O . H o l y a c h e n k o , A . Shulhai, O .

N y k y t y u k

SOCIAL MEDICINE AND HEALTH

PROTECTION ORGANIZATION

The textbook for foreign students of medical institutions

of III-IV accreditation levels
 Contents

Abbreviation List 5
Preface 6

Section 1. Theoretical bases of social medicine and health protection

Edited b y : O l e a n d e r H o l y a c h e n k o , A r k a d i Shulhai, O l e h N y k y t y u k
organization 7

Reviewers: Section 2. Statistics 20

I. Prokop — A s s o c i a t e Professor of the Chair of Foreign L a n g u a g e s of 2.1 The bases definitions 20
Ternopil State M e d i c a l University by I.Y. H o r b a c h e v s k y ; 2.2 Relative and average values and their reliability 26
V. Mezentsev — Associate Professor of the C h a i r of Social M e d i c i n e and 2.3 Dynamic analysis 38
Healts C a r e Organization o f K h a r k i v P o s t - D i p l o m a Physician A c a d e m y ; 2.4 Graphic representation and graphic analysis 44
R. Blonsky — Candidate of Medical Sciences, Associate Professor of the 2.5 Standardization ...... 50
Chair of Social M e d i c i n e and Healts Care Organization of Ivano-Frankivsk
Section 3. Health of the population 56
Medical A c a d e m y ;
3.1 Health bases parameters of the population 56
V. Kondratyuk — D M , D M , Professor, Head of the Chair of General
3.2 Social-medical aspects of major chronic diseases 71
H y g i e n e and H u m a n E c o l o g y of Ternopil State Medical University by
I.Y. Horbachevsky. Section 4. Organization of public health services and medical care 79
4.1 Organisation features of treating-and-prophylactic care to urban
population, workers of industrial enterprises and constructions 86
H o l y a c h e n k o O., S h u l h a i A . , N y k y t y u k O . 4.2 Maternity care and childhood 89
H 75 Social m e d i c i n e and health protection organization. — Ternopil: 4.3 Medical care to rural population 98
4.4 Organization of work of Primary care center (PCC) 100
U k r m e d k n y h a , 2 0 0 5 . - 164 p.
ISBN 966-673-015-4 Section 5. Sanitary-epidemiological services... (SES) 102

Section 6. Economy, planning, financing of establishments of the public

This textbook is written according to program for the foreing students of
health services in Ukraine 118
higher medical institutions on social medicine and health protection
organization. Section 7. The automated control systems in the establishments of public
The indicated program conrains with a main circle of problems, which one health services in Ukraine 119
compound nature of social medicine and health protection organization and
its are required to the future doctors in their activity. Section 8. Social insurance and social security. Medical insurance in
Ukraine 125

Section 9. Organization of primary health care (PHC) on the bases of

family medicine 131
 ABBREVIATION LIST
Section 10. The systems of public health services in the some economically
developed countries ( U S A , the European countries) 149
AIS Automatic information system
Section 11. Formation of healthy way of life 155 BC Bed complement
BO B e d occupancy
Section 12. Activity of the societies of Red Cross and Red Crescent 159
C S C o m p u t e r system
DH District hospital
Annotated bibliography 163
GP General practitioner
GNO G r o s s national output
LH L o c a l hospital
MPH's Ministry o f public health services
ME M e d i c a l establishment
MC's M e d i c a l c o m m i s s i o n o f specialist
MSD Medical sanitary department
PCC Primary care center
PHC Primary health ( medical sanitary) care
PMC Primary medical care
PMSC's Primary medical social c o m m i s s i o n of specialist
PP Primary prevention
RH R e g i o n a l hospital
SES Sanitary-epidemiological services
SMC Secondary medical care
SP Secondary prevention
SPH School of public health
TC Tertiary care
TMC Tertiary medical care
TP Tertiary prevention
UNO United N a t i o n s Organization
WHO W o r l d Health Organisation
WAHO W o r l d A s s e m b l y of W H O
 PREFACE
Social - medical aspect is one of the basic directions of activity of each
doctor and medical assistant. Each medical worker should understand social
conditions of a person's health and organizational actions for its improvement.
For this purpose the one who studies medicine, should seize the basic method
of knowledge of the social - medical phenomena - statistical, to be able to give
correct interpretation of parameters of public health - mortality, morbidity, mental
development, - to understand their tendencies, to connect a state of health with
bases of the organization of public health services and medical care, to know the
structure and functions of organizational forms of medical care.
During gradual development of mankind its health has been considerably
improved. Now in the world, unfortunately not everywhere, the high level of
quality and length of life were achieved. And all this is due to social reforms, in
particular in the organization of medical care for people. On this way new
grandiose discoveries and achievements are waiting for mankind.
The social medicine and the organization of public health services lays between
biological and social sciences involved in exploration of the activities of normal human
body and human body with pathologies. The social medicine and the organization of
health care plays an important role in the formation of the physician.
This textbook is written on the basis of the program of social medicine and
the organization of public health services for students of medical institutes and
colleges authorized by Ukrainian Department of health protection organization.
The program covers the basic circle of questions, which form the essence of
social medicine and are extremely necessary for the middle level of medical
worker in his activity.
Peculiarities of the present stage of social medicine and the organization of
public health services development in Ukraine is that it should theoretically
motivate reformation of the system of public health services which is being held in
the state.
It is extremely complicated task, and, in addition, it is far from being
completed. Therefore, we have many polemic judgments, concepts and programs.
In these conditions objective complexity of the creation of a modern textbook from
social medicine and the organization of public health services arises.
Processes relevant to the health of people and the organization of its
protection are rather dynamic. Taking into account this dynamism, in the given
textbook certain corrective amendments are made which, however, do not change
adopted program at all.
It is one more problem that authors who write about social medicine and the
organization of public health services are facing. Readers will decide in what
measure these complex and differences barriers were overcome.
Section 1 . T H E O R E T I C A L B A S E S O F S O C I A L M E D I C I N E A N D
HEALTH PROTECTION ORGANIZATION
Social medicine is a science that studies social laws of peoples health
and characterizes ways of its improvement according to rational
organization of public health services.
Social medicine lays between biological and social sciences which are
involved in studying the essence of health and morbidity of a person.
Bases features that differ social medicine from fundamental and
clinical disciplines that o c c u p y a prevailing part of teaching at the high and
secondary medical schools are the following:
1. T h e subject of its interest are health and diseases of g r o u p s of
people - collectives, populations, society as a w h o l e , not the separate
person, in other w o r d s n o t health or morbidity of an individual, but the
public's one.
2. Considering the occurrence, pathogenesis and clinics of separate
diseases all of them are equivalent b e t w e e n themselves. In fact it is
impossible to imagine the physician w h o has well learnt etiology,
pathogenesis and clinic of hyper tonic disease but is poorly acquainted with
the same questions dealing with stomach ulcer.
F r o m positions of social medicine diseases are not equivalent, because
at a certain historical stage they influence public health differently. So, 5 0 -
60 years ago most people w e r e dying from epidemic diseases and
tuberculosis, n o w - from so-called chronic degenerate diseases (of heart
and vessels, malignant formations, chronic diseases of lungs, etc.).
3. F u n d a m e n t a l and clinical sciences consider health and diseases to be
a biological p h e n o m e n o n , social m e d i c i n e - the social one.
An individual is a complex biopsychosociological system. It can be
viewed u n d e r three corners of sight: as a biological organism, as a
personality (the carrier of consciousness) and as a carrier of social quality
(Fig. 1).
A person as a biological organism is characterized by the following
properties: anatomy, physiology of his organs and systems, age, sex,
constitution.
T h r o u g h heredity biological properties are transferred to descendants.
 If the a n a t o m i c structure and physiological functions of an organism
are in borders so-called " n o r m s " , we say, that a person is healthy. T h i s is
the biological aspect of health.
In case of infringement of anatomic structure and functions of
organism and gaining properties, w h i c h are outside the limits of "norm", we
ascertain p r e s e n c e of disease.
This is the biological aspect of disease.
H o w e v e r , the health of a person is not limited by biological properties.
There are mental and social aspects of health and disease of a person.
An individual as a personality or the carrier of consciousness is
characterized by the following mental properties:
t e m p e r a m e n t (it is the closest thing to his biological nature), then we
have sensation, m e m o r y , perception, thinking, emotions, will.
The highest displays of mental properties of a person are his knowledge,
habits, skill, eventually, interests, inclinations, ideals, outlook and beliefs. All
this is accumulated in the orientation on its socially useful activity.
D w e l l i n g forces of a p e r s o n ' s behavior are his needs. T h e y h a v e social
character. T h e s e are the need in a h o u s e , various natural g o o d s , family
environment and relations with others, certain w o r k i n g conditions, rest, etc.
If these and other needs are satisfied, we m a y h o p e for a person to be
healthy, in other case - diseases are inevitable. Its genesis can be imagined
in this w a y :
Everything starts with the dissatisfaction of needs. W o r k can bring no
pleasure to An individual, but to be his labor duty. After work person finds
conflicts and misunderstanding at h o m e instead of p e a c e and consent. Its
dwelling p l a c e can be a hostel or a municipal apartment instead of a
modern apartment with all corresponding a c c o m m o d a t i o n s . To unsatisfied
needs we h a v e to add g r o w i n g rate of a life, stressful situations on w o r k and
at h o m e . A p e r s o n tries to "run a w a y " from all this, but frequently not
through high goals and ideals, but with a glass of vodka.
Dissatisfied needs result in negative emotions: envy, annoyance, anger,
jealousy, despair, and then — chronic anxiety and depression. Negative
emotions need to be overcome. Adaptive mechanisms of psychological
character "turn on". Ability of a person to cope with psycho-emotional
pressure is rather limited, adaptive mechanisms gradually hand over.
 T h e first displays of this are inadequate reactions to different birth In most African, Latin A m e r i c a n and Asian countries people died of
irritants. Inadequate reactions gradually transform in neurosis, w h i c h forms diarrhoea diseases ( during the first 18 years of life,average), tuberculosis,
a b a c k g r o u n d for the d e v e l o p m e n t of chronic diseases. malaria, and pneumonia.
S o m e of the w e a k e s t biological parts of an organism are being In E u r o p e a n and N o r t h A m e r i c a n countries - of h e a r t l a n d vessel
d a m a g e d — heart and vessels, stomach, k i d n e y s , etc. diseases, cancer, accidents, poisonings, t r a u m a s and chronic not specific
diseases of lungs.
Certainly, it is simplified m o d e r n of the development of disease. A
p e r s o n can be b o r a chronically ill; causes and results can be c o m p l e x and M o r e o v e r , if to consider health of p e o p l e living in Ukraine in regional
tangential, but one thing is visible: biological indices of disease are j u s t the aspect, significant differences in the reasons of mortality rate can be found.
final stage and social - psychological ones precede it. So, in the western region of U k r a i n e the mortality due to malignant
Therefore, there is a clear definition of health by World Health formations is 8 0 % less than in southeast, at the same time value of deaths
Organization(WHO): «Health is a condition of complete social, mental and due to chronic non-specific diseases of lungs in southern and east areas is
biological well-being, and not just the absence of diseases or physical defects». much smaller than in western region.
I t ' s evident that a h u g e difference is not caused by the biological
T h e r e is a natural question concerning influence of separate factors on
nature of Ukrainians, which live on different territories-, but rather different
health.
sociological-economic factors and p e o p l e ' s behaviour.
T h i s question is still poorly studied.
L e t ' s s h o w j u s t s o m e of the social factors and their influence on health
It is proved, that 25-30 % of p e r s o n ' s health depends on biological
(tab. 1.1).
factors, 10-15 % — on environmental conditions of ecological factors and
50 % on social factors.
Table 1.1. Influence of material well-being and people's behavior on their
A m o n g social factors - 1 0 % occupies the system of medical service,
health (for 1000 persons of the corresponding group, values are standardized)
the one that appeared quite a long time ago and gradually developed into a
Number of Number of Number of Number of
powerful social factor of protecting health. Social attribute healthy diseases of surgical malignant
T h e r e are some proofs regarding prevailing role of social factors persons nervous system diseases diseases
(causes) in affecting p e o p l e ' s health.At the beginning of our era average 1. Material well-
life duration of people w a s 19 years. being
Till the beginning of XX century it raised up till 40 years, which in Low 247,0 80,7 68,1 7,8
absolute calculation equals 21 year and in relative - two times. It h a p p e n e d Middle 247,9 192,3 149,0 9,7
not through double improvement of h u m a n biological nature (for the last High 371,4 571,4 49,8 24,9
4 0 , 0 0 0 years of peoples existence it has not changed considerable), b u t 2. Psychological
through i m p r o v e m e n t of social conditions of p e o p l e s life. overstrain
Yes 213,3 413,3 200,0 55,6
E v e n m o r e striking changes h a v e taken place i n X X century: average
No 234,9 104,4 96,2 12,1
life expectancy of p e o p l e has grown up to 67 years, and in s o m e countries -
Tobacco use
up to 80, w h i c h m e a n s that for the last century it has g r o w n twice m o r e Not using 269,0 136,8 110,6 8,1
than for previous 19 centuries. T h i s is the result of social and e c o n o m i c Moderate user 154,2 180,5 170,6 15,1
progress m a d e by m a n k i n d in XX century, which resulted w o n d e r Abuser 230,0 207,8 142,8 25,6
completely for the health of people.
Health and diseases of people on our planet are extremely non-
uniform.
 As we see from tab. 1.1, a m o n g p e o p l e with a high level of material
well-being there are 1,5 t i m e s m o r e healthy people than a m o n g poor
p e o p l e , surgical diseases are seldom a m o n g them as well. At the same time
rich p e o p l e suffer from n e r v o u s diseases and malignant formations m o r e
often c o m p a r e d to the p o o r ones.
Psychological overstrain, stresses, etc. h a v e a b i g influence on
p e o p l e ' s health. A m o n g p e o p l e w h o h a v e its negative factors average
dependent of them the following kinds of things n e r v o u s diseases are 4
times, surgical diseases are 2 t i m e s and malignant formations are 4,1 t i m e s
m o r e often in c o m p a r i s o n with those w h o h a v e no overstrain.
People that don't use tobacco are much more healthy than those who
abuses tobacco, and even those ones w h o use it moderately. Factors that cause
diseases are also called risk factors. There are some risk factors that cause most
diseases, but there are ones that are specific only to certain diseases.
Their influence on the occurrence and distribution of diseases is being
studied by so-called epidemiological researches.
F o r this p u r p o s e t w o groups are being taken u n d e r supervision:
the one in w h i c h factor operates and the one in w h i c h factor stays idle.
C o m p a r i s o n of diseases in these groups allows to establish an
orientation of factor's action and its p o w e r .
T h e r e is a natural question: in what w a y social influence on p e o p l e ' s
health n e e d s to be d o n e in order to improve it. T h e r e is also a logical
assumption that p e o p l e ' s health can be improved by a positive influence on
each of health factors.
Consideration of the m e c h a n i s m of this influence convinces, that it is
being d o n e through the social layers of the society.
B e l o n g i n g to this or other layer predetermines the level of social
behavior.
W e l l - b e i n g of p e o p l e and their health, first of all, d e p e n d s on h o w
society protects interests of their social layer.
In recent t i m e s , in the Soviet conditions, Ukrainian society w a s
divided into three social layers or classes: w o r k e r s , peasantry and
intelligence.
O n e m o r e level, w h i c h existence ignored w a s an administrative-party
t o p , with the value of nearly 0 . 3 - 0 , 5 % of the population.
It w a s stated that social differences b e t w e e n this layers are
indefatigably decreasing (the truth is it w a s not clear h o w and when they
have appeared) and at c o m m u n i s m they should be finally eliminated.
Actually these differences w e r e g r o w i n g instead of decreasing.
Study of the health of people in this social aspect was forbidden in the
Soviet conditions by statements that society is heading towards a social
uniformity. O n l y due to H o r b a c h o v reorganizations an opportunity for is
the following studies has appeared and very soon they h a v e s h o w n all
falsity of theories about social uniformity and its health (tab. 1.2).
Table 1.2. Social differences in health of different social layers of the Soviet
society (on 1000 persons of a corresponding lavert
Value of healthy Value of patients in sub compensated
Social layer
persons and non compensated conditions
City dwellers 330,9 27,3
Countrymen 134,8 44,1
Command top 402,9 15,2
As we see from tab. 1.2, a m o n g c o u n t r y m e n in each thousand there
were 134,8 healthy p e r s o n s , a m o n g city dwellers this value w a s 2,5 times
and a m o n g c o m m a n d top 3,0 times greater that a m o n g countryman.
At the s a m e time the value of patients in sub c o m p e n s a t e d and non
compensated conditions a m o n g c o u n t r y m e n w a s in 1,5 t i m e s greater in
comparison with city dwellers and almost three t i m e s greater in c o m p a r i s o n
with a c o m m a n d top.
T h e reason for these fundamental differences is in low social status of
the rural population. Country residents h a v e n ' t received a regular salary for
a long t i m e and when the last one appeared (in the beginning of 60th) it w a s
considerably lower than in city, the working day w a s not normalized here,
working conditions were far from good, life w a s not properly arranged and
illegal production of v o d k a prospered in every village.
D u r i n g the years of state i n d e p e n d e n c e , w h e n U k r a i n e has started
building socially oriented market e c o n o m y , the first fruits of this
construction appeared to be bitter. So-called market transformations
meanwhile had a pseudo-market character.
Social differences b e t w e e n separate layers of the U k r a i n i a n society
have considerably deepened. In several years a completely n e w social
structure has appeared:
1) very rich p e o p l e - oligarchs. H a v e received the capital on parasitic
intermediary, thanks to big export and import;
2) rich people - proprietors of middle business w h o are mostly engaged
in import of foreign illiquid assets into Ukrainian market;
3) businessmen of middle well-being, are engaged in fine trade and
sphere of services;
4) officials, has g r o w n in value for 2 or 3 t i m e s in comparison with
Soviet period;
5) poor p e o p l e , live on w a g e s ;
6) v e r y poor p e o p l e , live for scanty pension, welfare for u n e m p l o y m e n t .
U k r a i n i a n social-medical science h a s n ' t given an appropriate analysis
of the health of n e w social layers, because of n e w difficulties. If in the
Soviet conditions social-medical researches w e r e forbidden or limited,
n o w a d a y s they are complicated by confidentiality of the information about
the profits of citizens (so-called c o m m e r c i a l secret), etc.
W e k n o w m o r e about the incomes o f A m e r i c a n presidents,
b u s i n e s s m e n and officials rather then Ukrainian ones. We h o p e that it is a
temporary p h e n o m e n o n , result of the c h a n g e of epochs.
Social m e d i c i n e and the organization of public health services have
appeared w h e n health protection services h a v e got a public character.
F o r a long t i m e health services w e r e a private business of doctor and
patient. Isolated efforts of separate physicians could n o t influence the
p e o p l e ' s health essentially.
M a s s spread of diseases, first of all epidemic and tuberculosis at the
certain stage of h u m a n d e v e l o p m e n t turned into a braking factor of this
d e v e l o p m e n t , which should h a v e been o v e r c o m e .
Certainly, creation the system of public health services w a s needed
that w o u l d improve the health of not only a separate person, but of h u m a n
c o m m u n i t y in general.
T h e first attempt to create the following system in Ukraine w a s m a d e
in the second half of X I X century, w h e n the serfdom has been canceled.
Institutions of district government (so-called «zemstva») h a v e undertaken
the duty of public health services.
F o r this p u r p o s e they employed doctors, medical assistants and
midwifes, giving t h e m certain territory, they h a d to give the appropriate
medical services for e v e r y o n e w h o n e e d e d it. B e s i d e s on each of this
territories (which w e r e called " d i l n y c h n a " - district) regular precautionary
measures directed on the prevention of occurrence of epidemics and their
consequences had to be taken.
In 1847 the I -st congress of district doctors of K h e r s o n province has
formulated basic points for the organization of public health services:
• Availability of medical care to all social layers;
• Guaranteed of medical care for patients;
• Qualified medical care ;
• Sanitary (preventive) character;
• District principle of the organization with expansion on each district of
an a m b u l a n c e station and a hospital;
• Registration of diseases and deaths with the p u r p o s e of studying their
distribution and reasons.
L a s t basic w a s particularly important for social m e d i c i n e and
organization of public health services b e c o m i n g as a science. Registration
of diseases and death of h u n d r e d s thousand of people has allowed to
establish the basic laws of disease and death rate and to approach the
understanding of their social nature.
Outstanding founders and representatives of public medicine in
Ukraine w e r e O. Korchak-Chepurivsky, M. Uvarov, M. Tezjakov, S.
Igumnov, O. B o g a y e v s k y and others.
In 1906 O.Korchak-Chepurkivsky for the first time in the world
practice h a s read the classified course of n e w science, w h i c h he has called "
public h y g i e n e " in the K y i v c o m m e r c i a l institute.
A. Shingarev and Z. Frenkel has repeated his experience later in Saint
Petersburg.
In 1921 O.Korchak-Chepurkivsky organizes faculty of national health
in the National A c a d e m y of Sciences.
Later, in 1923-1924 faculties of social hygiene and the organization of
public health services are created in medical universities and a c a d e m i e s of
Kharkiv, K y i v and Odesa. T h e institute of public health services is created
in Kharkiv.
In the late of 30th social hygiene and the organization of public health
services experiences hard times.
On the basis of false theory about t h e disappearance of social
differences in the health of p e o p l e in j u s t constructed socialist society
social —hygienic researches w e r e forbidden.

M a n y theorists a n d those w h o practiced this science, as well as
genetics and epidemiologists, had been physically liquidated.
R e s e a r c h e s w e r e n a r r o w e d to the organization of medical care. In 1965
social hygiene has b e e n rehabilitated, but ideological barriers concerning
construction of socially h o m o g e n e o u s c o m m u n i s t i c society prevented the
d e v e l o p m e n t of social - hygienic researches.
O n l y in 1989 the w o r k of the only research institution - institute of
social hygiene and m a n a g e m e n t of public health services has been restored.
Since 1996 this institute w a s n a m e d " T h e institute of public health".
In 1990 the second congress of social hygienists of Ukraine has
changed the n a m e of a science to "Social medicine and health protection
organization ".
In the XX century the social medicine and the organization of public
health services gets out of the national borders and b e c o m e s an
international science.
In 1900 in Paris the first international classification of deaths w a s
adopted, w h i c h h a s allowed c o m p a r i n g the mortality all over the world.
At the end of X I X century in classification of not only mortality , but
morbidity as well w a s developed.
In 1948 the international classification of deaths w a s supplemented
with the classification of m o r b i d i t y .
In 1907 the first International bureau of public hygiene w a s created, in
1919 _ sanitary d e p a r t m e n t in the N a t i o n s structure of L e a g u e .
Especially big d e v e l o p m e n t of the international cooperation in the
field of p r o b l e m s regarding public health appears during the period after the
Second World War.
Problems of health and its protection were developed by many
intergovernmental organizations, the leading role among which plays the World
Health Organization ( W H O ) . This organization is one of the specialized
departments in the structure of United Nations Organization (U N O).
T h e decision of its creation was accepted in 1946, and the charter w a s
ratified on April 7, 1948; since that time April 7 is n a m e d the International
Health D a y .
T h e m a i n goal of the W o r l d Health Organization ( W H O ) is to achieve
the highest possible level of health in the world.
T h e p r i m a r y goals o f the W o r l d Health Organization are:
- Coordination of the international activity in the field of public health
services;
- Giving the countries necessary information concerning health of p e o p l e
and a condition of its protection;
- Giving the countries aid on questions regarding public health services;
E n c o u r a g e m e n t and the organization of w o r k concerning the w a y s of
o v e r c o m i n g epidemic, endodermic and other diseases;
- Protection of mental health;
Carrying out regular researches in the field of public health services;
Assistance in the training of medical staff.
T h e A s s e m b l y of W o r l d Health Organization ( W A H O ) is the highest
organ of the W o r l d Health Organization, w h i c h annually gather in G e n e v a
in the Palace of the Nations. Official delegations of the countries-members
of the W o r l d Health Organization representatives of the United N a t i o n s and
of other international intergovernmental and non governmental
organizations take part in its work.
Executive committee is a higher structure between sessions of the
Assembly of the W o r l d Health Organization, which consists of
representatives of 30 countries-members of the World Health Organization
mid which are selected for each 3 years.
Yearly one third of the C o m m i t t e e m e m b e r s is being renewed,
sessions are being held 2 times a year. T h e Secretariat of W H O , which is
headed by General Director, carries out the current organizational work.
There are 6 regional b u r e a u s in the structure of W H O - African (with
a center in Brazzaville), A m e r i c a n (Washington), Southeastern A s i a
, (Delhi), E u r o p e a n (Copenhagen), E a s t - M e d i t e r r a n e a n (Alexandria), the
Western part of Pacific ocean (Manila).
Main Office of W H O is situated in Geneva. M o r e than 1.4 thousands
people w o r k here, which are divided according to the following functional
departments, that are headed by the assistants of the General Director:
• a bureau of assistance to medical researches and their d e v e l o p m e n t s ;
• a legal department; international audit; the program of actions
concerning necessary medicines;
• division of the environmental protection; division of epidemiological
supervision, situational analysis and an estimation of tendencies of the
spread of disease; a division o f ' t h e information concerning health
protection and medical education;
• t h e p r o g r a m of struggle against malaria; the p r o g r a m on parasitic 5. E c o n o m i c a l , that enable to determine e c o n o m i c efficiency of systems
diseases; a division of infectious diseases; a division of biology of of m e d i c a l services.
carriers and t h e control; the e x p a n d e d p r o g r a m of immunization; T h e basic m e t h o d of social medicine is statistical. It is caused by the
• a division of the family health; a division of d e v e l o p m e n t of the staff of social m e d i c i n e in studies of the m a s s p h e n o m e n a w h i c h concern health
and its protection. So, the social medicine has b o r r o w e d the basic m e t h o d
health protection; a division of strengthening of protection services of
from other science, w h i c h is called medical statistics.
health;
• special p r o g r a m s of scientific researches and development; professional
Tablel.3. Factors, which influence on the public health
trainings in the field of reproduction of the population;
Factor Share of
• a division of infectious diseases and a division of diagnostics, Characteristic of factor
influence %
therapeutic and rehabilitation technologies; a division of mental health; Social- Standard of economics' development, social 50
• a division of coordination of p r o g r a m s of b i o m e d i c i n e and health economic guarantee of state, education, culture,
protection; a division of assistance to systems of the information; profession, financial maintenance, style of life,
• t h e special p r o g r a m of scientific researches and trainings of specialists family status, living condition, conditions of
by tropical diseases; a division of a personnel and the general service; a work and rest
division of the b u d g e t and the finance. Biological Heredity, age, sex, habits conditions, 25-30
T h e annual budget o f W H O reaches m o r e than 1 billion U S dollars. temperament
Fxological Natural and climatic conditions, surroundings 10-15
T h e s e m o n e y are given by country - m e m b e r s allocate of W H O and are
states, natural resources
supplemented by different humanitarian and voluntary p a y m e n t s .
1 .cvel of Level of primary health care, conditions of 10
P r i m a r y activities of W H O is realized through performance of medical care ambulatory, hospitalized and specialized
different p r o g r a m s at the international and district levels. In performance of medical care
these p r o g r a m s of W H O closely cooperates with scientific and practical
establishments of health protection of the different countries. Questions for self-checking:
T h e m o s t k n o w n of W H O ' S p r o g r a m s are the program of struggle
1. What do the social medicine and health protection organization study?
against a malaria, the p r o g r a m of liquidation of a natural smallpox,
2. A history of appearance a n d d e v e l o p m e n t of social medicine in Ukraine.
introduction of system of t h e p r i m a r y health care, training of m e d i c a l staff, 3. Outstanding figures of social m e d i c i n e and health protection
etc. organization in Ukraine.
Social m e d i c i n e as t h e science and a subject of teaching uses different 4. T h e bases c o m p o n e n t s of a p e r s o n as a biopsychosociological system.
methods. 5. C o n c e p t about an individual and public health.
- A m o n g t h e m it is necessary to n a m e the following o n e s : 6. Health p a r a m e t e r s of separate social groups of a society.
Historical, establishes historical regularities of development of public 7. W h a t are the risk factors a n d m e t h o d s of their studying?
health and its protection; 8. The W o r l d Health Organization - structure and principles of work.
Sociological, that allows studying social structure of a society and its
9. M e t h o d s of social medicine and health protection organization.
influence on health;
E x p e r i m e n t a l , allows studying advantages (lacks) of organizational
forms of m e d i c a l services;
4. E x p e r t i s e , w h i c h help quality and efficiency of m e d i c a l services is
studied;
Section 2. S T A T I S T I C S T h e stages of statistical research:
1.0 Composition of the p r o g r a m and plan of research.
2.1. T h e bases definitions C h o o s i n g of the aim and tasks of research,
choosing of the unit and object of investigation.
A m o n g m a n y definitions of statistics in general and medical statistics 2.0 Collection of the material.
in particular the best expression of the essence of the science m a k e s the M a k i n g a program of date collection and
following: analysis of date,current control.
L The medical statistics is a science which studies health of the 3.0 W o r k i n g up of material.
population depending on social, economic, cultural, sanitary-hygienic, D o c u m e n t s control.
medical and biologic factors and has a goal of establishment of tendencies E n c o d i n g and tabulation.
of these dependences in conditions of activity of medical care systerrO Distribution to groups.
T h e medical statistics studies: 4.0 Analysis of material.
1.0 Health of the population: M a c h i n e processing.
1.1 D e m o g r a p h i c processes; C o n c l u s i o n s and proposals.
1.2 Morbidity; 5.0 Putting into practice.
1.3 I n v a l i d i t y ; T h e w a y s of formation of statistical integrity:
1.4 S o m a t o m e t r y and determining of biochemical constants; 1.0 By v o l u m e
1.5 Mental health and psychometry. 2.0 By time
2.0 Conditions of an environment and p e o p l e ' s life styles: 3.0 By type
2.1 Air; T h e p l a n a n d p r o g r a m o f medico-statistical r e s e a r c h includes:
2.2 Water; 1.0 D a t a collection:
2.3 Radiation; 1.1 A concentration and preservation of the data;
2.4 Nutrition; 1.2 Data transmission.
2.5 Material welfare; 2.0 Data processing:
2.6 W o r k and training; 2.1 Normalization (standardization) of the data;
2.7 Rest; 2.2 C o d i n g and grouping of the data;
2.8 Behavior. 2.3 Registration;
3.0 Medical base: 2.4 Calculation of average values, dispersions, errors;
3.1 Medical e s t a b l i s h m e n t s ; 2.5 C o m p a r i s o n , definition of a difference;
3.2 Health m a n p o w e r ; 2.6 Correlation, regress, c o m p l e x estimations.
3.3 T h e budget of public health services. 3.0 T h e analysis of the data:
4.0 Activity of system of public health services: 3.1 Survey, interpretation analysis;
4.1 A m b u l a t o r y and polyclinics; 3.2 T h e mathematical analysis: disperse, discriminately, multifactor,
4.2 Hospitals; initial, logistic, system, etc.
4.3 Drugstores; So, the subject of studying of medical statistics is a level of health of
4.4 Social - medical activity. I he population in its structure and d y n a m i c s .
 T h e important interest of medical statistics is quantitative and
qualitative analyses of activity of a treatment-and-prophylactic network, an
estimation of this activity through the m e c h a n i s m of influence on a state of
health with the obligatory account of c o m p l e x influence of different factors.
Registration and accounting medical d o c u m e n t s can serve as p r o g r a m s
of medic-statistical research.
Medic-statistical research can be complete or selective.
Complete or continuous research covers all observation units.
Selective research covers a representative part of the supervision units,
w h i c h enables to evaluate p h e n o m e n o n in w h o l e .
R e s e a r c h is great important. T h e territory strongly influences the
a body 4 7 , 4 8 , 4 9 , 50, etc. see. This n e w b o r n can be of a different sex: b o y
or girl. A variable can be submitted as absolute, relative n u m b e r and
qualitative characteristics.
An absolute value - the n u m b e r which characterizes the p h e n o m e n o n
in its absolute (arithmetic) value.
A relative value - a n u m b e r w h i c h characterizes the relation of one
value to another and can m e a n a part, frequency or a ratio of one n u m b e r to
another.
E a c h value of variable (x) is answered with its frequency (n) from
which it repeats. A r o w of variable with their frequencies m a k e s a so-called
variation line. 1

results of research.
T h e next question is time and term of research. Research can last Table 2.1. A variation line
constantly^ that is to be current, to be carried out periodically, during Weight of newborns, g. Number of newborns, n
certain time or to be one-stage. 2900 1
Constant researches are: studying of natural m o v e m e n t of the 3000 2
population, periodic — studying of prevalence of chronic diseases, o n e - 3100 3
stage — population census, fixing of a condition of medical service. 3200 3
So, after collection the statistical data is b e i n g processed. This process 3300 2
includes quantitative and qualitative check, coding and grouping of these 3400 1
data. Quantitative check m e a n s check of correctness of statistical record of
d o c u m e n t s , qualitative - logic comparison of the data, for e x a m p l e , age and Variable w h i c h form a variation line, can consist of simple a variable
the diagnosis, age and e m p l o y m e n t , growth and weight of a body, etc. Later (weight - 2 9 0 0 g ) or discrete (2900-3100 g).
there is coding. To each quantitative or qualitative characteristic of the
p h e n o m e n o n certain code is given. The Range
Grouping m a y be a distribution of the data according' to quantitative or T h e range is the difference between the highest and lowest values in a
qualitative characteristics with the purpose of their analysis. Quantitative series.
characteristics are age, growth, weight, etc. Qualitative characteristics are 1. T h e range is used to m e a s u r e data spread.
b a c k g r o u n d , social status, occupation, disease, etc. 2. T h e range provides no information concerning the scatter within the
G r o u p i n g is simple (according to one characteristic), complex series.
(according to m a n y characteristics, w h i c h are c o m b i n e d a m o n g themselves) ^Statistical totality will consist of elements, w h i c h h a v e identical
a n d repeated (grouping before the divided earlier groups w i t h the p u r p o s e characteristics and represent an object of the statistical analysis/ F o r
of deeper studying the p h e n o m e n o n ) . example, in research of demographic p r o b l e m s of the country by statistical
G r o u p i n g — is the central m o m e n t of research and it should be carried set there will be all of its population; in research of the stationary aid -
out on the basis of deep study of the essence of a p r o b l e m . hospitalized patients.
Variable - is a quantitative or qualitative values of the concrete General statistical totality includes all elements of research.
characteristic of the p h e n o m e n o n , for e x a m p l e , n e w b o r n can h a v e length of
 Selective statistical totality contains a part of general totality, which Table 2.4. Territorial division of medical establishments according to the form
represents all of its elements. It should to be selected from general of property
statistical set to give the same chance to get in sample to each statistical Medical North Center South Total
unit. Establishments

