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Europe Day in KharkivOn 28 May 2006, our Project participated in the Europe Day in Kharkiv. The aim of this event was to disseminate the information about the European Union and its member states, their experience in democracy and social development, as well as about provision of EU technical assistance to Ukraine trough implementation of different EU projects. Currently, seven EU Projects are being implemented in Kharkiv Oblast. In the framework of the Europe Day celebration, the Project experts held working meetings with Zolochiv rayon authorities, rayon and oblast journalists. On Maidan Svobody, Kharkiv downtown center, the Project was introduced with information materials: newspaper "Family doctor+", booklets which inform readers about the main Project achievements. The Project experts were interviewed by a number local radio and TV journalists.    Results of the sociological surveys 2006 in the Popilniansky rayonINTRODUCTIONFrom 31 March through 13 April 2006 the European Union project „Health financing and management in Ukraine", jointly with the sociology department of NaUKMA, within the framework of the project carried out a repeat sociological study aimed at identifying attitude of the rayon’s population to the changes implemented in the healthcare sector in Popilniansky rayon of Zhytomir oblast. Objects of the studyIn fact, this study can be presented as consisting of two independent studies: the survey of the population and the survey of experts. The first survey is aimed at the population of the Popilniansky rayon of Zhytomir oblast, whereas the second is focused on experts of the same rayon, who included representatives of higher management of rayon administrations and medical agencies, which might have potential impact on the process of implementation of changes in the healthcare sector in the region. The object of the 2006 survey was fully identical with the object of the previous survey, carried out in 2004. Subject of the studySubject of this study is the attitude of the population of the rayon and local experts to introduction of changes in the healthcare sector, the population’s (and the experts’) assessment of certain parameters of the existing healthcare system, the awareness of the population and experts of the medical insurance and their confidence in information received from different sources. Parameters of asessment of the existing healthcare system includedà) for population: b) for of experts: Evaluation parameters, related to medical insurance, includedà) for population: b) for experts: The parameters, related to sources of information, includeda) for population: b) for experts: Besides, a separate subject of this study was the information on demografic characteristics of the population, in particular: gender age education social status. Compared to the previous study, certain parameters this time were expanded or modified. Thus, in the questionnaires for both population and for experts, in the section of parameters of assessment of the healthcare system there was added an open question regarding necessary changed needed for improvement of quality of medical services. In the same section for the questions in the expert questionnaires the number of alternatives/options for the question regarding appropriate radical changes in the healthcare for the population was added a question regarding a level of population’s awareness of the pilot project in the healthcare system of the rayon. In the same section of questions of the expert questionnaire the question concerning level of awareness of the OSMIS system was deleted, and were added the following three questions: Regarding the actual impact of the change in the hospital’s business status on the operation of the hospitals of the rayon; Regarding assessment of the authorities’ interest in changes in the financing of medical facilities; Regarding level of awareness of the functions of communal not-for-profit enterprises. In both general and expert questionnaires was modified a question concerning sources of payment for medical insurance, was added option „the state"; also modified was the question regarding favorable/unfavorable attitude to the system of medical insurance, where the option „do not support either existing healthcare system, or medical insurance" was replaced by option „support private medical insurance only". In both general and expert questionnaires was modified the last question concerning sources of information. In the previous study this question was aimed at identifying respondents’ preferences concerning different types of mass media, whereas this time the focus of the study was on the sources from which respondents received information on implementation of changes in the healthcare sector of the rayon. The goal of the studyThe goal of the study is both exploratory and confirmatory, it is to assess the population/experts’ view of certain aspects of the existing healthcare system, as well as certain parameters related to medical insurance, and certain characteristics of various sources of information, and also to assess trends in changes in these assessments both among the population and the experts. Methodology of the studyThe general study was carried out in the form of questionnaires handed out in the streets /intervieweing in residential areas of the rayon and partly – on the premises of medical facilities of respective residential areas or with the help of local medical workers. The expert study was carried out in the form of questionnaire hand-outs at the place of work of respondents. Methodology of this study carried out this year was identical to the methodology of the previous study. On the whole there were surveyed 228 respondents