Legal supply of primary health care reformation based on the family medicine in Ukraine

Background. The national task of Ukraine is strengthening the health of the population of Ukraine and the strategy for the development of the health care system driven by the accelerated evolution of civilization processes. Primary care on the principles of family medicine plays a decisive role in solving the problems of public health and reducing the prevalence of risk factors, introducing modern strategies for preventing chronic non-communicable diseases and developing a healthy lifestyle. Materials and methods. The method of the system approach of analysis was used for studying the legal acts. Results. The basis of the regulatory framework in the field of health care is the Constitution of Ukraine, the Fundamentals of Healthcare Legislation of Ukraine, and other regulatory acts. The article represents the stages of reforming primary care during the 21st century, analyzes the regulatory legal acts developed during this period by Ministry of Health of Ukraine and the Parliament of Ukraine. For the effective development of primary care based on the principles of family medicine, the scientific and pedagogical staff of the Shupyk National Medical Academy of Postgraduate Education in cooperation with other specialists developed Low of Ukraine No. 6634 dated June 22, 2017 “About Primary Health Care Based on the Principles of Family Medicine”. Conclusions. Thus, in modern conditions, new challenges have arisen for the strengthening of preventive services. They are increasing the availability and quality of medical care, improving primary care, staffing, modernizing infrastructure and ensuring equity in health care. The existing problems of health care are not easy to solve. They have a multidimensional complex nature, which necessitates the updating of health policy, the development and implementation of new strategies and programs.


Introduction
The strategy of the health care system development in Ukraine is caused by the accelerated evolution of civilization processes in the last quarter of the XX -the beginning of the XXI century. It requires strengthening the Ukrainian population's health as a nationwide task [1].
The level of population's health has a significant impact on the processes and results of its economical, social and cultural development, the demographic situation and the state of national security, and is an important social criterion for the level of social welfare.
The current state of public health in Ukraine is characterized by a crisis that indicates negative trends in the triad of statistical indicators, such as: population reproduction rates (medical and demographic data), indicators of children growth, indicators of physical development of adult population and population adaptation to environmental conditions (morbidity, disability).
At the same time, WHO experts emphasis the factors of these negative trends in Ukraine are all the main health factors, such as: the socio-economic situation in the country, the state of the environment, the quality of food and water, growing stratification of the population by income, organization of medical care, etc. [1] In Ukraine, the development strategy of the health care system is due to the accelerated evolution of civilization processes and requires the strengthening of the health of the population of Ukraine -a nationwide task [1].
The situation that arose as a result of a number of objective and subjective reasons is a real threat to the emergence and development of irreversible processes in the state of physical and mental health of the population of the country and, as a consequence, can be negatively impacted. socio-economic, political and spiritual development of the Ukrainian nation as a whole, which poses a threat to the national interests of the state. Primary health care systems in different countries vary according to historical and socio-economic conditions of development, but most of them are based on the principles of general practice -family medicine.
Primary care on the basis of family medicine plays a decisive role in solving public health problems and improving its determinants -reducing the prevalence of risk factors, introducing modern strategies for the prevention of chronic non-communicable diseases and the formation of healthy lifestyles.
The purpose of the study was to determine the current aspects of primary health care reformation in the systematic analysis of legal acts.

Materials and methods
The system approach and system analysis were used for studying legal documents.