Governmental

Governmental

Governmental
Communal

Communal

Communal
Statistical unit (unit supervision) submitted by an element of which
there is a statistical set(for e x a m p l e , a person, a family, a n e w b o r n , a
pregnant w o m a n , a patient with ischemic heart disease, etc.
Statistical attribute is a general property for all units, which is studied
during statistical research, for example, studying of weight, growth, disease
in n e w b o r n etc. District hospitals 3 17 5 35 1 14 75
Statistical index is the statistical value w h i c h m a k e s it possible to Regional hospitals 4 1 8 4 2 1 20
characterize the p h e n o m e n o n . Central area hospitals - - 1 — — — 1
Processing the statistical data and the formation of statistical tables Total 7 18 14 39 3 15 96
allows understanding the researched p h e n o m e n a better.
Statistical tables are breadboard m o d e l s , w h i c h will consist of c o l u m n s After processing the material and formation of statistical tables process
and lines on which crossing statistics data are placed. of calculation of statistics or values starts.
There are simple, group and combined tables. Absolute n u m b e r s have certain value, in particular, if the question is
about insignificant or, on the contrary, socially significant p h e n o m e n a . So,
Table 2.2. Number of medical establishments in the area (the simple table) one case of A I D S on a medical station indicates the extremely negative
Medical establishments Number of establishments epidemiological situation; at the same time 4 cases of A I D S has to put all
District hospitals 75 medical service of the region on ears.
Central area hospitals 1 T h e average value characterizes the p h e n o m e n o n in one way. It is
Regional hospitals 20 much m o r e frequently applied in the statistical analysis - an average term
Total 96 of stay of the patient in bed, average spaciousness of hospitals, etc.
T h e dispersion from average value s h o w s variability (fluctuation) of
Table 2.3. Territorial distribution of medical establishments In the area (the an individual cases in relation to average value.
Broun table) T h e average error displays the relation of the statistics received at
Medical establishments North Center South Total
selective research, to a parameter of continuous or complete research.
District hospitals 20 40 15 75
Parameters of correlation and regress are used for definition of
Regional hospitals 5 12 3 20
functional, causal relationships between t w o or m o r e characteristics.
Area hospitals - 1 - 1
Extensive p a r a m e t e r s characterize the structure of statistical totality.
Total 25 53 18 96
Intensive parameters display frequency of the p h e n o m e n o n in the
environment, indicate its level.
 N u m b e r of addressed - 1500 it is accepted by 100 %, n u m b e r of
2.2. Relative a n d average values a n d their reliability patients of each age — accordingly for X, from here per cent of what h a v e
addressed in a polyclinic in the age of 15-19 years from the general
As a result of statistical research during processing of the statistical number, will m a k e :
-
data of morbidity, mortality, lethality etc. absolute n u m b e r s are received,
which specify the n u m b e r of the p h e n o m e n a . T h o u g h absolute n u m b e r s
h a v e a certain cognitive values, but their use is limited. For determination
of a level of the p h e n o m e n o n , for comparison of a parameter in d y n a m i c s
or with a parameter of other territory it is necessary to calculate relative
values (parameters, factors) which represent result of a ratio of statistical
Table 2.5. Age groups of people, which have visit to polyclinic
n u m b e r s between itself. T h e basic arithmetic action at subtraction of Age group Absolute number % from the general number
relative values is division. 15-19 150 10,0
In medical statistics themselves the following kinds of relative 20-29 375 25,0
parameters are used: 30-39 300 20,0
-Extensive; 40-49 345 23.0
-Intensive; 50-59 150 10.0
— Relative intensity; 60 and senior 180 12.0
— Visualization; In total 1500 100.0
— Correlation.
For the determination of a structure of disease (mortality rate, lethality, Conclusion: most of the people that have addressed in a polyclinic
etc.) the extensive parameter is used. were in the age of 20-29 and 40-49 years.
The extensive parameter or a parameter of distribution characterizes a T h e extensive parameter at the analysis needs to be used carefully and
parts of the p h e n o m e n a (structure), that is it s h o w s , w h a t part from the we must r e m e m b e r , that it is used only for the characteristic of structure of
general n u m b e r of all diseases (died) is m a d e with this or that disease the p h e n o m e n a in the given place and at present time. C o m p a r i s o n of a
w h i c h enters into total. structure m a k e s it possible to tell only about change of a serial n u m b e r of
U s i n g this parameter, it is possible to determine the structure of the given diseases in structure of diseases.
patients according to age, social status, etc. It is accepted to express this If it is necessary to determine distribution of the p h e n o m e n o n
parameter in percentage, but it can be calculated and in parts per thousand intensive parameters are used.
case, w h e n the part of the given disease is small and at the calculation in The intensive parameter characterizes frequency or distribution.
percentage it is expressed as decimal fraction, instead of an integer. It s h o w s , h o w frequently the given p h e n o m e n o n occurs in the given
The general formula of its subtraction is the following: environment.
For e x a m p l e , h o w frequently there is this or that disease a m o n g the
population or h o w frequently people are dying from this or that^disease.
T e c h n i q u e of the calculation of an extensive parameter will be s h o w n To calculate the intensive parameter, it is necessary to k n o w the
on an example. population or the contingent.
To determine an age structure of those w h o has addressed in a General formula of the calculation is the following:
polyclinic if the following data is k n o w n :
 Table 2.6. Structure of morbidity, invalidity and the reasons of mortality
Structure of Index of relative
Structure of Structure of
the reasons intensity
Disease morbidity invalidity
of death Of reasons
Intensive parameters are calculated on 1000 persons. T h e s e are invalidity of death
parameters of birth, morbidity, mortality, etc.; on separate disease they are Traumas 12.0 8.0 30.0 0.35 2.0
being calculated on 10.000 and disease, w h i c h occurs seldom - on 100000 Heart and ves- 4.0 27.0 19.0 6.76 4.75
sel diseases
persons.
L e t ' s consider a technique of its subtraction on an e x a m p l e . Diseases of 6.0 8.0 1.33
nervous
E x a m p l e . N u m b e r of died in the area — 175, n u m b e r of the population
system
at the beginning of year - 2 4 0 0 0 , at the end of year - 2 6 0 0 0 . To determine Poisonings 0.3 0.4 13.3
- -
a p a r a m e t e r of mortality: Tuberculosis 0.5 5.0 5.5 10.0 11.0
Other 74.2 52.0 41.5 0.7 0.56
Total 100.0 100.0 100.0 - -

Parameters of relative intensity represent a numerical ratio of t w o or

We determine an average value of the population; for this purpose we
take the n u m b e r of the population to the beginning of year plus n u m b e r of
the population at the end of year and divide it by 2:
We m a k e a proportion: 175 persons, w h o died correspond to 2 5 0 0 0
people, and h o w m a n y p e r s o n s , w h o died correspond to 1000?
175-25000
6-1000
P a r a m e t e r s of birth, morbidity are calculated similarly etc.
several structures of the same elements of a set, w h i c h is studied.
T h e y allow determining a degree of conformity (advantage or
reduction) of similar attributes and are used as auxiliary reception; in those
cases w h e r e it i s n ' t possible to receive direct intensive parameters or if it is
necessary to m e a s u r e a degree of a disproportion in structure of two or
several close processes.
For e x a m p l e , there are data only about structure of the general
morbidity, physical disability and mortality rate.
C o m p a r i s o n of these structures and subtraction of parameters of
relative intensity allows finding out the relative importance of these or
those diseases in health parameters of the population.
So, for e x a m p l e , comparison of densities of physical disability and
mortality rates from cardiovascular diseases with its densities in morbidity
allows to determine, that cardiovascular diseases o c c u p y almost in 7 times
more part in physical disability and almost in 5 times — in mortality, than in
structure of morbidity.
Procedure of the calculation of these parameters is the following:
F o r e x a m p l e , densities of cardiovascular diseases in structures:
— General morbidity — 4 , 0 %;
-Disability -27,0%;
 - R e a s o n s of mortality - 19,0 %.
T h e parameter of relative intensity of disability is received by a Table 2.7. For example. Expression of parameters of visits to polyclinic
1 i • f "» a Ul V13113 iu polyclinic
division of densities of cardiovascular diseases in structure of disability to Polyclinic Number of visits Parameter of presentation =
densities of these diseases in the structure of the general morbidity, which Polyclinic No 1 (100%)
•Ni> 1 850 100,0
equals: JV2 2 920 108,1
No 3 990 116,1
No 4 1200 141,1
T h e parameter of relative intensity of mortality is received in the
No 5 1290 151,7
similar w a y :

T h u s , parameters of relative intensity represent parameters of a
disproportion of particles of the same elements in the structure of
processes, which are studying.
The parameter of visualization characterizes the relation between
diverse values.
F o r e x a m p l e , the parameter of average b e d o c c u p a n c y , nurses, etc.
The techniques of subtraction of the visualization parameter is the
s a m e a s for i n t e n s i v e p a r a m e t e r , n e v e r t h e l e s s t h e n u m b e r o f a n i n t e n s i v e
p a r a m e t e r s t a n d s i n t h e n u m e r a t o r , i s i n c l u d e d into d e n o m i n a t o r , w h e r e
as in a p a r a m e t e r of v i s u a l i z a t i o n of n u m e r a t o r a n d d e n o m i n a t o r
different.
E x a m p l e . N u m b e r of b e d s — 2 8 0 , an average n u m b e r of the
population - 2 6 0 0 0 0 . W h a t is the b e d o c c u p a n c y ( B O ) rate?
The parameter of correlation characterizes the relation of any of
c o m p a r a b l e values to the initial level accepted for 100. This parameter is
used for convenience of comparison, and also in case shows a direction of
p r o c e s s (increase, reduction) not showing a level or the n u m b e r s of the
phenomenon.
It can be used for the characteristic of d y n a m i c s of the p h e n o m e n a , for
c o m p a r i s o n on separate territories, in different g r o u p s of the population, for
the construction of graphic.
F o r 100 % we take n u m b e r of visits in a polyclinic Jfal then the index
of correlation in the polyclinic JV°2 will be :
It is possible to calculate correlation parameters, using absolute
n u m b e r s , intensive parameters, parameters of visualization, average values,
but not extensive p a r a m e t e r s , taking into account the a b o v e m e n t i o n e d
about this parameter.
It is e n o u g h to calculate parameters with the practical p u r p o s e to
within one tenth.
To determine the tenth share, it is necessary to m a k e calculation to the
second sign after a point.
D e p e n d i n g on, whether there will be a second sign m o r e than five or
less, the first sign after a point is determined, in the first case it increases
for a unit, in the second — it r e m a i n s the same.
A v e r a g e v a l u e s are parameters of the basic quality of the p h e n o m e n a
w h i c h are studied, or a unit of m e a s u r e m e n t s of the central t e n d e n c y of
distribution a variant.
In all researches w h i c h concern a state of healthj the great value has
comparison of the p h e n o m e n o n with the standard as which the average
value acts.
A v e r a g e values can be expressed by absolute or Relative values.
A v e r a g e simple arithmetic is determined according to the model •

Where :
Ma - average arithmetic;
 So, the p h e n o m e n a which h a v e the variant character are estimated by
X - the sum of a variant; average number. For example, 60 patients had different duration of disease
N - the general n u m b e r of variants. - from one till 45 days.
r
. T h e list of duration of each case or variants of disease gives a certain
For e x a m p l e , the weight of six n e w b o r n b o y s is determined: 3000, notion about this disease.
2600, 2 8 0 0 , 3 1 0 0 , 3 2 0 0 , 2700. H o w e v e r , it is possible to characterize duration of current of this
disease by one n u m b e r , a so-called average parameter.
If to sum up duration of current of disease any of 60 fallen ill and to
share the received sum into general n u m b e r of patients we shall h a v e the
average duration of current of disease. F o r e x a m p l e , in our case it is equal
A v e r a g e m i x e d arithmetic is determined according to the m o d e l : to 22 days.
This n u m b e r can be c o m p a r e d to average term of duration of other
disease and to express, for e x a m p l e , concerning their complexity.
It is clear, that the greater term of current of disease is the more complex
the treatment. So, the average number allows to characterize by one number
Where: the phenomenon which can have a set of an individual displays.
M - average mixed; A v e r a g e terms of stay of the patient concern to average n u m b e r of
X n - the s u m of products a variant on their frequency; beds, average cost of treatment of one patient, etc.
n - t h e sum of frequencies of a variant. F o r an estimation of health of the population and activity of medical
institutions it is possible to u s e both general or continuous and selective
Table 2.8. For example. Distribution of infant according to their growth statistical sets.
Growth, sm (X) Number ot lnlant, n Certainly, general totality gives absolutely authentic result. T h e
125 1
sample gives the a p p r o a c h e d result, but, u n d e r condition of correct
126 2
selection of observation units, this result essentially does not differ from
127 4
that general totality gives.
128 5
3 Taking into account this circumstance and also h u g e e c o n o m y of
129
1 forces and m e a n s , it is necessary to use mainly selective statistical set.
130
Let's stop on an example. It is necessary to research health, in
particular morbidity, city dwellers w h e r e 200 thousands of people live. It is
possible to take into account of any diseases, certainly. But the n u m b e r of
the following diseases will reach several h u n d r e d s of thousands.
Expediently from these 200 thousands to select the certain part of people,
In a variation line the m e d i a n and a m o d u l e can be determined. so that it will display qualitative structure of the population of all city.
M e d i a n — is a variant,which occupies m e d i a n position. In a case if M o r b i d i t y of this part will display essence of morbidity of city
n u m b e r of the variant is pair, the m e d i a n represents average value of t w o dwellers.
variant.which o c c u p y m e d i a n position. It is necessary to apply the certain k i n d s of s a m p l e w h i c h are
M o d u l e or d o m i n a n t — is a variant, w h i c h occurs in a variation line r e c o m m e n d e d with a statistical science for this purpose.
with the greatest frequency.
 M e c h a n i c a l if each tenth or twentieth city dweller or behind so-called Let's consider the above-stated e x a m p l e further. Instead of 2 0 0
distribution of r a n d o m n u m b e r s , say, is selected. ihousands we select 200 city dwellers. In them 150 diseases are revealed.
T h u s all the inhabitants h a v e the same probability to get in n u m b e r of So, disease p will be equal to.
elite, in fact sample will display age, sexual, professional and other
qualitative type of the population.
Typological if general totality is preliminary broken into types (age,
sexual, professional layers, etc.), and then from any the proportional part of
people is taken. Let's determine m under condition of different parameter of reliability t.
R e g i o n a l if the certain area of city is under consideration. If t = 1 according to the law of the big n u m b e r s in 68.3 % of cases the
C o m b i n e d if the above mentioned types of samples are united. result is received at selective research,
H o w e v e r , as we h a v e said the result received during selective research, on value -+ m will differ from result of continuous research :
will differ all the same from the result received during continuous research.
It will be influenced both objective (each unit supervision contains as
the general, and u n i q u e an individual features and subjective (influence of
those w h o collects a statistical material) reasons.
This difference between result of selective and continuous research is
So, in 68.3 % - 75 % - 3.1 % will be equal to. If t = 2 in 95.5 % of
called as an error of selective research (m). It should be in the certain
cases will differ from p on 2m, that is he will be equal to 75 % - 6.2 %.
borders so that it would possible to be satisfied with the result of selective
This result is considered comprehensible for statistical researches in public
research or to consider its authentic it m e a n s comprehensible for correct
health services.
conclusions.
So, w e h a v e t w o conclusions:
T h e b a s e definition of reliability of result selective research or its error
1. It is possible to be satisfied with result of selective research, if the part
is the law of the big n u m b e r s .
from division of this result into its error is equaled 2 and m o r e ;
Mathematical expression of this law for the alternative phenomena, that
2. It is possible to determine necessary n u m b e r of examination for
is which are characterized by relative parameters, is the formula:
receiving authentic result during selective research, having m a d e the
necessary transformations to the above-stated formula:

Where:
t - parameter of reliability;
p - relative value (disease, mortality rate, etc.);
g - alternative of relative value, M a t h e m a t i c a l expression of an error for average n u m b e r s is the
1-p, 1 0 0 - p ; formula (model):
n — n u m b e r of observation units. where a - average quadratic deviation of variant from

So, the greatest the error will be if the alternative is equal to average value.
0.5 o n 0.5 or 5 0 % on 50 %. Let's stop on examples. As it has already b e e n said, the average value
In all other cases it will be smaller. one n u m b e r characterizes m a n y variants, but these variants can be different.
 Table 2.9. Applications and characteristics.
1. Average duration of treatment of 2. Average duration of treatment of T h e standard deviation is the most useful m e a s u r e of dispersion.
traumas in hospitals N°l traumas in hospitals .N°2 In certain circumstances, quantitative probability statements that
Variant Number of Variant Number of characterize a series, a sample of observations, or a total population can be
X,n, X,n 2
(X,) variant (ni) (X ) variant (n )
2 2
derived from the standard deviation of the series, sample, or population.
5 1 5 5 2 10
Let's m a k e calculations for the above-stated e x a m p l e s :
6 2 12 6 3 18
7 10 70 7 6 42
Table 2.10.
Hospital .N°l Hospital N»2
8 2 16 8 3 24
Number of Deviation Number of Deviatio
9 1 9 9 2 18 d, 2
n d, 2
d 2
n d 2

variant mi) fdii

r
variant n )
( n 2 ) ( d 2
2 r 2

Sn =16
]
£X,ni=112 Zn =16
2
ZX n =112
2 2
1 -2 4 4 2 -2 4 8
2 -1 1 2 3 -1 1 3
10 0 0 0 6 0 0 0
2 1 1 2 3 1 1 3
1 2 4 4 2 2 4 8
2
Zn,=16 Zn,-d| 2
Zn =16
2 Zn d 2 2

= 12 =22
So, in both hospitals average duration of treatment of traumas is
identical - 7 days. But it is visible to us, that in hospital Nf>} average
displays essence of the matter affair, than in hospital JV° 2 better. In the first
hospital variants are less dispersed around of average, than in the second:
10 variant are equaled by average (in the second hospital — 6) while
extreme deviations (5 and 9 days) in the first hospital h a v e on one variant,
in the second — on t w o .
T h i s dispersion a variant around of average characterizes an a v e r a g e
quadratic deviation (a) N o w we shall determine errors of both average

W h e r e d - a deviation of variants from their average X - M .

If En < 3 0 , from In it is taken away 1.

S t a n d a r d (quadratic)deviation
Definition. l . S o , in 68.3 % of cases M it will be equal to:
T h e standard deviation is the positive square root of the variance. in the first case 7 ± 0.23 d a y s ;
 in the second case 7 ± 0.31 days. Table 2.11
In 95.5 % of cases it will be equal to : Year Bed occupancy (days)
M

1.7 ± 0 . 4 6 d a y s ; 1994 340.1

2.7 ± 0.62 days. 1995 340.9
In the a b o v e stated e x a m p l e s average duration of treatment concerning 1996 338.0
1997 343.0
traumas in hospitals identical (7 days) t h o u g h the average quadratic
1998 341.2
deviation testifies, that it is typical for concrete cases. But it happens
1999 339.1
seldom.
2000 344.2
As a rale, parameters differ between themselves.
T h e r e are questions: if the difference is essential (that is caused by the
Is the following parameters are applied for to the analysis of changes
objective reasons) or, on the contrary, insignificant.
of the p h e n o m e n o n .
For example, in hospital JV° 1 average duration of treatment of patients
with hyper tonic disease m a d e 17 days (an error of a parameter per 1 day), ''"Rate of growth - the relation of all n u m b e r s of dynamic lines to a
previous level which is accepted for 100 %.
and in hospital N° 2-15 days (an error of a parameter per 0.5 days).
W h e t h e r essential there is a difference or, really, in hospital Ks 1 treat
the same disease longer, than in hospital N° 2?
We find the answer according to the formula:
tPure gain — a difference b e t w e e n following and previous n u m b e r s of
d y n a m i c lines.
F o r 1995y. the pure gain has m a d e 340,9 - 340,1 = 0,8 days, for 2 0 0 0
- 3 4 4 , 2 - 3 3 9 , 1 = 5 , 1 days.
/Rate of gain - the relation of pure gain to previous number.
If t >- 2 — a difference, as a rule, essential, if it is less 2 -
insignificant).

- —~

^ 3 . Dynamic a n a t y s i s ^
E s s e n c e of correlation
Health of people and activity of medical establishments changes in
time. Correlation is a m e a s u r e of mutual correspondence b e t w e e n t w o
Studying of d y n a m i c s of the p h e n o m e n a is very important for the
variables and is denoted by the coefficient of correlation.
analysis of a state of health and activity of system of public health services.
Applications and characteristics
We shall result for an e x a m p l e a d y n a m i c line of n u m b e r s :
a) T h e simple correlation coefficient, also called the Pearson's product-
m o m e n t correlation coefficient, is used to indicate the extent that two
variables change with one another in a linear fashion.
b) T h e correlation coefficient can range from - 1 to + 1 and is unites (Fig.
A , B , C). _^
c) When the correlation coefficient approaches - 1, a change in one variable is
Confidence of correlation coefficient
more highly, or strongly, associated with an inverse linear change (i.e., a
change in the opposite direction) in the other variable (Fig.A).
d) W h e n the correlation coefficient equals zero, there is no association
b e t w e e n the changes of the t w o variables (Fig.B).
e) W h e n the correlation coefficient approaches + 1 , a change in one variable
is m o r e highly, or strongly, associated with a direct linear c h a n g e in the
other variable (Fig.C).
Criteria t should be > 3 that corresponds to probability of mistakes
A correlation coefficient can be calculated validly only w h e n both
p r o g n o s i s (p) 3 9 9 , 7 %
variables are subject to r a n d o m sampling and each is chosen independently.
A l t h o u g h useful as one of the determinants of scientific causality,
Table 2.12. Evaluation of character and strength of correlation connection by
correlation by itself is not equivalent to causation.
, . correlation coefficient
For example, two correlated variables m a y be associated with another Character of connection £
factor that causes them to appear correlated with each other. Strength of connection Direct (+) Reverse (-)
A correlation m a y appear strong but be insignificant because of a Weak From 0,01 to 0,29 from -0,01 to -0,29
small sample size. Medium From 0,3 to 0,69 from -0,3 to -0,69
Strong From 0,7 to 1 from -0,7 to 1

S t u d e n t ' s tests (t) b a s e d on t h e t distribution, w h i c h reflects greater

variation d y e to c h a n c e than the n o r m a l distribution are used to analyze
small samples.
T h e (t) distribution is a continuous, symmetrical, unimodal distribution
of infinite range, w h i c h is bell-shaped, similar to the shape of the normal
distribution, but m o r e spread out.
As the s a m p l e size increases, the t distribution closely resembles the
normal distribution. At infinite degrees of freedom, the t and normal
distributions are identical, and the t values equal the critical ratio values.
Correlation connection
Table 2.13. Table of Critical ratio (abbreviated)
1. M e t h o d of ranges (by Spearman) Probability that Value Lies
Critical ration Within The ratio Within ± the Outside ± the
critical Critical ratio Critical ratio
1.0 .341 .683 .317
2. M e t h o d of squares (by Pearson) 1.645 .450 .900 .100
1.96 .475 .950 .050
2.0 .477 .945 .046
2.567 .495 .990 .010
3.0 .499 .997 .003
 S t a n d a r d error of a m e a n

1. T h e standard error of a measure is based on sample of a population and

is the estimate of the standard deviation of the measure for the
population.
2. T h e standard error of a mean, one of the most c o m m o n l y used types of
standard error, is a measure of the accuracy of the sample m e a n as an
estimate of the population mean. In comparison, the standard deviation
is a m e a s u r e of the variability of the observations.

Fig. 2. The standardized normal distribution shown with the percentage of values included Applications
between critical ratios from the mean.
a) T h e standard error of the m e a n is used to construct confidence
A. Student's test for a single small s a m p l e limits around a sample mean.
Student's t test for a single small sample c o m p a r e s a single s a m p l e b) Standard errors are used in Student's t test.
with a population.
Student's t tests are used to evaluate the null hypothesis for continuous Confidence limits of a m e a n
variables for s a m p l e sizes less than 30.
T h e t table. T h e u p p e r and lower confidence limits define the range of probability,
Probability values are derived from the t value and the n u m b e r of that is, the confidence interval, for a measure of the population based on a
degrees of freedom by using the t table for each degree of freedom, a r o w m e a s u r e of a s a m p l e and the measure's standard error.
of increasing t values corresponds to a r o w of decreasing probabilities for 1. Confidence intervals are expressed in terms of probability based on the a
accepting the null hypothesis the value of the t. error.
Confidence intervals. 2. T h e confidence limits of a m e a n define the confidence interval for the
In small samples, especially sample sizes less than 30, the t distribution population m e a n based on a sample m e a n .
is used to calculate confidence intervals around the sample mean F o r large s a m p l e s , confidence limits are b a s e d on the critical ratio for
the associated probability.
The (t) table (abbreviated) For a 9 5 % confidence interval, the estimated sampling error is
Probability multiplied by 1.96;the chances are 9 5 % (19 out of 20) that the interval
Degrees of freedom (df) .10 .05 .01 includes the average result of all possible samples of the same size.
1 6.31 12.71 63.66
F o r small s a m p l e s (less t h a n 30), confidence limits are based on the t
2 2.92 4.30 9.93
value for the n u m b e r of degrees of freedom and the associated probability.
8 1.86 2.31 3.36
9 1.83 2.26 3.25
A p p l i c a t i o n s a n d characteristics
10 1.81 2.23 3.17
(a) Confidence limits of a m e a n are used to estimate a population m e a n
1.64 1.96 2.58
based on a s a m p l e from the population. T h e confidence interval is the
m a r g i n of error of the point estimate.
( b ) A repeated r a n d o m s a m p l e from the population will yield another point
estimate similar to, but not necessarily the s a m e as, the first sample. T h e
9 5 % confidence interval probably will cluster in the same area.
( c ) T h e most c o m m o n l y used confidence limits are 9 5 , 5 % confidence
limits, which indicate that there is a 9 5 , 5 % probability that the
population mean lies within the upper and lower confidence limits and a
5% probability that it lies outside these limits (p = 0.05).
Screening
Screening is the initial examination of an individual to detect disease
lot yet u n d e r medical care. Screening m a y be concerned with a single
lisease or with m a n y diseases(called multiphasic screening).
I. P u r p o s e . Screening separates apparently healthy an individuals into
groups with either a high or low probability of developing the disease
for which the screening test is used.
!. T y p e s of diseases. Screening may be concerned with many different
types of diseases, including:
a) A c u t e c o m m u n i c a b l e diseases (e.g., rubella)
b) Chronic c o m m u n i c a b l e diseases (e.g., tuberculosis)
c) A c u t e n o n c o m m u n i c a b l e diseases (e.g., lead toxicity)
d) Chronic n o n c o m m u n i c a b l e diseases (e.g., g l a u c o m a )
At construction of schedules character of the data which are subject to
a graphic representation, p u r p o s e of schedules (demonstration at
conference, lectures, a reproduction in scientific work, etc.), the p u r p o s e of
the schedule (evidently to show the received results or only to e m p h a s i z e ,
allocate any law or the fact), a level of an audience before which the
schedule is shown are taken into account.
T h e choice will depend on all it is the following as a graphic
representation, color, the n u m b e r , a proportion of a print, etc. In all cases
schedules should be clear, convenient and easy for reading.
In medical statistical researches linear diagrams, plane diagrams,
cartograms and linear or coordinate are used.
L I N E A R D I A G R A M S are schedules on w h i c h numerical values are
displayed by curves which allow to trace d y n a m i c s of the p h e n o m e n o n in
time or to find out d e p e n d e n c e of one attribute on another (Fig. 3).

^ G r a p h i c representation and graphic analysis

Results of examinations after their statistical processing can given as

raphic representations, on which numerical n u m b e r s are presented as
rawing. Schedules give a general characteristic of the p h e n o m e n o n and
efine its general laws, enable to analyse the given researches m o r e deeply. Fig. 3. Age mortality rate of the population in Ukraine(Ukrainian Center of medical
T h e y facilitate comparison of parameters, give imagination about statistics, Kyiv,1999)
Key words : mortality, age.
tructure and character of connection between the p h e n o m e n a , specify their
mdencies.
W h e t h e r on linear diagrams with t w o and a plenty of curves probably
Therefore, graphic demonstration we often connect with the graphic
also c o m p a r i s o n of n u m b e r s in t w o the greater n u m b e r of d y n a m i c lines,
nalysis for which the graphic representation serves not only means of
and also an establishment of d e p e n d e n c e of changes of fluctuations w h i c h
emonstration of results and conclusions research, but also means of the
occurs in the other n u m b e r line.
nalysis of the received materials, revealing of internal connections and laws.
 Linear diagrams are m a d e according to system of rectangular
oordinates w h e r e the horizontal scale is postponed at the left — to the right
n a line of abscissas ( X ) , and vertical - from b e l o w - u p w a r d s on a line
/hich is called as ordinate (Y). T h e obligatory requirement of construction
f any schedule is scale, that is the image on d r a w i n g should be reduced,
o m p a r e d with corresponding figures.
Contrast to linear diagrams which describe d y n a m i c s of any process,
ilane diagrams are used in the case w h e n it is necessary to represent the
tatistical p h e n o m e n a or the facts, independent one from another.
T h e most simple e x a m p l e of plane diagrams is the diagram as
ectangular or figures. Digital n u m b e r s on plane diagrams average
epresented by geometrical figures — rectangular, squares. These diagrams
ire used for demonstration and popularization of the resulted data, and also
n cases if it is necessary to represent structure of the p h e n o m e n o n on o n e
)f the m o m e n t s of supervision.
F o r e x a m p l e , age type fallen ill or structure of disease in any
>ettlement.
In long-pillar diagrams digital n u m b e r s are represented by rectangular
columns with an identical basis and different height.
T h e height of a rectangular corresponds to the relative value of the
Fig. 4. Age structure of the population in Ukraine, 1990, %
Dhenomenon which is studied. For construction a long-pillar diagram we (the part of each age layer was determined to all population).
ase a scale according to w h i c h it is possible to determine the height of each
column. In circular diagrams they use to display ratio of h o m o g e n e o u s absolute
Long-pillar diagrams serve for comparison of several sizes. It is sizes.
possible to rectangular w h i c h represent sizes, it is possible to place also on T h e y d o n ' t use the area of a rectangular, but the area of a circle.
the plane diagram not on a vertical, and across and then there will be a tape But it is necessary to r e m e m b e r , that the areas of circles m a t c h up one
diagram (Fig.4). In s o m e cases the image of sizes as tapes (stirs) is m o r e another as squares of their radiuses, therefore at construction of circular
convenient, than as c o l u m n s because it is easier to sign with each tape by a diagrams we must extract off the diagram sizes and on this basis to
horizontal inscription. construct radius, and having radius, it is easy to describe a circle.
With the aid of column and tape diagrams it is possible not only to In a case if the circular diagram displays parts of the w h o l e , it is
compare different sizes, but also simultaneously to display structure of these necessary to display circles not separately one from another, and to impose
numbers and to compare their parts. For example, long-pillar or tape diagrams against each other. T h e w h o l e is possible also and its parts to submit as the
which show distribution of diseases on the basic nosological forms, it is circle divided on sectors - the sector diagram. At construction of the sector
possible to show also percent of diseases among m e n and women. diagram all area of a circle is accepted for 100 %, and each sector occupies
F o r this purpose it is necessary (a figure or a tape) to divide each is the following part of the area which correspond to the necessary percent.
rectangular for t w o parts, any of w h i c h will correspond to digital n u m b e r of
disease a m o n g m e n and w o m e n .
 In practice for construction of sector diagrams it is possible to use not
ily the area of a circle, but also the area of a square and a rectangular.
Nevertheless, often it h a p p e n s to divide is the following figures is
ore hard, than a circle and consequently they are rather seldom used as a
isis of sector diagrams.
Radial or linear - circular diagram (Fig.5) are constructed on the basis
' n u m b e r coordinates in w h i c h the radius replaces vertical scale of
agrams which are based on system of rectangular coordinates.
Fig. 5. The radial diagram.
Seasonal prevalence of mortality rate of the population of Kalinovsky district of Vinnitsya
region (1984- 1998,Ukraine).
T h e e x a m p l e of the radial diagram is a wind rose with the aid of w h i c h
/e represent on m a p s the change of a direction of a wind during any
alendar period of time (month, year).
Radial diagrams are used for an illustration of seasonal fluctuations of
ny n u m b e r s , for e x a m p l e diseases or mortality rates.
T h e s e diagrams are constructed on a circle which center has 12
adiuses. E a c h radius saws from a circle an arch in 30 ( 3 6 0 / 1 2 = 3 0 ) also
epresents ordinate of one of calendar m o n t h s : January, M a r c h , etc.
As an initial zero point they take the center of a circle, and then on radiuses
according to the scale chosen before render numbers which display intensity of
seasonal fluctuations of the phenomenon in any of calendar months.
H a v i n g connected the m a r k e d points, we receive the closed line w h i c h
enables to imagine seasonal fluctuations.
W h e n building radial diagrams, it is necessary to r e m e m b e r a rule of
calculation of radiuses from the top part of the diagram and in other w o r d s .
C o m p a r i s o n s of the different p h e n o m e n a according to a territorial
attribute cartograms are built, if necessary.They represent geographical
m a p s , on w h i c h with the aid of graphic symbols w h e r e the intensity of
distribution and grouping of the p h e n o m e n o n ( morbidity, mortality, etc.)
for any period of time ( F i g . 6) is shown.
Fig. 6. Regional features of mortality from cancer in Ukraine.
Therefore they are better for building on simplified m a p s on w h i c h
only administrative frontiers and s o m e big settlements are shown. At
construction of a cartogram the great value has grouping the p h e n o m e n a
w h i c h are displayed.
T h e most simple grouping is division of s o m e parameters on group
with parameters b e l o w average and group with parameters is higher than
average. A c c o r d i n g to this division regions districts with parameters than
will be shaded on a cartogram and b e l o w average — not shaded.
5. Standardization Standard definition
Branch Hospital N" 1 Hospital No2 The standard
C o m p a r i s o n of parameters in sets w h i c h differ in the structure, Number Number Number
m a n d s their standardization, it m e a n s the a m e n d m e n t , provided that the of % of % of %
•ucture of sets will be s h o w n to the uniform standard. patients patients patients
Therapeutic 2100 64,8 970 32,6 3070 49,4
Standardization m e t h o d s Surgical 560 17,3 990 33,2 1550 24,9
Direct —Indirect— R e v e r s e Gynecologic 580 17,9 1020 34,2 1600 25,7
Total 3240 100,0 2980 100,0 6220 100,0
Stages of direct standardization m e t h o d :
Calculation of intensive indices in compared groups. Let's determine average duration of treatment in b o t h hospitals
C h o i c e and calculation of standard. provided that the structure of hospitalized patients w o u l d be identical.
Calculation of " e x p e c t e d " figures in every group of standard.
Calculation of standardized indices. Hospital N°l Hospital Nn2
Standard
Comparative of simple intensive and standardized indices, conclusions. Branch distribution Standard distribution we Standard distribution we
of sick(%) multiply for the term of multiply for the term of
U s a g e of standardized indices : treatment treatment
Therapeutic 49,4 49,4 x 15,8: 100 = 7,8 49,4 x 16,8 : 100 = 8,3
C o m p a r a t i v e evaluation of demographic indices in different age and
Surgical 24,9 24,9 x 9,5 : 100 = 2,4 24,9 x 9,8 : 100 = 2,4
social groups.
Gynecologic 25,7 25,7 x 7,0 : 100= 1,8 25,7 x 7,5 : 100= 1,9
C o m p a r a t i v e analysis of morbidity in different age and social groups.
Total 100,0 standard parameter 12,0 standard parameter 12,6
Comparative evaluation of treatment quality in hospitals with different
kinds of patients in departments.
Q u e s t i o n s for self-checking:
Table 2.14. Example. Average duration of treatment in the hospitals 1. A subject and contents of statistics and medical statistics, its value in
Department Hospital N° 1 Hos pital No2 activity of the doctors.
Number Bed days The period Number Bed days The period 2. Stages and kinds of statistical researches concerning completeness of
of patients of treatment of patients of treatment scope and time of research.
'herapeutic 2100 33180 15,8 970 16296 16,8 3. C o d i n g and grouping of the statistical data.
Surgical 560 5320 9,5 990 9702 9,8 4. K i n d s of statistical tables.
ynecologic 580 4060 7,0 1020 7650 7,5 5. Relative values, definition and a technique of their calculation.
Total 3240 42560 13,1 2980 33648 11,3 6. A v e r a g e values and a technique of their calculation.
7. Definition of reliability of statistics.
As we see, average term of treatment in the hospital N°2 is much lower 8. D y n a m i c lines, parameters of d y n a m i c lines, a technique of their
comparison with hospital JVel. But the analysis of these parameters in calculation.
>arate branches testifies to an inaccuracy of this conclusion. 9. Graphic representations of parameters.
In hospital JSfel therapeutic patients prevail, and in hospitals Ne2 - 10. K i n d s of diagrams, application, a technique of their construction.
necologic, which terms of treatment essentially differ. 11. W h a t is the standardization in statistics?
 Appendix Table 2.16. Relative values
A verbal
Determinatio
Index Formula determinati
n of index
Table 2.15. Group characteristic of features and parameters of statistics on
N Characteristic of features Parameters A frequency

