ADMINISTRATIVE AND LEGAL ENFORCEMENT OF HEALTH CARE: CONCEPTUAL FRAMEWORKS

Introduction: The analysis of the administrative and legal enforcement of health care in Ukraine indicates the lack of sufficient regulatory and legal acts due to the lack of and deficiencies in conceptual documents, doctrinal developments, strategic planning in this area. The modern administrative-legal management is historically due, since during the Soviet period health care regulation was determined by the high centralization of governance, the imperative of decision-making, the precise regulation of the activities of its subjects, the lack of overall control and supervision. The Conceptual Frameworks in this area, as shown by the analysis of scientific literature and legal documents, should include general provisions, goals, objectives, principles, legal framework, subject and object, priority areas of implementation, phases and stages, terms, amount of financial, material and technical resources, expected results. Each component of the Conceptual Frameworks should be scientifically verified, confirmed by practical experience and statistical data, and also to correspond to the real state of health care in Ukraine. Interconnectivity and intersectionality of the structural parts of the Conceptual Frameworks will ensure its effectiveness.

INTERNATIONAL HEALTH CARE REGULATION AT NATIONAL AND INSTITUTIONAL LEVELS IN LATVIA

The number of foreign patients who use medical services in Latvia increases every year and health care institutions have to provide quality services. The research problem is related to lack of a unified quality system in Latvian healthcare industry. The aim of the study is to introduce suggestions regarding the implementation of the international requirements to health systems outlined by the Directive 2011/24/EU. Research method is a focus group discussion with 8 Latvian health care experts and executives. Research results indicate that health care provider measures are introduced to a higher grade than national level measures reflecting the need for more comprehensive systemic changes in the governance of the system. Main improvements should be made regarding e-health system on national level, and medical follow-ups on institutional level.

Health Care Regulation Spending Trap

Our health care system has faced many challenges over the past 40 plus years. Now these challenges have forced us into a complicated situation that makes it confusing on how best to proceed. Today third party insurance payers make most health care payments. Our premiums are paid into a risk pool-on medical services for other people. Consumers are disconnected from knowing the cost of goods or services that they are receiving. This commentary reviews the current situation and provides a few common sense approaches for pursuing the best potential policies.

Research In Medical Regulation: An Active Demonstration of Accountability

To a large extent, health care regulation has been an “evidence-free” zone largely informed by anecdotal, traditional and legal considerations. Medical regulatory authorities (MRAs) are the owners of unique and valuable information regarding the performance of the medical profession. Innovative partnerships between teams of researchers and MRAs can be conducted ethically, securely and confidentially and will enable MRAs to undertake research that would otherwise be beyond their technical capabilities. Research will allow MRAs to gain a more nuanced understanding of the personal and environmental factors that impact on physician performance as well as how performance can be best maintained and improved. Additionally, the MRAs are the primary decision-making bodies able to capitalize on the results of such research activities in their policy making processes. By engaging in research, MRAs can advance the state of knowledge in medical regulation and, in doing so, actively demonstrate their commitment to accountability and transparency to both the public and the profession. Actively working to generate evidence to support accountability in decision making is a step towards making evidence-informed medical regulation a reality.

Patient-Centered Outcomes Research in Voice

Patient-centered outcomes research is critically important to improving the management of patients with voice disorders. Currently, wide variation in outcome definitions and treatment decisions exist. It is the responsibility of voice clinicians and researchers to improve the quality of and access to care for patients with voice disorders through the conduct of collaborative and rigorous patient-centered outcomes and comparative effectiveness research. Patients are the ultimate arbiter of their treatment, but need reliable and valid information to make informed decisions. Improving outcomes research will require collaborations among clinicians and study design experts in epidemiology, biostatistics, and data analysis. Moreover, researchers should be encouraged to compare the effectiveness of current treatments, which, to date, are implemented with little systematic, rigorous reinforcing evidence. Patient-reported outcomes research is increasingly emphasized by funding sources and in health care regulation. Oversight is inevitable and the voice community must ensure that it can justify those treatments that we know are beneficial to patients through compelling and patient-centered outcomes research.

Rhetorical Federalism: The Role of State Resistance in Health Care Decision-Making

The Patient Protection and Affordable Care Act (ACA) represents the most significant reform of the United States health care system in decades. ACA also substantially amplifies the federal role in health care regulation. Among other provisions, ACA expands government health care programs, imposes detailed federal standards for commercial health insurance policies, creates national requirements on employers and individuals, and enlists state administrative capacity to implement various federal reforms. In response, a persistent voice in the protracted, contentious debate surrounding ACA was, and continues to be, resistance from states. The rhetoric of federalism — states’ rights, reserved powers, state sovereignty, limited government, and local diversity — resonates deeply even around provisions of ACA that do not specifically implicate state interests. For example, the loudest and most persistent state objections target the new mandate that individuals maintain health insurance, a requirement imposed by ACA and enforced through federal tax penalties.