Modern Civilistic Instruments of Medical Reform: Issues of Law Implementation and Law Enforcement

2020 ◽  
Vol 27 (3) ◽  
pp. 109-127
Author(s):  
Iryna Senyuta
Keyword(s):  
Primary Care ◽  
Law Enforcement ◽  
Medical Care ◽  
Primary Care Physician ◽  
Legal Regulation ◽  
Care Physician ◽  
Third Parties ◽  
Medical Reform ◽  
Judicial Practice ◽  
The Right

The study of the latest civilistic instruments of medical reform is conditioned by its purpose, which is to clarify the legal nature of the declaration of choice of primary care physician and the contract for medical care under the programme of medical guarantees, highlighting the specific features of the right to choose a doctor, conditioned by the outlined tolls, as well as identifying gaps and controversies in the legislation of Ukraine and judicial practice in law enforcement in this area. The main method of the study was the method of studying judicial practice, which allowed to assess the effectiveness of law enforcement, the level of perception of legislation in this area in practice, as well as to determine the necessity of improving the legal regulation. The study highlights the problematic aspects related to the exercise of the right to free choice of a doctor, in particular due to legislative changes regarding medical reform. The legal essence of the declaration on the choice of a primary care physician has been covered. The study clarifies that it is not a transaction, but a document certifying the exercise of the right to freely choose a primary care physician. The contract on medical care of the population under the programme of medical guarantees is analysed and its civil law matter is established. It is determined that it is a contract for the provision of services under the public procurement, concluded for the benefit of third parties. The reimbursement agreement was also investigated, which is also an agreement in favour of third parties – patients in terms of full or partial payment for their medicines. The judicial practice is analysed, which gives grounds to assert the problems with enforcement and administration of law, and proposals are made to improve the current legislation, including in the aspect of the subject of the contract under the programme of medical guarantees. The "legitimate expectation" that arises in a person in the presence of regulatory guarantees is under conventional protection, as illustrated by the European Court of Human Rights in its decisions, and to change the paradigm of implementation requires a transformation of legislation. The practical significance of this study is to intensify scientific intelligence in this direction, to improve the legal regulation of these innovative legal constructions, to optimise the enforcement and administration of law in the outlined civilistic plane

The Role of the Primary Care Physician in the Care of Children with Serious Heart Disease

PEDIATRICS ◽  
1994 ◽  
Vol 94 (3) ◽  
pp. 284-290
Author(s):  
Paul C. Young ◽  
Yu Shyr ◽  
M. Anthony Schork
Keyword(s):  
Primary Care ◽  
Heart Disease ◽  
Chronic Illness ◽  
Medical Care ◽  
Primary Care Physician ◽  
Primary Care Physicians ◽  
Care Physician ◽  
Care Needs ◽  
Care Services ◽  
Primary Care Services

Objective. To determine the roles of primary care physicians and specialists in the medical care of children with serious heart disease. Setting. Pediatric Cardiology Division; Tertiary Care Children's Hospital. Subjects. Convenience sample of parents, primary care physicians, and pediatric cardiologists of 92 children with serious heart disease. Design. Questionnaire study; questionnaires based on 16 medical care needs, encompassing basic primary care services, care specific to the child's heart disease and general issues related to chronic illness. Results. All children had a primary care physician (PCP), and both they and the parents (P) reported high utilization of PCP for basic primary care services. However, there was little involvement of PCP in providing care for virtually any aspect of the child's heart disease. Parents expressed a low level of confidence in the ability of PCP in general or their child's own PCP to meet many of their child's medical care needs. Both PCP and pediatric cardiologists (PC) were significantly more likely than parents to see a role for PCP in providing for care specific to the heart disease as well as more general issues related to chronic illness. PC and PCP generally agreed about the role PCP should play, although PC saw a bigger role for PCP in providing advice about the child's activity than PCP themselves did. PC were less likely to see the PCP as able to follow the child for long term complications than PCP did. PC were more likely than PCP to believe that PCP were too busy or were inadequately reimbursed to care for children with serious heart disease. Only about one-third of parents reported discussing psychosocial, family, economic, or genetic issues with any provider, and PCP were rarely involved in these aspects of chronic illness. Conclusions. Primary care physicians do not take an active role in managing either the condition-specific or the more general aspects of this serious chronic childhood illness. With appropriate information and support from their specialist colleagues primary care physicians could provide much of the care for this group of children. Generalists and specialists are both responsible for educating and influencing parents about the role primary care physicians can play in caring for children with serious chronic illness.

scholarly journals INTERNATIONAL ECONOMIC STANDARDS OF MEDICAL PROVISION: LEGAL CHARACTERISTICS AND PROBLEMS OF IMPLEMENTATION IN UKRAINE

2020 ◽  
Vol 5 (5) ◽  
pp. 28
Author(s):  
Dmytro Bilinskyi ◽  
Mushfik Damirchyiev
Keyword(s):  
Health Care ◽  
Medical Care ◽  
Care Delivery ◽  
Synthesis Method ◽  
Legal Regulation ◽  
Right To Health ◽  
The State ◽  
International Standards ◽  
Medical Reform ◽  
The Right