1. Intensive
I Distribution of features Relative values: of Absolute dimension of occurance Level,
l n l w ln n n s

Intensive indices phenomenon widespread,

x ] UU ( 1UUU)
(occurrence) frequency,
- extensive indices Absolute dimension of environment * main base
in certain widening
indices of relative intensity environment
indices of correlation
Specific

2. Extensi-
indices of visualization A sense of the
Abs. dimension phenomenon's part , weight,
II Average level Average values: part in the nn
share(part),
Mo — mode whole Abs. dimension of the whole phenomenon structure,
phenomenon

ve
Me — median distribution
M — arithmetical mean

3. Visualization
III Variety of feature Li — limit A frequency Providing
Am — amplitude of population
phenomenon Abs. phenomenons dimension , , with
8 — average quadratic deviation x 0 0 ( 1 0 0 0 1 0 0 0 0 0 0 0 0 0 )

in it's non Abs. environmentis dimension chemist's

C — coefficient of variation
v
productive medical
I Representation of features Errors of relative (m%) and environment workers
V average (m ) values
H

V Correlation between occurrences Correlation coefficient

And features (Pxv, fxv)
Table 2.17. Table 2.18. Evaluation of confidence of statistics investigation results

Difference is considered incredible if meaning of t (Student's tests) — 2

Probability without error prognosis (p)

l ' o r t = l , p = 68.3 %
For t=2, p=95,5%
For t=3, p=99,7%
Section 3 . H E A L T H O F T H E P O P U L A T I O N C e n s u s is b e i n g held at the certain m o m e n t of time (for instance, on 12
o clock on January, 14).
3.1. Health bases parameters of the population F o r this m o m e n t all inhabitants of the country are included on special
forms. T h u s if the form is filled after the fixed date (process of copying can
last several w e e k s ) forms are filled on those w h o has died after the fixed
Public health is m e a s u r e d by the following bases parameters: date.
demographic, morbidity and physical development. T h e data on the n u m b e r and national structure of inhabitants of
Demographical parameters of the social medicine and the organization Ukraine for years of post-war censuses is given in table 3 . 1 .
of public health services were borrowed in the demography.
T h e d e m o g r a p h y is a science about population in its social Table 3.1. National structure of the population in Ukraine within censuses
development. T h e d e m o g r a p h y studies is the following basic processes Year 1959 1970 1979 1989
w h i c h occur to the population: statistics, mechanical movement, natural In total 41869046 47126517 49609333 51449479
movement. Ukrainians, 32158493 35286517 36488951 37370368
T h e statistics of the population displays its number, sexual and age Absolut number
structure, professional structure, a level of erudition, a level of a material Part in structure 76,8 74,9 73,6 72,6
well-being, etc. for the certain period of time. All these characteristics as it of all population, %
has b e e n said a b o v e the health of people. Rate of a gain, % 9,7 3,4 2,4
T h e census gives the exact data of the population statistics. Sweden Russians, 7090813 91263331 10471602 11340250
Absolut number
w a s the first w h i c h has m a d e the census in XVIII century, later the census
Part in structure of all 16,9 19,4 21,1 22,0
was m a d e by other countries. In the developed countries these censuses are
population, %
held periodically these days. H o w e v e r not all countries in particular the
Rate of a gain, % 28,7 14,7 8,3
undeveloped ones, practice censuses.
Jews, absolut number 840311 777126 634154 485976
N u m b e r of inhabitants of these countries is established by an indirect
Part in structure of all 2,0 1,6 1,3 0,94
way. population, %
So, for e x a m p l e , w h e n for the first time the data of the n u m b e r of Gain rate, % -7,5 -18,4 -23,4
China inhabitants w e r e established they used the quantity of the eaten Poles, absolut number 363297 295107 258309 218891
kitchen salt. T h e constant need of kitchen salt for a day is known. T h e y Part in structure of all 0,87 0,63 0,52 0,43
h a v e c o m p a r e d these censuses with the data of population of China later, population, %
and the difference appeared insignificant. Gain rate, % -18,8 -12,5 -15,3
In 2 0 0 0 the population of a planet has achieved 6 billion, from them 1 Others, absolut number 1416132 1644096 1756317 2033994
billion lives in the developed countries of E u r o p e , Northern America and in Part in structure of all 3,4 3,5 3,5 4,0
Japan (so-called " gold billion " ) , other 5 billions - mostly in the population, %
undeveloped countries. Most of people live in China - 1,2 billion, then in Gain rate, % 16,1 6,8 15,8
India ( l b i l l i o n ) , Ukraine enters to the first thirties of the most populated
status of the world - 49,1 million inhabitants (2000.). A c c o r d i n g to the last census, there are 45 % of men and 55 % of
F i v e population censuses h a v e b e e n carried out during the post-war w o m e n in Ukraine. A d v a n t a g e of w o m e n a b o v e m e n in n u m b e r is caused
period in U k r a i n e : 1 9 5 9 , 1 9 7 0 , 1979, 1989, 2 0 0 1 .
 As a rule, this parameter is determined on 1000 p e o p l e that enables to
by the c o n s e q u e n c e s of w a r s in w h i c h m e n are mostly killed, and higher
c o m p a r e these parameters in space and time. It is necessary to take into
mortality rate of m e n compared to w o m e n .
account the following definition of concept of "live-birth".
By age parameters the population of U k r a i n e w a s distributed in the
Criteria "live-birth" in our country and requirements by W H O ' s are
following w a y : 0-14 years - 24,9 %; 15-49 years - 48,7 %; 50 years and
different.
senior - 26,4 %.
In our country the n e w b o r n is considered alive if it w a s born not
If in age structure of the population children (0-14) prevail of people
earlier than 28 w e e k s of pregnancy, has weight of not less than 1000 gram,
of 50 years and senior, such type of age structure of the population is called
growth not smaller than 35 sm a n d has palpitation and breath. A c c o r d i n g to
progressive, if on the contrary — regressive.
the criteria of W H O - 22 w e e k s of pregnancy, 4 5 0 gram, p r e s e n c e of a
If the n u m b e r of children and p e o p l e of the nature age is
heart beat only.
approximately identical, it is stationary type of age structure of the
T h e infant w h i c h w a s b o r n a n d does not correspond to t h e s e criteria, is
population.
considered as stillbirth.
T h e specific part of old m e n steadily grows, that a n u m b e r of essential
T h e general mortality rate is determined in this w a y :
social — medical consequences — increase of morbidity and mortality rate
and n e e d in medical care.
T h e second aspect of d e m o g r a p h i c studying of the population is its
m o v e m e n t . M o v e m e n t can be mechanical and natural.
M e c h a n i c a l m o v e m e n t is a constant m o v e m e n t of p e o p l e so that to
It is possible to put n u m b e r s of died and people of the certain age in
find a n e w p l a c e of residence and e m p l o y m e n t . As a rule, p e o p l e migrate to
numerator and a d e n o m i n a t o r to get a parameter of age mortality rate.
the places w h e r e better social conditions of life.
T h e special attention is given to the mortality rate of infant on the first
So, for the last 30 years m o r e than 15 million of migrants has m o v e d
year of life (infant mortality r a t e ) .
to the E u r o p e a n U n i o n in the search of work. Migration of Ukrainians
In table 3.2, d y n a m i c s of parameters of birth and mortality in Ukraine
during the period of independence has got n e w spontaneous character.
for last years is shown.
Because of the m a s s u n e m p l o y m e n t , hundred of thousand of Ukrainians
have illegally g o n e to the countries of E u r o p e a n d Northern America.
Table .12. Dynamics of birth and mortality in Ukraine for 1990-1999 (on 1000
T h e second prominent feature of mechanical m o v e m e n t of people is population).
their resettlement from village to city. At the beginning of XX century 5 % Year General birth General mortality Vital gain
of the population of a planet lived in the cities, at the end of XX century - 1990 12,7 12,1 0,6
almost 7 0 % . 1991 12,5 12,9 -0,8
Vital m o v e m e n t of the population is the process that includes birth 1992 11,4 13,4 -2,0
rate, mortality rate and a natural g a n e of the population. T h e parameter of 1993 10,7 14,2 -3,5
the general birth of the population is determined in the following w a y : 1994 10,0 14,7 -4,7
1995 9,6 15,4 -5,8
1996 9,1 15,2 -6,1
1997 8,7 14,9 -6,2
1998 8,3 14,3 -6,0
1999 7,8 14,8 -7,0
 T h e vital gain is a difference b e t w e e n the birth rate and mortality rate. Table 3.4. The reasons of infant mortality in Ukraine in 1999 (%)
As we see from table 3.2, the vital gain in Ukraine from 1991 b e c a m e The reasons of infant mortality (%)
negative and its n u m b e r quickly grows. It is a result of conditions of Conditions, which have arisen in perinatal period 38,0
p e o p l e ' s life during these years, reduction of availability of medical care Congenital anomalies 27,4
for poor layers of the population and deterioration of this care. Diseases of respiratory organs 7,6
Accidents, poisonings and traumas 7,6
Mortality testifies the influence of the conditions of p e o p l e ' s life on
Infectious and parasitic diseases 5,5
death a m o n g rural people and cities dwellers. So, in 1999 mortality in city
Diseases of nervous system and sense organs 3,3
w a s 13,0 %o, village - 18,7 %o, vital gain -5,9 -9,3 %o.
Others 10,6
Except for the worse social conditions of life, hard extinction of rural
p e o p l e , c o m p a r e d with city dwellers, is also caused by the fact that specific
As we see from table 3.4, it is m o r e than half of died infant on the first
part of old p e o p l e in structure of the population in villages is significant. In
year of life die from the conditions w h i c h h a v e arisen during birth and
table 3.3 the structure of mortality reasons of the population of U k r a i n e is
anomalies.
s h o w n in c o m p a r i s o n with other countries.
T h e third and fourth places are occupied by diseases of respiratory
system (which s o m e decades before p a y s to itself w e r e on the first place),
Table 3.3. Structure of mortality reasons (in percentage to number of died,
1997) accidents, poisoning and t r a u m a s - the reasons, being an attribute of the
Mortality reasons developed undeveloped Ukraine newest time, are caused by extremely those changes which occur due to
countries countries conditions and a w a y of infant life.
Infectious and parasitic diseases 1 43 1,4 Infants on the first year of life have died non-uniformly. Most
Perinatal and maternity mortality 1 10 1,0 intensively during the first w e e k of life, then during the first month. From
Oncological diseases 21 9 12,7 all infants w h o died during the first year, not less than 50 % of them died
Diseases of cardiovascular system 46 24 57,5 during the first w e e k of life (early neonatal mortality rate) and 60 % during
Diseases of respiratory system 8 5 5,7 the first m o n t h of life ( n e o n a t a l mortality ).
Other and unseated reasons 23 9 11,7

