorized person is not subject to parliamentary government and is independent of the national health system.and recognize the consequences of errors. Movement in defending victims of medical mistakes . b) nongovernmental organization.

the insured person pays 20% of these costs and 80% of the insurance company pays. Program "Medikeid" provides insurance to the poor.S. employers insure employees. Some of the necessary financial resources for formation of fund of this program shall consist of a special tax that pays the employees. another pa rt is paid by the employer. In the United States is highly developed tradition of insurance of employee on company account. but on the account of the owner. This program pays admission to nursing homes for elderly people requiring constant care and can not do without the help of others. 2.. that tax revenue is about 15% of employed Americans. The state covers two basic programs: "Medikeid" and "Medicare". but the costs for medical services provided are franchise . Traditionally. another part is paid by other governments in each State. government covers more than 40% of all spending for medical services rendered to insured persons. The last necessary part of fund that remains is covered by the state. for these services are spend more than half of the funds this program.29 - imposed famous English legal system to recognize that medical errors are a particular area of activity that requires some reforms in the judicia ry of the country as well as special training for judges to adopt the correct and timely decisions. mostly women and children from socially vulnerable families. In . about 50%. State insurance program "Medicare" is a program that ensures people over age 65 or who are approaching that age. in sum. American Experience The United States health care is one of the most complicated. Funding for the program is twofold: the federal funds. In addition to health insurance employees can benefit for life insurance from loss of working capacity and other types of insurance. costly (health spending is about 14% of gross domestic product) and one of the most burdensome as a system for management. These types of insurance are a little like social health insurance practiced by other countries and represents commercial insurance. but has serious health problems. The U.

S. Medical insurance occupies a special place in the public welfare system. On the one hand. Unlike other types of social insurance. is so-called ³directed expenditure´. the injury. In this variant the risk that spending will exceed revenue is removed on the shoulde rs of health care providers. nursing homes for the elderly. accident at work.2. On the other hand. evident and their economies remain the same. so enrolled in labor. enter into contracts to provide medical services to insured persons in return for fixed premiums for each person. loss of working capacity. it differs from other types of social insurance by the degree of population coverage. it is closely related to other types of social insurance: unemployment insurance cases revenue. unemployment and disability.S. social assistance is granted medical insurance rather than cash. as from disease.. Analysis of the demographic processes across the country during the transition shows a pronounced reduction in population. 2. The essence of these schemes is that health workers and most of them hospitals. because the disease can be treated based on medical insurance need employees and citizens alike are not . The process of decreasing the population of Moldova has held in several cases. If the unemployment insurance need people who came from the work activity. The place of health insurance and problems related to it in the national sector of Republic of Moldova The transition of the republic built on the company planned economy to a marke t economy has had repercussions in all spheres of social life. Another commonly practiced form of insurance in the U. there is a close mutual c onnection. they are called ³insurance compensations´ because the insurance company compensates the 80% of expenses incurred for treatment. conditioning the substantial changes in socio-demographic situation of the country. the main being the dramatic fall in birth rates in recent years. but natural.30 - the U. networks or associations of health workers with free practice. increased mortality and migration tide.

diphtheria. etc. In transition economies. etc. The decrease of birth in Moldova occurs on the back ground of population increase in mortality (Table 2. syphilis. given the sudden descent level of social protection should focus on mandatory social health insurance on reasonable scale. In health insurance. In health insurance (and the stage of rehabilitation) should be paid and provided the interested medical goods and services. In the first half of the 90's. increased mortality (including newborn). the morbidity of infectious diseases (tuberculosis. both because women refuse to give birth. which provides absolutely required. In transition economies. treatment. the second material problems arise. the third position living conditions.. Birth indices both fell in Moldova due to shrinkage in the number of women of appropriate age. for ethical reasons and. The primary reason is lack of confidence in tomorrow.31 - the use of certain drugs and medical services. medical assistance is determined by size of target -set of patients need (medical care. For many poor health prevents them find their place in the market economy. . health is one of the factors that influence the degree of adaptation to the current economic situation. unlike other types of social security does not depend on the previous wage.2.). dysentery bacterial.).2). Moldova has worsened indices that reflect population health: reduced life expectancy.

32 - Table 2.2 75.2 times.2. An important role in reducing birth rates and increased mortality.0 16. In the first decades (1950-1970) mortality rate is characterized by a decrease rather highlighted.6 11.9 7.9 Å . Accordingly. takes the phenomenon of aging population (Table 2.8 7. the birth rate in Moldova fell from 38.4 27. Also.. in 1960 formed the rate of 57% from 1950 and in 1970 .9 Death Wight in % 1000 from 1950 inhabitants (Å) 100 11.5 6.2 Birth and death dynamics of Moldova's population Years Birth 1000 inhabitants (Å) 38.1 42.0 83.8 9.already 66%.4 8.0 106.4 51.3).8 11. once in question shown above. in 2005 the birth rate was only 30.2 1950 1960 1970 1980 1990 2000 2005 As can be seen in the postwar period (1950 .2005).09 29.9 to 11.9 Wight in % from 1950 100 57.2.1 66. The decrease of births during that period was 3.0 72. we see a great variety in character development of population mortality.6% from the rate of 1950.4 20.3 19.3 30. Thus.4 49.7 10. So it is well noted that after 1960 the rate of mortality of the population of Moldova began to increase. .3 66.