from 18 to 85 years of age, of which 22 were experts and 206 - respondents of the general study. We should note a certain unpreparedness of the rayon administration to cooperate with researchers: in the process of power change following the elections, the representatives of the administration were obviously preoccupied with other problems. Thus, for instance, head of the rayon state administration over a few days could never be located at his work place; and the highest level of experts includes deputy heads of the rayon state administration. However, local medical personnel actively assisted the researchers in their search for respondents and to increase the response rate, since when carrying out this year’s survey the response rate was unusually low (which is unusual for this type of study). According to the survey workers, practically every third or fourth respondent refused to participate, whereas in the past this proportion was never higher than 10-15% of the respondents. People explained their refusals, or unwillingness to participate, by their disappointment in the election’s results, by uncertain political, economic and social situations, and, respectively, by disappointment in any forms of public activity. The instrument of the study was a semi-standard questionnaire (in two forms - for population and for experts), approved by the Ministry of health. Changes, which the instrument of the study underwent, are detailed in the paragraph "Subject of the study". QuestionnaireIn light of conditions in which the survey was carried out (street interviewing of the population and interviewing experts at their work places), the principal requirements to the questionnaire were its substantiveness, brevity and minimum time needed to fill it out. The questionnaire for population consisted of 22 questions, of which 4 (specifically - age, education, gender, and social status) concerned social characteristics of respondents. The first subject section comprised 8 questions (6 – closed ones, of which one was with compatible options, 1 – semi-open, and 1 – open), and concerned parameters of the population’s assessment of the existing healthcare system. The other bloc, which concerned medical insurance, included 8 questions, all of the closed type. The last subject section dealt with various sources of information and formally had 2 questions, one of which was semi-open. The questionnaire for experts consisted of 19 questions, which represented subject sections identical to those of the population questionnaire, but did not include questions regarding social parameters of the respondents. The first section, which dealt with parameters of the existing healthcare system, consisted of 6 closed questions and 1 open question. The section of questions concerning medical insurance was somewhat different compared to the respective section in the questionnaire for population and comprised 10 closed questions. The last subject section concerned various sources of information and formally consisted of 2 questions, one of which was semi-open. Changes, which the instrument of the study underwent, are detailed in the paragraph "Subject of the study". SampleThe type of the sample for the expert survey is the target one, and the "experts" were representatives of higher management level of rayon administrations and medical agencies, which may have a potential impact on the introduction of changes in the healthcare sector in the region. The type of the sample for the population survey is the combined rayon-cluster type, with the gender-based and residential area size quotas. For gender, men were required to represent no less than 40%, and women – no more than 60% of the total number of respondents. Such quotas can be explained by the fact that relative shares of men and women in the total population of Ukraine equal 46% and 54% respectively, and in the rural areas the situation regarding the gender composition of the population is somewhat worse due to the shift towards the elder population, which is predominantly female, given significantly shorter life expentancy of Ukrainian men compared to that of Ukrainian women. Besides, the sample was required to reflect an actual relationship between the population and size of the residential areas. At the first stage for the rayon there were received the lists of residential areas with numbers of residents and primary socio-demographic characteristics of the population of the rayon. Then the residential areas were grouped into three categories: rayon center, large villages (over 800 adult residents) and small villages (less than 800 of adult residents). For every list there was formed a quota to ensure maximum accuracy of the repeat study, and in the sample were againincluded Popilnia, and villages Kornin and Kotliarka . Exploratory character of the study permits this type of sample as adequate for this study. The size of the sample for the population is 189 respondents. The sizeof the sample for the experts is 22 respondents. Compared to the 2004 study partly was changed the type of the sample: this year there was no age-based quota, and the population level separating large and small villages was reduced to 800 adult residents. ConfidentialityAll respondents were assured of anonimity and confidentiality of the information, and survey workers pledged to use the information only in the summarized form. Analisis of dataData analysis was carried out using the statistical computer program SPSS, and the results were exported to Excel and presented as tables and diagrams. Interpretation of the results of the 2006 study and comparative analysis of the results of the 2004 and 2006 studies PopulationThe age distribution has a classic rhombus structure, unlike that of the 2004 