As we see from this table, Ukraine occupies an intermediate place

b e t w e e n developed and undeveloped countries. According to the share of
infectious and parasitic diseases, perinatal and maternity mortality Ukraine
is close to the developed countries; according to the share of malignant
diseases, diseases of respiratory system - to undeveloped countries. At the
same time the specific part of cardiovascular diseases in Ukraine is the
greatest and occupies almost t w o thirds of all deaths.
Mortality of infant on the first year of life is called as infant mortality
rate. It is determined in the following w a y :
 T h e s u m of early infant mortality rate and stillbirth m a k e s the perinatal
mortality rate. T h e integrated d e m o g r a p h i c p a r a m e t e r is m i d d l e duration of
an expected life.
T h i s p a r a m e t e r m e a n s that n u m b e r of years, w h i c h will be lived on
average by the representative of generation, w h i c h w a s born in the certain
year (for e x a m p l e , in 2 0 0 0 year) provided that this generation will die out
with the same intensity this year.
In 2 0 0 0 middle duration of an expected life in the world has made 67
years, including the developing countries - 50-52 years and in the
developed countries - 75-82 years. In Ukraine this year middle duration of
an expected life has m a d e 67 years, it m e a n s that it w a s at the average -
lanetary level.
T h e level w a s m o v e d as one of the greatest in the world of distinctions
in average life expectancy of m e n and w o m e n (the man - 63 years, and
w o m e n - 74 years). A c c o r d i n g to this principle in Russia (12 y e a r s ) , '
Byelorussia (11 years), M o l d o v a (8 years) are close us.
In the developed countries the difference between life expectancy of
m e n and w o m e n does not exceed 4-5 years for the benefit of w o m e n .
So, the demographic situation in Ukraine lot this moment is
unsatisfactory. T h e coordinated efforts of the state, public and the whole All these parameters can take into account all diseases or s o m e of
population, directed on the increase of birth rate and reduction of mortality them then in numerator corresponding n u m b e r s are substituted. Except for
rate of people are necessary. all diseases acute infectious diseases and the important not epidemic
T h e important parameter of health of the population is morbidity. It is diseases (cancer, a tuberculosis, venereal diseases, etc.) which are of great
studied on three sources: according to the visits of patients to medical importance for an estimation of public health are often separated.
establishments, data of preventive services and the data on the reasons of T h e p r i m a r y medical d o c u m e n t in w h i c h all diseases are registered is
death. the medical card of out-patient (F 025/a). F o r registration of hospitalized
A c c o r d i n g to the first source acute diseases are revealed according to patients by the p r i m a r y medical d o c u m e n t there is a medical p a t i e n t ' s card
the data of preventive services — chronic diseases, according to the data of of in-patient ( f 0 0 3 / a ) .
the reasons of death — diseases, u n k n o w n for persons at h u m a n life (first of F o r the analysis of disease intermediate medical d o c u m e n t s , w h i c h are
all traumas), and also those diseases, w h i c h diagnosis have not been based on primary:\
established and specified during of morbid a n a t o m y survey. \ T h e statistical coupon for registration of the specified (final) diagnoses
(f025-2/a);
Morbidity is determined on the followine parameters: ' .-^A control p a t i e n t ' s card of dispensary supervision (f 030-/0);
— T h e emergent report about acute infectious disease, occupational disease
and unusual allergic reaction (f 058/0);
— A statistical p a t i e n t ' s card of out-patient (f 066/0);
— T h e certificate of invalidity and other.
 The world statistics does not know the parameters of morbidity. They On the second place there were t r a u m a s and poisonings (7,3 % ) ,
absent in annual epidemiological directories of W H O . The matter is that our diseases of a skin and h y p o d e r m i c (are farther than 6,2 % ) , disease of
country, unlike many countries of the Western Europe and Northern America, urinogenital system (5,7 % ) .
has a long history of registration of diseases according to people is visits of T h e a b o v e listed diseases o c c u p y t w o thirds of all primary diseases
medical establishments. This practice has been established by the founders of and have m o s t l y acute character. Further, diseases of blood circulation
public medicine in Ukraine and Russia in the middle of XTX century. system h a v e mostly chronic character, diseases of bone-muscular system
Founders of public medicine fairly considered, that the rational (4,7 % ) , diseases of eyes (4,5 % ) . In fact the basic part of primary
organization of medical care includes not only the correct disease treatment but morbidity is m a d e with acute diseases.
also its registration. In 1911 at the international hygienic exhibition in Dresden.
Russian public medicine showed to the world the completed statistics of the Table 3.5. Primary morbidity of the population in Ukraine, 1999
common disease of the population which covered millions of cases. Diseases On 1000 inhabitants of%
In the Soviet U n i o n diseases have started to be registered not only Active tuberculosis 0,54 0,1
during the reference of p e o p l e for medical care, and by carrying out of Cancer 3,2 0,5
scheduled preventive reviews. It has added the data concerning levels and Diseases of endocrine systems 12,5 1,9
Diabetes 1,3 0,2
structures of disease of people. Morbidity has b e e n used not only as a
Mental deficiency 4,9 0,7
parameter of health, diseases of the population, and as the basis for
Diseases of nervous system 15,4 2,3
p l a n n i n g development of a n e t w o r k of preventive and treatment-and-
Diseases of eyes 29,6 4,5
prophylactic establishments.
Diseases of an ears 23,2 3,5
So, registration of morbidity is historical property of native system of
Diseases of blood circulation system 39,1 5,9
medical care w h i c h should be saved and developed. It should be emphasize, Hypertonic disease 17,7 2,2
as in the period of so-called pseudo-market transformations in the country, Ischemic heart disease 12,3 1,5
s o m e o n e calls the population to stop registration of the current disease on Stenocardia 4,6 0,6
the ground that does not exist in the modern developed countries which Acute heart attack of a myocardium 1,1 0,1
mostly are guided by a parameter of death rate. Cerebrovascular diseases 8,4 1,0
In particular it is important that there is a primary and general Insult 2,9 0,4
morbidity of the population. Primary takes into account only those cases of Diseases of respiratory organs 290,6 43,9
diseases w h i c h are revealed for the first time in life and are registered in Chronic bronchitis 2,1 0,3
that year for w h i c h primary disease is determined. Bronchial asthma 0,3 0,1
General takes into account all cases of diseases which h a v e b e e n Diseases of digestive organs 28,1 4,2
registered in one year for w h i c h disease is determined, it m e a n s that disease Stomach ulcer and 12f. guts 1,5 0,2
can be revealed and in previous year, also n o w proves to be true. Diseases of skin and hypodermic fat 40,9 6,2
T h e data on primary morbidity of the population in Ukraine is shown Diseases of bone—muscular system 31,1 4,7
Diseases of urinogenital system 37,8 5,7
in table 3.5.
Congenital abnomalities 1,2 0,2
As we can see from table 2 8 , in 1999 on each one thousand inhabitants
Traumas and poisonings 48,2 7,3
in Ukraine for the first time in a life 661,2 diseases have been registered, Total 661,2 100,0
diseases of respiratory system h a v e m a d e of t h e m almost half (43,9 % ) , in
particular acute respiratory infections.
 T h e greater index of accumulation of diseases, first of all indicates two
T h e data on the general morbidity of the population in Ukraine are things: prevalence of chronic forms of diseases above acute o n e s and
resulted in table 3.6. As s h o w n in this table, during 1999. on each one successes of medical care and beneficial effect of other social factors on a
thousand inhabitants in Ukraine 1411,9 diseases were registered or in 2,1 course of diseases.
times m o r e , than for the first time the diseases h a v e b e e n registered. In
In the structure of the general morbidity, essential differences
other w o r d s of the c o m m o n diseases to primary ones m a k e s a so-called
compared with primary ones are visible.
index of accumulation of diseases.
Diseases of respiratory system takes the 1-st place, but their part
m a k e s only the fourth part of all diseases (24,4 % ) , and the index of
Table 3.6. General morbidity of the population in Ukraine, 1999
accumulation has m a d e only 1,2 units.
Diseases On 1000 of% an index of
Diseases of blood circulation system are on the 2-nd place (22,4 %, an
inhabitants accumulation
index of accumulation - 8,1), diseases of digestion system (9,0 %, an index
Active tuberculosis 2,4 0,2 4,4
Cancer of accumulation - 4,5), are farther than disease of bone-muscular system
15,2 1,1 4,8
Diseases of endocrine systems 70,4 (5,6 %, an index of accumulation - 2,6), diseases of eyes (5,2 %, an index
5,0 5,6
Diabetes 18,2 1,3 14,0 of accumulation - 1,9), diseases of urinogenital system (5,0 %, an index of
Mental deficiency 46,2 3,3 9,4 accumulation - 1,9), diseases of endocrine and digestive system (5,0 %, an
Diseases of nervous system 43,1 3,1 2,8 index of accumulation — 5,6).
Diseases of eyes 73,4 5,2 2,5 In fact in the structure of general morbidity chronic diseases prevail.
Diseases of an ears 30,4 2,2 1,3 T h e analysis of the data concerning morbidity of the population is
Diseases of blood circulation system 316,8 22,4 8,1 m a d e according to the International classification of diseases, t r a u m a s and
Hyper tonic disease 159,5 9,2 9,0 the reasons of death.
Ischemic heart disease 129,3 7,5 10,5 This classification is started in 1900 and usually each 10 years is
Stenocardia 40,6 2,3 8,8 reconsidered.
Acute heart attack of a myocard urn 1,2 0,1 1,1 N o w is the World Classification of 10-th revision acts.
Cerebrovascular diseases 57,3 3,3 6,8
Insult 3,3 0,2 1,1 Table 3.7. International classification of diseases (icd-10) by 10' review (1996)
Diseases of respiratory system 344,5 24,4 1,2 1 Infectious and Parasitogenic diseases
Chronic bronchitis 24,1 1,7 11,5 2 Malformations
Bronchial asthma 4,3 0,3 14,3 Diseases of Blood and Hemopoetic organs and some disorders with
3
Diseases of digestive system 127,7 9,0 4,5 Immune mechanism
Stomach ulcer and 12f.guts 19,0 1,3 12,7 4 Endocrine diseases, Disorders of Nutrition and Metabolism
Diseases of a skin and hypodermic fat 48,7 3,5 1,2 Disorders of Psychics and Behavior
5
Diseases of bone—muscular system 79,5 5,6 2,6 6 Nervous diseases
Diseases of urinogenital system 70,0 5,0 1,9 7 Eye diseases and its supplementary Apparatus
Congenital abnomalities 5,1 0,4 4,3
8 Disorders of the Ear and Mastoideus Processus
Traumas and a poisoning 50,8 3,6 1,1 9 Diseases of Circulatory System
Others
10 Diseases of Respiratory Organs
Total 1411,9 100,0 2,1
11 Diseases of Digestive Organs
 12 Diseases of Skin And Subcutaneus Fat 1 2 3 4 5
13 Diseases of Bone-Muscle System and Connective Tissue Diseases of endocrine systems,
14 Diseases of Urinary and Reproductive System frustration of a meal, a
15 Pregnancy, Delivery and Post-partum Period metabolism and immunity 163,6 74,3 90,9 87,3
16 Some States that Appear in Perinatal Period Diabetes 15,9 14,3 4.6 16,5
17 United Defects of Development, Deformations and Chromosomal Mental deficiency 54,6 68,6 6,8 27,9
Abnormalities Diseases of sight 63,6 134,3 54,6 82,3
18 Symptoms, Signs and Deviations from Norma the are revealed at Diseases of nervous system 217,8 165,7 93,2 160,7
Clinical and Laboratory Investigations and are not classified in other Diseases of an ear and
30,0 51,4 34,0 55,7
Headings mastoid a shoot
19 Traumas, Poisonings and some other Consequences of Action of Diseases of blood
309,1 488,6 150,0 336,7
External Factors besides of 19 Diseases Classes To led-10 there were Circulation system
22,7 8,6 4,6 2,5
included two additional Headings: Rheumatism
97,7 188,6 52,3 140,5
20 External Reasons of Morbidity and Mortality Hyper tonic disease
61,4 177,1 22,7 97.5
21 Factors Influencing on the Health State of Population and Appears to Ischemic heart disease
Establishment of Health Care Diseases of respiratory system 195,4 231,4 52,3 140,5
Chronic bronchitis 61,4 42,9 15,9 16,5
Pneumosclerosis, emphysema 52,3 122,8 9,! 29,1
Morbidity is socially caused. As an e x a m p l e the morbidity revealed
Diseases of digestive system 172,7 168,6 72,7 103,8
during preventive services_in incomplete and complete families. T h e
Stomach ulcer 9,1 17,1 1,4 8,9
incomplete family is a family w h e r e one of its basic supporters, as a rule,
Diseases of urinogenital
the father is absent. 34,1 31,4 18,2 43,!
system
It is not necessary to speak that and the w a y of life of these families is Diseases of female genitals 243,2 54,3 138,6 46,8
worse than a condition of complete ones(table 3.8). Diseases of skin and
43,2 20,0 22,7 13,9
hypodermic
Table 3.8. Morbidity according to preventive services among complete and Diseases of bone-muscular
incomplete families (on 1000 persons, pair sample) 156,8 125,7 59,1 70,9
system
Incomplete families Complete families Others 40,9 11,4 20,5 17,7
Other adult Other adult I'olal 1775,0 1671,4 843,2 1196,2
Diseases Mother members Mother members
of family of family
Morbidity of mothers from incomplete families in 2,1 times e x c e e d s
1 2 3 4 5
disease of mothers from complete families, and disease of other adult
Infectious and parasitic
15,9 8,6 6,8 8,9 m e m b e r s of incomplete families — on 39,7 %.
Tuberculosis of respiratory
6,8 2,7 0,3 2,5 Morbidity of mothers from incomplete families prevails disease of
organs
Good-quality neoplasm 25,0 25,7 18,2 32,9 mothers from complete families on all resulted classes and g r o u p s of
Cancer 9,1 11,4 4,6 15,2 diseases and separate diseases.
In particular it concerns is the following diseases, as a tuberculosis of
bodies of breath - in 22,7 times, cancer — in 2,0 times, diabetes - in 3,5
limes, mental disorders - in 8,0 times, diseases of nervous system - in 2,3
times, diseases of blood circulation system - 2,1 times, including
rheumatism - in 4,9 times, ischemic heart disease of - in 2,7 times, diseases
of respiratory system - in 3,7 times, including chronic bronchitis - in 3,9
times, a pneumosclerosis, e m p h y s e m a easy - in 5,7 times, diseases of
digestion system — in 2,4 times, including a stomach ulcer - in 6,5 times,
diseases of b o n e -muscular system — in 2,7 times.
In 1999 in Ukraine on every 100 working and on every 10 thousand
w o r k i n g — 64,9 cases so-called primary (for the first t i m e 53,6 cases of the
temporary disability h a v e b e e n registered in a life) proof disability. Proof
disability is also called physical invalidity.
In total in U k r a i n e there are 2,5 million invalids.
If main causes of temporary disability are mainly acute diseases (acute
respiratory infections, a flu, traumas and a poisoning, diseases of bone-
muscular system), a rack — chronic diseases (diseases of system of blood
circulation, cancer, diseases of nervous system, consequence of traumas).
Invalidity is characterized by is the following parameters:
T h e decision on giving to the worker the status of invalid is m a d e by
medico-social c o m m i s s i o n of specialists ( M S C ' s ) which exists at territorial
b o d y of social protection of the population.
T h e basis for m a k i n g of is the following decision is the letter w h i c h
the doctor o n c e patient with fills constant disability.
T h e proof, is the following disability which lasts m o r e than 4 m o n t h s
during one year. Exception is m a d e with diseases w h i c h h a v e recurrent
character (total duration of relapses should exceed 5 m o n t h s during one
year) and a tuberculosis if disease lasts m o r e than 10 m o n t h s .
Tme important p a r a m e t e r ^ the health the population, especially at
infant's age, is physical development. It is measured by the following basic
criteria — growth, weight, m e a s u r e m e n t s of thorax, of head, etc.
T h e r e are standards of physical development which are received by the
determination of average indices of representative population.
Standards, as a rule, are determined for each territory separately as
physical development is influenced by medical-geographical and ethnic
features.
.
Table 3.9. Health indices
1. D e m o g r a p h y indices (birth rate, mortality rate, neonatal mortality rate,
early neonatal mortality rate, stillbirth rate, infant mortality rate ).
2. Morbidity indices (primary, general, according to preventive serviceSi
hospital morbidity, morbidity with temporary disability ).
3. Invalidity indices (primary, general).
4. Indices of physical development.
Distribution of the p o p u l a t i o n according to health g r o u p s :
I group — healthy
II group — practically healthy
III group —patients in compensation stage
IV group — patients in sub c o m p e n s a t i o n stage
V group — patients in n o n compensation stage
3.2. Social — medical aspects of major chronic diseases
From all diseases as it has already been said, certain groups of diseases
are allocated w h i c h have special influence on public health and d e m a n d
purposeful medico-social m e a s u r e s .
A c o r d i n g to the social importance a m o n g these diseases the first place
is occupied by cardiovascular diseases.
T h e y are on the first p l a c e a m o n g the reasons of mortality rate of the
population (more half of all death rate), on the first place a m o n g the
reasons of proof disability (20-22 % ) , on the second place a m o n g the
reasons of the general morbidity of the population (22 %) and effect people,
mainly of middle and old age.
 They are named the "Plague" of XX century, emphasizing the exclusive
role which they play, first of all, among the reasons of death of people.
In Ukraine the value of people died of diseases of the blood circulation
system for the last decade is more than 60,0 %, and on every 100 thousand
inhabitants m o r e than 710 persons died annually.
Diseases of heart and vessels are the principal reason of physical
inability of people. Its result consist 20-22 % of all cases of p r o o f disability.
Cardiovascular diseases affect mainly p e o p l e of m i d d l e and old age. It
is that part of the population which is marked not only of significant w o r k
capacity, but experience as well.
Therefore, of losses (first of all economic) in which these diseases result,
essentially exceed their specific part among this contingent of patients.
Sexual features of mortality rate and cardiovascular diseases are the
following: average parameters of mortality rate from cardiovascular
diseases of m e n and w o m e n are approximately identical, standardized - in
men almost twice higher in comparison with w o m e n .
In particular,significant advantage m e n h a v e before w o m e n
concerning such reason of death, as ischemic heart disease. H e r e advantage
reaches m o r e than two times, and the mortality rate of m e n from a heart
attack of a m y o c a r d i u m in the age of 30-59 years is in 3-6 times is higher in
comparison with w o m e n .
A v e r a g e parameters of general morbidity of diseases of blood
circulation system by w o m e n almost twice higher in comparison with m e n ,
and standardized - approximately identical, in particular by hyper
tonic disease and vascular defects of brain.
Standard parameters of the general morbidity of ischemic heart disease
are higher in m e n , in particular in the age of 40-59 years. Nevertheless,
rheumatism is almost twice higher at w o m e n .
Value of diseases of system of blood circulation indefatigably grows with age
of people. Mortality rate from cardiovascular diseases in the age of 60 years and
more senior in 67.0-74.0 times above in comparison with the age under 20 years.
Growth of mortality rate from ischemic heart disease carries exponential
character as in every five years age group mortality rate roughly twice exceeds
a parameter of previous age group (at young age—at 5-10 times).
M u c h m o r e slowly in comparison with mortality rate the general
morbidity g r o w s : in the age of 70 years and senior it exceeds 30 t i m e s
morbidity in the age of 15-19 years.
As to ischemic disease of heart, morbidity growth here is much higher: in
70 years it and senior it is in 75.0 times more, than in 25-29 years.
D y n a m i c s . Since the second half of 60th two opposite tendencies in
distribution of diseases of heart and vessels were determined. Mortality rate
advanced in the countries of E u r o p e and Northern A m e r i c a and started
reducing steadily having fallen for the last 25 years from ischemic heart
disease of on 11 %, from vascular defects of brain - on 30 %.
It w a s the result of the thought over and consistently introduced
system of p r i m a r y and secondary prophylaxis of these diseases and their
consequences.
In U k r a i n e mortality rate from diseases of heart and vessels in these
years indefatigably g r e w to the middle of 80th years then there has c o m e
the period of fluctuations.
So, from 1975 till 1985 mortality from diseases of blood circulation system
-
has increased from by 556,4 up to 757,8 died inhabitants on 100 thousands.
After significant falling in 1986 (up to 678,4 on 100 thousand) it has
risen up to 714,7 in 1988 then again has sharply g o n e d o w n in 1990 - up to
641,5 inhabitants died on 100 thousands, then again has promptly risen up
to 782,6 in 1993 then continues to creep u p w a r d s (1996 - 874,2 on 100
thousand persons). /
Mortality rate from a heart attack of a m y o c a r d i u m steadily grew, from
hyper tonic disease w a s stabilized, from vascular defects of brain, as well
as from a heart attack of a m y o c a r d i u m , grew.
D y n a m i c s of primary mortality almost repeated d y n a m i c s of mortality
rate. T h e bases g r o u p s of cardiovascular diseases for the last years,grew: a
heart attack of a m y o c a r d i u m - from 86,3 in 1985 up to 107,8 in 1995 (on
100 thousand adults ), a stenocardia - according to 106,2 up to 289,9, hyper
tonic disease — from 514,1 up to 8 2 7 , 5 , vascular defects of brain — with
246,8 up to 581,5 on 100 thousands of adults.
Social features.
In separate social layers of a society essential differences of diseases
by cardiovascular diseases are observed.
So, a m o n g c o u n t r y m e n these diseases w e r e found out twice m o r e often
in c o m p a r i s o n with city.
In particular, there is a great difference concerning hyper tonic disease
(in 2,8 times), ischemic heart disease of (in 2,1 times), vascular defects of
brain (in 2,1 times).
 In separate age groups this difference i s s t i l l big. S o , in the age of 2 0 -
39 years hyper tonic disease -among c o u n t r y m e n m a k e s 38 %o, city — 13,8
(in 2,8 times is higher), in the age of 4 0 - 5 9 years accordingly 142,1 and
54,9 %o (in 2,6 times is higher).
V a s c u l a r defects of brain in countrymen of 4 0 - 5 9 years old are meet
in 3 times m o r e often in c o m p a r i s o n with city.
Diseases of system of blood circulation system a m o n g mothers of
incomplete families is in 2,1 t i m e s higher in comparison with c o m p l e t e ,
including concerning r h e u m a t i s m — in 4,9, ischemic heart disease of — in
2,7, vascular defects of brain — i n . 2 , 0 , diseases of arteries and veins - in
2 , 1 , than hyper tonic disease - in 1,9 times is higher.
Regional features. - -
Mortality rate from cardiovascular diseases has essential regional
differences.
In the east - central region of Ukraine which has the worst integrated
parameter of health, mortality rate under this reasons is the highest and for last
decade on 28,2 % mortality rate prevailed in the most optimal western region.
It concerned also the separate reasons, for e x a m p l e , from hyper tonic
disease (on 15,7 % ) , vascular defects of brain (on 172,7 % ) .
If we consider separate areas of Ukraine here differences will be
greater. So, mortality rate from diseases of heart and vessels in general in
Vinnytsya area w a s in 2 times higher in comparison with Zakarpatya.
Concerning the separate reasons differences were even more bigger: so,
mortality rate from rheumatism in Vinnytsya area was by 72,9 % higher, than in
Mykolaiv, from hypertonic disease in Kharkiv area in 4,5 times higher, than in
Chernivtsi, from vascular defects of a brain in the Sumy area in 4,3 times higher,
than in Ivano-Frankivsk and from a heart attack of a myocardium in Republic of
Crimea in 2,5 times higher, than in Khmelnytsky area.
Unfortunately, the official reporting often changes a technique of data
presentation about diseases of system of blood circulation and their
prevalence. Concerning separate diseases it is necessary to note, that
regional differences of morbidity are even more significant in comparison
with mortality rate.
So, for the last decade general morbidity of vascular defects of brain in
the east - central region w a s higher in comparison with western in 2,4
times, at the s a m e time general morbidity of r h e u m a t i s m , on the contrary,
in the western region w a s on 40,9 % higher, than in east - central.
General morbidity of rheumatism w a s higher in Zakarpatya area in
c o m p a r i s o n with Kharkiv in 3,1 times, hypertonic disease in Z h y t o m y r area
in c o m p a r i s o n with Zaporizhya — in 2,3 t i m e s , of vascular defects of a brain
in the S u m y area in comparison with Ternopil - in 5,4 times, and of heart
attack of a myocardium in Republic of Crimea in comparison with
Z h y t o m y r area — in 2,2 times.
A m o n g the social - medical reasons of cardiovascular diseases are
following: insufficient physical activity and the use of tobacco, poor
nutrition w h i c h result in excessive weight and psychoemotional overstrain.
In w h a t m e a s u r e t h e s e , differences are predetermined by social,
ecological, sexual and age factors,a level of availability and quality of
medical care is the task of social medicine (medical science).
•
Cancer
P r o b l e m N° 2 of public health is a cancer. In general, a m o n g 50 million
p e o p l e w h i c h die in the world each year, 5 millions die from cancer. In the
advanced countries the part of cancer a m o n g the reasons of death reaches
20 %.
In Ukraine this particle is much lower 12-13 % and frequency of
death has m a d e in 1995 -200,8 died inhabitants per 100 thousands.
C a n c e r are one of principal reasons of physical inability. Their part is
almost the s a m e , as diseases of blood circulation system (19-20 % ) .
Primary morbidity of cancer is rather small: for the last d e c a d e it -has
m a d e in U k r a i n e 271,1 cases on 100 thousand inhabitants;
general morbidity — 1206,9; a so-called index of accumulation (the rate
of general morbidity and p r i m a r y = 4,5).
So, at rather small prevalence of cancer, they h a v e heavy
consequences.
Sexual features of mortality rate and morbidity of cancer are the
following: mortality rate a m o n g m e n is higher in comparison with w o m e n
in all age groups, and this index d e p e n d s on age.
So, if in the age of 30th years it m a k e s almost 20 %, in the age of 70
years and older almost 1 0 0 % .
Indices of morbidity of m e n and w o m e n are different. F o r last 50
years age morbidity a m o n g w o m e n (on 20-30 %) prevails due to diseases
of female genitals; after (>() years disease of m e n considerably e x c e e d s same
a t w o m e n ( b y 70-100 % ) .
 W i t h the years,mortality rate and morbidity of cancer p r o m p t l y g r o w s ,
so in the age of 70 years and older, in comparison w i t h the age u n d e r 30
years, mortality rate increases in 95 times, disease — in 90 times.
Dynamics.
A c c o r d i n g to the data of W H O , for last 40 years age parameters of
mortality rate a m o n g m e n testify reduction of mortality rate from a cancer
of a stomach and a gullet, increase — from cancer of respiratory system and
stabilization from other kinds of cancer.
In general parameters h a v e increased due to predominant increase of
mortality e from a cancer of respiratory system. At w o m e n , a g e parameters
of mortality from cancer of respiratory system, stomach and the cancer of
cervix and uterus h a v e decreased.
At the s a m e time mortality rate from cancer of respiratory system in
w o m e n is grew. Nevertheless, in general, in w o m e n the great increase of
mortality rate from cancer hasn't taken place.
In U k r a i n e the general parameters of mortality from cancer are g r e w in
the following rates (by 100 thousand inhabitants): 1975 - 140,6; 1980 -
149,5; 1 9 8 5 - 168,8; 1 9 9 0 - 1 9 5 , 4 ; 1 9 9 5 - 2 0 0 , 8 .
At the end of 70th the tendencies of mortality from cancer of a
stomach and organs of respiratory system w e r e crossed at the certain
decrease in mortality rate from a cancer of a stomach (1975 — 3 3 , 3 ; 1980 —
3 0 , 5 ; 1985 - 30,6; 1990 - 2 9 , 8 ; 1995 - 28,1) and p r o m p t growth of
mortality rate from a cancer of respiratory system organs (1975 — 2 8 , 3 ;
1980-32,6; 1985-39,7; 1990-49,1; 1995-47,2).
Mortality from cancer of respiratory system achieved also a step rise
( 1 9 7 5 - 8 , 1 ; 1 9 8 0 - 9 , 3 ; 1 9 8 5 - 11,3; 1 9 9 0 - 1 3 , 1 ; 1 9 9 5 - 1 5 , 1 ) .
Primary morbidity rate of cancer is also steadily proving: in 1985 it
has m a d e 275,2 cases on 100 thousand inhabitants, in 1990 — 3 0 1 , 2 ; in
1995-308,1.
Social features. Mortality rate from cancer a m o n g social layers of the
society have not been investigated till n o w .
T h e official statistical reporting doesn't assume such studies because
special researches d e m a n d very large value of population w h i c h are rather
difficult for carrying out in practice.
Statistics of mortality from cancers a m o n g city and rural population
isn't true due to the fact died c o u n t r y m e n practically do not give in to
pathologo-anatomical research, (it reduces real values of m o r t a l i t y ) .
B e l o w the results of special research of morbidity of cancer a m o n g
s o m e social layers of a society are given diagram.
As we can see, a m o n g countrymen in comparison with city dwellers
and a m o n g incomplete families in c o m p a r i s o n with c o m p l e t e , levels of
morbidity are m u c h higher.
To give an exhaustive explanation to these differences is impossible
meanwhile. The new profound researches are necessary. Among risk factors of
cancer the most investigated is the role of nicotine and lacks of nutrition.
Morbidity risk of cancer of respiratory system of person w h o abuse
tobacco, is in several times higher in comparison with those w h o does not
use tobacco. B e s i d e s , 96 % persons die of a cancer of lungs - those w h o
used tobacco.
On development of cancer are also influence such factors, as solar and
other radiation, contaminated air, filled with so-called carcinogenic substances,
first of all exhaust gases of automobiles, late marriages, abortions, an early
excommunication or a complete excommunication of infant.
In general, m o r e and m o r e certificates are gathering that the w a y of
life essentially influences morbidity of cancers and confirmation to this are
regional features of morbidity and mortality from cancer.
Except for the data which w e r e mentioned a b o v e , we m a y add the
following information.
F o r the last decade mortality from cancer in the east - central region of
U k r a i n e is 189,2 died inhabitants per 100 t h o u s a n d s , and in w e s t e r n - 123,3
that is on 53,4 % lower, primary disease accordingly - 2 7 8 , 0 and 206,9 or
on 34,4 % is lower.
T h e r e is interesting data concerning s o m e kinds of cancer.
Mortality from cancer of respiratory system in the east — central region
of republic is on 64,2 % higher in c o m p a r i s o n with western and if to study
separate areas in Z a p o r i z h y a - in 2,4 times is higher, than in Zakarpatya.
Morbidity from those diseases is accordingly higher on 38,8 % (and in
t Dnipropetrovsk area is in 2 times higher in comparison with Rivne).
Morbidity of cancer of skin in the east - central region is on 46,2 %
higher, than in western (in Vinnitsa area in 2,4 t i m e s is higher, than in
Zakarpatya). .
Mortality from a cancer of respiratory system in Kharkiv area is also
in 2,8 times higher, than in Zakarpatya.
 A m o n g the bases social factors w h i c h affect distribution of c a n c e r are:
lack of nutrition, smoking, p s y c h o e m o t i o n a l overstrain, radiating pollution,
air pollution by exhaust g a s e s , artificial interruption of p r e g n a n c y , etc.
Each fourth inhabitant suffers from mental disorders. Most of them
neurological diseases on the basis of which the different somatic diseases arise
often and chronic alcocholism.Only in Ukraine more than one million chronic
alcoholics are registered. The narcotism and glue sniffing are distributed,
almost 400 thousand addicts and glue sniffers are n o w registered.
The bases social reasons of this phenomenon are low culture, family
disorders, insufficient education, psychoemotional overstrain, traditions, etc.
In Ukraine m o r e than o n e hundred thousands A I D S patients are
registered.
Every year their value g r o w s .
T h e important social — medical problem are accidents, poisonings and
traumas.
T h e y o c c u p y the HI p l a c e a m o n g the reasons of mortality reasons and
the s a m e place a m o n g the reasons o f p r o o f disability (9-10 % ) .
T h e bases social reasons of the accidents and t r a u m a s are alchogolism,
social and e c o n o m i c disorders, the insufficient organization of the safety
precautions at production.
Questions for self-checking:
1. Subject and the contents of a d e m o g r a p h y , parameters of health.
2. Population census, technique of its carrying out.
3. D y n a m i c s of birth rate and mortality rate in Ukraine.
4. T e c h n i q u e of calculation of birth rate.
5. T e c h n i q u e of calculation of mortality rate.
6. Infant mortality rate.
7. Other mortality parameters of infants.
8. C o n c e p t about average duration of an expected life.
9. T e c h n i q u e of studying of morbidity parameters. > — T h e international cooperation;
10. T h e reasons of the general and primary morbidity.
11. T h e bases reasons of temporary disability.
12. T h e bases reasons of p r o o f disability.
13. T h e bases parameters of physical development.
14. T h e major chronic social diseases — cardiovascular, cancer, accidents,
poisonings, t r a u m a s and their reasons.
Section 4 . O R G A N I Z A T I O N O F P U B L I C H E A L T H S E R V I C E S A N D
MEDICAL CARE
•
It is n e c e s s a r y to distinguish two concepts if we are talking about
public health services: "public health services" and "medical care".
"Public health services" m a y be defined as follows:
Public health services -is a system of state, public, individual actions
and m e a n s w h i c h assist health, prevention of diseases and the prevention of
p r e m a t u r e death, maintenance of persons active ability to live and work.
Definition o f " medical care " is the following: medical services - is a
system of special medical actions and m e a n s which assist health,
prevention of diseases and the prevention of premature death, maintenance
of p e r s o n s active ability to live and work.
S o , the concept o f " public health services " is universal, it includes
everything, that concerns the health of p e o p l e : state policies, social and
e c o n o m i c conditions of people, environment of conditions, b e h a v i o r of
p e o p l e or their w a y of life, etc.
"Medical care" — is a c o m p o n e n t of public health services,which
* covers special activity of medical institutions.
M a i n principles on w h i c h the public health services and medical care
in Ukraine are based:
— T h e state character with equal rights for the existence of public and
private o w n e r s h i p ;
— Decentralization of m a n a g e m e n t ;
— Socially focused availability;
— E c o n o m i c efficiency;
— A preventive orientation;
— A free choice of the doctor;
— Scientific m a i n t e n a n c e ;
— W i d e participation of the public in public health services;
These bases are proclaimed in " Bases of the legislation of Ukraine about
public health services ", which accepted by the Supreme Council in 1992.
A l s o we should stop on the following major aspects of this act on
which public health services and medical care in U k r a i n e are developed.
The law proclaims the right of each person on public health services.
T h e right on public health services provides:
 1) H i g h standard of life, including clothes^ dwelling, medical care both
social service and the m a i n t e n a n c e , necessary for health of the person;
2) E n v i r o n m e n t safe for life and health ;
3) Sanitary - epidemic well-being of territory and settlement w h e r e the
citizen lives;
4) Safe and healthy w o r k i n g conditions, life and rest;
5) T h e qualified health care, including free choice of the doctor and
establishment of public health services;
6) T h e authentic and up-to-date information about the condition of the
health of all people, including existing risk factors and their degree;
7) Participation in discussion of projects of acts and offers concerning
formation of a state policy in the field of public health services;
8) Participation in m a n a g e m e n t of public health services and carrying out
public examination on these questions in the order, stipulated by the
legislation;
9) Opportunity of association in public organizations with the p u r p o s e to
assist public health services;
10) Legal protection from a n y illegal forms of discrimination connected
with personal state of health;
11) C o m p e n s a t i o n of the h a r m caused to health;
12) T h e appeal of wrongful decisions and actions of workers,
establishments and bodies of public health services;
13) Opportunity of carrying out of independent medical examination in
case of disagreement of the citizen with conclusions of the state
medical examination, application to him of c o m p u l s o r y treatment and
in other cases if actions of the worker of public health services can be
the humiliate of h u m a n and civil rights;
At the s a m e time, the law also regulates duties of citizens in the field
of public health services, n a m e l y :
1) D u t y to take care of the health and health of infant, not to be harmful to
health of other citizens;
2) In the cases stipulated by the legislation to pass preventive medical
examinations reviews and to do inoculations;
3) To live the e m e r g e n c y care to other citizens w h o are in m e n a c i n g for
life or health ;
4) To execute other duties stipulated by the legislation concerning public
health services;
State, public and other organs, enterprises, organizations, officials and
citizens are obliged to provide priority public health services in their o w n
activity, not to d a m a g e the health of the population and separate persons, in
borders Of the c o m p e t e n c e to live the care to patients, invalids and suffering
from accidents, to assist the activities of the w o r k e r s of medical organs and
establishments of public health services, and also to execute other duties
stipulated by the legislation on public health services.
According to the law the state policy of public health services is provided
with budgetary assignations in volume according to its scientifically-grounded
based needs, but not less than 10 % of the national income.
T h e law stipulates the financing of departmental and other
establishments of public health services which serve only separate
categories of the population, at the expense of the enterprises,
establishments and organizations to w h i c h they serve.
T h e law stipulates gradual creation of the system of medical insurance.
T h e n b u d g e t a r y funds, m e a n s o f the e n t e r p r i s e s , e s t a b l i s h m e n t s a n d
the organizations, and also the personal means of citizens will be
g a t h e r e d b y i n s u r a n c e o r g a n i z a t i o n s w h i c h start t o f i n a n c e g i v i n g o f
medical care.
It is supposed to develop the special law concerning medical
insurance. G o v e r n m e n t organizes material support of the public health
services in the v o l u m e necessary for giving for the population of the
guaranteed level of the health care.
All establishments of public health services h a v e the right to solve
questions of the material support independently.
T h e law regulates professional rights, privileges and duties of medical
workers.
P R i g h t s a n d privileges:
I n o c c u p a t i o n with medical and pharmaceutical activity according to a
specialty and qualifications;
2) Appropriate conditions of professional w o r k ;
3) I m p r o v e m e n t of professional skills, retraining not less than o n c e in five
- years in the corresponding establishments;
4) Free choice of the approved forms, m e t h o d s and m e a n s of activity,
introduction of modern achievements of a medical and pharmaceutical
science and practice;
5) Gratuitous age of the social and special medical information necessary
^ f o r realization of professional duties;
6)- Obligatory insurance at the expense of the proprietor of establishment
of public health services in case of causing h a r m to their life and health
in connection with performance of professional duties in the cases
stipulated by the legislation;
7) The social care of the state in case of disease, invalidity or in other cases of
disability which were caused by performance of professional duties;
8) To fix in official organs of public health services average rates and
official salaries at the level, w h i c h not lower from average w a g e s of
industry workers ;
9) T h e reduced working day and additional p a y m e n t rest in the cases
established by the legislation;
10) Concessionary terms of a provision of pensions;
11) Preferential providing with dwelling and p h o n e ;
12) Gratuitous using an apartment with heating and lighting by those w h o
live in a countryside, giving of privileges concerning p a y m e n t of the
land tax, crediting, providing the a facilities and construction of o w n
h o u s e , p u r c h a s e of auto and motor-transport;
13) P r i m e reception of the treatment-and-prophylactic care and provision
with medical and orthopedic m e a n s ;
1 4 ) C r e a t i o n of scientific medical societies, trade u n i o n s and other public
/
organizations;
15) Legal protection of the professional honor and dignity.
Besides, other rights and privileges for medical and pharmaceutical
workers can be stipulated. By the legislation privileges,which are
established for the workers by the enterprises, also can be distributed to
t h e m by establishments and the organizations to w h i c h they give the health
care.
•
Duties:
1) To assist protection and strengthening of health of people, prevention
and treatment of the diseases, to give qualified medical care;
2) Free-of-charge emergency call service to citizens in case of accident
and other extreme situations; . and then district hospitals (since the fortieth years). T h e district doctor also
3) To distribute scientific and medical knowledge a m o n g the population, to
propagandize, including o w n example, a healthy way of life;
4) To keep the requirement of a professional etiquette and of a deontology,
to save medical secret;
5)" To raise constantly the level of a professional k n o w l e d g e and skills;
6) To live the advisory care to the colleagues and other workers of public
health services.
T h e bases principles w h i c h b e l o n g to medical care in Ukraine, d e m a n d
m o r e detailed consideration. T h e m o d e r n system of medical care in Ukraine
is a c o n s e q u e n c e of long evolutionary development. Its sources as it is scare
above, begin after the cancellation of serfdom in Ukraine, having received
the n a m e of public medicine.
T h e first principle on which the public m e d i c i n e w a s created, w a s its
availability to people. There w a s an idea to divide territory administrative
unit (district, province) on so-called districts and to employ the doctor so
that he gave inhabitants of that district accessible medical service.
At first, the doctor has driven around district (so-called traveling
system of public medicine), and then the system has been replaced by
stationary one w h i c h essence w a s , that in the territorial center of a district
the hospital w a s situated w h e r e the doctor stayed constantly.
Districts gradually became smaller and at the moment of apogee of public
medicine (1913) have achieved the following middle parameters: radius of a
district — 20 km, number of inhabitants on a district—28 thousands.
T h e Soviet medicine has b o r r o w e d a district of the organization as the
basic and with the end of its existence has finished normative parameters of
districts to the following figures: a rural medical district — radius of 7 km,
n u m b e r of inhabitants - 4 thousands.. In city districts b e c a m e differentiated.
So-called therapeutic district for adult population, was limited to 1700
inhabitants, pediatric — to 800 children.
In the independent U k r a i n e these figures have b e e n tested in 1999: in a
city therapeutic district -2041 inhabitants, on pediatric — 704 children, on a
rural 1 district —3850 children and adults in total.
T h e principle of availability w a s united with a principle of
qualification of medical care.
Therefore, near to development of districts, there w a s a superstructure
above them, all over again as district hospitals (since the twentieth years),
specializes, dividing into divisional of the pediatrician and the therapeutist
(from the end of the fortieth years).
 Districts should give the primary health care, district and city hospitals - Place of its w o r k can be a separate medical a m b u l a n c e station.
specialized and regional establishments — highly specialised care. Directing patients to n a r r o w specialists or to a hospital, the family
So there is a three-level system of medical care. Each following level doctor, unlike modern district doctor, does not finish his function, but
should give not only higher degree of the specialized care, but also to together with the n a r r o w expert or the doctor of a hospital continues
supervise over lower levels. supervision over the patient and giving him the care.
By v o l u m e medical service was distributed as following: a primary After long years of discussions family m e d i c i n e in Ukraine began to
level - 5-20 %, secondary - 4 0 - 7 0 %, tertiary - 10-20 %. develop. In 2 0 0 2 year there w e r e 1352 family doctors.
Meanwhile, world experience proves, that the primary level can concentrate It is still not enough if to take into account, that the n u m b e r of
up to 90 % of all volume of medical care (as it was during the period of public medical districts in U k r a i n e e x c e e d s 35 t h o u s a n d s (2002).
medicine) and narrow specialists should concentrate on giving the more complex The Soviet medicine has saved a principle of gratuitousness of medical
care which demands application of high medical technologies. care for patients and considerably it has developed, having passed medicine
T h e basic quantity indices of the n e t w o r k of medical institutions in completely in duties of the state. It was a significant step forward which had
Ukraine n o w is the following (tab. 4.1). huge global consequences. T h e state maintenance of medicine was gradually
distributed in the world, and n o w there is no civilized country where the part of
Table 4.1. Bases parameters of system of medical care in Ukraine, 1999 the state in financing of medicine would be smaller than 75 % (besides of the
1. Number of hospital establishments 3122 U S A where this part makes roughly 50 % ) .
2. Number of establishments which give the out-patient — 6429 • H o w e v e r the state maintenance of m e d i c i n e , besides doubtless positive
(polyclinic) medical care advantages, has also the essential lacks.
3. The general number of hospital beds 444495
First, always it is not sufficiently provided with m e a n s .
4. Total number of doctors (including dental) 205759
A c c o r d i n g t o r e c o m m e n d a t i o n s o f W H O (World Health Organization
5. Total number of nurses 498845
), on medical care the state can allocate not less than 6,5 % of the total
6. Number of doctors on 10 thousands people 41,6
internal product.
7. Number of nurses on 10 thousands people 100,9
If it is less allocated it will inevitable resulted in an impoverishment
8. Number of hospital beds on 10 thousands people 89,9
and backlogs of medicine.
9. Average capacity of hospital establishments:
T h e second lack is that the m e a n s are irrationally spent. It has lead to
Area hospital 837
190 upset of the display ratio of factors of medical care :a lot of medical
City hospital
230 workers w e r e trained but medical technologies were not developed.
Regional hospital
District hospital 73 Besides state source of financing, which can remain the basic (not less
Local hospital 16 than 80 % from needs ), in conditions of the market should exist other
sources of financing: public and private.
T h e public m e d i c i n e has introduced a preventive orientation of
T h e doctor of the general practice or the family doctor can m a k e a
medicine. As a preventive direction, the Soviet m e d i c i n e has proclaimed an
basis of a primary level of medical care. He can not be appointed, but
a m b u l a n c e station and a polyclinic.
selected by patients. H i s financial state can be determined by n u m b e r of
patients w h i c h h a v e selected h i m . T h e basic m e t h o d of w o r k of a m b u l a n c e stations and polyclinics
He should not enter structure of city or central district hospital, and b e c a m e dispensary, w h i c h essence has consisted in active revealing of
have administrative, financial and legal independence. patients and their active improvement. C o m p l e x and target routine
examinations of the population have b e e n introduced.
 Rationality dispensary m e t h o d did not cause doubt and d u e to them
indisputable successes in revealing a lot of diseases, first of all infectious, a
tuberculosis, venereal, malignant, etc. h a v e been achieved.
F o r years of independence of the basic changes in a preventive
orientation of system of medical care in Ukraine has not taken place.
T h e dispensary method from obligatory has passed to the category of
desirable.
H e r e still m u c h should be corrected and finished.
Q u e s t i o n s for self-checking:
1. G i v e definition of the concept "public health services" and "medical
care".
2. T h e fundamental principles of public health services and medical care
in Ukraine.
3. T h e legislation bases of Ukraine about public health services, their
essence.
4. Introduction of bases of availability, qualification, gratuitousness and a
preventive orientation of medical care in Ukraine.
4.1. Organisation Features of Treating-And-Prophylactic Care to
U r b a n Population, W o r k e r s of the Industrial Enterprises and
Constructions
T h e basic organizational form of giving medical care to the population in
city is versatile city hospital. It consists of the following departments:
polyclinics, hospital, auxiliary diagnostic-medical service and administrative
service. The object of activity of hospital is the population of all city or its
certain part district. City hospitals are of two types: for adults and children.
T h e primary goals of city hospital are the following:
1. Giving of the inhabitants of the fixed district the primary health care.
2. Giving to inhabitants the specialized medical care from the basic
structures.
3. Preventive services o f the population.
4. Expertise of t e m p o r a r y disablement.
5. Maintenance of sanitary - e p i d e m i o l o g i c a l well-being
^activity.
6. Educative activities.
7. T h e organization of the public activity for participation in business and
i m p r o v e m e n t of medical care.
T h e territory of activity is divided into medical districts w h i c h are
headed by district doctors. T h o s e are leading specialists of the city hospital.
T h e district nurses help them.
Besides district doctors, n a r r o w specialists w o r k in the structure of
polyclinics. Their n u m b e r is determined in each polyclinic according to the
needs,but the total n u m b e r d o e s not e x c e e d the limits of the specification
authorized by store department of Ministry of public health services
( M P H s ) in Ukraine.
T h e m o d e r n city polyclinic, as a rule, gives the specialized out-patient
care of 15-35 specialties.
N a r r o w specialist consult patients w h o are sent to t h e m by district
doctors, and also conduct independent reception of patients. Dispensary
patients,who need the specialized care, are under supervision of the narrow
expert.
T h e polyclinic spends anti-epidemic actions.
First of all, they are carried out by district doctors.
Besides, in structure of a polyclinic there is a cabinet of infectious
diseases w h e r e all patients with the fever and suspicion on an infectious
disease m u s t go. T h e cabinet of infectious diseases carries out necessary
inoculations according to the established n o r m s and requirements.
First of all, it concerns children.
In structure of polyclinics the Day— hospitals and hospitals i n - h o m e
are organized recently. D a y -hospitals are opened in the specially equipped
r o o m s and can have several or tens beds.
Patients are sent by district doctors and n a r r o w specialists for carrying
/ out medical actions which are taken from m o r n i n g till evening according to
an individual plans.
We speak about chronic patients w h o need scheduled anti-relapse and
precautionary treatment. T h e patient is sent h o m e for night.
i A hospital at h o m e is carrying out the certain diagnostic and medical
actions to the patient at his place. As a rule, it deals with chronic patients
w h o can be examined and treated by portable equipment.
in area of In 2 0 0 2 in Ukraine in structure of day — hospitals and hospitals i n -
h o m e m o r e than 2,5 million patients w e r e treated.
 F o r optimization of streams of patients that go to a polyclinic,
departments of preventive maintenance are organized. T h e y consist of such
subdivisions: a r o o m of pre-medical reception, r o o m s of the therapeutist
and the basic specialists (the neurologist, the oculist, the otholaryngologist,
the surgeon), a fluorographic room, clinical laboratory. In the room of
premedical reception medical workers work.
Here medium level a blood pressure, visual acuity and hearing are
measured to patients, ECG and some other simple examinations are being
m a d e , the patients are sent to X-ray and laboratory examining. By results of
these previous examinations a patient is directed to doctors r o o m s . T h e
department of preventive maintenance allows to order the carrying out of
preventive examinations and to rationalize the further reception of patients
in the polyclinic.
In structure of polyclinics the departments of rehabilitation are
organized recently.
Patients are sent for renovated treatment after the end of an acute
disease period.
The basic contingent of departments of rehabilitation -orthopaedical,
traumatological, neurological and cardiovascular patients. Here the wide
spectrum of renewal means is used: physiotherapy, balneology, work therapy.
In the polyclinic patients are selected to hospitalization.
Patients from district doctors room a n d doctors of a n a r r o w specialty
are sent to a reception department. H e r e the patient is e x a m i n e d , the
primary medical d o c u m e n t is filled in p a t i e n t ' s card and the g o e s to the
special department.
City hospitals contain, as a rule, 5-10 specialized stationary
d e p a r t m e n t s of therapeutic a n d surgical character.
Capacity of departments changes from 20 up to 80 b e d s . In a hospital
all store of diagnostic and medical actions and m e a n s for c o m p l e t e
examination and treatments of patients is used.
Besides dispensary and hospital care, the people m a y receive an
e m e r g e n c y care,that is given by e m e r g e n c y stations.
T h e y include the general and specialized brigades equipped with
special diagnostic m e a n s a n d transport. T h i s e m e r g e n c y care is given
twenty-four-hour. T h e care is given at h o m e , in case of need the patient is
hospitalized to a hospital. In the b i g cities special hospitals of e m e r g e n c y
care are organized w h i c h accept patients in acute states all d a y and night.
In cities the c a r e to inhabitants is organized not only by territorial, but
also by an industrial principle. T h e essence of last the o n e is, that at the
enterprises m e d i c a l care centres ( M C C ) are developed.If there are m o r e
than 4 t h o u s a n d s w o r k e r s on the enterprise, M C C includes a polyclinic and
hospital. B e s i d e s it m a y include dietary dining r o o m and dispensaries.
For smaller n u m b e r s of workers, M C C consists only of a polyclinic
and if the n u m b e r of workers less than 1000, medical or medical assistant's
stations are created.
M C C may be of closed (treat only workers of the enterprise and their
family) a n d o p e n t y p e s (treat also the population of district which adjoins).
M a i n principle of P r i m a r y care center is w o r k the same, district. B u t the
districts h e r e are the shops of the enterprise. T h e doctor is called as the
shop doctor. He observes 2 t h o u s a n d s of w o r k e r s .
Periodically, d e p e n d i n g on available industrial harmfulness, the shop
doctor or the medical assistant organizes routine examinations of w o r k e r s .
By results of the examination chronic patients are taken on dispensary
registration. Special attention is preventive of industrial traumatism.
By results of state of workers health,every year physicians M C C
together with trade union and administration of the enterprise m a k e a
c o m p r e h e n s i v e plan of the sanitary m e a s u r e s aimed at i m p r o v e m e n t of
w o r k i n g conditions and life of workers and i m p r o v e m e n t of their health.
Q u e s t i o n s for self-checking:
1. Structure and functions of the city incorporated versatile hospital.
2. Duties of a district doctors a n d district nurses.
3. Structure a n d functions of a m e d i c a l care centres.
4.2. Maternity C a r e a n d Childhood
In Ukraine during the years of its independence a n u m b e r of the
important acts and the state p r o g r a m s aimed at improvement of health of
w o m e n and children was accepted.
T h e law "About the state help to families with children" establishes a
level of material support to families w i t h children a n d guaranteed state
help w i t h d u e regard to family, its structure i n c o m e s , age,children's health,
etc.
 T h e following k i n d s of the state help are stipulated:
1) M o n e t a r y p a y m e n t s on p r e g n a n c y and child birth. T h e size of the care
m a k e s , as a rule, 100 % of earnings;
2) A l u m p sum allowance at a birth of the child. This care is given to
families in the quadruple n u m b e r of the minimal w a g e s . To m o t h e r s ,
w h o w a s registered in medical institution in early terms of pregnancy
(till 12 w e e k s ) , on a regular basis of attendance and carried out the
r e c o m m e n d a t i o n of doctors, at a birth of the child the additional care in
the d o u b l e size of the minimal w a g e s is given;
3) M o n e t a r y p a y m e n t s of the children till his three-year old age is given to
w o r k i n g w o m e n (or to other m e m b e r s of family) at a rate of the minimal
w a g e s irrespective o f w o r k e x p e r i e n c e ;
4) M o n e t a r y p a y m e n t s to mothers (parents) occupied care with three and
m o r e children till 16 years old; are appointed at a rate of the minimal
w a g e s at presence of three children and double minimal w a g e s at
presence of four and m o r e children;
5) M o n e t a r y p a y m e n t s of the children — invalids till h i s reaching 16-years
old at a rate of the m i n i m a l w a g e s ;
6) M o n e t a r y p a y m e n t s on temporary disability in connection with care of
the ill children till 14 years old;
7) M o n e t a r y p a y m e n t s on c h i l d r e n till 16 y e a r s o l d ( p u p i l s - till 18
y e a r s ) is g i v e n at a rate of 50 % of the m i n i m a l w a g e s on e a c h child
if the monthly average cumulative income on each m e m b e r of family
for p r e v i o u s y e a r d o e s n o t e x c e e d the t r i p l e n u m b e r o f t h e m i n i m a l
wages;
8) M o n e t a r y p a y m e n t s on children to single -unmarried m o t h e r s , in n u m b e r
half or c o m p l e t e minimal w a g e s on each child till 16 y e a r s old (pupils -
till 18 years);
9) M o n e t a r y p a y m e n t s on children of military m e n of e m e r g e n c y services is
given at a rate of the m i n i m a l w a g e s on each child;
10) M o n e t a r y p a y m e n t s on children w h o are under s o m e b o d y ' s
guardianship (trusteeship) or care; is given at a rate of double minimal
w a g e s on each child;
11) T h e temporary monetary payments for minor children w h o s e parents
e v a d e from p a y m e n t of the alimony or if collecting of the alimony is
impossible; it is given at a rate of 50 % of the minimal w a g e s on each
child.
In 1997 in U k r a i n e the national target c o m p l e x program "Children of
Ukraine " w a s adopted.
It is the important p r o g r a m , which p u r p o s e is the coordination of
actions connected with the performance of directions of Conference U N O
about the rights of children, according to the Decree of the President of
Ukraine it should provide social protection of children, create favorable
conditions for their physical, intellectual a n d spiritual development.
It is already emphasized in the introduction to the Program in the
primary school, 60 % of children have diseases of i m m u n e system, chronic
inflammatory diseases of respiratory system, organs of digestion,
urinogenital w a y s and a thyroid gland.
T h e objective reasons of acute decrease in the level of health of rising
generation is d e e p social and e c o n o m i c crisis, environmental p r o b l e m s ,
critical condition concerning provision of children with a balanced diet,
w e a k material b a s e of system of medical care a n d education.
T h e p r o g r a m "Children of U k r a i n e " should be a reference point for
taking m e a s u r e s concerning improvement of children health. In particular,
the question is in prophylaxis of disease and providing children most with
the effective medical care, m e a n s of treatment and restoration; carrying out
radical actions on prevention of infectious and parasitic diseases;
introduction of the scientific inventions aimed at on the solution of actual
problems of the childhood.
It is necessary to emphasize, that in the basic directions of the Program
is the great r o l e of family is emphasised in particular.
T h e family remains the best natural environment for physical, mental,
social and spiritual development of infant.
T h e basic m e t h o d s of preservation and strengthening of health in
family conditions are prophylaxis of diseases and keeping the certain
hygienic rules in e v e r y d a y life, o p t i m u m physical activity, b o d y training, a
balanced meal, prevention of the harmful p h e n o m e n a and habits.
As for tasks of the state, the subject of its special attention is reduction
of negative influence of surrounding natural environments on a state of
health of children , development of services of planning family, the genetic
centres, establishments of out-patient — polyclinic network and giving of
the specialized medical care to e a c h child w h o needs it.
It is possible from the p r o g r a m on expectancy the consecutive
reduction of mortality rate of infants up to 12 on 1000 b o r n alive.
 Realization of the b a s e s actions on i m p r o v e m e n t of health of infants,
decrease infant morbidity and mortality rate is assigned by Ministry of
public health services of U k r a i n e .
T h e question is introduction of m o d e r n m e t h o d s of antenatal
diagnostics and treatment genetic disorders; creation of district sanatoria —
dispensary for pregnant w o m e n on the basic of district m o d e r n
establishments and district centres are opened in Kyiv, Lviv and D o n e t s k
for support of w o m e n lactation.
It is supposed to create in Kyiv the Ukrainian c h i l d r e n ' s centres of
chronic hemodialysis and m e t h o d s of treatment; to base the center of
treatment of the n e w b o r n having a retinopathy, to d e v e l o p the program of
d e v e l o p m e n t of the city of Evpatoria as national c h i l d r e n ' s resort.
T h e questions of c h i l d r e n ' s food will be solve consistently and
persistently.
F o r e x a m p l e , it is planned to organize the manufacture of products of
c h i l d r e n ' s meal with pertinacious additives for prophylaxis of morbidity of
children injured by C h e r n o b y l accident.
Realization of the state p r o g r a m "Children of U k r a i n e " will a l l o w to
improve the demographic situation, will provide strengthening of health of
children, will protect them from consequences of social and e c o n o m i c crisis
and will strengthen position of w o m a n in the society.
All t h e s e e m e a s u r e s will assist r e a l i z a t i o n in U k r a i n e a state p o l i c y
of the c o m p l e x s o l u t i o n of p r o b l e m s of the c h i l d h o o d in c o m p l e t e
c o n f o r m i t y w i t h the i n t e r n a t i o n a l s t r a t e g y a c c e p t e d b y the U n i t e d
N a t i o n s O r g a n i z a t i o n and w i t h the C o n v e n t i o n o n t h e r i g h t s o f the c h i l d ,
will e n a b l e t o c r e a t e c o n d i t i o n s for r e a l i z a t i o n i n U k r a i n e t h e W o r l d
declaration on maintenance of survival, protection and development of
children.
Especially medical actions maternity care and childhood are covered
t w o basic units:
1. T h e obstetrical -gynecologic medical care;
2. T h e treatment-and-prophylactic c h i l d r e n ' s medical care. v syphilis is investigated. In case of a p a t h o l o g y the w o m a n is hospitalized,
The basic obstetrical-gynecologic establishments in cities are maternity
homes and obstetrical-gynecological departments of the hospitals, in villages -
obstetrical-gynecological departments of the central regional hospitals.
Maternity h o m e s ( departments) must be provided with the qualified
medical care of pregnant w o m e n , parturient w o m e n and gynecologic
patients. Maternity h o m e s consists of t w o structural parts - antenatal clinic
and a hospital.
Antenatal clinic is a main subdivision of maternity home. It can exist also
as an independent medical institution. Antenatal clinic gives this kind of the
preventive and medical care both to pregnant and gynecologic patients.
D o c t o r s of antenatal clinic and their assistants —nurses w o r k according
to a district principle.
Antenatal clinic starts w o r k i n g from active revealing of pregnant
w o m e n in early terms of pregnancy (on 2-3 m o n t h ) .
Further pregnant w o m e n are under d y n a m i c dispensary supervision.
Early revealing and supervision are aimed at giving the necessary
medical care, finding by pregnant w o m e n of hygienic habits, mental
prophylactic training for the prevention of complications of pregnancy,
prophylaxis of a prematurely, giving a maternity leave to pregnant w o m a n .
Antenatal clinic carries out also supervision parturient women,
controlling their keeping observance hygienic r e c o m m e n d a t i o n s , corrects
bringing up of the child, etc.
T h e area of activity of antenatal clinic is divided on obstetrical districts
which h a v e the district into obstetrical-gynecologist and the nurse. T h e y
work in close contact with district therapeutists and other specialists.
D u r i n g the first attendance of the clinic a pregnant w o m a n is registered
and is completely examined monthly, and during one and a half month -
not less than o n c e in two w e e k s . T h e s e t e r m s can be changed in special
cases, d e p e n d i n g on a state of health of a pregnant w o m a n .
T h e special attention is give to pregnant w o m e n with w r o n g position
of a fruit, with a n a r r o w pelvis, and also with inauspicious obstetrical
o u t c o m e complicated previous labors.
All p r e g n a n t w o m e n are examined by therapeutist, and also n a r r o w
specialists if t h e y need. Blood, urine is regularly analysed, arterial pressure
is m e a s u r e d , the Ultrasonic research is carried out.
In the first and second half of p r e g n a n c y b l o o d on p r e s e n c e of a
or sent to a special sanatoria, solve questions of e m p l o y m e n t , improving
procedures, a dietary meal, etc.
Pregnant w o m e n and parturient w o m e n are subject of obligatory
nursing supervision at h o m e . It is carried out by nurses and visiting nurse
under the doctor control.
 Regular prophylactic and medical attendance is aimed at:
1. H e l p i n g pregnant w o m e n in observance of the existing legislation
c o n c e r n i n g protection of their health and other rights;
2. E x a m i n a t i o n of the general state of the pregnant w o m a n , control over
her w a y of life, regular attendance of the hospital;
3. T r a i n i n g the rules of p e r s o n a l hygiene and care of n e w b o r n s .
T h e first patronage attendance is carried out not later after t w o w e e k s
w h e n the pregnant w o m a n is registered. If need, patronage attendance is
carried out by the doctor.
The important task of antenatal clinic is prophylaxis of abortions, wide
propagation of modem contraceptive means and training of women to use them.
Childbirths in a maternity hospital - the closing stage of long and
many-sided w o r k of antenatal clinic.
T h e maternity hospital consists of the following structural parts:
1. T h e casualty ward;
2. Physiological obstetrical department;
3. Observational (second) obstetrical department;
4. T h e department of pathology of pregnancy;
5. T h e d e p a r t m e n t for n e w b o r n s ;
6. G y n e c o l o g i c department.
In the casualty ward which consists of reception room, the filter,
separate examination showers rooms and both for physiological and
observational departments, the women are coursing their sanitary treatment.
T h e filter serves for interrogation and previous examination of the w o m e n
after delivery and sent to physiological or observation departments.
T h e physiological department accepts healthy parturient w o m e n , to
observation o n e — the w o m e n with a fever, skin diseases, those w h o had
contact to infectious patients etc.
F r o m physiological d e p a r t m e n t are sent the parturient w o m e n with the
complicated postnatal course (fever, an influenza etc.). „ d o w n by t h e doctor in a history of d e v e l o p m e n t of infant.
Physiological and observation departments h a v e identical structure:
sanitary r o o m (for examination), delivery r o o m , postnatal r o o m s , the
department for n e w b o r n s . T h e y differ in capacity, observation department
is smaller than physiological one. Both departments are completely
separated o n e from another.
Department of a pathology of pregnancy is used for w o m e n with the
complicated pregnancy, w h i c h needs constant medical supervision (toxics
of pregnancy, disease of heart and vessels, etc.), and also for prophylaxis of
probable complications at a n a r r o w pelvis, wrong position of fetus, average
abortions and other pathological states.
In small maternity hospitals for a pathology of pregnancy separate
rooms are in structure of physiological department.
T h e gynecologic department is used for hospitalization of w o m e n
which suffer of diseases of female genitals. It is isolated from the
obstetrical department.
A v e r a g e being of postpartum w o m a n in maternity hospital after
normal delivery is 7-8 days. In case of any complications or diseases — till
complete recovery.
After leaving in maternity hospital parturient w o m e n are cared by the
antenatal clinic observes.
In department of newborns medical supervision and care of newborns is
carried out. It is the doctor — pediatrician and nurses. Physiological and
observation department have separate department for newborns.
In observation department for newborns should be kept separate room.
In a n y of t w o obstetrical departments special r o o m s for p r e m a t u r e l y
born and w e a k e n e d infant w h o need in particular careful treatment are
separated.
Infant w h o w e r e ill, and also infant of sick mothers should be isolated
in isolation w a r d s . Quality of care has great importance for health of
newborns bringing u p , observance of requirements of personal hygiene the
medical personnel and mothers.
E v e r y n e w b o r n is m a d e preventive and antitubercular vaccination if
there are no contra-indications.
O n l y healthy infants leave from maternity h o m e . C h i l d r e n ' s polyclinic
is informed on the day of their leaving.
Results of delivery and c o n s e q u e n c e s of medical supervision are put
Children's consultation informs the maternity home of all diseases revealed
by it. In maternity h o m e constant struggle against infections is conducted.
T h e sanitary regimen, correct organizational structure of maternity
h o m e , high culture of care by the pregnant w o m e n , parturient w o m e n and
n e w b o r n s must be strictly kept.
T h e current and scheduled preventive sanitary processing of bed,
linen, r o o m s is made. D u r i n g a year for three m o n t h s the hospital is closed
for preventive actions. Effective preventive action is system of cyclic filling
of parent and infant's rooms with the purpose of their periodic cleaning and
disinfection.
A personnel of hospital is periodically examined on presence of the
bacilloses.
It is necessary to pay attention to education of personal hygiene at
w o m e n , to an explanation of hygiene of application of contraceptive m e a n s ,
to training a future m o t h e r to look after the b a b y , to bring up and feed him
correctly.
The final results of activity of obstetrical-gynecologic service are
parameters of mortality, stillbirth, early neonatal rate, perinatal mortality rate.
The typical treatment-and-prophylactic establishment for children is
independent children hospital or children departments in structure of big
hospitals.
T h e r e are also independent children polyclinics and children
consultations or children departments in independent polyclinics.
T h e s e establishments provide children with all kinds of medical care
and constant survey in a polyclinic, at h o m e , in hospitals, in day
kindergartens, in schools.
T h e basic structural subdivisions of c h i l d r e n ' s hospital are a polyclinic
and a hospital. T h e general hospitals for adults can give the medical care to
children.
T h e c h i l d r e n ' s polyclinic is the base part in treatment-and-prophylactic
medical care of children. It takes care of healthy children, carries out
preventive actions, provides the qualified medical care in a polyclinic and
teaches mothers to take care of the child. T h e polyclinic at h o m e w o r k s
according to a district principle.
A district p e d i a t r i c i a n - services 800 children in cities and 1200
children in villages.
T h e c h i l d r e n ' s polyclinic consists of t w o basic parts'! department for
healthy children and departments of the medical care with separate filters,
isolation w a r d s , m e d i c a l r o o m s .
T h e basic part o f w o r k o f c h i l d r e n ' s polyclinic - i s prophylaxis.
First of all, it deals with h o m e nursing of infants that begins in the
antenatal period.
As soon as c h i l d r e n ' s consultation obtains the first data on the future
child from maternity hospital her visiting nurse of c h i l d r e n ' s polyclinic
attends a future mother, talks to her,teaches key rules of take care of the
child and his bringing u p , explaining her rights and a privileges. T h e
m o t h e r ' s schools are organized.
On day w h e n the infant leaves a maternity hospital he is visited by the
district pediatrician and visiting nurse giving all necessary care. If
necessary attendance m a y be repeated. Further monthly the child is
examined by the pediatrician in the polyclinic, and visiting nurse at h o m e .
At last during the first year of infant life.
T h e n patronage attendance b e c o m e s different - o n c e a quarter on the
second year of life, o n c e a h a l f - y e a r - o n the third and further annually.
On the third and sixth years of life the careful examination of the child
by so-called n a r r o w specialists - the neuropathologist, the surgeon, the
oculist, the oto-laryngologist is m a d e .
During the first patronage visiting on the first year of life the special
attention is preventive to bringing up of the child, his regimen, his physical
training.
T h e basic positive results of h o m e nursing of infant are continuity and
absence of illnesses. F o u n d sick infant are being taken on dispensary
registration.
T h e necessary medical care, is given these infants, as a rule, at h o m e .
In case of need ill infants are hospitalized to c h i l d r e n ' s hospitals.
T h e first task of hospitalization is not to allow infant infections to be
brought in hospital.
W i t h this p u r p o s e precautionary m e a s u r e s are taken - the careful
examination, isolation at the least suspicions on infectious disease, the
information of the district doctor on epidemiological conditions of a house
and in infant establishments which child (a d a y nursery, school) is visiting.
Infants with infectious and infectious diseases are separated.
They stay in infants box. Infants are hospitalized together with mothers.
In case of need, joint hospitalization is applied to children.
M e d i c a l p r o c e s s is united also with educational and pedagogical ones.
It is necessary to fill in leisure of infant with interesting stimulating
actions, entertainment's for children of school age.
All actions on h o m e nursing infants and their treatments will put d o w n
in a history of d e v e l o p m e n t of infant.
On its basis quantitative and quality indices of w o r k of c h i l d r e n ' s