The purpose of the paper is to analyze the current legislation on medical reform in the context of harmonization with international standards. In the conditions of social state building in Ukraine, the thesis is axiomatic regarding that the state should show concern for their citizens, including for the protection of their health. In this context, it is relevant to study the implementation of medical reform in Ukraine, since its content and the degree to which the proclaimed provisions are enforced depend on the ability of each person to access quality health care. Methodology. The article is based on international legal acts, laws and by-laws of Ukraine in the field of legal regulation of medical care. Both general scientific and special methodology were used for the research. Methods of analysis and synthesis, method of description, method of induction, method of deduction, method of correlation, etc. were applied. Results. The article defines the directions for harmonization of the legislation of Ukraine on health protection in accordance with international standards. Based on the ECHR practice, proposals have been formulated to improve the legislation of Ukraine. Conclusions. The ECHR has repeatedly concluded that the right to health is complex and includes: the right to information about one's health and the confidentiality of such information; the right to health care; the right to choose the doctor and the remedies freely; the right to a safe environment that affects health and so on. The state does not cover all aspects of providing medical care to citizens, but resorts to limited funding, since the state budget funds are only one of the types of sources of financing. Practical implications. We have formulated the following tasks: to analyze Ukraine's international legal obligations regarding health care; to identify major changes in health care financing and health care delivery in line with health care reform standards in Ukraine; to identify major health care funding issues.

scholarly journals Multiple Myeloma in the Practice of a Primary Care Physician: A Clinical Case

2020 ◽  
Vol 27 (3) ◽  
pp. 139-145
Author(s):  
A. E. Shklyaev ◽  
E. A. Semenovikh ◽  
E. S. Gaysina
Keyword(s):  
Primary Care ◽  
Multiple Myeloma ◽  
Primary Care Physician ◽  
Clinical Case ◽  
Abdominal Cavity ◽  
Percutaneous Biopsy ◽  
Care Physician ◽  
Lumbosacral Spine ◽  
Retroperitoneal Neoplasm ◽  
The Right

Aim. To demonstrate difficulties in diagnosing multiple myeloma at the out-patient stage on the example of a clinical case.Materials and methods. The course of establishing a diagnosis in a 58-year-old patient complaining of pain in the hip joint was analysed on the basis of the patient’s medical records both at the out-patient and in-patient stages.Results. A case of multiple myeloma occurring under the guise of common degenerative-dystrophic diseases is presented. An oncological diagnosis was suspected due to the patient’s complains of persistent pain, which was poorly relieved by non-steroidal anti-inflammatory pain agents, and progressive changes in the general blood test (acceleration of ESR to 40 mm/h, and then to 50 mm/h; reduction of hemoglobin from 145 g/l to 134 g/l). The diagnostic search started with an ultrasound examination of the abdominal cavity and pelvic organs, which revealed both an extensive formation in the pelvis in the right iliac region and the lymphadenopathy of the inguinal lymph nodes. Subsequently, spiral computed tomography of the abdominal cavity and the pelvis was conducted. In all bones at the study level, multiple spherical solid formations with uneven contours causing destruction of bone tissue were detected, allowing myeloma to be suspected. The patient was referred to the Republican Clinical Oncology Dispensary, where a percutaneous biopsy of the retroperitoneal neoplasm, as well as morphological and immunohistochemical studies, were carried out. As a result, the following diagnosis was established: multiple stage IIIA myeloma, first detected, with damage to the thoracic, lumbosacral spine, ribs, pelvic, and thigh bones. The patient was hospitalised in the Hematology Department of the First Republican Clinical Hospital, where he underwent chemotherapy according to the VCD scheme (bortezomib, dexamethasone, cyclophosphomide), and was discharged with improvement.Conclusion. The diagnosis of multiple myeloma is a challenging task for a primary care physician due to the diversity of the clinical picture and the lack of clinical suspicion. At the same time, timely diagnosis of the disease at the out-patient stage can significantly increase the effectiveness of treatment and, therefore, improve the prognosis. Thus, more attention should be paid to the differential diagnosis of degenerative diseases of the musculoskeletal system and multiple myeloma.

scholarly journals Similarities and Differences of Approaches to the Legal Regulation of Subsidiary Liability of Persons Controlling the Debtor in Russian and Foreign Law

2021 ◽  
Vol 16 (12) ◽  
pp. 35-44
Author(s):  
A. D. Parkhomenko
Keyword(s):  
Law Enforcement ◽  
Legal Regulation ◽  
Third Party ◽  
Theoretical Understanding ◽  
Legal Entity ◽  
Legal Principles ◽  
Judicial Practice ◽  
Foreign Countries ◽  
Foreign Law ◽  
The Right

The paper constitutes a comparative legal study of some aspects of subsidiary liability of persons controlling the debtor and its foreign counterparts. Taking into account the experience of foreign countries in the regulation of these relations, the author draws parallels between different approaches to this legal phenomenon using foreign literature and judicial practice. The key aspect of the problem of liability of persons controlling the debtor is the existence of two opposite legal principles: organizational and property isolation of a legal entity and inadmissibility of abuse of the right. Bringing the persons controlling the debtor to subsidiary liability makes it possible to erase the boundaries of isolation of a legal entity and to identify its property with the property of its controlling persons for the purpose of satisfying the creditors’ claims. Thus, creditors of a legal entity have the opportunity to restore the violated right at the expense of the property of a de facto third party that is not a party to the original obligations. In foreign legal orders, the study of this ratio takes place over a long period. During this time, a certain theoretical understanding was formed, as well as law enforcement practice in this area.

Review of The fifteen minute hour: Applied psychotherapy for the primary care physician.

1988 ◽  
Vol 6 (4) ◽  
pp. 483-487
Author(s):  
Richard P. McQuellon ◽  
Guyton J. Winker
Keyword(s):  
Primary Care ◽  
Primary Care Physician ◽  
Care Physician
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