study, where the age structure had a significant shift toward the older population. It can be explained by the lack of age quotas that was compensated by the randomness of the selection, which resulted in the normal distribution of the age characteristics in the sample. Young people less than 30 years of age amount to almost 30% of the respondents, middew-aged people (30-49 years old) account for a bit less than 2/5 and 30.7% are elderly people. The age of the youngest respondent is 18 years, and that of the oldest - 85 years. The gender structure of the respondents of the Popilniansky rayon is almost the same as the typical for entire Ukraine situation: there is a certain dominance of women over men (women account for practically 58% of the respondents). Indirectly this situation can be explained by the age structure – the normal age distribution resulted in improvement of, compared to the 2004 study, adequacy of the gender categories representation. On the whole the education structure of respondents of the Popilniansky rayon looks as follows: almost ? of the respondents have secondary education (73.5%), slightly more than the fifth part of the respondents indicated that they have higher education (20.7%), and almost 6% indicated that they have only primary education. The reduction in the number of people with primary education, in comparison with the 2004 study, was primarily caused by the physical reduction in the number of elderly people. And the reduction in the number of people with higher education, accordingly – by the greater number of the middle-age population. The category of secondary education, therefore, comprised the traditionally different sub-categories of secondary and secondary professional education. Changes in the distribution based on the social status, which vividly demonstrate that, first of all, the social structure of the rayon is dominated by the following three categories: workers/farmers – almost 25%, pensioners – a bit less than 23%, and servicemen – 21% of the respondents, are caused by the normal age distribution within the sample. The increase in the number of pupils and students up to 9% is also likely to have been caused by the normal age distribution. The stable share of the private entrepreneurs – slightly more than 5% of the respondents and the increased proportion of the unemployed population (by 5%) attest to the worsening of the economic situation and slowpace of development of private entrepreneurship in the rayon. The number of those who are on disability has almost doubled - from 1.2% to 2.6%. Slightly less than one third of the respondents (like in the 2004 study) indicated that they ask for medical assistance quite rarely – once a year. By 6% grew the number (which now exceeds one quarter of the respondents) of those who use medical services once a month. At the same time almost by 10% was reduced the proportion of those who need medical assistance less often – once a quarter. 18.5% of the respondents chose option "other". Assessment of quality of services in rayon’s state medical facilities Practically the same (compared to the previous study) is the distribution of the assessment of quality of services provided by the rayon’s state medical facilities. A significant part of the respondents estimated quality of services of the rayon’s state medical facilities as average (almost 49%). Less than onethird of the respondents (32%) find quality of services low. Another 14% of the respondents could not adequately assess this indicator. 5% of the respondents believe that the quality of services is high. Therefore, this indicates that the population, for any reasons, keeps giving low grades to the quality of services provided by the rayon’s state medical facilities. As we can see, the distribution of answers to the open question regarding changes necessary for improvement of quality of medical services, which wasn’t there in the previous study, demonstrates that the population is less realistically (unlike the experts) and more diffusely estimates changes necessary for improvement of quality of medical services. Almost one third of the respondents (32%) believe that quality of services will improve if the material-technical basis of medical facilities is improved. Almost 18% of respondents are certain that to improve quality of medical services it is necessary to improve their accessibility. One tenth of the respondents think that improvement of quality of services can be facilitated by the increased qualification level of medical personnel. 7% of the respondents believe that quality of services will improve if the attitude of medical workers to patients is improved, or material support for medical workers themselves is strengthened. Alsowere proposed the following mesures for improvement of quality of medical services: reduced prices on medical drugs, strengthening responsibility of medical workers, introduction of medical insurance, etc. At the same time, almost 5% of the respondents could not give an answer to this question. The structure of spending on medical treatmentThis question suggested a five-point scale for each of the spending options, except for cases where respondents don’t spend anything on medical treatment at all, which means that there is noting to rate. A part of the respondents did exactly that, whereas the other part rated only one or two options out of the three alternative options. Only 1% of the respondents indicated that they do not spend money on medical treatment at all, which is why presented below are the tables of distributions for rates parameters. Spending on purchases of medical drugs was rated by 181 respondents. Compared to the 2004 survey the proportion of those who spend on purchasing medical drugs much