hospital are calculated - completeness and a continuity of h o m e nursing,
conditions of .bringing u p , morbidity of children, completeness of scope by
preventive inoculations, frequency of complications of diseases, fatality, in
particular at hospital.
In public health care of c h i l d r e n - c h i l d r e n ' s preschool establishments
play the important role.
Here children are brought u p , they are provided with appropriate
health care.
M e d i c a l care is given by c h i l d r e n ' s hospital on which district the
c h i l d r e n ' s preschool establishment is situated.
F o r each c h i l d r e n ' s establishment the doctor - pediatrician w h o
organizes patronage, preventive and medical w o r k activity, control
establishments sanitary - anti-epidemic conditions, a medical regimen.
N u r s e s help doctors in their work.
Questions for self-checking:
1. Maternity care and childhood, its legislative bases.
2. T h e maternity hospital, its functions, structure, parameters of activity.
3. C h i l d r e n ' s polyclinic and the hospital, functions, structures, activities.
4. Preventive and anti-epidemic w o r k of c h i l d r e n ' s polyclinic.
4.3. Medical care to rural population
Rural population of U k r a i n e are characterized by t w o features:
considerably w o r s e conditions of life compared with urban population and
settling in large territories.
In general a m o n g all Ukrainians the social layer of poor people is
about 80 % in villages this share considerably e x c e e d s almost 90 %.
U n e m p l o y m e n t c o m p e l s the people leave their settlement and look for
better life in cities and abroad due to the very small w a g e s and pensions,
w o r s e w o r k i n g conditions. A c c o r d i n g to our researches, a level of the
c o m m o n disease in village in 1,6 times larger than in city.
Countrymen are settled on small settlements, even less than1000 persons
live in them. It influences the organization of medical care.
It has here precisely certain levels: p r i m a r y , secondary and tertiary.
P r i m a r y , the basic, include rural medical districts. As it has b e e n
scare above, the district covers approximately 4 thousand inhabitants. In the
greatest villages of a district which is called settlement, the medical
a m b u l a n c e station or district hospital is placed.
T h e medical a m b u l a n c e station has as a rule, doctors of the
therapeutist, the pediatrician and the stomatologist, and also the medical
assistant of an a m b u l a n c e station, nursing medical nurses, nurses of a
physiotherapeutic room, the laboratory assistant with m i d d l e medical
education in the staff.
In the case if the district is headed by district hospital, its spaciousness
changes from 25 up to 100 beds. A major part of b e d s is m a k e by
therapeutic and pediatric. In the big district hospitals (50 beds and more)
can be developed obstetrical, surgical, neurological and infectional beds.
Primary care centres ( P C C ) in so-called no-settlement villages
provinces of the regions are organized.
More details about the organisation of their work will be written below.
T h e rural medical district gives inhabitants of the attached district the
primary health care ( P H C ) .
A c c o r d i n g to definition of W H O , - simple diagnostics and treatment,
sending of patients in difficult cases to consultation task on higher level, -
the preventive care and the basic sanitary - educational actions is the basic
medical work.
All these functions are also carried out by P C C .
S e c o n d a r y medical care to inhabitants of villages is given by regional
hospitals Secondary medical care, according to the definition by W H O ,
needs service of the special character, m o r e specific and c o m p l e x , includes
the care which is given by the specialized services according to primary
parts of medical care.
In the structure of Regional hospital there are polyclinic, hospital,
emergency services, an organizational - methodical cabinet, pathologo-
anatomical department, administrative service. Here the specialized out-
patient care of 15-35 specialties, the specialized medical care at 5-
10 departments, and also the round-the-clock fast care according to a call of
rural district doctors or workers of P C C is given to the inhabitants of the area.
Organizational-methodical cabinets of Regional hospital organizes a
methodical m a n a g e m e n t of a network of rural medical districts, plans and
carries out the control of giving to inhabitants of villages the specialized
care by specialists of Regional hospitals ( R H ) , introduces in practice the
best practices of work and achievement of a medical science.
 Tertiary medical care is given by central area establishments -
Sanitary - anti-epidemic and protection direction covers the following
central area hospitals and clinics. It is the care needing highly skilled
actions: environmental protection carrying out of inoculations against the
service which is given in the centres specially equipped with this
infectious diseases, the current sanitary examination of objects, revealing
purpose.Central area hospitals and clinics concentrate the latest
epidemic zones, message SES about cases of infectious, parasitic, occupational
achievements of medical science and practice.
diseases, poisonings and infringement of sanitary-and-hygienic requirements.
In structure of central medical institutions there are organizational —
methodical departments and cabinets w h i c h provide an organizational -
Table 4.2. Specifications of health care professions of Primary care c
methodical m a n a g e m e n t of secondary and primary medical care. — . . . v n . c piuio>juiis o r r n m a r y care center
Number of posts at service of the population
(persons)
Post From From From From
4.4. Organization of w o r k of Primary care center ( P C C ) From
700 up 1301 1801 2401
901 up
to 900 to 1300 up to up to up to
T h e staff of P C C work in three directions: social -hygienic, treatment- 1800 2400 3000
and-prophylactic and sanitary —anti-epidemic. Managing item (the medical
assistant, the nurse) 1 1 1 1 1
T h e basic direction of activity of P C C is social - hygienic. It is
the medical assistant, the
predetermined by the most social essence of public health services, close nurse 0,5 1 1,5 2
connection b e t w e e n a state of health of a person and social and e c o n o m i c
The nurse on physiotherapy On 15th< msands of populatic n - 1 rate
conditions in w h i c h he is.
T h e social — hygienic orientation of activity of the medical assistant
and the n u r s e is based on a strong social and legal basis as the public health On the typical primary health care center there should be cabinets and
auxiliary r o o m s :
services of a person, according to bases of the legislation in U k r a i n e about
1) A cabinet of the medical assistant;
public health services, is a duty of all state organs, enterprises,
2) Chemist's laboratory;
establishments and organizations.
3) A r o o m for sterilization of medical instruments;
T h e treatment-and-prophylactic direction in the w o r k of the medical
4) A r o o m for carrying out of inoculations;
assistant and the nurse includes patient reception hours and the care to
5) A physiotherapeutic c a b i n e t ;
patient at h o m e , selection of patients for medical examination, the
6) A cabinet of the nurse ;
organization of reception of the district doctor and doctors - specialists
7) A room for an electric autoclave;
directly at the station on participation in m a s s prophylactic examinations of
8) A corridor — waiting r o o m for patients;
adults dispensary supervision of patients, careful performance of the
9) A r o o m for preservation of fuel;
doctors prescriptions, h o m e nursing of pregnant w o m e n , infant, drugs
10) A subsidiary r o o m for stock.
treatment of patients, examination of t i m e disability, the statistical account
and the analysis of state of health of the population.
Q u e s t i o n s for s e l f - c h e c k i n g :
A c c o r d i n g to researches, third of inhabitants of non-settlement villages
1 .Primary medical care in the country.
start and finish treatment at a medical assistant and nurse. M e d i c a l
2.Secondary medical care to rural inhabitants .
assistant and nurse send m o r e than 40 % to the district doctor. So, the
3. Tertiary m e d i c a l care to rural inhabitants .
destiny of the three fourth of inhabitants of non-settlement villages are in
4.Organization of w o r k of Primary care center.
hands of workers of P C C .
Section 5. S A N I T A R Y - E P I D E M I O L O G I C A L S E R V I C E S ( S E S )
As it w a s marked above, a m o n g all factors of health the biggest role is
played by the social ones — operating conditions and living of people, their
w a y of life. Primary health care ( P H C ) and, first of all, the family doctor
can render the b i g influence on these factors.
Nevertheless, it is not enough to use efforts of only initial link for
rendering these factors, the special sanitary-epidemiological services (SES) is
also engaged in them. It is represented by district (in rural areas) and regional
(in a structure of cities), city, central regional, linear, port and water-pool
sanitary — epidemiological stations, which are subjected to the appropriate
leading bodies or so-called state sanitarian doctors: regional, city, central
regional. All service is headed by main sanitary-epidemiological department of
Ministry of public health services ( M P H ' s ) in Ukraine.
Sanitary -epidemiological services solves such p r o b l e m s :
• T h e prevention and liquidation of environmental contaminations (land,
reservoirs, atmospheric air);
• I m p r o v e m e n t of w o r k i n g conditions at the industrial enterprises and in
agriculture, the prevention and reduction of general and professional
disease;
• Creation of favorable conditions for the normal d e v e l o p m e n t and
training of children and teenagers;
• I m p r o v e m e n t of conditions of nutrition of the population, introduction
of balanced diet and the prevention of poisonings and diseases of
alimentary type;
• I m p r o v e m e n t of operating conditions with radioactive matter a n d
sources of radiations, prophylaxis of professional affection;
• T h e prevention decrease and liquidation of infectious and parasitic
diseases, the prevention and distribution of quarantine infections to the
country.
T h e list of these p r o b l e m s testifies their preventive character. T h i s
prophylaxis has received the n a m e ' p r i m a r y ' as it is directed on the reasons
of diseases a n d their prevention.
First of all, preventive actions are carried out by medical
establishments, but dispensarization is qualified as secondary prophylactic.
From positions of public health services advantage of sanitary -
preventive actions before medical-and-prophylactic is not doubtful.
T h e legal bases of activity of sanitary-epidemiological services is the
medico-sanitary legislation, regulations of the state sanitary inspection a set
of sanitary-and-hygienic and sanitary -epidemic n o r m s and rules which are
issued by o r g a n s of local and central authorities and system of the state and
departmental standards ( G O S T and O S T ) .
A c c o r d i n g to these officials d o c u m e n t s the organs and establishments
sanitary —epidemiological services have the right:
- To attend objects of supervision and lay c l a i m s concerning elimination of
sanitary infringements on the side of separate citizens, officials of the
ministries, departments, the enterprises, establishments and the
organisations;
- To take part in for construction, termination of places of a water-fence
and conditions of removal of sewage and emissions in an a t m o s p h e r e
with giving corresponding conclusions;
- To consider projects of planning and building of settlements and long-
term plans of the industry ;
- To take part in formal acceptance of apartment distribution houses,
buildings of cultural and c o m m u n i t y p u r p o s e , industrial and other
objects concerning their conformity the sanitary-hygienic and sanitary —
anti-epidemic rules a n d n o r m s ;
- To take tests of foodstuff, p r o d u c t s , subjects a n d materials for the
laboratory analysis and hygienic examination.
D u r i n g carrying out sanitary -anti-epidemic m e a s u r e s experts of S E S
have the right:
- Suspend of sick persons or bacteria-carrier, that can be a sources of
distribution of infectious diseases;
- To d e m a n d obligatory hospitalization of infectious patients that represent
which are d a n g e r o u s to other p e o p l e ;
- To provide with quarantine persons which had contact to infectious
patients;
- To p r o v i d e obligatory disinfection of the centres of an infectious disease;
- To solve p r o b l e m s concerning carrying out preventive inoculations.
In case of gross and regular infringement of sanitary-hygienic
requirements o r g a n s and establishments sanitary -epidemiological services
h a v e the right to take m e a s u r e s of c o m p u l s i o n , n a m e l y :
- Carrying out of prohibition or suspend sanitary - anti-epidemic actions of
w o r k i n g industrial objects if necessary ;
- Prohibition of the use of chemical substances and products due to their
d a n g e r o u s influence on health of people;
- Impose fines on officials and citizens;
- Infringement before states of Public Prosecutor questions concerning
institute criminal proceedings against somebody.
Despite of the big list of the rights, practice of their application has
s h o w n restrictions of opportunities of sanitary - e p i d e m i o l o g i c a l services.
It acts not as the last instance w h i c h m a k e s a decision concerning all
these a b o v e mentioned p r o b l e m s , only as an participator w h i c h instructions
are quite often ignored.
R e g i o n a l (in rural area) sanitary-epidemiological station has the
elementary structure. It consists of sanitary-hygienic and epidemiological
departments. In structure of sanitary-hygienic department there is a
laboratory and in structure of epidemiological — bacteriological laboratory
and disinfectant department.
M u n i c i p a l and regional (in cities) sanitary-epidemiological stations
have m o r e powerful structure. T h e sanitary-hygienic department is based
on laboratories of municipal hygiene, hygiene of work, hygiene of nutrition
and h y g i e n e of children and teenagers.
T h e epidemiological department consists of the epidemiological and
parasitological department a n d bacteriological laboratory.
Separate disinfectant department w h i c h consists of department of
evacuation and seat disinfection, c h a m b e r s of disinfection and sanitary
processing, preventive disinfection, disinfestation and deratization.
A r e a S E S has sanitary-hygienic, disinfectant, epidemiological,
organisational departments and a department of especially dangerous
infections. T h e sanitary-hygienic department consists of departments of the
radiological control, municipal hygiene, hygiene of work, hygiene of
nutrition, hygiene of children and teenagers and is based on laboratories of
municipal hygiene, hygiene of work, hygiene of nutrition, physical and
chemical research m e t h o d s , research of rural chemicals and toxicology.
T h e epidemiological department has anti-epidemical, parasitological,
bacteriological, virological department and bacteriological laboratories.
T h e organisational department carries out an organisational -
methodical m a n a g e m e n t of city and regional S E S and takes such m e a s u r e s :
- Studies a state of health of the population;
- P l a n s improving, sanitary - preventive and anti-epidemic actions;
- Analyses material and technical base S E S , maintenance and level of
e q u i p m e n t their staff;
- Improves organisational forms and m e t h o d s of work, studies the best
experience and introduce it in its practice;
- Analyses activity of subordinates S E S ;
- Control w o r k of public councils (sanitary-epidemiological, laboratory, for
the sake of m e d i c a l assistants and lab assistants ).
Sanitary-epidemiological stations carry out the state sanitary
inspection w h i c h is introduced by t w o basic forms.
Precautionary sanitary inspection of construction, p l a n n i n g and
building of settlements, long term planning of contribution of the industry.
T h e expertise of the documentation on planning, supervision of
construction and reconstruction of the enterprises, change of a structure and
the " k n o w - h o w " , and also participation in the commissions putting into
operation apartment houses, cultural and c o m m u n i t y buildings, the
industrial enterprises and constructions.
Precautionary supervision provides a sanitary-hygienic estimation of
research and serial equipment, p o l y m e r i c and synthetic materials, industrial
products, technologies of devices and tools at stages of design protect and
protect development.
T h e current sanitary inspection is carried out for the objects of
municipal services and the industrial enterprises, food objects, children's
school a n d other educational establishments, sources of radioactive
substances a n d radiations.
Carrying out of the analysis of the general, professional, infectious and
parasitic disease in combination with studying sanitary-hygienic and
sanitary - e p i d e m i o l o g i c a l situations allows to find out the reasons which
influence state of health of the population and to develop concrete actions
on its improvement.
H o w e v e r , traditional S E S mostly are engaged in studying of infectious
disease. As for the general morbidity this studying is in the very beginning.
In 1994 in Ukraine the law « A b o u t maintenance of s a n i t a r y -
epidemiological well-being of the population » w a s accepted.
This law, in particular, adjusts public relations w h i c h arise in sphere of
maintenance of sanitary - e p i d e m i o l o g i c a l well-being, determines
corresponding rights and duties of the state organs, enterprises,
establishments, organisations and citizens.
 • To carry out the laboratory control of harmful substances and materials,
Citizens h a v e the right on: m a d e due to their activity waste products and emissions, and also
- Safe for health and life food stuffs, drinking water, conditions of work, finished production;
training, education, life, rest and environment;
• On the d e m a n d of officials of the state sanitary-epidemiological services
- Participation in development, a substantiation and public expertise of projects
give gratuitously samples of used raw material and materials, and also
programs and plans of providing of sanitary-anti- epidemical well-being of
products which are m a d e or sold, carrying out of the state sanitary-
the population submit on these questions to corresponding o r g a n s ; hygienic expertise;
- T h e indemnification, caused to their health due to infringement by the
• To carry out orders and instructions of officials of the state sanitary-
enterprises, establishments, the organisations, citizens of the sanitary
epidemiological services on their realisation of the state sanitary-anti-
legislation;
epidemic survey by them; To suspend of p e r s o n s w h i c h are carriers of
- T h e authentic and timely information about state of the health, health of
activators of the infectious diseases sick on dangerous for surrounding
the population and also about existing and probable risk factors for
infectious diseases or p e r s o n s w h i c h w e r e in contact with such patients,
health and their degree.
on presentation of corresponding officials of the state sanitary-
Citizens are obliged:
epidemiological services and also persons w h o avoid obligatory medical
- To take care of their health and health and hygienic education of their examination or inoculations against infections.
children, do not harm health of other citizens;
• informs organs and establishments of the state sanitary-epidemiological
- To take part in carrying out sanitary and anti-epidemic actions;
services about extreme events and situations which threaten the health
- To p a s s obligatory medical examinations to m a k e inoculations in the
of the population, sanitary and epidemic well-being immediately;
cases stipulated by the legislation;
• To c o m p e n s a t e workers and citizens the losses to their health d u e to
- To carry out orders and instructions of officials of the state sanitary-
infringement of the sanitary legislation.
epidemiological services at their realisation of the state sanitary-
T h e law also regulates d a n g e r o u s factors of manufacture and an
epidemiological s u p e r v i s i o n ;
environment, establishes the order of carrying out of the state sanitary-
- To execute other duties stipulated by the legislation on providing of
hygienic expertise and provides other actions directed on providing of
sanitary - e p i d e m i o l o g i c a l well-being.
sanitary - epidemiological well-being of the country.
T h e law regulates rights and duties of the organisations and
Structure of sanitary-epidemiological services in U k r a i n e :
establishments.
- State chief sanitary doctor of Ukraine
T h e enterprises, establishments and organisations have the right on:
— State chief sanitary doctor of area
• Receiving from bodies of the state and executive authority, local and - State chief sanitary doctor of city (municipal station)
regional self-management, and also corresponding bodies and — State chief sanitary doctor of region
establishments of public health services of the information on state of
health of the population, a sanitary and epidemic situation, legislative, Q u e s t i o n s for self-checking:
statutory acts on questions of providing of sanitary - e p i d e m i o l o g i c a l 1. Organisation of sanitary-epidemiological services in Ukraine.
well-being of the population and sanitary n o r m s ; 2. Sanitary-epidemiological stations ( S E S ) , its p r o b l e m s , structure, the
• T h e indemnification, caused by infringements of the sanitary legislation organisation previous and current sanitary inspections.
• by the organisations, establishments and separate citizens. 3. E s s e n c e of the L a w of U k r a i n e " A b o u t m a i n t e n a n c e of sanitary and
• T h e enterprises, establishments and organisations are obliged: epidemiological well-being of the population".
• A c c o r d i n g to offers of officials of the state sanitary-epidemiological
services develop and carry out sanitary and anti-epidemic actions;
Section 6. E C O N O M Y , P L A N N I N G , F I N A N C I N G OF T H E
ESTABLISHMENTS OF PUBLIC HEALTH SERVICES
IN U K R A I N E
We h a v e n ' t had sufficient theoretical substantiation of the problem of
e c o n o m y of public health services yet. Defining these p r o b l e m s in the
Soviet conditions the fundamentals of socialist e c o n o m y w e r e taken as a
basis. Long-term experience of creation of this e c o n o m y has s h o w n its
inefficiency and has ended with complete b r e a k d o w n .
At the same time experience of the countries with market e c o n o m y
testifies the big influence of national features on e c o n o m i c p r o c e s s e s in
these countries.
In p a r t i c u l a r , it c o n c e r n s s u c h specific a r e a , as p u b l i c h e a l t h
s e r v i c e s . P r a c t i c a l l y e a c h c o u n t r y o f m a r k e t s y s t e m , b a s i n g o n the
g e n e r a l e c o n o m i c l a w s , h a s its n a t i o n a l a n d , a s a m a t t e r of fact, a u n i q u e
s y s t e m o f p u b l i c health s e r v i c e s . All this can b e t a k e n into a c c o u n t also
in o u r U k r a i n i a n c o n d i t i o n s d u r i n g t h e p e r i o d w h e n t h e r e is a difficult
p r o c e s s o f t r a n s i t i o n o f e c o n o m y o f o u r state from s o - c a l l e d socialist t o
market bases.
T h e e c o n o m y of public health services studies action of laws of the
market in system of medical care and influence of public health services on
a major factor of industry — a labor resources.
Public health services as the system of the state, public and an
individual actions and m e a n s has no precisely outlined contours, uniform
m a n a g e m e n t , etc.
On one pole of this system are laws which are accepted by the state on
public health services of the citizens, on the o t h e r - b e h a v i o r of the citizens
which not less influence their health. It is hard to investigate this system
from positions of market laws, this problem is not only e c o n o m i c , but
political, social - psychological, as well etc. ~
A n o t h e r matter is the system of medical care as a c o m p o n e n t of public
health services. It is a separate area of a national e c o n o m y , has precisely
outlined contours, external and internal connections, structural functional
characteristics, object and the subject of m a n a g e m e n t .
T h a t ' s w h y in definition of e c o n o m y of public health services as a
science, it is necessary to limit studying of action of laws of the market
with system of medical care.
As for the influence on health and reproduction of labor as a major
factor of manufacture here we should speak about public health services in
general as this influence is complex, here all typical systems of public
health services operate in indissoluble and constant connection.
There is no the generally accepted definition of concept of the market.
Researchers of market system do not see the need for definition of physical
essence of concept of the market.
It is defined, that the essence of concept of market stipulates any
character of activity, w h e r e processes of buying and selling are available
and w h e r e laws of market e c o n o m y act.
T h e concept of market e c o n o m y covers e c o n o m i c system at which
decision-making process concerning manufacture and distributions of
resources is based on the prices created by a voluntary e x c h a n g e between
manufacturers, buyers, workers and o w n e r s of other factors of manufacture.
Decision-making in conditions of e c o n o m i c relations of such character is
conducted decentralized. T h e market system provides also equal in rights
existence of different forms of ownership - private, public, state.
T h e bases laws of market system are reduced up to several major
aspects:
- First, definition of m a i n principles of functioning of separately taken
m a r k e t s and their interrelation;
- Second, an establishment of d y n a m i c development of basic elements of
m a r k e t system - objects and v o l u m e s of manufacture, m e a n s of
production, subjects of consumption of results of manufacture;
- T h i r d , definition of a regulating role of the state;
- T h e fourth aspect provides achievement of the highest level of national
well-being.
T h e market system considers concepts "product" and "service" as
equivalent.
M e d i c a l establishments and the medical attendants which are engaged
in public or private practice, give medical services. T h e y are paid by
intermediaries through insurance firms (which receive these m e a n s from
the state, or citizens pass the enterprises these m e a n s by medical insurance)
or direct by the the state and citizens.
The state receives incomes as taxes which it collects from the enterprises
and separate citizens (families). Citizens (families) receive medical services
directly from medical establishments (medical attendants) or through the
intermediary organizations. The state and the enterprises deliver medical
establishments factors of medical care, first of all workers, equipment and - M a n u f a c t u r i n g an additional product during the t i m e to w h i c h the life of
p e o p l e is prolonged ;
medicines through the corresponding market where their cost is defined.
E c o n o m i c aspects of functioning of medical care in market conditions - Reduction of expenses on social insurance and social security through
can be divided into two levels: macro (state and regional), and micro (the decrease reduction in t e m p o r a r y and c o m p l e t e disablement;
patient, medical attendant, medical establishment, incorporated medical - A c h i e v e m e n t of e c o n o m y of expenses for health services at the expense
of reduction in it.
establishments).
At the microlevel processes of functioning of market of the medical So, reduction mortality and morbidity of people has not only social
services, the certain e c o n o m i c proportions within medical establishment, in and medical, but economic benefit. As well it is measured by a difference
between losses caused by mortality rate and morbidity rate and carrying out
particular ratio of factors of medical services, a ratio of the w a g e salary and
preventive and medical m e a s u r e s .
other expenses on medical service, pricing, changes of a level of d e m a n d of
the population on medical services, etc. are investigated. So, for e x a m p l e , e c o n o m i c losses d u e to morbidity and traumatism can
be determined by such formula:
T h e basic purpose at this level is satisfaction of o p t i m u m need of
p e o p l e in medical care d e p e n d i n g on public opportunities and their o w n
spiritual needs and n u m b e r s . El = C n e t + Ch +Ctr. + Ptd. + C e m . ,
T h e public health services has social, medical and e c o n o m i c
Where,
efficiency.
Social efficiency of public health services will consist in maintenance El — e c o n o m i c losses due to morbidity and a traumatism;
of longevity, active ability to live, high quality h u m a n lives. C net - cost of product not produced in connection with disease
(trauma);
If a person is healthy, its chances of realization of its potential
Ch— cost of hospitalization;
opportunities are high and he can achieve all desirable.
Ctr. - cost of out-patient treatment;
Criteria of social efficiency of public health services are death rate
Ptd. — p a y m e n t of temporary d i s a b l e m e n t ;
and average duration of an expected life. T h e lower mortality rate and the
higher life expectancy of p e o p l e , the m o r e effective social function of C e m . — cost of e m e r g e n c y call services ;
public health services is.
Cnet. = (Usal. + A p r . ) x U d . x N p . ,
M e d i c a l efficiency of public health service consist in reduction of
Where:
disease of people and consequences of diseases. It is caused by positive
action of the special medical actions directed at achievement of this Usal. — the average w a g e salary of one w o r k e r per day;
purpose. Apr. — average profit of one w o r k e r per a day;
E c o n o m i c efficiency of public health services consists in achievement Ud. - average n u m b e r of days of temporary disability which falls at
one patient;
of e c o n o m i c benefit and additional manufacture of a national product
N p . - n u m b e r of patients.
through reproduction and strengthening of health of a major factor of
manufacture — labor force.
Let's a s s u m e that due to realization of corresponding improving and T h e big economic n u m b e r has rational use of material resources of
system of medical care, first of all w o r k of medical w o r k e r s and u s e of b e d s
medical actions reduction of death rate of workers is achieved, their disease
supply.
is reduced, the significant part of complications of diseases is w a r n e d . It
will h a v e such e c o n o m i c consequences: M e d i c a l workers are major factor of manufacture of medical services
as the product.
 There are specifications of labour expenses of medical workers — number
of patients which the doctor or the medical assistant during outpatient reception
hours can examine during, number of patients to which the stationary help can
be given every day, specifications of examination and treatment of patients.
T h e s e are n o r m s developed on the basis of special scientific researches
and their approbation in practice. Specifications are periodically
reconsidered.
In fact, there is an opportunity to compare actual work of the medical
assistant or the doctor with normative one and to define so-called function
of medical worker.
If function is not carried out (less than 100 % ) , it results in direct
e c o n o m i c losses, b e c a u s e expenses for w a g e s of medical w o r k e r s ,
municipal services, on e q u i p m e n t and stock do not decrease.
If function is considerably exceeded, it is also not advantageous, as
affects quality of medical care and testifies necessity of revision of
specifications.
In fact, it is necessary to aspire up to 100 % -s' performance of
function w h i c h results in the greatest e c o n o m i c and medical effect.
T h e basic m e a n s (it is m o r e than 70 %) are spent on stationary help.
Thus,it is important, that beds in a hospital w e r e constantly occupied
with patients, that is to carry out their function. Function of a bed or its
average bed o c c u p a n c y is determined as follows:
T h e part from division can m a k e 340 days per year. It is an optimum
parameter.
A difference (365-340) in 25 days are those days w h e n there is bedturn
over.
If a b e d w o r k s less t h a n 340 days, the hospital has direct e c o n o m i c
losses as all m e a n s , except for assignments for treatment by medicine and a
food of the patients are nevertheless.
If a bed w o r k s less than 340 days for a year, it is b a d t o o , it is an
evidence of density of patients and discrepancies of their available n u m b e r
to the need.lt affects the quality of service of patients.
In that case it is necessary to specify bed c o m p l e m e n t of the
population.
Bed c o m p l e m e n t is determined as follows:
where:
BC — n u m b e r of n e c e s s a r y b e d s ;
N p . — n u m b e r of the population w h i c h will be served by hospital;
Pp. — percent of the population w h i c h goes on hospitalization;
D p . - average duration of stay of o n e patient on a b e d in a hospital.
Let's determine the need of b e d s for administrative rural area w h i c h
lias 80 thousand inhabitants:
BC = 8 0 0 0 0 x 20 x 15 / 3 4 0 x 100 = 706 beds
P p . = 20 % — the present percent of selection of p e o p l e on
hospitalization,
D p . = 15 days — average duration of stay of o n e patient in a hospital.
F o r o p t i m u m provision of the population of this area in the stationary
care 706 b e d s are necessary.
T h e market is a w a y of labor division. F o r the rational organization of
manufacture it is necessary to plan it. It c o n c e r n s also medical care. T h e
plan is a forecast for the future and substantiation of w a y s of its
achievement.
In market conditions medical establishments get m o r e independence,
than under conditions of administrative c o m m a n d system. Here planning is
from top to bottom and the skill of each medical establishment to m a k e the
business p l a n is the m o s t important.
T h e basic requirements and sections of the business plan of medical
establishment are the following.
 T h e business plan is the document aimed at achievement by the
managerial staff of the concrete strategic p u r p o s e s concerning the further
i m p r o v e m e n t of medical care to people.
First the introduction or a short statement of the plan is written. It is
short (no m o r e than t w o pages of the text), but extremely, d e e p and
purposeful.
In the introduction the contents of the plan, the primary goals, ways of their
realization, the basic financial information and expected results are defined.
T h e history of establishment is described: conditions of its foundation,
the bases stages of its development, an explanation of the present state of
the establishment.
T h e next section of the business plan - the characteristic of u s e of
stationary and out-patient medical services. It is based on existing system
of reception of the statistical data.
M o v e m e n t of patients in a hospital and an a m b u l a n c e station,
performance of function by medical w o r k e r s and b e d s is care fully and
completely analyzed for s o m e calendar years, tendencies it m e a n s an
orientation of these p h e n o m e n a are established.
Here the reliability of the statistical data concerning activity of
medical establishment can be analyzed, w e a k points are found and w a y s of
their elimination are specified.
T h e n the analysis of area of service of medical establishment, the
characteristic of the population and other establishments placed in area of
service is given.
H e r e the detailed description of demographic situation in the area of
service is given: to n u m b e r of population, its age-sexual type, structure of
families, disease of the population, their n e e d for medical services and
distribution of these services b e t w e e n the given establishment and other
establishments placed in the territory of service.
The detailed characteristic of financial opportunities of establishment plays
an essential role, namely, expected budgetary appropriations and reception of
means from other sources, first of all, by insurance of the population.
It is important in this section of the plan to determine the price for
medical care, aiming to achieve the highest results with the lowest possible
expenses.
T h e next section of the plan - the ideas concerning reconstruction of
medical establishment. H e r e they speak about possible changes in structure
of medical establishment: opening n e w structural divisions and curtailing of
old ones with the purpose of improvement of medical care to patients.
Reconstruction should be financially proved.
T h e n there is an e c o n o m i c analysis: comparison of the price for
medical services with probable financial expenses of establishment.
T h e next section of the plan - strategic directions and marketing. This
is very important section of the plan.
Till n o w mostly the present state of establishment w a s described.
N o w it is necessary to glance in its future, to prove probable strategic
directions of its development.
This section, in its turn, will consist of such divisions:
- D e v e l o p m e n t of strategic directions. H e r e the analysis is m a d e aimed at
establishment of a priority of different purposes, opportunities, first of
all financial of their achievements are determined, strong and w e a k
points of other establishments in the area of service are defined, the
sequence of achievement of the purposes is coordinated, m e a s u r e s
concerning w o r k with the population are outlined;
T h e plan of marketing.
T h e question of choice of services and separate p r o g r a m s the
opportunity of their carrying out by of the medical staff, definition of the
prices for separate medical services and other possible c h a n g e s during
realization of the plan, advertising or a w i d e massive campaign a m o n g the
population concerning necessity of using modern medical services are
under consideration in this part of plan.
Performance of the plan of marketing. It is realized through separate
purposeful c a m p a i g n s , for e x a m p l e , giving obstetrical help, the e m e r g e n c y ,
services to the patient on a diabetes, etc. Constant h o m e nursing due to
realization of purposeful c a m p a i g n s can be carried out.
T h e n e x t section of the plan - financial forecasts. H e r e the detailed list
of financial offers and forecasts concerning use of services, possible risks,
barrier and w a y s of their o v e r c o m i n g is given.
T h e n t h e r e is a p l a n of action of e s t a b l i s h m e n t . T h e d e t a i l e d plan of
c o n c r e t e a c t i o n s w h i c h t h e m e d i c a l e s t a b l i s h m e n t can c a r r y o u t , t e r m o f
their p e r f o r m a n c e a n d a p e r s o n s r e s p o n s i b l e for t h e i r p e r f o r m a n c e is
made.
This section of the plan can quarterly be reconsidered, corrected and
updated, taking into account the current course of performance.
 In the end of the business plan s o m e - concrete calculations, an establishment on the base of cooperative societies, the small organizations,
explanation, reference material, etc., m a y be added. the joint-stock c o m p a n i e s , the separate enterprises, etc.
Till n o w drawing up of business plans hasn't b e c o m e the widespread Activity of all these divisions is legislatively caused,also the
practice in activity of medical establishments. P l a n n i n g is m e a n w h i l e establishment can operate w o r k within the current legislation.
limited to drawing up of the financial plan or the budget w h i c h is based on I n c o m e s of the b u d g e t are distributed according to such accounts of
three d o c u m e n t s : tariffication, the list of staff and the estimate of i n c o m e s the estimate:
and charges. 1. Charges on w a g e s .
Tariffication is a d o c u m e n t in which occupied posts of establishment a) collection of taxes to obligatory state pension insurance (security);
and their salaries are fixed, it m e a n s that salary which is received by each b) collection of taxes to obligatory social insurance;
worker according to his qualification, categories, a post, a condition of 2. T h e current account which accumulates m e a n s for expenses for
work, etc. e c o n o m i c , municipal, m e d i c i n e needs etc.
T h e list of staff is a d o c u m e n t w h i c h displays distribution of n u m b e r 3. T h e account for special m e a n s (a rent, p a y m e n t s of service).
of doctors, m i d d l e , low-level and other personnel according to the n u m b e r 4. T h e s u m s from c o m m i s s i o n s (on this account sponsor's and charitable
of population w h i c h lives in territory of activity of establishment. p a y m e n t s are accumulated).The expenditure of these m e a n s is spent on
a basis o f Status o f e s t a b l i s h m e n t " .
T h e estimate is the b u d g e t m a d e on separate fields. It is the basic
T h e " s t a t u s "is affirmed e v e r y y e a r a n d r e p r e s e n t s t h e d o c u m e n t
scheduled financial d o c u m e n t .
w h i c h d e f i n e s o n w h a t i t e m s o f c h a r g e s m e a n s from t h e g i v e n will
First its project on the basis of performance of the plan of previous
be used.
year, changes in tariffication and a regular list is m a d e u p .
As a rule, the establishment has an opportunity to u s e this m o n e y to
E a c h medical establishment sends the project of the estimate in the
all items (on the salary, a m e a l , m e d i c i n e s , repair, etc.).
fourth quarter of the current year in territorial department of public health
5. T h e Chernobyl account. M e a n s for it are allocated directly from the
services (in rural area - to the head physician of the central regional
state budget for workers of establishment w h o took part in liquidation
hospital, in city - to departmentof public health services).
of Chernobyl accident.
T h e r e the general budget of medical establishments of city (area) is
T h e expenses of the estimate includes such basic items:
m a d e up w h i c h is sent to regional finance administration.
1) T h e current expenses:
T h e r e from the b u d g e t is sent to a regional finance administration, and
a) P a y m e n t of w o r k of workers of budgetary establishments;
the b u d g e t o f a r e a - t o the Ministry o f finance o f U k r a i n e .
b) C h a r g e on w a g e s ;
T h e last one studiesthese budgets, m a k e s the state b u d g e t and after its
c) P u r c h a s e of subjects of supply and materials, m a i n t e n a n c e of budgetary
statement the S u p r e m e Council directs to areas estimated figures w h i c h
establishments;
accordingly p a s s all return w a y d o w n to medical establishment.
d) P a y m e n t of municipal services, energy, etc.;
B u d g e t s of medical establishments are approved on sessions of
2) Capital expenses:
regional (city) councils of people's deputies.
a) Capital construction (purchase);
Incomes of budgets of medical establishments are formed of t w o
b) Overhaul, reconstruction;
sources: the m o n e y selected with the city (regional) budget, and special
c) Purchase of equipment and subjects of long-term use, etc.;
fund at the expense of additional m e a n s w h i c h the medical establishment
3) Non-distributed expenses.
earns independently.
4) Crediting with subtraction of repayment;
E a c h medical establishment according t o " the L a w of U k r a i n e on local
5) P a y m e n t s in the budget:
self-management " has an opportunity to earn additional m e a n s by
a) T a x e s and obligator)' p a y m e n t s (except for the profit tax and the tax to
the added cost);
b) T h e profit tax;
c) T h e cost-added tax.
It is necessary to note, that the m e a n s , intended on the salary, are spent
only with the given purpose. T h e head has no right to spend them in other
purposes.
N o w appropriate financing is received actually only by one item of
expenses of the estimate, namely, expenses a m o n g which p a y m e n t of w o r k
of workers and p a y m e n t of municipal services and energy carriers.
M o n e y for other charges are allocated insufficiently, and for capital
charges (capital construction, repair, reconstruction, purchase of
equipment) is not allocated at all.
Therefore,it forces the head to search for additional m e a n s and to
increase special fund.
Questions for self-checking:
1. W h a t does the e c o n o m y of public health services study?
2. W h a t is social, medical and e c o n o m i c efficiency of public health
services?
3. H o w to count up losses caused by diseases and traumatism?
4. H o w function of medical worker is defined?
5. H o w bed occupancy is defined?
6. H o w bed c o m p l e m e n t is defined?
7. N a m e the bases sections of the business plan of medical establishment.
8. N a m e bases items of profitable and account parts of the estimate of
medical establishment.
Section 7 . T H E A U T O M A T E D C O N T R O L S Y S T E M S I N T H E
ESTABLISHMENTS OF PUBLIC HEALTH SERVICES
IN UKRAINE
M a n a g e m e n t - is the most ancient feature of h u m a n activity. At the
beginning elders and chiefs ruled. T h e y m a n a g e d relying on experience of
previous generations or on precedent: so w a s before them, so they did to.
This is so-called empirical management. It occurs also n o w a d a y s . E x c e p t
his experience, the leader (head) is relying on intuition, forecast, etc.
Last decades have found out a sharp need in scientific m a n a g e m e n t . It
is caused, in particular in public health service, by scale of p r o b l e m s ,
necessity of the complex approach to their decision, accumulation of huge
human and material resources.
Science of m a n a g e m e n t has a lot of definitions, that is the certificate of
its youth. We can cite one of t h e m : " M a n a g e m e n t is the organization and
realization of purposeful actions " (V.Trapeznikov).
T h e system of k n o w l e d g e of m a n a g e m e n t science consists of such
basic sections: the theory, the organization, culture, m e t h o d s , techniques.
M a n a g e m e n t begins with gathering, processing and the analysis of the
information. An information link is initial and major in the administrative
cycle. T h e m o r e objective and timely information is collected, the m o r e
detailed analysis it is subjected to, the higher probability of the o p t i m u m
administrative decision is.
T h e information link distinguishes scientific m a n a g e m e n t from
empirical one. But at the same time the information is a black bread of
management, its the hardest link. It needs m a n y efforts, time, is
characterized by m o n o t o n y even routines.
T h e leader should not be engaged in this work, but he should do his
best so that this w o r k w a s carried out at the highest level.
It does not mean, that the leader in the field of public health services should
not be the expert on questions of computer science, medical statistics, the
organization, management and economics of public health services.
T h e leader can be engaged directly in other stages of an administrative
cycle and first of all, making, on the basis of the collected and processed
information, the administrative decision. To think is the main task of a
leader, because the final result depends on his correct decision.The more
complex object of m a n a g e m e n t , the more scale character of a problem is,
the longer validity of the decision, the more important expected results
(positive or negative) are.
T h e m a n a g e r should a l w a y s r e m e m b e r about it.
D e c i s i o n - m a k i n g is a creative w o r k which needs m a n a g e r is
intellectual and physical efforts. It is important to adhere to the certain
sequence in this work. First, to develop variants of the decision, then to
analyze t h e m , accept a final variant, precisely,to formulate it, to d r a w it up
d o c u m e n t a r y , put tasks to subordinates.
T h e decision can be classified as follows:
1. T h e decision w i t h risk and degree of risk is calculated, this is an
o p t i m u m decision;
2. T h e counterbalanced decision, so to say, with secure, this is a good
decision, but it d o e s not give the big effect;
3. T h e impulsive decision, is m a d e with lack of the information, time, etc.;
m a y have h e a v y consequences for system;
4. T h e delayed decision, as well as previous, for m a n a g e m e n t is unsuitable.
T h e decision can be m a d e on that level on w h i c h the problem arises as
the leader of this level h a s the most complete information. It should not
contradict earlier accepted decision or infringe on the rights of delegated
assistant; can be concrete, timely, e c o n o m i c , flexible, proxy, has the
b e g i n n i n g and the ending of action.
T h e analysis of non-fulfilled decisions testifies, that the reasons can be
different: the decision has b e e n badly formulated, purpose was not clear, it
remained not clear for subordinates, the conditions w e r e not created for its
performance, subordinates h a v e not b e e n interested in its performance.
Provision of all these questions m a k e s a stage of planning and the
organization of the decision m a k i n g .
T h e final stage of an administrative cycle is n o t less important — the
control over performance of the accepted decisions. Even the good decision
w h i c h w a s not carry out through, can not give expected results and m a y
p r o v o k e the very managerial process. H i g h quality of the control is an
integral feature of scientific m a n a g e m e n t .
T h e culture of m a n a g e m e n t e m b r a c e s the big circle of questions:
culture of technology of process m a n a g e m e n t , culture of information
provision, culture of d o c u m e n t a r y m a i n t e n a n c e , questions of the special
c o m p e t e n c e of a leader in the field of e c o n o m i c k n o w l e d g e , m a n a g e m e n t ,
marketing, the "know-how".
T h e leader can be guided by fundamentals of the general culture,
professional deontology, psychology of m a n a g e m e n t ,
first of all social psychology, business relations, rhetoric to adhere to
the certain style in administrative work, to apply motivational m e c h a n i s m s .
A m a n a g e r m a y be notable for his c o m p e t e n c e , has organization
abilities, enjoys authority of subordinates, w a s able to unite intellectual and
strong-willed c o m p o n e n t s in m a n a g e m e n t , to see further e v e r y d a y and
obvious, to be able to capture essence of the interrelations, inherent in the
phenomenon,
to p r o d u c e original ideas and decisions, to find an opportunity of
reorganization of system for its m o r e effective functioning.
T h e leader can be initiative, show a personal e x a m p l e of diligent work.
To achieve of the best results it is important correctly to stimulate staff
work.
T h e leader has some stimulation for this purpose : moral, material and
compulsory.
It is important to unite t h e m skill fully, mostly using material and
moral incentives and applying a c o m p u l s o r y o n e only in case of need.
It is possible to allocate three basic hierarchical levels of m a n a g e m e n t
with public health service in U k r a i n e : b a s e , regional and state.
B a s e level covers rural administrative area and a city.
In rural administrative areas it is represented by the general director of
territorial association (the former head physician of area).
Simultaneously, he is the head physician of the central regional
hospital.
In cities a base level of m a n a g e m e n t of public health services is
something different. H e r e in structure of city state administrations there are
departments of public health services headed by the chief.
T h e r e is a group of m a n a g e r s w h i c h basis consists of so-called main
specialists (the therapeutist, the surgeon, the pediatrician, etc.). T h e
department is g u i d e d also by the administrative d e p a r t m e n t s of city
hospitals.
T h e state administrations perform the following functions in the field
of public health services : m a n a g e m e n t a n d d e v e l o p m e n t of forecasts of
development of a n e t w o r k of establishments of public health service ; the
organization of medical care of the population; the organization of control
over a sanitary condition of the e n v i r o n m e n t a n d observance of rules of
sanitary protection; carry out prevention actions against infectious diseases;
the control over giving privileges to mothers and children, improvement of
living conditions of large families; the control over observance of rules of
protection of work, the safety precautions, industrial sanitary, ecological
requirements at the enterprises, in the organizations and establishments.
B a s e level - is the basic one in the system of medical care. H e r e both
the first and second links are concentrated. T h e y are structurally
incorporated 90 % of out-patient - polyclinic and 80 % of the stationary
care are concentrated here.
Results of activity of all system depend practically on quality and
m a n a g e m e n t efficiency at this level.
Arial departments of public health services in their w o r k are based on
administrative subsystems of medical institutions which provide tertiary
medical care.
T h e status of the m a i n non-staff specialists is given to head physicians
of the district specialized clinics and m a n a g e r s of the specialized
departments of regional hospitals.
Regular and non-staff specialists carry out the direct strict control over
m e a n s of city and regional specialists of development of the separate
specialized services in the area.
T h e state level of m a n a g e m e n t of public health services is represented
by Ministry of public health service and the c o m m i s s i o n on questions of
public health services of the S u p r e m e Council of U k r a i n e .
At the state level medical -statistical and information services are created,
which on the one hand, take into account interests of supply with information
of all levels of management of public health services, on the other - becomes a
basis for wide development of researches in the field of social medicine, the
organization and management of public health services.
A u t o m a t i o n - is m e a n s of providing qualitative performance of
functions of management.lt is possible to distinguish three types of
application of m o d e r n c o m p u t i n g equipment - the C O M P U T E R - in
m a n a g e m e n t of public health services:
First of t h e m , the elementary, provides performance with the help of
the c o m p u t e r of the certain c o m p u t i n g functions.
T h e second type of application of the c o m p u t e r is connected with
introduction in m a n a g e m e n t of automated information systems ( A I S )
which help preliminary according to the set programs, to process it by the
computer and to use them for performance of different functions.
T h e third type of application of the c o m p u t e r is automated control
systems ( C S ) . Their characteristic feature is j o i n e d work of the man and the
machine w h e r e they act as equal in rights partners.
T h e center of gathering, processing of the information and decision-
making is the certain system of gathering of the information, c o m p u t i n g
means for its preservation, processing and c o m p u t e r analysis of different
types and p e o p l e w h i c h m a k e final decisions (managerial staff).
T h e s e centres are created in the central regional and city hospitals.
Functioning of A I S is as follows :
In medical institutions - rural medical district hospitals and regional
hospital ( R H ) intermediate data carriers - the coupon of out-patient ( C P )
and a card form of inhabitant ( C F I ) - o n all inhabitants are gathered. T h e y
concentrate in the Center of gathering of information that is created at
regional hospital. Processing and the analysis of both data carriers is
reduced to definition of disease a m o n g different layers of the population -
social, professional, age.
D o c t o r s of an ambulance station, polyclinic and hospital fill to (CFI)
and out-patient card ( O U C ) on each patient.
T h e s e d o c u m e n t s are also sent to the Center of gathering of
information. H e r e they are processed according to the accepted algorithms
and p r o g r a m s .
E v e n m o r e often automated m e a n s are used in so-called s c r e e n -
systems.
Screening is the expected identification of uncertain illness with the
help of tests, researches or other p r o c e d u r e s which are d o n e without the big
expenses of time. R e q u i r e m e n t s to tests are the following : reliability,
accuracy, convenience, simplicity, availability, easy recognition by people
and the m e d i c a l staff.
A s e x a m p l e o f screen researches m a y b e examinations o f the
population according to the p r o g r a m of annual prophylactic medical
examination.
N o w the searches of m o r e accessible and exact screening examinations
are taking place.
In particular, c o m p u t e r p r o g r a m s of an estimation of bio currents of an
organism w h i c h are r e m o v e d from the skin points placed on hands feet of a
 Section 8. S O C I A L I N S U R A N C E A N D S O C I A L S E C U R I T Y .
person are developed. T h i s research is simple and accessible to the patient
MEDICAL INSURANCE IN UKRAINE
and also gives considerably authentic estimation of his health.
T h e more automated information systems are introduced into practical
In 1996 in Ukraine the L a w « A b o u t insurance » w a s adopted.
activity of medical institution, the higher d e g r e e of its automation is.
It determines concepts of insurance: it is a kind of civil-law relations
H o w e v e r , it is necessary to remember, that the final decision a l w a y s
concerning protection of property interests of citizens and legal persons in
remain for the m a n , that is for the medical worker, the very automation, its
case of the certain events
essence are developed and entered into the m a c h i n e .
( insurance cases), determined by the contract of insurance or the
current legislation,at the expense of monetary funds which are formed by
Q u e s t i o n s for self-checking:
discharge of citizens and legal persons of insurance p a y m e n t s .
1. W h a t is the science of m a n a g e m e n t ?
Objects of insurance can be also the property interests connected, in
2. T h e bases stages of administrative cycle.
particular, w i t h life, health and w o r k i n g activity.
3. T h e b a s e s levels of m a n a g e m e n t of public health services in U k r a i n e
The insurance connected with temporary disablement includes such cases:
and their tasks. • D i s e a s e s and industrial t r a u m a s ;
4. W h a t is the automated information systems (AIS)?
• Household traumas;
5. W h a t is the automated screen systems?
• C a u s e d by abortions;
• On ill p e o p l e nursing;
• In connection with pregnancy and delivery ;
• In connection with sanatorium treatment;
• In connection with hospitalisation;
•
• In connection with quarantine actions.
In all listed cases the insured person receives c o m p e n s a t i o n at the
expense of funds of social insurance w h i c h are formed from insurance
• payments of legal p e r s o n s (employers) and the citizens (monthly charges
from the w a g e salary). M e a n s of social insurance are at the disposal of
trade u n i o n s .
T h e conclusion about temporary disablement and the right on
compensation of social insurance is m a d e by medical institutions. F o r this
purpose they give out the insured person the form of invalidity. F o r the first
6 days of disease or an industrial trauma the form of invalidity is given out
by the doctor (in certain cases mentioned by the medical assistant).
In all other cases the conclusion about time invalidity is m a d e with
medical c o m m i s s i o n of specialists ( M C ' s ) . It exists in all medical
institutions, w h e r e n u m b e r of medical posts not less than 15.
If n u m b e r of medical posts less 15, functions of M C ' s are carried out
by the doctor in charge together with the head physician.
 M e d i c a l c o m m i s s i o n of experts w h i c h consists of three specialists is
headed by the assistant of the head physician of medical c o m m i s s i o n of
specialists.
He is responsible for the organisational work concerning maintenance
of the qualified and qualitative expertise of ability to w o r k in hospitals.
If disease lasts m o r e than 4 m o n t h s (exception - see section 3.0),
M C ' s raise the question o f proof disability. M C ' S prepares letters o n
such patients and sends t h e m for conclusions to medical-social
c o m m i s s i o n s of specialists ( M S C ' s ) w h i c h are created at establishments of
social protection of the population. M S C ' s solve also questions on
disability in case of congenital defects and in other cases w h i c h n e e d social
protection.
MSC's consists of the doctors - specialists headed by the head
physician. T h e r e are also auxiliary workers. M S C ' s are of two types: the
c o m m o n and specialised (psychiatric, cardiological, etc.).
M S C ' s determines:
• Degree of restriction of persons abilities a state of working ability, the
group of physical invalidity, the reason and time of invalidity o w i n g to
the general morbidity, a labour mutilation or occupational disease;
• D e g r e e of disability (in percentage);
• Causal relationship of physical invalidity with disease or a mutilation
w h i c h h a v e arisen in the childhood, congenital defect;
• Causal relationship of physical invalidity of former military m e n w i t h
their b e i n g at the front or with other kind of military service;
• D e g r e e of health loss group, the reason and time of physical invalidity
of citizens which have suffered due to political reprisals and C h e r n o b y l
accident;
• D e g r e e of proof disability at patients for their sending to boarding -
houses for aged and invalids;
• M e d i c a l indications on the right of reception by invalids of automobiles
with hand control.
T h e degree of disability is divided into three groups of physical
invalidity:
• T h e f i r s t - c o m p l e t e disability w h e n outside assistance is necessary ;
• T h e second - c o m p l e t e disability without necessity of outside assistance;
• T h e third - partial disability which requires lightening of w o r k i n g
conditions.
P a y m e n t s at proof disability (physical inability) are carried out at the
expense of funds of pensions security.
Since 1992 in Ukraine the law « About pensions security » by which
such pensions are specified :
• L a b o u r : on age, on physical invalidity, in case of loss of the bread-
winner, for long service;
• Social: in cases if a p e r s o n did not w o r k or worked less than the
established m i n i m u m and n e e d s social protection.
T h e disability pension is appointed, as a rule, for a year or s o m e years
and is periodically reconsidered, according to repeated examination of
work ability.
L a b o u r pensions on age are established according to the experience of
work (not less than 25 years old for m e n and 20 for w o m e n ) and the size of
earnings at achievement by the m a n - 60, and the w o m a n - 55 years.
In case of harmful work term of retire decreases. Separate kinds of
workers can retire for long service (teachers, doctors, art w o r k e r s , military
men).
In case of loss of the supporter the pension is appointed to children till
16 years (at training - to the end) of its term), to adult m e m b e r s of family
of the support - for life.
A n u m b e r of categories of w o r k e r s use privilege increment to
p e n s i o n s - office employers, those w h o h a v e suffered from Chernobyl
accident, military m e n , scientific researchers.
R e c e n t l y offers concerning introduction in Ukraine medical insurance
are putting forward. Medical insurance is a version of social insurance at
diseases if treatment is paid from private, public or the state fund. It c o m e s
from private insurance n a m e l y financing of medical care at the e x p e n s e of
citizens which organisation w a s undertaken with insurance c o m p a n i e s .
Later the c o m m u n i t y (the b u r d e n of expenses for separate citizens
b e c a m e excessive) has j o i n e d medical insurance, and recently the state.
A n d accents or v o l u m e s of expenses w e r e displaced in this direction.
H o w e v e r , the m a i n feature of medical insurance - it is address
character, it m e a n s financing of medical actions is not general, but directed
on the separate inhabitant - at all stages r e m a i n s constant.
It has found out the advantages to b u d g e t a r y financing.
 correctness of expenses, quality and efficiency of medical care, in
First, powerful positions of public health services in system of public
particular, is increased medical institutions and separate medical workers
priorities ( m e a n s of public health services h a v e b e e n protected from
lose grants if e x p e n s e s exceed the certain fixed level of cost.
e n c r o a c h m e n t s of m o r e powerful establishments w e r e provided.
All v o l u m e of medical care, as a rule, is divided into two parts: a
S e c o n d , mainly decentralised character of financing w a s provided it
guaranteed m i n i m u m and additional services.
w a s clearer for each person where there are m e a n s earned by him, public
T h e first is paid at the expense of the state and the enterprises.
solidarity on the equal countries was supplemented with group solidarity at
T h e second - at the expense of m e a n s of citizens, the enterprises and
a level of a w o r k staff.
the state.
M e d i c a l insurance has found out also a n u m b e r of other advantages.
Additional services are called in the greater measure to react to
Presence b e t w e e n the c o n s u m e r (patient) and the manufacturer (the doctor,
incomes of citizens, they display those n e w offers which appear in the
medical institution) an intermediate link - an insurance s o c i e t y - has
market of m e d i c a l services.
provided independent, m o r e effective control over activity of m e d i c a l
On the character they are directed m o r e on preventive m a i n t e n a n c e of
institutions, of quality and efficiency of medical care.
diseases. Participation of the enterprises and citizens in additional p r o g r a m s
A n d this control w a s based not only on administrative, b u t on
of medical insurance is e n c o u r a g e d with the state.
e c o n o m i c as well. M e d i c a l insurance as a version of social insurance, w a s
Often these m e a s u r e s are not taxes. To the b u s i n e s s m a n it is
always united with its other directions. In particular, the insurance society
favourable, as well-being of workers is improving not d u e to w a g e s
paid not only medical services, but as follows kinds of social insurance, as
increase that w o u l d cause the product price increase and its lower
p a y m e n t of time temporary disablement, maternity leaves, etc.
competitiveness, but thanks to medical services.
It enabled to involve economic levers in the complex, so to say, on
T h e society as a w h o l e will win as people will have less m o n e y and
c o m p l e t e capacity.
this will constrain inflationary processes.
Long-term experience of the West in the field of medical insurance is
T h e worker will win as in case of non-use the m e a n s of additional
characterised by as follows basic features. First, it is multichannel the
insurance twill c o m e b a c k to him.
following financing with a g r o w i n g role of the state in c o m p a r i s o n with
hi all countries w h e r e there is a medical insurance, it is based on a
other sources.
contractual basis. Insurance societies sign contracts, on the one hand, with
Second, m e a n s for medical insurance, as a rule, are taken from w a g e s
medical w o r k e r s and medical institutions, as manufacturers of m e d i c a l
of citizens. It has exclusive n u m b e r for public health services as the cost of services, o n the a n o t h e r - w i t h patients, a s their c o n s u m e r s .
labours in that case growing. It creates objective e c o n o m i c preconditions
In the contract t e r m s of insurance are admitted: v o l u m e a n d conditions
for improving its health. T h e w o r k e r k n o w s a part of the w a g e s w h i c h
of the aid, its cost, results, the responsibility for infringement of articles of
spends on protection of his health and it is favourable to him not to be ill as
the contract.
u n e x p e n d e d insurance m e a n s c o m e back to him in the form of different
In s o m e countries doctors w h o cooperage with insurance societies, are
privileges, in particular extra charges to pension, etc.
forbidden to be engaged in private practice or to take from patients a
T h e third feature of medical insurance is the period of expectation ( 1 -
payment over the caused level.
4 d a y ) with p a y m e n t of time temporary disablement. Insurance
On the w a y of creation of insurance societies w h i c h w o u l d be engaged
c o m p e n s a t i o n for the period of disease m a k e s 60-70 % of earnings and is
in medical insurance in Ukraine, there is a n u m b e r of essential barriers.
p a i d during the certain period.
First, insurance societies w h i c h h a v e already existed in U k r a i n e and
Cost of medical services in all countries is constantly growing. To
are e n g a g e d in different k i n d s of insurance developed on c o m m e r c i a l b a s e s .
k e e p the g r o w t h medical insurance in most countries is b r o u g h t to n o n -
commercial b a s e s . T h e control over insurance societies is and the state for
 Commercialisation of public health service economically in expedient,
its consequences in the U k r a i n i a n conditions w i t h the b i g m e a s u r e of
reliability can be predicted as negative.
T h e basis of insurance societies consists of specialists of three t y p e s :
lawyers ( w e h a v e not e n o u g h of them, there are not also e n o u g h laws of
functioning of public health services in market conditions), economists
(their n u m b e r is not extremely enough), highly skilled specialists — doctors
(they should pass from other existing controls public health services).
Certainly, that the organisation of insurance societies will encounter
counteraction of existing which lose thus m u c h of imperious p o w e r s .
Obviously, process of introduction of medical insurance in U k r a i n e will
h a v e gradual character, having b e g u n from voluntary insurance as follows
insurance already started in Kyiv, Z h i t o m i r and s o m e other cities of
Ukraine.
Q u e s t i o n s for self-checking:
1. W h a t cases of time disability are subject to social insurance.
2. T h e primary goals of medical -social c o m m i s s i o n s of experts.
3. T h e kinds of pensions according to the existing legislation.
4. Essence of medical insurance.
Section 9 . O R G A N I Z A T I O N O F P R I M A R Y H E A L T H C A R E O N
THE BASES OF FAMILY MEDICINE
T h e leading role of out-patient medical care in public health care of
the population is oblige heads of corresponding medical establishments and
all medical personnel constantly to improve of its multi-sided activity.
C h a n g e s of ideology and e c o n o m i c conditions at transition to the
market relation have caused necessity of development and an e m b o d i m e n t
during a life of the actions directed on reduction of system of health
protection organization in conformity to inquiries of a society.
H e a d s h a v e begun reforming system of public health services, one of
which directions is transition to giving the service on the basis of medical
insurance. This w o r k will last certain time, its rates in different regions can
be different, that is caused by is the following objective reasons:
• State of e c o n o m y ;
• D e v e l o p m e n t of all infrastructure of medical service;
• C h a n g e of structure of the population;
• Character of a pathology;
• A level of m a n a g e m e n t and development of a certain areas, cities, areas.
T h e psychological factor play significant role in the state of training of
heads of various levels of m a n a g e m e n t , consciousness of necessity of
reforming of certain areas of national e c o n o m y (including public health
services) by workers of this or that area, readiness of m a n a g e r s and
subordinates for introduction of n e w b a s e s , forms and m e t h o d s of w o r k in
to practical activity. It is necessary also to take into account the necessity of
training of the population to changes in usual for t h e m system of public
health services.
Reforming d e m a n d s training and retraining of medical w o r k e r s to
work in n e w conditions, redistribution's of the medical service b e t w e e n
medical establishments of corresponding levels. It will lead to delimitation
of fields of activity between structures of primary, secondary or tertiary
medical service. T h u s the role of primary health care ( P H C ) will
considerably increase.
In world practice from the beginning of 60th years the concepts of primary
care (PC) were introduced. In 7 0 - th years other term appeared- primary
medical care (PMC) and primary health (medical sanitary) care (PHC).
 T h e c o m m i t t e e of Institute of medicine in the U S A (1995) has offered
is the following determination: primary health care ( P H C ) is provision of
the integrated accessible service concerning public health services by
clinical physicians w h o are responsible for the significant majority of needs
of public health services of a person, p r o m o t e development of long - t e r m
partnership with patients and practice it at the family level and the
community.
T h e E u r o p e a n regional bureau of W H O has given is the following
determination: primary health care ( P H C ) includes consultation and first
care w h i c h is given an individual ly or by group of experts on public health
services and related trades with it with the preventive and medical purpose.
F o r m u l a t e d in b a s e s of the legislation of U k r a i n e on public health
services (1992) the concept about the primary health care coincides with
other determination o f W H O , namely: P H C i s the basic medical and
preventive service, simple diagnostics and a direction in difficult cases on
consultation of higher level and the basic sanitary - educational actions.
It is a little n a r r o w e r in comparison with determination of the A l m a -
Ata conference (1978) w h i c h introduced the term " the Primary health care
" (PHC).
P H C is not only treatment of the widespread diseases and t r a u m a s by
the basic m e a n s , but also assistance in the organization of a balanced diet,
provision with good-quality water, carrying out of sanitary - improving
actions, public health services of mother and the child, immunization
against the basic infectious diseases, prophylaxis of endemical diseases and
struggle against them, sanitary education of the population.
Reforming of public health services in U k r a i n e , first of
all,determination of a place and role of P H C a m o n g all medical care. It can
provide significant v o l u m e of the medical care at substantial i m p r o v e m e n t
of its quality.
Functions of P H C are not limited only to medical service. A priority of
its d e v e l o p m e n t s is connected also with the need to provide:
T h e guaranteed v o l u m e of the medical, psychological and social
service;
Availability of corresponding medical and social services to all
population;
Continuity of supervision over patients.
High-grade functioning of P H C needs the solution of s o m e p r o b l e m s :
Carrying out organisation of actions;
Determination sources of financing;
I m p r o v e m e n t and reorganization of infrastructure of P H C ;
T h e coordination of its interaction with other kinds of medical service;
Trainings and retraining of medical a n d other staff;
Carrying out of corresponding sanitary - educational m e a s u r e s a m o n g
the population.
P H C is a link providing the solution of the majority of p r o b l e m s of
health of the population. P H C service possible with observance of the main
principles, determined by W H O (the A l m a - A t y conference, 1978):
B e l o n g i n g to national system of public health services;
T h e m a x i m a l proximity to a residence and w o r k of a person;
T h e m a x i m a l availability according to a level, v o l u m e , technologies
and term of medical service giving;
Conformity of vocational training of experts and material b a s e ;
Service of provision of impressionable g r o u p s of the population
( w o m e n , children) and p e r s o n s w h o w o r k in harmful conditions;
Regulation of activity of P H C by corresponding n o r m a t i v e d o c u m e n t s .
T h e decision of the following p r o b l e m s is put on the P H C :
Diagnostics and treatment ill recovery or complete indemnity patients
on the most widespread diseases, including not therapeutic type;
An after-care after reception of other kinds of the service;
A target direction for reception of medical care in cases which are
outside the c o m p e t e n c e of the doctor of the c o m m o n practice;
Carrying out of a c o m p l e x of preventive actions;
Prophylactic medical examination of patients with orientation to p r e -
medical diagnostics and medical-social preventive provision ; E m e r g e n c y
service.
P H C is based on the fundamental of family m e d i c i n e which
introduction is determined by a n u m b e r of preconditions.
First of all, it deal with e c o n o m y state and a patient m o n e y .
T h e family doctor, working for a long t i m e with a constant contingent,
can take into account influence of various factors on their health, in
particular their w a y of life.
He studies a person in details, his family and social environments,
taking into account medical, psychological and social aspects of his state of
health.