3 Changes in the age structure of the Moldovan population (%) Age 0-9 10-19 20-29 30-39 40-49 50-59 60-69 70 and over 1979 25. which in turn is exacerbating inequality.1 128.3 14.2.0 182.3 106.3 18.4 7. is a close connection with economic efficiency.9 2.3)..8 113.8 10.8 As shown (Table 2. At the same time increase the rate of old age groups.9 16. to minimize loss of effectiveness. Redistribution to social protection is performed by several methods:  transfer payments.33 - Table 2.8%.0 13.2. respectively.9 15.9 4.4 2005 16.8 80..5 6. unemployed etc. the share of population aged 0 -9 years in 2005 constituted only 65% of the corresponding rate in 1979.4 9. for example. the age structure of population is a perceived reduction in the rate of younger age groups as a result of reduced birth rate.4 4. t herefore.7 13. The demographic factor in the next 10 years will have a destabilizing influence on the economy (social and military spheres).  price regulation at important social production. pensioners. Stigler (USA) have concluded that compels state income redistribution in favor of the interests of the wealthy and middle class but the poor have almost nothing.5 12. So.9 166.3 18.0 11. Director E.3 2005 weight in % to 1979 65. .9 1998 18.6 10. Inequality.9 18. Also the share of age groups over 60 increased by 166 and 182.0 7.8 5.1 17. and the company is putting the task: how should redistribute income. Income difference also plays an important role in stimulating people's initiative to conclude a contract of health insurance and oriented towards increasing the efficiency of labor. and J.3 111. it means benefits paid to low-insured groups.

environmental protection of the population . accidents. etc. the principle of social self-protection system..34 -  indexation of fixed income and transfer payments in relation to the inflation rate. medical assistance in the areas of education.) and the general situation labor markets (middle looking for work.  imposing progressive taxes for which tariff revenue increases as the nominal size. pensions and student grants) and prevent worsening working conditions in production (the injury prevention field production. influencing the size of savings. where the administration of social insurance bodies are freed from direct state administration system. minimum guarantees in payroll administration. sickness. payment of compensations to families with many children. paying pensions and granting benefits. etc. to standardize the initial distribution income market conditions (special allowances unemployed. in line with economic conditions change: the standard of living. determine the size of the real demand. price index and labor income growth. Providing social assistance to ensure a record number of people with the poor class.). Health insurance market is largely affected by the causes of deaths occurring after illness.by creating the appr opriate legal basis to national and local territorial level. The system of social protection in transition economies must ensure the health and lives of all population groups in case of the general risks of life (old age.  statutory minimum wages in all spheres of the economy. housing subsidies. protection of youth work. scholarships. . it carried the principle of a single space (general) social issues unique standards when the state (general) population social protection. This determines the actual size of the income tax roll and rate. Insurance is an effective means of social protection of population in conditions of market economy. unemployment. paying benefits to persons who work only a half day). professional counseling.

3 11. The economic crisis has negatively influenced health care in Moldova. Regardless of the large number of doctors and hospital beds per capita. Worsening socio-economic conditions of life of people.2 9. the cause of the increased cost of treatment and preventive care.4 Mortality causes of Moldova's population (in%) Total deaths Reasons: Infectious Diseases Cardio-vascular diseases Malignant Tumors Respiratory Diseases Digestive Diseases Nervous System Diseases Accidents and poisoning Other diseases 1995 100 1.6 6. including alcohol).2. reckless attitude towards healthy lifestyle (improper food.6 50.6 6. The same situation is in Moldova (Table 2. first in cases of death are cardio-vascular diseases. on the third . murders. lower health -epidemiological control. to maintain previous volume level for the granting of basic health services. It's not a .7 10. alcohol)..35 - In CIS countries.0 9. has worsened the problem of funding. The transition to market relations. the second oncological diseases.6 9. medicine is no longer able to protect h uman health.2.4). accidental poisoning.2 43.the reason is external (accidents. The last group of diseases is an important factor in the loss of potential years of life.5 10. the liberalization of p rices and tariffs for goods and services.7 As we draw conclusions. suicides.6 2005 100 1. Table 2. the place it occupies predominant causes of death between cardio-vascular diseases for which the rate of growth is a visible trend.1 1.5 0. ecological crisis because of factors which increa se social stress and the morbidity and mortality. smoking.2 13.6 14. because they affect youth and people of average age.