and very much money (indicated ratings 4 and 5) has reduced almost in one and a half times and account for a bit more than half of the respondents. The share of those for whom these costs are in the middle of the scale between much and little (rating 3) has remained almost the same (17%). At the same time the proportion of respondents, who spend on medical drugs relatively little money (ratings 1 and 2) grew from 7% to 27%. As we can see, this is a rather positive trend. Of the 164 respondents, who rated their spending on charitable contributions, more than two thirds indicated that they spend on this relatively little and very little money (they indicated ratings 1 and 2). By 5% grew the share of those for whom these expenditures are in the middle of the scale between much and little (indicated rating 3). Almost halved the number (from 21% down to 10%) of those who spend on charitable contributions relatively much money (indicated ratings 4 and 5). This parameter also demonstrates a positive trend. The expenditures on bribing medical workers were rated by 156 respondents. Compared to the 2004 study doubled was the proportion (from almost 40% to almost 80%) of those who spend on bribes relatively little and very little money (they indicated ratings 1 and 2). By 5% was reduced the share (which now accounts for 9% of the respondents) of those for whom these expenditures are in the middle of the scale between much and little (they indicated rating 3). The proportion of those who spend on bribes relatively much money (they indicated ratings 4 and 5) fell from 44% down to 12% of the respondents. Therefore, on the whole the structure of spending on medical treatment undergoes positive changes in the direction of the reduction of the quantity of money that is being spend. When estimating the attitude of local medical workers to the respondents as to patients, almost twice as many respondents (32%) regarded it as very good. By 12% has reduced the proportion of respondents unsatisfied with this indicator: 42% believe that the attitude to patients is insufficient, and 12% find it unsatisfactory. At the same time another 13% of the respondents could not find an answer to this question. Generally, it is fair to say that the distribution of answers to this question reflects positive trends. The share of the respondents who normally spend in the waiting line to a doctor an hour and more than one hour has reduced from almost two thirds to over one half of the respondents. Slightly grew the proportion (from 24% to almost 29%) of those who spend on this approximately half an hour. Also grew by 8% a proportion of the respondents in the Popilniansky rayon, who spend in the waiting line to a doctor 5-15 minutes. Therefore we may regard this parameter as one of those which underwent positive changes. Among the respondents of the Popilniansky rayon, compared to the 2004 study by 4% fewer respondents indicated that they don’t use services of private medical facilities and doctors. At the same time almost doubled the proportion of those who sometimes use private healthcare (from 22% to almost 39% of the respondents). And again, reduced by half the proportion of those who use services of private healthcare regularly (from 22% to 11%). Such a situation indicates that respondents have become more aware of the difference between services of private clinics and doctors, and services of doctors they are acquainted with, who are in fact do not belong to the category of private healthcare. According to the survey workers, this question proved very difficult for the respondents: they are aware of the need in changes, but can’t articulate the nature of these changes. As the new option was added („granting greater autonomy to medical facilities"), the structure of the distribution of answers did not change radically. In fact, the structure of answers to the question regarding what radical changes in the healthcare system the respondents find necessary, demonstrates the need in practically all specified in the question changes. The least popular was the new option concerning the granting of greater autonomy to medical facilities (20% of the respondents). Almost by 10% grew the proportion of those who suggests as a radical change the increased funding. The same remains the proportion of the respondents (over half), which said that necessary changes included the improving of accessibility of medical assistance. By 6% reduced was the proportion of those who finds it necessary to improve responsibility/accountability of medical workers. By 18% shrank the proportion of those who supports the free-of-charge provision of the most essential healthcare services. Almost by 10% raised the proportion of those who finds it necessary to ensure more effective use of existing within the system resources. In response to the question concerning the goal of the obligatory medical insurance the respondents of the Popilniansky rayon were consistently concordant. Majority of the respondents (three quarters) believe that the goal of the obligatory medical insurance is to make all medical services accessible to all people. It is understandable and it is natural that in the existing conditions people want to have an accessible and quality healthcare. Besides, another almost 14% have favored the option "make medical services accessible to those who pay contributions". Halved were the proportions of the respondents, who think that the goal of the OMI is to cover all medical services, and of those who believe that OMI must cover only the most critical healthcare services. Almost the same remained the distribution of assessments of the goal of voluntary medical insurance. Two fifths of the respondents believe that voluntary medical insurance must