T h e family doctor, caring patients at disease, solves also the certain
p r o b l e m s of the social plan, b e c o m e s the authoritative person and his
advice are listened to, he can influence the different sides of life of the
population.
So historically happened, that domestic clinical school, unlike a
foreign o n e , w a s always m a r k e d by its skill to treat the patient, not his
disease. District doctors in m a n y respects play a role of family doctors.
Organizational forms of family medicine in the different countries of
the world are different, never the less their principles do not differ in there
essence.
T h e principles of family medicine r e c o m m e n d e d by the decisions of
the International symposium on public health services (Saint Petersburg,
October 1995 p.), are the following:
Supervision over rather stable contingent of the population taking into
account medical -social p r o b l e m s of family;
Providing a family with a free-of-charge, available, continuous and
constant P H C ;
A free choice of the patient of the family doctor;
Central figure of P H C is a family doctor ( general practitioner); the
basic form of the organization of w o r k - group practice of doctors, nurses
and other workers.
At different stages of P H C activity and also in different countries P H C
are represented by different experts : family doctors, doctors -
therapeutists, pediatricians, obstetrics-gynecologists. Practicing medical
sisters and assistants to the doctor after corresponding training, social
workers involve in P H C activity.
T h e m a i n p e r s o n in P H C is a family doctor (the doctor of the general
practice).
T a s k s of the family doctor are determined by the E u r o p e a n u n i o n of
doctors in 1984.
F a m i l y doctor is a graduated medical w o r k e r w h o personally gives the
primary medical sanitary and continuous service to separate patients, to
families and the population of a site, irrespective of age, a sex and a kind of
disease.
He services patients in r o o m i n g a place of residence, sometimes in
hospitals. He possesses a priority in the decision of all p r o b l e m s of patients.
A family doctor constantly looks after patients with chronic, relapsing
and incurable diseases. L o n g contact to them allows to trace a situation, to
adjust good relations based on trust. T h e responsibility for health of the
population is based on cooperation with colleagues of medical and n o n
medical spheres. M o d e l s of w o r k of family doctors can be very different.
An individual practice in Austria, B e l g i u m , D e n m a r k is often met.
G r o u p practice prevails in Great Britain, the U S A .
T h e centres of health are distributed in the Scandinavian countries.
A n d these m o d e l s can coexist.
Medical service of family doctors on the basis of polyclinics is most
popular to s o m e countries of the East E u r o p e and the countries of former
USSR.
In C z e c h in P H C , except for doctors of the general practice,
pediatricians also take part. Doctors of the general practice have the certain
business hours, if necessary, patients go to the centres of first care of a
primary link of public health services.
In D e n m a r k family doctors also give medical service during certain
day time, and after the end of reception of the family doctor, the population
go to e m e r g e n c y service.
O n e of m o d e l s of the Israeli public health services (by the e x a m p l e of
Jerusalem) is activity of the centres of health. Participation in P H C is
provided by doctors of the general practice, pediatricians, psychologists,
social workers, dietologists, experts on sanitary education and
epidemiologists. T h e significant role is played by nurses w h o are involved
in scheduling, introduction of n e w p r o g r a m s and techniques.
As it w a s stated above, P H C in the centres of health is typical also in
the Scandinavian countries. In Finland there are m o r e than 2 0 0 centres of
health, each of which approximately serves about 10 t h o u s a n d of
population. In structure of the center of health, except for medical
a m b u l a n c e stations, there are : a public health department of m o t h e r and the
child, general hospital, clinical laboratory and etc.. For the greater
availability of medical service of the centres with m o t o r transport.
Taking into account the experience of the U S A , a family doctor is a well
trained specialist of the general practice who works according in a proper -
equipped medical institution, instead of goes from one house to another, being
engaged only with patients. It is considered, that he should not only give
medical service, but also to be the leader, the defender of the patient.
 T h e doctor can advise them concerning diseases and m e t h o d s of Except for the doctor»s visiting, if necessary, patients can call him to
treatment, to direct to specialists, to provide the continuous service at there places in case of significant worsening of a state of health.
chronic conditions. It is very important as for the w a y of the control over A v e r a g e of visits during o n e year — 3-4, about 10 % from them are
cost of treatment, over u s e a n d rational distribution of resources. medical care at h o m e as in Britain it is not d o n e to visit patients with fever
T h e average n u m b e r o f visits o n o n e inhabitant d e p e n d s o n a g e a n d and infectious patients. T h e advanced n e t w o r k of roads, high security of the
population with m o t o r transport, culture of mutual relations influences this
sex a n d m a k e s 5,0 during o n e year.
process. B e s i d e s the significant part of contacts is correspondence and is
Table 9.1. The characteristic of visits of family doctors in the USA connected w i t h repeated prescriptions.
Average number of visits during a year T h e doctor spends approximately 9 m i n u t e s for one visiting (on the
average 7 visits in o n e hour).
Years Number of visits Sex Number of visits In G e r m a n y duration of visit is also short —not m o r e than 10 minutes.
Up to 6 6.5 Men 4.4 In the U S A its duration is m o r e : in 39 % of cases till 10 m i n u t e s , in
6-16 3.2 Women 5.7 30 % of cases - from 11 till 15 m i n u t e s and almost third - is m o r e than 16
4.5 —
17-44 - minutes
45-64 5.8 —
- In S w e d e n 2,4 visits (consultations l a s t ) on the average one hour.
65 and more 7.6 - - It is necessary to note, that according to the British doctors of family
practice — at b e g i n n i n g s y m p t o m s of disease quite a big part of patients (up
T h e experience of system of family practice in Great Britain is very to 75 %) start in self-treatment a n d o n l y 25 % see a doctor. It c o n c e r n s
interesting. mainly acute short-term diseases and w h i c h do not result in significant
T h e population of the country has the right to a free choice of the worsening of a state of health.
doctor a n d is in o v e r w h e l m i n g majority is satisfied with h i m (85 % ) . On chronic diseases supporting or anti-relapse therapies), up to 10 %
F a m i l y doctors provide with treatment almost 90 % of patients and of doctors visits are caused by m e n a c i n g conditions (a sharp heart attack of
only 10 % are directed to n a r r o w specialists. a m y o c a r d i u m , a brain insult, etc.).
All d a y and night they observe a state of health of 1800 patients (on T h e first place in structure of disease, according to the d o c u m e n t s of
the average) during all their lives. At his disposal a family doctors has doctors of family practice, is occupied by diseases of bodies organs of the
m e a n s at a the rate per on one patient. breath,the second - diseases of system of blood circulation, and also
Several workers are subordinate to each doctor: frustration of mentality and behavior. T h e y m a k e third of all pathology.
a nurse; A b o u t 40 % of a p a t h o l o g y consist of diseases of b o n e - m u s c u l a r
a secretary; system and a connecting tissue, e n d o c r i n e , diet disorder and infringement
a computer operator; of a m e t a b o l i s m , n e r v o u s system a n d sense organs, digestive organs, skin
a manager; and cellar tissue.
a bookkeeper. V o l u m e of medical care (according to statistics of the general practice
T h e y are e m p l o y e d i n b r i g a d e o f P H C , taking into account expediency in G e r m a n y ) is the following: 11.70 % of doctor»s visit are c a u s e d by
and financial opportunities. internal diseases, 10 % surgical, about 12 % — neurological,
Besides doctors can cooperate with the midwife, the physiatrist, the otolaryngological a n d dermato-veneral diseases.
psychologist, diet nurse, the logopedist, the w o r k e r of service of public F a m i l y d o c t o r s i n the G r e a t B r i t a i n , p r o v i d i n g r o u n d - t h e - c l o c k
trusteeship which are financed from other sources. medical care, prefer group practice. It enables to organize mutual
s u b s t i t u t i o n , t o a d v i s e p a t i e n t s t o t a l , t o get a n d u s e the c o m p l e x and
expensive equipment.
T h e concept of group practice w a s supported by 40-th W o r l d medical
assembly (1998) as one of m e a n s of giving of continuous and high-quality
medical service.
T h e o v e r w h e l m i n g majority of medical a m b u l a n c e stations (90 %) in
Britain is computerized.
U s e of computers enables to form a database with the information on
each patient (date and results of consultation, the a n a m n e s i s , recipes, results
of e x a m i n a t i o n s ) to get rid or considerably r e d u c e a m o u n t of p a p e r carriers
of the patient.
T h e system of a discharging of repeated recipes w h i c h saves t i m e
doctor and the patient is also computerized and also r e d u c e s n u m b e r of
mistakes in drugstores.
During the patient visit the doctor sees on the screen all his data and he
supplements the information himself. P a p e r carriers are necessary only
w h e n visiting of patients at h o m e . H e r e the portable computer and u s e of
the m o d e m care.
T h e p a p e r s system allows to provide clearness of the information, to
save t i m e of the secretary and m e a n s , a p l a c e for a c c o m m o d a t i o n of the
documentation.
N e v e r t h e l e s s it is necessary to take into account its significant cost,
danger of loss of the information due to any a n n o y i n g case.
B e s i d e s , transition to is the following system d e m a n d s t i m e and efforts
for transferring of the information from cards of patients and can w o r s e n a
psychological atmosphere during reception as the patient m a y think, that
the doctor is not interested him.
T h a t ' s w h y doctors try to use a computer before the beginning or after
the termination end of reception.
T h e system of family m e d i c i n e in Great Britain h a v e b e e n functioning
almost half of century, is estimated as effective, taking into a c c o u n t its
popularity a m o n g the population and profitability.
Nevertheless it has also unresolved problems, For example,
hospitalization turn. They are connected, in opinion of workers, with increase
of requirements of patients to quality of the service. To service this, the British
doctors try to reduce terms of treatment in a hospital, having improved medical
- diagnostic process at pre-hospital and hospital stages.
T h e similar problem d e m a n d s the solution in m a n y countries.
Essential influence on reduction of t e r m s of treatment in a hospital can
have expansion of medical service at the patient"s place.
From this point of view rather interesting there is working experience of
agencies giving medical service at the patient»s place which have appeared in
the U S A in 50years and have eventually been widely spread.
Their w o r k is directed in satisfaction of n e e d s of the patient in his o w n
health services and in the situations dealing with to influence of different
socially psychological factors.
T h e interrelation of hospital and a g e n c y is of great value.The later,
first of all, should take part in the process of patients discharge from
hospital.
Planning of the discharge can start during p a t i e n f ' s stay in a hospital,
and sometimes before it and allows to give the most expedient medical
service, to provide all needs for services with the least expenses.
T h e general rounds with participation doctor, the senior nurse, one of
executives of a social service and the head of the agency fixed behind a
certain d e p a r t m e n t of a hospital also care to plan a p a t i e n t ' s discharge.
T h e y m a k e a decision on health services of the patient after his
discharge.
At active participation of a g e n c y in p l a n n i n g an extract of patients the
problem of continuity of medical service is solved. In addition, the staff of
agency further passes doctors of a hospital the information of a state of
health discharged patients.
At a direction on h o m e treatment the w o r k e r of a g e n c y Total with the
doctor determines all its m e t h o d s and procedures, checks necessity of the
certain services and finds out opportunities of family concerning
corresponding support of the patient. It is necessary to determined a
personnel for providing the care, to receive necessary equipment and
different m e a n s from auxiliary services.
M e d i c a l service is provided i n - h o m e with the coordinator. To this post
usually appoint the medical sister. She is responsible for the decision of all
p r o b l e m s during treatment, a correct initial and current estimation of a state
of health of the patient.
A c c o r d i n g l y the p l a n of the treatment developed by the doctor and the
coordinator, the brigade from personnel of a g e n c y and a doctor w o r k i n g
according to the schedule, m a d e by the coordinator.
 T h e coordinator is responsible for realization of the program of
treatment, consultations of the patient by the certain specialists.
Before the end of the course of treatment provided with agency, the
coordinator m a k e s out the file the form inquiry - the information of a state
of health and results of treatment, the list of medical r e c o m m e n d a t i o n s
concerning the further treatment and improvement.
T h e need for health services at h o m e can arise not only after hospital
treatment, but also to family doctors, patients or their relatives can go the
certain agencies.
T h e w o r k i n g experience of agencies on giving medical service in
conditions d e m a n d s detailed studying with the p u r p o s e of the further
i m p r o v e m e n t of P H C s system in our country.
T h e experience of R u s s i a significant interest causes as our systems of
public health services w e r e identical and Russia has started the organization
of the service on the basis of family medicine earlier.
T o d a y the majority of doctors of the general practice (family) work in
the state medical institutions, their insignificant part is engaged in private
practice or w o r k s in official bodies.
B o t h an individual and group practice take place except for family
doctors, the stomatologist, the pediatrician, the obstetrics-gynecologist, and
also medium-level medical staff - nurses of procedural and dressing r o o m s
the y o u n g e r nurses are involved in group practice.
F a m i l y doctors conduct reception of therapeutical, neurological,
ophthalmological patients and etc.
A c c o r d i n g to the expert estimation, in a transition period family
doctors can provide from 36 % up to 46 % of visiting of the
ophthalmologist, the otolaryngologist, the neuropathologist and about 23 %
of the surgeon.
W o r k i n g in a polyclinic, they use its medical - diagnostic base.
In independent medical a m b u l a n c e stations, far from a polyclinic, the
v o l u m e of researches is b e i n g reduced.
O n e doctor serves approximately 1600-2500 persons. D u r i n g a year on
consultation to other experts about 20 % of patients, are directed on
examination to other establishments — 14 %.
It is offered to plan not less than 4 visits in a year for 1 inhabitant, the
probable level of hospitalization is a b o u t l 5 %.
Providing of interaction of family doctors with other services and
establishments, including polyclinics, hospitals, clinics, the advisory -
diagnostic centres is of great importance.
T h u s there is a task concerning reorientation of work polyclinics to
giving mainly specialized care, to performance of improving programs,
carrying out of regenerative treatment with necessary use of additional
medical subdivision.
Reforming the primary medico-sanitary service on the basis of family
medicine, U k r a i n e takes into account world experience and studies
different forms of its organization.
Actually n u m e r o u s medical establishments take part in giving of P H C :
independent polyclinics and a m b u l a n c e stations (including a m b u l a n c e
stations of rural district hospitals), polyclinic branches of city, central
regional, regional hospitals, children's polyclinics, female consultations,
medico-sanitary parts, and also establishments of the pre-medical services .
Establishments of e m e r g e n c y j o i n them also.
T h e primary health care in m o d e r n conditions is provided by district
therapeutists and pediatrics, nevertheless its v o l u m e is far from the
1
desirable one in connection with doctors of other specialties.
F o r rather long period priority b e l o n g s to the d e v e l o p m e n t of the
specialized service. T h e r e for the n u m b e r of general therapeutists is
significant - a m o n g all doctors, serving city and rural population, and
m a k e s accordingly 12 % and 20 %.
In m a n y countries the part of doctors of the general practice is
significant and m a k e s 40-55 % (the U S A , Canada, France). T h e y provide
treatment of almost 90 % of patients, about 10 % go to "narrow" experts.
In U k r a i n e to 60 % of all medical services are visits of n a r r o w
specialists.
Provision with district therapeutists of certain part of P H C is not
sufficient, taking into account the needs of the population concerning
volume and quality. T h e organization of giving of P H C on the basis of
family m e d i c i n e ( general practice) is stipulated by the basic directions of
reforming of system of public health services of U k r a i n e in m a r k e t
conditions.
A c c o r d i n g to the developed by national Ministry of public health
services stage-by-stage reforming of P H C with test period in separate