improving health services through more sustained application of economic levers and diversification of financing of medical institutions. a necessary condition for progress of society. own food. The causes of bad health in Moldova are the prevalence of risk factors in lifestyle and environment. primarily health insurance to be cha rged correctly. the insured person or emergency service is addressed to the family doctor. the person may apply to private or emergency medical service specialist medical institution. but also a state resource. and the absence of effective prophylaxis and the low level of medical services. Health is not only one basic human rights. health related. to be achieved through: improving people's living standards. promoting a healthy lifestyle. strengthening the institutional capacity of public health sector by issuing the legal and health management restructuring.  regional advisory councils medical decision. This protection is made contributions towards the expense of training to ensure health insurance funds. The unique program of compulsory insurance provides that upon occurrence of health problems. linen.  Regulation stating internment scheduled medical institutions (waiting lists). investigations and treatments. The situation is not corrected by the already developed programs because of insufficient fundin g. . environmental protection and enhancing efficiency of healing and prevention of diseases.. to pay for healthcare insurance if needed. upon request. Placing scheduled (for chronic diseases) in public medical institutions shall be made only upon:  ticket issued by the family residence under visa of the patient (principle of territoriality). should be well thought out on a technology plan. In the case of voluntary health insurance. Medical insurance system in the transition economy is a system of reports on the protection of material interests of the population.36 - secret for anyone that is currently in Moldova patients are forced to come into budgetary hospitals with medicines. for consultations. Any type of insurance.

free from departmental interests. Research situation on the insurance market in Moldova currently generates Track the conclusion that market is still in formation stage. based on the estimate approved by the Government.. . the state creates conditions for ensuring the protection in individual insurance . and also formulating some proposals: 1. 3) unfavorable taxation system. Research on the market situation this is due to: 1) low purchasing capacity of the main consumers of insurance. Moldovan insurers currently offering 30-40 budge types of insurance services. For a more extensive protection of population against unwanted consequences of insurance events. The establishment and development of health insurance is a necessary condition of national economy's recovery. A current issue of the domestic insurance market is the small number of proposals from insurers. Insurance Sup ervision Inspectorate and non-state pension funds must be separate from the Ministry of Finance and subordinate to Government directly. we believe that for effective supervision of insurance activities. while insurance market research in developed countries shows that the services of over 300 insurance the most varied types. 4) lack of economic incentives. 4. based on the law.health insurance.37 - Conclusions Making a full study on the insurance market problems and the mechanisms of legal regulation of health insurance in Moldova have arrived at these conclusions. 5. 2. 3. have clear responsibilities. 2) inadequate capitalization of the insurance. Considering that in most European countries the insurance supervisory bodies are separated by institutional and absolutely independent. 5) lack of knowledge and experience in implementing on the market types of mass insurance. Control bodies must be independent. We believe that financing of the insurance supervisor should be done at the expense deductions of insurance premiums collected by insurers on all types of insurance or certain types.

Edi ia VI 3 -7 octombrie. p. 2004. E co. E co. 3.12.Zilele Universit ii consacrate jubileului 60 de ani ai mintului medical superior din Republica Moldova. Chi in u.98 2. . 260-263. 5. 2008. 6.Zilele Universit ii consacrate jubileului 60 de ani ai mintului medical superior din Republica Moldova. 2005. 2005. de s n tate public i management. Calitatea serviciilor medicale s n tate public inv i aprecierea ei in cadrul asigur rilor de s n tate // Analele tiin ifice Volumul II. Idricean. Seria Ä tiin e Exacte i Economice´. 21 -23. 7. Zilele Universit ii 16 -17 octombrie 2003. C. V.02. 407-XVI from 21. we believe necessary to operate on the insurance law of RM a number of restrictions on insurers by the end of legal documents.P. Malanciuc. Problemele medico -biologice. Iu. Chi in u.. Malanciuc. Capsizu Valeriu. 4. Problemele actuale de i management. Law on Insurance nr. Edi ia VI 3 -7 octombrie. Principiile conceptuale ale asigur rilor de s n tate// Analele tiin ifice Volumul I. 4. Problemele actuale de i management. p. V. 398403. In order to guarantee the payment ability and financial stability of insurers. í Chi in u: CEP USM. Iu.1585-XIII from 27. Idricean. 8 (18). Idricean.Lascu Dumitru. Covali Olga Finan area ingrijirilor de s n tate in rile cu economia in tranzi ie // Studia Universitatis. p. V. Chi in u.2006. Idricean. Nr. farmaceutice. economie i management in medicin ´. Calitatea serviciilor medicale s n tate public inv i aprecierea ei in cadrul asigur rilor de s n tate // Analele tiin ifice Volumul II. References: 1. Importan a marketingului in perioada de trecere asistemului ocrotirii s n t ii la economia de pia // Revista ÄS n tate public . nr. p. V. 260-263.38 - 6.147. Law on mandatory health insurance Nr. C. 142 .

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