cover those medical services, which are not covered by obligatory medical insurance. At the same time, almost 59% of the respondents believe that the goal of the VMI is to cover absolutely all medical services. Such a situation sooner indicates the respondents’ unawareness of differences between VMI and OMI, rather than anything else. As to the question that may directly concern respondents in reality, the distribution of answers has somewhat changed. Thus, almost by 8% reduced was the proportion (from 60% to 52% of the respondents) of those who agree to pay 10% of insurance contributions. The number of those who agree to pay 30% of the contributions grew from 7% to almost 9%. By 1% increased the proportion of those who agree to cover 50% of the payment of insurance contribution. However, on the other hand the proportion of those who does not want to pay anything also grew from 29% to 35% of the respondents. This can be explained by the difficult economic situation in the country, and by the increased presence in the sample of the unemployed population, who don’t have money to pay insurance contributions. On the other hand, 10% is not a lot in the eyes of the average citizen, particularly if we take into account that even approximate amounts of possible contributions were not indicated. Due to the presence in the optional answers to the question concerning sources of payment for medical insurance of the new option – „the state", the answer distribution changed as follows: from 25% to 27% increased the proportion of those who believe that sources of payment for medical insurance must be both employers and employees (in equal or varying proportions); in three times decreased the share of people who believe that sources of payment for medical insurance must be employees only; and drastically (from 66% down to 9% of the respondents) fell the number of those who view only employers as a sources of payment for medical insurance, whereas the option of the state as a source of payment of the insurance contribution was supported by 60% of the respondents. This distribution pattern agrees well with the previous question: people are practically unprepared to carry this financial burden, particularly not knowing its weight; in the past they put it on the employer’s pocket, now – on the state’s pocket, which is bigger. The positive answer to the question regarding availability of medical insurance for respondents or their relatives this time was given by 40% of the respondents (almost by 10% more than the last time). Accordingly, by 10% was reduced the number of respondents who gave a negative answer (60% of the respondents). So, generally there is a trend toward the increase in the proportion of the population involved in the pilot project in the healthcare sector of the rayon. Type of the available medical insuranceThe structure of the distribution (pattern) of answers to the question regarding the type of the available medical insurance has not undergone substantial changes. Thus, by 5% reduced was the proportion (from 92% to 87%) of those who received medical insurance through the mutual hospital fund. And by 2% grew the number (from 8% to 10% of the respondents) of those who has a private medical insurance. Despite certain changes in the options for this question, in comparison with the previous study, a part of respondents, who are supportive of the system of medical insurance (involving both state and private insurance companies), remained almost the same, and account for over two fifths of the respondents. Support for the existing healthcare system rose more than twice. However, it should be recognized that for those respondents, who are users of mutual hospital insurance funds ("likarniany kasy"), the options regarding support for the existing healthcare system and for the system of obligatory medical insurance in fact lead to something else. If we turn on the filter for question regarding the type of the existing/available medical insurance, meaning that we calculate the frequency table separately for those who is insured through the mutual hospital insurance funds, we will receive slightly different results. In such a case the number of supporters of the system of medical insurance increases almost in one and a half times, and reaches 60% of the respondents, whereas the relative number of supporters of the existing healthcare system almost doubles, amounting to 35% of the respondents. In this case almost 5% of respondents expressed they support for private medical insurance only. Level of awareness of the pilot project ("the experiment") in the healthcare system of the rayonThis question was not asked in the course of the previous study. The proportion of the population, who are aware of the pilot project in the healthcare system of the rayon, amounts to one quarter of the respondents, and, respectively, three quarters have declared that they are unaware of the pilot project. Generally, this distribution pattern is somewhat contradictory: despite the fact that medical insurance is had only by almost 40% of the respondents (86% of whom received it through mutual hospital insurance funds), only 62,5% of holders of medical insurance are aware of the pilot project. One of the explanations of this phenomenon is that the respondents who indicated an alternative option „no" have only vague information on the pilot project, rather than substantial information about it, and thus call themselves incompetent in this matter. Another, even more probable explanation is that the respondents may not be connecting their membership in the mutual hospital insurance fund with the pilot project in the healthcare system of the rayon. Level of confidence in information received from various sourcesThe