regions and cities of different models and s c h e m e s of its organization is
stipulated.
T h e first stage, preparatory, began in 90th years and includes
d e v e l o p m e n t of n o r m a t i v e — legal documentation, training and creation of
material, organizational b a s e , approbation of different m o d e l s .
At the second stage the reform aimed at introduction of the general
m e d i c a l practice in out-patient( polyclinic) network.
First it is r e c o m m e n d e d to j o i n district therapeutists, pediatricians and
obstetrics -gynecologists. In m o d e r n conditions they, as a rule, w o r k in
different medical establishment. Therefore the basic p r o b l e m is providing
the coordination of their actions. Further district therapeutists and pediatrics
will be responsible for the care at diseases of not therapeutic type.
Day time and domestic hospitals will be widely used, organizational
associations of therapeutic and pediatric department will be opened, in one
establishment family brigades will be created.
Studying of world experience of giving of P H C on the basis of family
m e d i c i n e and experience of its development in our state has allowed
e m p l o y e e s of the U k r a i n i a n institute of public health to offer three
organizational m o d e l s of reforming of district -territorial system:
• G r o u p practice of m e d i c a l care in the form c o m p l e x of brigades
(therapeutists, pediatricians, obstetrics-gynaecologists);
• General practitioner w h o gives medical care to the population allot to him
(adult or children's);
A family doctor w h o serves all family realization of gradual transition
to practice of the family doctor (the doctor of the general practice) d e m a n d s
significant time expenses. Transfer of children on service to the family
doctor will be carried out in the certain sequence. First children older 12
years will pass to h i m , then — 7, 3 years and 1 year, and at last - all others.
T h e end of this stage will finish transition to a family principle with the
right of a free choice of the doctor.
A family doctor in U k r a i n e can be the specialist with the higher
m e d i c a l education w h o s e training is regulated by the corresponding
qualifying characteristic is certified as the certificate on a specialty "general
practice — family medicine".
He can w o r k an individual ly or with other doctors (group practice) in:
Official institution (a polyclinic, city or rural medical station, a
medico-sanitary station), not state medical institution (the small, j o i n t -
stock, collective enterprise, cooperative society).
• A private (an i n d i v i d u a l ) medical a m b u l a n c e station.
T a k i n g into account e c o n o m i c profitability an individual practice is
reasonable in settlements with a small population, in n e w districts of cities
without the advanced infrastructure, at straggling districts.
G r o u p practice as voluntary association of doctors can be carried out
on different b a s e s :
Association of several family doctors;
Association of family doctors with other specialists (obstetrics -
gynecologists, pediatricians, stomatologists).
Its advantages will consist in providing of the best opportunities for
diagnostics and treatment, in interchange ability of doctors and carrying out
of consultations, high-grade use of material base (for purchase or rent of a
room, medical and other equipment), in an opportunity of attraction for its
service not only the middle-level medical staff, but also social w o r k e r s , the
lawyer, the economist.
Cells of group practice can be placed on the basis of w o r k i n g medical
establishments and in separate premises.For this p u r p o s e small polyclinics,
medical a m b u l a n c e stations are used.
Existing big polyclinics are turned into the advisory — diagnostic and
rehabilitation centres with which doctors of group practice or separate
doctors cooperate.
T h e use of base of medical establishments by family doctors is carried
out on the basis of the contract, in w h i c h the v o l u m e of diagnostic
researches and kinds of auxiliary m e t h o d s of treatment are specified which
are given to patients in a concrete medical establishment.
Independently w o r k i n g family doctors can direct patients to diagnostic
and additional — m e d i c a l divisions on the t e r m s specified in the contract.
T h e n u m b e r of patients of the family doctor essentially differs in
different countries - from 1000 (Austria, B e l g i u m ) up to 2 0 0 0 ( G e r m a n y ) .
In opinion of Russian scientists, n u m b e r of patients should n o t e x c e e d
1300-1500, others consider, that it can be greater (Luchkevich, 1997).
T h e n u m b e r of population is determined by conditions of providing of
medical expediency and e c o n o m i c profitability and t h a t ' s w h y it should not
be less than 1500 persons. If their n u m b e r will exceed 3 0 0 0 persons., a
doctor cannot give necessary medical-social services in appropriate v o l u m e
and a corresponding quality.
T h e radius of service of the population is determined by concrete
conditions of settling of patients, density of residing, type of buildings,
condition of w a y s and so on.
W o r k i n g time of family doctors are stipulated in the corresponding
contract according to the w o r k i n g normative d o c u m e n t s .
D e v e l o p m e n t of family medicine requires the solution of a c o m p l e x of
legal, e c o n o m i c , organizational tasks with regard for the psychological
factor - readiness for recognition of is the following system of the medical
service by medical w o r k e r s and patients.
T h e free choice of the doctor can be realized on is the following terms:
Opportunities of this or that doctor to provide medical care to o p t i m u m
n u m b e r of patients;
Distance from a p a t i e n t ' s to a place of w o r k of the family doctor;
Opportunities or convenience of reception of medical service from
doctors of separate specialties.
T h e solution of this task, as well as other p r o b l e m s concerning the
doctor - patient - medical establishment -city administration " d e m a n d s
determination of administrative - legal bases of activity of family m e d i c i n e
a hospital for treatment his patients.
as a w h o l e , its p l a c e and mutual relations in the system of the medical
service and etc.
T a s k of the family doctor in the certain m e a s u r e are identical with
p r o b l e m s of the district therapeutist as in both cases the question is service
of a concrete contingent and performance not only especially medical
actions. Nevertheless,there are also the differences connected first of all
with the fact that that the family doctor gives the service not only
concerning diseases of a therapeutic type.
A doctor of the general practice (family) independently starts and
finishes treatment of a great n u m b e r of patients, if necessary send them to
shock, acute heart and vascular insufficiency, etc.);
advisers or directs the patient on hospitalization in the scheduled or
e m e r g e n c y order.
Practical actions of the family doctor concerning :
rehabilitation patients a n d participation in their realization;
Diagnostics;
E m e r g e n c y call services;
prophylactic w o r k w i t h the population.
E m e r g e n c y hospitalization;
Consultations of other doctors;
Self treatment and treatment on consultations of advisers;
Scheduled of hospitalization.
Duties, rights, the responsibility of the family doctor and his relations
doctors are determined by corresponding.
A family doctor provides:
- Out-patient reception hours and h o m e visit;
- Carrying out of preventive, medical, diagnostic and rehabilitation actions
in the cases stipulated by qualifying characteristics;
- Giving e m e r g e n c y call service if necessary ;
- T h e organization of day time and domestic hospitals;
- T h e help in the solution of medical-social p r o b l e m s of family;
- Carrying out anti-epidemic actions in the centres of an infectious disease;
- Informing about cases of infectious diseases doctor of room of infectious
diseases and s a n i t a r y - e p i d e m i o l o g i c a l station.
A family doctor guarantees to the population:
- early diagnostics;
- complete value timely out-patient and domestic t r e a t m e n t ;
- a timely direction to the s p e c i a l i s t ;
- organization of hospitalization of scheduled and urgent patients.
T h e family doctor, according to the agreement, m a y h a v e s o m e b e d s in
Abilities and practical skills of the family doctor should include:
- be able to u s e a technique of previous diagnosing;
- definition of necessity and sequence of application paraclinical m e t h o d s
of diagnostics, a skill of their correct to estimation ;
- definition of the clinical diagnosis;
definition of tactics of patient treatment (the e m e r g e n c y call service,
e m e r g e n c y hospitalization, scheduled hospitalization, necessity of
consultations of other experts, out-patient treatment);
G i v i n g e m e r g e n c y call service at e x t r e m e condition (all kinds of a
C a r r y i n g out of the most widespread manipulations;
M a k i n g o f p l a n s o f prophylactic medical examination and
T h e solution of tasks of disablement of invalidity carrying out of
doctor cannot give necessary medical-social services in appropriate v o l u m e
and a corresponding quality.
T h e radius of service of the population is determined by concrete
conditions of settling of patients, density of residing, type of buildings,
condition of w a y s and so on.
W o r k i n g t i m e of family doctors are stipulated in the corresponding
contract according to the w o r k i n g normative d o c u m e n t s .
D e v e l o p m e n t of family m e d i c i n e requires the solution of a c o m p l e x of
legal, e c o n o m i c , organizational tasks with regard for the psychological
factor - readiness for recognition of is the following system of the medical
service by m e d i c a l w o r k e r s and patients.
T h e free choice of the doctor can be realized on is the following t e r m s :
Opportunities of this or that doctor to provide medical care to optimum
n u m b e r of patients;
Distance from a p a t i e n t ' s to a place of w o r k of the family doctor;
Opportunities or convenience of reception of medical service from
doctors of separate specialties.
T h e solution of this task, as well as other p r o b l e m s concerning the
doctor - patient - medical establishment -city administration " d e m a n d s
determination of administrative - legal b a s e s of activity of family m e d i c i n e
a hospital for treatment his patients.
as a w h o l e , its p l a c e and mutual relations in the system of the medical
service and etc.
T a s k of the family doctor in the certain m e a s u r e are identical with
p r o b l e m s of the district therapeutist as in b o t h cases the question is service
of a concrete contingent and performance not only especially medical
actions. Nevertheless,there are also the differences connected first of all
with the fact that that the family doctor gives the service not only
concerning diseases of a therapeutic type.
A doctor of the general practice (family) independently starts and
finishes treatment of a great n u m b e r of patients, if necessary send t h e m to
shock, acute heart and vascular insufficiency, etc.);
advisers or directs the patient on hospitalization in the scheduled or
e m e r g e n c y order.
Practical actions of the family doctor concerning :
rehabilitation patients a n d participation in their realization;
Diagnostics;
E m e r g e n c y call services;
prophylactic w o r k with the population.
E m e r g e n c y hospitalization;
Consultations of other doctors;
Self treatment and treatment on consultations of advisers;
Scheduled of hospitalization.
Duties, rights, the responsibility of the family doctor and his relations
doctors are determined by corresponding.
A family doctor provides:
- Out-patient reception hours and h o m e visit;
- Carrying out of preventive, medical, diagnostic and rehabilitation actions
in the cases stipulated by qualifying characteristics;
- Giving e m e r g e n c y call service if necessary ;
- T h e organization of day t i m e and domestic hospitals;
- T h e help in the solution of medical-social p r o b l e m s of family;
- Carrying out anti-epidemic actions in the centres of an infectious disease;
- Informing about cases of infectious diseases doctor of room of infectious
diseases and s a n i t a r y - e p i d e m i o l o g i c a l station.
A family doctor guarantees to the population:
early diagnostics;
- complete value timely out-patient and domestic t r e a t m e n t ;
- a timely direction to the s p e c i a l i s t ;
- organization of hospitalization of scheduled and urgent patients.
T h e family doctor, according to the agreement, m a y h a v e s o m e b e d s in
Abilities a n d practical skills of the family doctor should include:
- be able to use a technique of previous diagnosing;
- definition of necessity and sequence of application paraclinical m e t h o d s
of diagnostics, a skill of their correct to estimation ;
definition of the clinical diagnosis;
definition of tactics of patient treatment (the e m e r g e n c y call service,
e m e r g e n c y hospitalization, scheduled hospitalization, necessity of
consultations of other experts, out-patient treatment);
G i v i n g e m e r g e n c y call service at e x t r e m e condition (all kinds of a
C a r r y i n g out of the m o s t w i d e s p r e a d manipulations;
M a k i n g o f p l a n s o f prophylactic m e d i c a l examination and
T h e solution of tasks of disablement of invalidity carrying out of
 M u t u a l relations of doctors of family practice and specialists,
regions (Lviv, Zhytomyr, Ternopil, Khmelnitskiy), but its estimation and
including those of stationary establishments, are determined by
further use d e m a n d studying on a great n u m b e r of people.
corresponding contracts.
In regions and cities in Ukraine different organizational forms of P H C
D e p e n d i n g on forms of the organization family doctors in some
are applied. Family ambulance stations with one doctor, department of
countries can cooperate not only with family nurses, but also d o c t o r ' s
family doctors (brigade) are operating.Group practice is considered to be
assistants.
more reasonable, there is an working experience of a polyclinic of family
Duties of the family medical sister are rather varied. She actively
medicine (Dniprodzerzhinsk).
participates in carrying out preventive, anti-epidemic and sanitary
T h e average n u m b e r of population w h i c h is served by the family
educational work, pre-delivery and postnatal h o m e nursing of pregnant
doctor, c h a n g e s within the limits of 1500-1900 (in city) and 1100-2100 (in
w o m e n and parturient w o m e n , provides of a material for laboratory
village).
researches, gives e m e r g e n c y medical service, services the doctor at surgical
operations, carries out the control over p a t i e n t ' s performance of medical On the basis of the gained experience, rational m o d e l s of family
medicine and the form of interaction of this link with other medical
and improving recommendations.
institutions are being developed. Simultaneously, task, functions,
Medical workers of system of family medicine actively cooperate with
organizational forms of activity of existing out-patient (polyclinic) and
services of social security.
stationary establishments are being changed.
Social worker can be a subordinated to a family doctor under the
agreement with states of social security.
Questions for self-checking:
A family doctor has the right to charge to the middle-level medical
1. Factors which influence the reforming of medical care on the bases of
staff and social workers some kinds of activity which do not demand
medical insurance.
medical knowledge.
2. Determination of concept of P r i m a r y health care ( P H C ) .
To post of the family doctor the following persons m a y be appointed:
A doctor after inter-ship on a specialty "General practitioner"; 3. M a i n principles of P H C .
A doctor after corresponding cycles of specialization on education 4. D e v e l o p m e n t factors of family medicine.
"general practitioner" or "pediatrics" with the certificate "General 5. Contents of w o r k of family doctor by W H O ' S determination.
practitioner". 6. T h e characteristic of existing organizational models of family d o c t o r ' s
work.
T h e P H C of family medicine with the purpose of providing of
population on the basis special ambulance stations are also organized. 7. E x a m p l e s of the organization of system of family practice in the
different countries.
T h e ambulance station of family medicine can be organized as:
• the independent out-patient (polyclinic) establishment subordinated 8. Actual state P H C in Ukraine, its stage-by-stage reforming on the bases
to corresponding b o d y of public health services; of family medicine.
9. P r o b l e m s and the contents of family d o c t o r ' s work .
Subdivision of municipal polyclinic establishment;
10. Possible organizational m o d e l s of family medicine in Ukraine.
Subdivision of not state medical institution;
11. A m b u l a n c e stations of family medicine.
Private medical institution (several doctors can w o r k in i t ) .
E x p e r i m e n t concerning giving of P H C on the basis of family medicine
for the first time in U k r a i n e b e g a n in L v i v city.
Is the following experience is gradually collected in cities (Kyiv,
Zhytomyr, Ivano-Frankivsk, Vinnytsya, Dnipropetrovsk, etc.), in separate
Table 9.2. Comparative characteristic of expenses for medical care in different Section 10. T H E S Y S T E M S O F P U B L I C H E A L T H S E R V I C E S I N
countries THE SOME ECONOMICALLY DEVELOPED
Great COUNTRIES
Parameter Ukraine USA Canada Germany
Britain
Expenses for one
T h e specified countries are elected for the review of foreign systems of
human soul(in 34,6 3773 1401 714 1472
public health services not casually.
$US)during 1 year
T h e y are marked by a high level of development of medicine in
State share in 78
30 42 74 86 conditions of market relations, a high level of satisfaction of n e e d s of the
expenses, (%)
Quantity of people population in medical care, positive tendencies on the basic p a r a m e t e r s of
222 428 464 729 656
for one doctor health of the population.
Quantity of people T h e U n i t e d States o f A m e r i c a
86 150 106 238 203
for one nurse T h e c o u n t r y w i n s first p l a c e in the w o r l d on expenses for public health
Doctor's average services: 14 % from a G r o s s national output ( G N O ) .
wage (during 1 year 1043 188000 82764 42641 79518 In this country there is no independent Ministry of public health
in US dollars) services.
Level of T h e m a n a g e m e n t is carried out by D e p a r t m e n t of public health
hospitalization(on 20,3 14,7 14,5 15,8 21,1
services, education and well-being, n a m e l y services of public health in
100 inhabitants)
structure of its departments.
Medical care share in
6,0 8,1 In the U S A at a federal level the following questions of public health
gross inner output 2-3 15,0 8,8
services are b e i n g solved:
(GIO),%
• Sanitary protection of borders;
• External medical connections;
• T h e organization of m e d i c a l statistics;
• T h e control over activities of regional medical services;
• Quality assurance of food, m e d i c i n e s and cosmetic m e a n s ;
• T h e organization of medical care and civil defense;
• G i v i n g of medical care to certain categories of citizens.
• At the expense of the state giving medical care is provided:
• to civil servant;
• to staff of a r m e d forces;
• to veterans of w a r s ;
• to the A m e r i c a n Indians.
In the m a i n department of public health services and education there
are 9 regional departments w h i c h control over activities of regional m e d i c a l
services.