Results and discussion
"Primary Health Care" is determined in the Article 3 of the Law of Ukraine "Amendments to the Fundamentals of the Legislation of Ukraine in Health Care Regarding the Improvement of the Provision of Medical Care", dated 07.07.2011 N 3611-VI [2] as: «primary health care (PHC) -medical care provided in outpatient setting or at the place of patient's residence (stay) by a general practitioner/family doctor and involves counseling, making diagnosis and prescription the treatment of the most common diseases, injuries, poisonings, pathological, physiological (pregnancy) conditions, implementation of preventive measures; directing a patient who does not require emergency care to secondary (specialized) or tertiary (highly specialized) medical care according to medical indications; provision of urgent medical care in case of acute physical or mental disorder of a patient who does not need emergency, secondary (specialized) or tertiary (highly specialized) medical care» [3, Article 35-1. Primary health care].
The World Health Organization (WHO) provides the following definition of primary health care: it is a range of treatment and prevention services provided at the local community level, usually by family doctors, nurses, local outpatient staff or other medical staff [3].
Family medicine is an accessible continuous, patientoriented medical care available to all family and community members, prevention and treatment of the most common diseases, taking into account socio-economic, physical, genetic, psychological, cultural-religious factors, and promotion of a healthy lifestyle [4].
In Ukraine, family medicine has been implemented since 1986-1987, with changes, reforms and improvements. The aim of continuous reformation and improvement is to ensure the availability, quality, timeliness of health care and prevention at the proper level. In other words, it has to adequately meet the population needs in medical care. Therefore, one of the main priorities of the policy of reforms is the steady increase in the level of people's well-being, improvement of the functioning of the health care system in order to improve the quality of medical services, their availability and the introduction of incentives for healthy lifestyles and decent working conditions [5].
The . The result of this reform in Ukraine was the provision of primary care at PHCC, outpatient family medicine clinics, as well as private general practitioners / family doctors [5,6].
It is common known, that the basis of the regulatory framework in health care is the Constitution of Ukraine, the Fundamentals of Ukrainian Legislation in Health Care and other normative acts.
Another wave of reorganization and optimization of medical care in Ukraine has started since 2017-2018 with the creation of an effective health care system, aimed at the priority development of primary health care / family medicine [5]. It is noted in the National Program "Health 2020, the Ukrainian Dimension", the Law of Ukraine The results of the first steps of reform were completed at the end of December 2018: the transformation of primary care centers to a new financing model "money follow the patient" was implemented, 97% of primary health care establishments signed agreement with NHSU and moved to a new financing model till February 2019 (1,185 primary health care establishments among them 104 private clinics and 100 entrepreneurs, the rest are communal) [8].
The electronical medical records, e-Health system for its management and patient's attachment and the International Classification of Primary Care ICPC-2 is being implemented in order to provide better control and quality of health care in PHC facilities (Order of the Ministry of Health dated 4.01.2018 No. 13 "About some questions regarding the application of the Ukrainian version of the International Classification of Primary Healthcare ICPC-2-E»). The electronic healthcare system helps to issue electronic recipes since April 2019 according to the program "The Available medicines" (Cabinet of Ministers Decree dated 25.04.2018, No. 411 "Some issues electronic health system").
The medical records in the electronic health care system will be able to make by specialists of secondary care -laboratories, clinics and consulting and diagnostic centers, and for hospitals' information which started to work with the NHSU under the program "Free Diagnostics" since 2020 [8].
It is planned that the state program of medical guarantees will appear in Ukraine in the end of 2020, which will cover all levels of medical services, including inpatient. In addition, the development of health insurance should begin in 2021.
Today, the policy of the Ministry of Health of Ukraine is aimed at ensuring every person by guaranteed coverage of basic medical services of primary, specialized, emergency care through the NHSU. In addition, giving opportunity to take advantage of insurance benefits for employers, government agencies, local authorities and patients. The Ministry of Health of Ukraine sees the development of insurance medicine in the formation of a competitive market in which the patient and employer have a free choice of insurer.
The strategy of transformations and the main organizational principles of PHC reformation in Ukraine for future includes the following measures [8]: -the final transition to the provision of PHC on the basis of family medicine; -determination of a general practitioner / family doctor as a direct supplier; -improvement of quality of PHC; -proper equipment of PHC facilities, electronic document circulation, telemedicine; -increasing the accessibility of PHC and equal access to PHC regardless of residence place by a network The Strategy for the Development of Medical Education in Ukraine for next10 years has been officially approved as the document which provides a comprehensive approach to changes in medical education. It was the first time in the history of Ukraine and its independence when such document was made. The main objective of the Strategy is to increase the competitiveness of higher medical education and, as a result, to improve the quality of provision of medical services. The main task of the Strategy is to change the following directions: improving the quality of higher medical education; qualitative change of postgraduate education; effective funding and management of medical universities; change of academic culture, development of scientific research [8].

Conclusions
Thus, in current conditions the health care system faced new challenges in strengthening preventive services, improving accessibility and quality of health care, improving primary health care and staffing, infrastructure modernization and ensuring equity in health care. The existing healthcare problems are complex and multifaceted; it causes the necessity to update the healthcare policy, the development and implementation of new strategies and programs.
C onflicts of interests. Authors declare the absence of any conflicts of interests and their own financial interest that might be construed to influence the results or interpretation of their manuscript.