alternative options in this question may be grouped into three categories as follows: confidence in government authorities, confidence in relatives, and trust to other social sources. As regards the government authorities, here we observe a rather high level of trust on the part of the respondents: information, received from the central government authorities is fully or partly trusted by 53% of the respondents, and that received from the local authorities – by 64%, whereas respective shares of information are 46% and 35%. Relatives demonstrate even higher level of trust: thus, relatives are trusted by 91% of the respondents, and not trusted - only by 8%; for friends respective indicators of trust/distrust equal, respectively, 87% and 11%. Among the so-called social sources of information the least trusted are mass media, which are fully or partly trusted by 58% of the respondents, against 39% of those who distrust them. Neighbors are trusted by more than two thirds of the respondents, but are not trusted by less than one third. Information, received from the church, is trusted by slightly more than three quarters of the respondents. At the same time 16% fully or partly do not trust this information. It is interesting, that the unusually high level of trust to therapists or a family doctor (84%) can be explained by at least two factors: first, by personal characteristics of one’s doctor, and second, according to the survey workers, the respondents meant mostly the confidence in professional, rather than in any other information. Among the information sources, which provided the population of the rayon with the information on implementation of changes in the healthcare sector, the first position (almost 20% of the respondents) is held by newspapers. The second position is shared by „Project activities/measures" and „television" (respectively 9% and 8% of the respondents). Another 3% of respondents received information on implementation of changes in the healthcare sector from the radio, and almost 2% - from the project’s web-page. Despite this, almost 61% of the respondents had heard nothing about the project in question. This question did not have mutually non-exclusive alternative options, however, it was interpreted by the as such, which is why the coding took it into account. Among the respondents, who received information about the project from the newspapers, 75% of the respondents indicated as their sources national newspapers. 25% of the respondents found such information in rayon newspapers, and 20% - in the oblast newspapers. Among of respondents, who received information about the project from the radio, 50% of the respondents listened to the national, and 50% - to the oblast radio. 25% of the respondents heard this information from the rayon radio. A respondent who said that he received information about the project from the television, referred to the national television. ExpertsGenerally the assessment of the quality of services in rayon’s state medical facilities by the experts has worsened. This is partly due to the fact that the survey was conducted after the elections. That is, in conditions where the new authorities have not been announced yet, and the previous authorities are no longer there, people may be less afraid of a possible pressure and thus can afford to be more frank. It is also likely that such negative views of the experts follow from their pessimistic vision of many aspects of the activities of the government and society in general. Of the expert respondents over half believe that quality of services in rayon’s state medical facilities is low. At the same time, more than one third estimate it as average, and 9% could not decide on the evaluation of this parameter. It is very telling that not a single expert chose an alternative option „high" with respect to the quality of services in rayon’s state medical facilities, whereas in 2004 this option was supported by almost 15% of the respondents. The answers to this open question regarding opinions of the experts concerning the need in certain changes to improve quality of medical services, were distributed as follows: a bit less than a quarter (23%) of experts believe that it is necessary to ban bribing - obviously, for all of the experts this problem is very urgent; almost one fifth (18%) are convinced that it is necessary improve the qualification of medical workers; 14% of experts believe that it is necessary to ensure the sufficient financing for the healthcare; 9% are convinced that it would be enough to modernize the material – technical basis of medical facilities. Also the experts indicated that for improvement of quality of medical services it is necessary to introduce medical insurance, improve attitude of medical workers to patients, and improve accessibility of all types of medical services and to improve medical services for veterans. Almost one fifth (18%) of the experts could not answer this question. This question was not in the questionnaire of the previous study, but the structure of distribution of answers to this question partly explains the structure of assessment of the previous parameter. The structure of spending on medical treatmentThis question suggested a five-point scale for each of the three medical treatment spending options. However, some respondents rated only one or two alternative options out of three. All experts rated expenditures on medical treatment based on the 5-point scale. The proportion of those who spend on purchasing medical drugs much and very much money (indicated ratings 4 and 5) grew significantly and reached 91% of the respondents. At the same time for 9% of the experts expenditures on medical drugs account for little money. Partly this can be explained by inflation processes, which make medical drugs more expensive. Among those 14 experts, who rated their expenditures on charitable contributions, the overall distribution almost has not changed: a bit less than three quarters indicated that they spend on this relatively little and very little money (indicated ratings 1 and 2). 