148

In each state there is a centre of public health services w h i c h functions
is the organization of: ,,,
• anitary - anti-epidemic protection of the population;
• M e d i c a l education;
• T h e control over health of schoolboys;
• Maternity care and childhood;
• Struggle against infectious, venereal, mental diseases and tuberculosis.
T h e population of the U S A receives stationary medical care in
hospitals which are divided into two basic groups: federal and not federal
which belong to the governments, administrations of conditions, to city
municipalities, charities, religious organizations, private proprietors.
• T h e greatest part of hospital beds is used for the treatment of patients
with mental, infectious diseases, tuberculosis and deliveries.
• H i g h cost of stationary medical care forces to reduce its v o l u m e . T h e
degree of business of hospital b e d s is 59 % and continues reducing.
• Out of hospitals medical care is given by practitioners doctors (65-70 %
of all doctors are involved in private practice). T h e insurance c o m p a n i e s
or patients are m a k i n g p a y m e n t for medical services. Almost the system
of medical insurance is everywhere entered. T o d a y there are more than
1800 insurance medical organizations in the country, most k n o w n of
them -" the Blue Shield " and " the B l u e Cross ".
• M e d i c a l insurance is a voluntary thing. It covers almost 65 % of the
A m e r i c a n citizens.
A l m o s t 15 %, or nearly 40 millions A m e r i c a n s , do not u s e a uniform
kind of medical insurance at all and p a y w h o l e cost of medical services.
T h e important social achievement w a s an introduction of t w o
preferential systems of giving of medical care: "Medicare" and "Medicaid".
" M e d i c a r e " program provides dismissal from w o r k for an individual s
of 65 years and older and than the p a y m e n t of hospital and in part out of
hospital medical care on 80 % from its complete cost. All pensioners have a
right to use this kind of medical service, with no difference of what kind of
profit did they have.
" M e d i c a i d " program is the unique program of medical insurance that
provides identical rules a n d standard n u m b e r of p a y m e n t s on all territory of
the country.
" M e d i c a i d " p r o g r a m provides financing from governmental funds on
50-80 % of expenses for medical care to the deprived population of the
country and invalids.
Serious p r o b l e m for the U S A is l o w a m o u n t of medical staff, first of
all, of physicians. In the ratio of doctors of "narrow" specialties and the
general practice the first ones prevail, though the needs of population are
quite opposite.
In the U S A nurses also play the big role in system of medical care.
T h e circle of their duties constantly extends, in particular by giving the
primary m e d i c o - sanitary aid.
It is necessary to note, that the multi departmental control system of
public health services significantly influences forms and m e t h o d s of giving
of medical care; it includes T h e A m e r i c a n medical association, the
A m e r i c a n hospital association, the A m e r i c a n association of medical
colleges.
E c o n o m i c a l l y a d v a n c e d E u r o p e a n countries
Economically advanced E u r o p e a n countries - is the following as
France, G e r m a n y , the Scandinavian countries and the Benelux countries
(Belgium, Netherlands, L u x e m b o u r g ) - have a c o m m o n feature: systems of
public health services are a development of the system of medical
insurance.
All services of public health organizations in the economically
advanced E u r o p e a n countries are divided on:
1. State;
2. District (municipal);
3. Private.
Ministry of public health is coordinate and control the activity of the
state and district services of public health service. T h e conditions incur is
the following functions in the field of public health service:
• Sanitary protection of borders;
• S a n i t a r y - e p i d e m i o l o g i c a l activity
• T h e control over activities of district (municipal) services.
T h e system of insurance in the majority of economically advanced
countries of N o r t h e r n and W e s t e r n E u r o p e provides three basic sources of
p a y m e n t of expenses for medical care:
1. D e d u c t i o n from w a g e s of the insured p e r s o n s : for e x a m p l e , in F r a n c e T h e system of medical insurance of the majority of economically
and G e r m a n y m o n t h l y p a y m e n t s m a k e from 6 up to 12 % from w a g e s . advanced E u r o p e a n countries provides indemnification of 80 % of cost of
2. D e d u c t i o n from the state budget: in N e t h e r l a n d s — 10 %, in G e r m a n y - given m e d i c a l services and c a n b e carried out b y t w o w a y s :
about 20 %, in the Scandinavian countries from 20 up to 50 %. 1. Directly during the stay of the patient in a hospital or after t h e visit of
3. D e d u c t i o n from profits of businessmen — 50 % in G e r m a n y , a n d about the doctor with the subsequent returning of 80 % of a sum of m o n e y
15 % of all m e a n s for m e d i c a l care in other countries. through insurance (hospital) c a s h departments.
60-80 % of all population is insured. At presence of three n a m e d 2. T h r o u g h insurance cash d e p a r t m e n t s w h e r e the patient p a y s up to 20 %
sources of financing there are certain specific features of system of medical of cost of medical services.
insurance in these countries. O u t of hospitals medical care is given by doctors of the general
For G e r m a n y , Netherlands, Belgium, L u x e m b o u r g , Austria the practice w h o conduct reception of the insured in the private cabinets,
following model is a average thing: insurance funds are created, by the big cabinets of g r o u p practice and out-patient branches at hospitals.
part, at the expense of obligatory p a y m e n t s of w o r k e r s or the enterprises T h e s y s t e m of public health services in G r e a t Britain can be
and are not state b o d i e s of a finance administration. Insurance funds stack characterized as governmental or as British n a m e it, national. It is based on
a g r e e m e n t s w i t h the m e d i c a l establishments, privately practicing doctors is the following principles:
regarding v o l u m e a n d giving medical care. • Priority participation of the state in expenses for public health services;
In the rest of the countries w h e r e the basic part of funds is m a d e with • Professional i n d e p e n d e n c e of doctors;
b u d g e t a r y p a y m e n t s , the rigid state control over their activity is stipulated. • Support of a family doctors;
State expenses on medical care are nearly 10 %, as m u c h m a k e • P a y m e n t by the population of the special t a x on d e p e n d i n g on a state of
personal m e a n s of citizens, the rest - 80 % of expenses are m a d e by funds health.
of medical insurance. • Entirely free-of-charge medical care for the population is impossible.
Table 10.1. Expenses for public health services in some countries in Europe (1993) • Structure of e x p e n s e s for public health services is the following:
The general expenses rrom a bxpenses per one person • Public funds - 85 %;
Country Gross national output (%) in US dollars • M e a n s of social insurance — 10 %;
Switzerland 9.9 2283 • Personal m e a n s of the population — 5%.
France 9.7 1835 C o n t r a r y to other countries, the national system of public health
Austria 9.3 1777 services in Great Britain has three sectors:
Finland 8.8 1363
• District hospitals a n d medical establishments of public health services;
Netherlands 8.7 1531
• out-patient c l i n i c ;
Italy 8.6 1523
8.2 1592 • in— patient clinic.
Norway
Sweden 7.5 1266 T h e district services of public health service subordinated to municipal
Great Britain 7.1 1213 self-government institutions, carry out the following basic functions:
Luxemburg 6.9 1933 • T h e prevention of infectious diseases;
Denmark 6.8 1296 • Vaccination of the population;
Western Europe in 8.0 1337 • G i v i n g of the social service to the patient;
general • T h e help birth at h o m e ;
• T h e organization of female and infant consultations.
• O u t —patient medical care is given by doctors of the general
practitioners w h o w o r k by a principle of the "family d o c t o r " and serve
from 2 0 0 0 up to 3 5 0 0 population which voluntary selects them.
L a s t y e a r s in the c o u n t r y g r o u p practice w a s distributed:
• 5-6 doctors u n d e r the certain schedule conduct the general reception,
serving of 10-20 t h o u s a n d s of p e o p l e and provide j o i n t carrying out of
consultations of patients.
From the point of v i e w of the organization of the hospital care in the
Great Britain is divided into 15 "hospitals" areas, each of which totals 3-4
million inhabitants.
H e a d s of the hospital are councils, which are responsible for the
organization and planning of the in-patient care. In turn, each hospital
council unites as a w h o l e on the country of 4 0 0 hospital c o m m i t t e e s in the
structure of w h i c h doctors, representatives of the enterprises, trade unions
and the population are included.
D u r i n g t h e last d e c a d e s there is a reformation of a national system of
public health services w h i c h resulted in:
• Putting in order of m a n a g e m e n t system;
• D e v e l o p m e n t of the strategy of planning;
• E x p a n s i o n of private practice;
• Increase in assignments at stationary medical care;
• Increase in assignments at carrying out of research development in the
areas of m e d i c i n e and public health services.
Questions for self-checking:
1. M a n a g e m e n t of system of public health services in the U S A .
2. Organization of medical care in the U S A .
3. M e d i c a l insurance in the U S A .
4. Organization of public health services in economically advanced
E u r o p e a n countries.
5. Features of system of medical insurance in the economically advanced
E u r o p e a n countries.
6. Principles of national system of public health services in Great Britain.
7. Distribution and p r o b l e m s of public health services in Great Britain.
8. Organization of medical care in Great Britain.
• posters, tables, illustrated slogans and brochures on walls and rotating
Section 11. F O R M A T I O N O F H E A L T H Y W A Y O F LIFE
Educative activities concerns the major directions of preventive
activity of medical workers. I t ' s object is, on the one hand, raising sanitary
culture of the population, a n d on the other one — preparing a sanitary active
which does not only distribute sanitary k n o w l e d g e a m o n g p e o p l e , b u t also
aids medical attendants in carrying out of medical and preventive work.
Forms of health education are various: oral propagation
(conversations, lectures, reports, public speeches on radio and T V ) , written
or printed propagation (distribution of the literature, release of sanitary
bulletins, wall n e w s p a p e r s ) , evident propagation (creation of the corners
and r o o m s of health, the organization of thematic exhibitions).
Giving educative activities, it is necessary to adhere to several basis
methodical requirements.
F i r s t , the subjects and the maintenance of health education actions
should be closely connected to the performance of general e c o n o m y
problems.
S e c o n d , sanitary agitation and spreading of health education actions
should be b a s e d on a district material. It is necessary to take into account
features the group of p e o p l e or separate persons with w h o m the following
w o r k is going to be spent.
T h i r d l y , it is necessary the content of any health education actions is
to be clear.
District Councils and public organizations h a v e the big help to the
medical attendants in carry out of the educative activities.
Therefore,medical workers periodically involve to this w o r k the
managerial personnel, experts from different areas a n d intelligence and
with their help sanitary posts and sanitary divisions are organized, training
of sanitary active is being held.
B e s i d e s educative activities spend in h o u s e s of culture (clubs) and
libraries, it needs to be held in children's preschool establishments and
schools, at h o m e .
So, during outpatient reception hours it is expedient to organize an
individual and group conversations, paying the basic attention to hygiene
and preventive maintenance of diseases. In reception medical institutions it
is necessary to arrange small thematic exhibitions. It is possible to hang out
stands. Beside it is expedient to place wall n e w s p a p e r s and the sanitary -
educational bulletins, w h i c h are prepared by the medical attendants.
On p r o m i n e n t place there can be w a l l a board of questions and
correspond to. B u t it is n e c e s s a r y to avoid rather detailed medical advice, it
is n e c e s s a r y to m a k e the basic accent on preventive maintenance of
diseases, observance of a m o d e by patients.
Efficiency of the educative activities directly depends on a sanitary
and aesthetic conditions of the medical establishments and from quality of
health services in them.
In houses of culture (clubs) it is necessary to organize lecture halls and
sanitary - educational circles, thematic evenings, exhibitions, to create sanitary
stand, to make wall newspapers, to show sanitary - educational films. In
libraries it is expedient to spend debates and exhibitions of the literature. In
industrial premises the best form of educative activities are conversations and
employment on sanitary education, creation of sanitary stand, release of
corresponding bulletins and wall newspapers. Conversations on sanitary-and-
hygienic themes can be spent during visiting patients at home.
M e d i c a l w o r k e r s of m o r e and m o r e attention give propagation of a
healthy w a y of life. T h e state of health of a p e r s o n is mostly determined by
the social and e c o n o m i c conditions in w h i c h he lives, closely connected
with influence of an environment, air, water, solar radiation, space
radiation, electromagnetic fluctuations, etc.
T h e task of the health educators is to acquaint people with h o w natural
factors influence an organism of a person. It is necessary to emphasize that
environmental contamination has an adverse effect on a state of health of a
person that everyone should participate actively in an a c c o m p l i s h m e n t and
gardening of cities and villages, in struggle against noise, air pollution,
waters, ground.
V e r y important factor for health of a p e r s o n - correctly organized
w o r k w i t h regular breaks for rest. Covering in conversation or lecture these
questions, medical attendants should take into account professional features
of students. It is necessary to aid to graduates of schools to c h o o s e their
profession correctly.
B a l a n c e d diet also m e a n s a lot for the health of a person. It is
necessary to w a r n people of typical mistakes in nutrition - non-observance
of a m o d e , hyper alimentation, consumption of m o n o t o n o u s foods, fast
meal, abusing fats and sweet, sharp seasonings, hard liquor.
It is impossible not to p a y attention at personal and public hygiene. It
is necessary to propagandize bases of mental hygiene. In fact, it is proved,
that emotional stresses - are principal cause of the occurrence of hyper
tonic disease, heart attacks of a m y o c a r d i u m , heavy defeats of n e r v o u s
system, etc. So, during lectures and conversations it is necessary to
emphasize, h o w important it is to avoid stressful situations in daily life. T h e
big h a r m to health renders smoking, abusing alcohol, self-treatment.
T h e child since the childhood needs to be brought up benevolent,
cheerful; with a life optimism, m a k e impacts on a good sense of humor, to
bring up respect for others and, on the contrary, it is necessary to struggle
with displays of egoism, vanity, to aid to get rid of bad character traits.
It is possible to offer the following themes for lectures and
conversations on a healthy w a y of life:
1. T h e nature and health of a person.
2. Christian m o r a l s and health.
3. Prophylactic medical examination - a basis of health.
4. W o r k — t h e source of health and longevity.
5. Profession a n d health.
6. Be able to h a v e a rest.
7. Personal bases and public hygiene.
8. H o w to eat correctly.
9. Physical culture and health.
lO.Quenching, self-massage, self-checking.
11.Emotions and health.
12.Habits and actions which are injurious to health (smoking, abusing
alcohol, etc.).
13.Be able to s u b m i t first care.
14. Y o u r health — in your hands.
15.Hygiene and sexual life.
16. A b o u t h a r m of self-treatment.
E x t r e m e l y b i g n u m b e r has sanitary-and-hygienic w o r k at schools.
T h e m e s that n e e d to be covered are identical to schoolboys of any age.
T h e y differ o n l y in v o l u m e and character of a teaching material.
T h e t h e m e I - « Improving n u m b e r of physical training » will consist
of 4 sections: m o r n i n g hygienic gymnastics, quenching, formation of a
correct bearing, an implant m o d e .
 T h e t h e m e II - « H y g i e n e of brainwork of schoolboys » covers a m o d e
of day, h y g i e n e of w o r k at school, hygiene of training, rational rest,
h y g i e n e of dream.
T h e t h e m e m — «Hygiene of polytechnic training)) is devoted to the
rational organization of w o r k and to the prevention of industrial t r a u m a s .
T h e t h e m e IV — «Public and personal hygiene. Preventive m a i n t e n a n c e
of infectious diseases)) for pupils of 1-3 classes will consist of 4 sections,
for pupils of 4-7 classes — from 3, for pupils of 8-10 classes — from 5
sections.
T h e m e s "Personal hygiene", " H y g i e n e of an environment", "Infectious
d i s e a s e s " study pupils of all a g e groups, a t h e m e "the N a t u r e and health of
a p e r s o n " — children of 7-9 and 15-17 years, and a t h e m e " S o m e questions
of social h y g i e n e " - only senior pupils.
T h i s subjects should be guided, holding an appropriate w o r k at school.
As it w a s already m a r k e d , without the aid of groups of sanitary active
and medical attendant it will be hard to perform these tasks. P r e p a r e s o m e
profile g r o u p s of a sanitary active w h i c h are responsible for protection of
work, performance of anti-epidemic actions, care of patients, struggle
against a tuberculosis, health protection of children, p r o p a g a t i o n of a
healthy w a y of life, etc.
T h e y are expedient for creating on the basis of industrial institutions,
schools, clubs and libraries.
W i t h g r o u p s of a sanitary active regular and purposeful m e t h o d o l o g i e s
w o r k should be done. T h e best form of w o r k - thematic rates. Carrying out
of them should be united with other m a s s actions, which are spent in the
city or in the village.
T h e centres of health are engaged in a m a n a g e m e n t of sanitary -
educational work. D o c t o r s and average medical w o r k e r s — m e t h o d o l o g i e s
from sanitary — educational w o r k should be a part of their structure.
•% I I
Q u e s t i o n s for self-checking.
1. T h e b a s e s principles of educative activities.
2. W h a t questions are solved educative activities?
3. Subjects of educative activities at school.
Section 12. A C T I V I T Y O F T H E S O C I E T I E S O F R E D C R O S S A N D
RED CRESCENT
T h e international m o v e m e n t of the R e d Cross and R e d Crescent has
arisen in the m i d d l e of X I X century as a reaction to the C r i m e a n c a m p a i g n
of 1854-55 in w h i c h Russia and T u r k e y w e r e involved, supported by
England and F r a n c e . To m e d i c o -sanitary departments of belligerent parties
it w a s impossible to c o p e with h u g e a m o u n t of w o u n d e d on a battlefield.
A l m o s t simultaneously idea of attraction of peace appeared in England
and Russia, first of in females, a personnel involved in the organization and
giving of medical care to victims of war.
G r o u p s of sisters of mercy, which have left on the battlefield, have
been organized, and a k n o w n surgeon M.Pirogov headed one of these
groups of sisters of mercy. Further this idea has extended, has got
organizational forms, both in national, and in international scales.
T h e international organization o f the R e d C r o s s a n d the R e d Crescent
was finally issued within I world w a r in Switzerland. In 1919, during
existence of U k r a i n i a n National R e p u b l i c , the Ukrainian R e d Cross has
been created. In the former U S S R this organization b e g a n o n l y at 1923.
N o w to the structure of the International R e d Cross belong:
• International C o m m i t t e e of R e d Cross
• L e a g u e of societies of the R e d Cross a n d R e d Crescent
• N a t i o n a l societies of the R e d Cross and Red Crescent; in m o r e than 150
national societies unites m o r e than 2 5 0 million m e m b e r s .
• Representatives of these three c o m p o n e n t s of m o v e m e n t , together
with representatives of countries — participants of the G e n e v a
conventions, e a c h four years are g o i n g on the International
conference of the R e d Cross and the R e d Crescent. T h e basic role
of this conference is to be the highest advisory b o d y of m o v e m e n t
a n d t o study p r o b l e m s o f the general character, t o accept
resolutions, to distribute m a n d a t e s .
• T h e international C o m m i t t e e of the R e d C r o s s is private,
independent Swiss association w h i c h headquarters is in G e n e v a .
International c o m m i t t e e of R e d Cross — is the organization neutral
in the political, religious and ideological relation.
• Principal body in the International C o m m i t t e e of Red Cross is its
C o m m i t t e e which structure does not exceed 25 m e m b e r s . T h e
 committee spends A s s e m b l y during w o r k of which the politics submission. To a network of the National Society 655 city and
and principles of work are determined. regional organizations and 32667 primary societies which unite
• Operative activity and administrative w o r k of the organization is millions winners enter.
carried out by central establishments of the International T h e y s p o n s o r invalids, lonely patients of old age, children - orphans,
C o m m i t t e e of R e d Cross w h i c h are allocated in zones of conflicts. aid to facilitate sufferings to victims of acts of nature, accidents,
• Financing of the International C o m m i t t e e of R e d Cross is confrontations.
provided with voluntary p a y m e n t s o f : • T h e international connections of the Society with the W o r l d
• Countries - participants of the G e n e v a C o n v e n t i o n s ; organization of public health services extends and its authority
• National c o m m u n i t i e s ; g r o w s . F o r the last five years 15 cooperation a g r e e m e n t s and
• Private persons; mutual aid with national societies of R e d Cross and R e d
Crescent have been m a d e .
• Private p a y m e n t s as gifts and wills.
• In activity of the International C o m m i t t e e of Red Cross is guided A g r e e m e n t s on opening Regional delegations of the International
committee of R e d Cross in K y i v and the International federation of
by the international humanitarian right. At present four G e n e v a
societies of R e d Cross and Red Crescent are signed.
conventions of 1949 operate. Conventions provide the following
kind of protection: • T h e important event in the life of the society of R e d C r o s s and
• T h e convention 1: protection of w o u n d e d or patients in field armies, and R e d Crescent is constant participation of delegation of Red
Cross of Ukraine in w o r k of sessions of General A s s e m b l y of
also the sanitary personnel and priests at armies;
the International federation of societies of Red Cross and R e d
• T h e convention 2: protection w o u n d e d , sick, the sanitary personnel and
Crescent.
priests of armed forces on the sea and p e r s o n s w h o h a v e h a d ship
T o d a y the society of R e d Cross and R e d Crescent stands on the
failure;
positions of:
• T h e convention 3: protection of the captives;
• Necessities of the international help to victims of Chernobyl tragedy;
• T h e convention 4: Protection of civilians w h o s e country are in state of
conflict or w h o are in the occupied country. • T h e further assistance to Ukraine in creation of service of accidents
• On June, 8, 1997 at Diplomatic conference in Geneva in addition • importance of strengthening of mercy services of the Ukrainian Red
to Four Conventions there were accepted two Reports which are Cross as c o m p o n e n t of social protection of the population;
applied in cases: • Strengthening of cooperation of National societies on a bilateral basis.
D u r i n g ten years the R e d Cross of Ukraine gives the aid to victims of
• T h e international confrontations (Report 1)
C h e r n o b y l accident. Seventy percents of the humanitarian aid which acts to
• Not-international confrontations (Report 2)
U k r a i n e through the R e d Cross, goes on a special-purpose designation - for
• L e a g u e of societies of R e d Cross and R e d Crescent - is a n o n
victims o w i n g to failure on the Chernobyl atomic p o w e r station.
governmental organization w h i c h unites national societies of R e d
At the expense of the Society medical equipment w a s given for the
Cross and R e d Crescent all over the world.
U k r a i n i a n center of science of radiating m e d i c i n e , the U k r a i n i a n clinic of
T h e U k r a i n i a n R e d Cross w a s founded in D e c e m b e r , 1991 and gained
radiating protection of the population and treatment-and-prophylactic
a structure of the U n i o n of societies of R e d Cross and Red Crescent of
establishments of the K y i v and Z h y t o m y r areas.
former Soviet U n i o n and has c o m e in L e a g u e of societies.
T h e Red Cross b e c a m e the initiator of acceptance of the complex
• N o w a d a y s the R e d Cross of independent Ukraine will consist of
international program "Chernobyl". D u e to this the state has received from
one republican, 25 regional and 2 city organizations of republican
the international c o m m u n i t y dosimeters, mobile diagnostic laboratories,
installations for clarification of water.
T h e service of m e r c y of the Ukrainian Red Cross operates.
T h e service totals three thousand workers, which during the last four
years have given aid to almost 6 0 0 thousand persons.
Besides the R e d C r o s s of Ukraine gives the aid injured from high
waters, carries out winter operations (support needy in the winter period);
struggle against a tuberculosis, A I D S and a H I V diseases.
W i t h this p u r p o s e the ramified network of the specialized centres and
stations of the medico-social care that will assist patients suffering from
tuberculosis is created.
T h e effective system of controllable out-patient treatment which will
assist effective treatment of socially unprotected layers of the population is
introduced; the services of nurses which will assist the social care to the
patients with tuberculosis b e c o m e s stronger; sanitary - educational work
a m o n g the population which will constrain uncontrollable distribution of
diseases b e c o m e s m o r e active.
Q u e s t i o n s for self-checking:
1. Structure and functions of the International R e d Cross and R e d Crescent.
2. T h e p r i m a r y goals of the Ukrainian R e d Cross and R e d Crescent.
Annotated bibliography
1. Batkis G.A., Leka L.G. Social hygiene and health protection organization.
Medicine, 1969, 599 p.
2. Legislation bases in Ukraine about public health service. " Voice of Ukraine ",
1992, JN° 238.
3. Bases of social hygiene. Edited by Kolarova P.V., Medicine, 1969,456 p.
4. Holyachenko O.M. Social medicine and health protection organization. Kyiv,
1993, 198 p.
5. Management of social hygiene and health protection organization. Edited by
Lisitsin J.P., Medicine, 1987, Volume I, 429 p., Volume 11,463 p.
6. Health parameters of the population and establishments activity of public health
service (statistical materials for 1980-2000). Ministry of public health services
in Ukraine, 2001.
7. Sepetliev D. D. Statistical methods in scientific medical researches. Medicine,
1968,419 p.
8. Social medicine and health protection organization. Edited by Voronenko J.V.,
Moskalenko V. F . J e m o p i l , "Ukrmedknyga ", 2000, 680p.
9. The sixth bulletin about a condition of public health services in the world.
Volume I, Geneva, 1981, 348 p.