29% of those respondents spend on charitable contributions much money (indicated the rating 5). Among those 10 experts, who rated their expenditures on bribing medical workers, 30% indicated that they spend on it relatively little and very little money (indicated ratings 1 and 2). For one tenths of those respondents these expenditures are in the middle of the scale between much and little (indicated rating 3). 60% spend on bribes relatively much money (indicated rating 5). We can see that at the same time slightly grew the shares of those who spend on bribes for medical employees little money and of those who spend on it much money. Generally, compared with the population survey, observed is the contrary situation– population declares that it spend on medical drugs, charitable contributions and bribes much less money than in 2004. Assessment of the attitude of local medical workers to patients has a trend toward a negative assessment (73% of the respondents). Only 23% of the experts view it as very good. At the same time 4% of the experts found it difficult to assess this parameter. This parameter, as well as assessment of the quality of medical services, may have been influenced by the overall negative trends that took place after the elections. As to the average time patients spend in a waiting line to a doctor, its distribution shifted toward the longer waiting time. Thus, 36% of the experts believe that it exceeds one hour, 27% say it is one hour, and 32% believe that in a waiting line to a doctor patients spend from 5-15 minutes to half an hour (respectively, 9% and 23%). As we can see, no expert has used private healthcare services regularly. Almost halved the proportion of those who never used services of private healthcare. At the same time, almost tripled the number of the experts who sometimes use services of the private medical facilities and private doctors - approximately 68% of the respondents. However, chances are that it means that these people do not use services of their district doctors, but get treated by acquaintances: practically half of the experts are medical workers themselves. Changes in the distribution pattern for answers to the question about the need in certain radical changes, are most probably related to the changes in the way this question was formulated in the questionnaire this time. Assessment of changes necessary to improve quality of medical services, 2006The most necessary change in the healthcare system, in the opinion of the experts of the rayon, is the ensuring of the list of the free-of-charge essential services and of the paid provision of other medical services – more than three quarters of the respondents chose this option, which in fact is an indirect confirmation of the popularity of the idea of medical insurance. The second position (with almost two thirds of answers of the respondents) is taken by the need to increase effectiveness of use of the available resources. The third position is taken by the need to increase financial revenues (55% of the respondents), and the fourth position is that of the need to provide a greater autonomy to the state medical facilities (18%). This question allowed mutually non-exclusive alternative options – one could take up to three answer options. Parameters related to medical insuranceBy 23% increased the part of experts (from 45% to 68%) who believe that the goal of the obligatory medical insurance is to make all medical services accessible to all people. By 8% reduced the number of experts (from 40% to 32%) who are convinced that the goal of the obligatory medical insurance is to make them accessible for those who pay contributions. The alternative option „cover only the most essential medical services" did not receive any support from the experts. As usual, opinions of the experts on the goal of the voluntary medical insurance split into two halves: 50% of the experts of the rayon believe that the VMI ought to cover absolutely all medical services, and 50% of the experts maintain that covered should be only those services which are not covered under OMI. When there was no option „hard to tell", in 1.5 times grew (and reached almost 64% of the respondents) the part of the experts who agree to pay 10% of the insurance contribution. From 4% to 9%, which is almost twice, rose the proportion of those who agree to pay 30%. None of the experts agreed to pay a half. By 8% grew the proportion of those who does not want to pay anything. It should be noted that the experts are funded from the budget and thus cannot boast large income levels. And again, 10% is not that much in the eyes of the average citizen, particularly if we take into account that even approximate amounts of these contributions were not indicated. Generally, the trend is positive, meaning that greater numbers of the experts (almost three quarters of the respondents) agree to pay some part of insurance contribution . With the new alternative option added to the answer options for the question regarding sources of medical insurance („the state"), the distribution of this parameter changed as follows: by three percent (from 47% to 50%) increased the proportion of those who say that the sources of payment of medical insurance should include both an employer and an employee; by nine percents (from 45% to 34%) shrank the category of the experts, who believe that sources of payment for medical insurance must be an employer; almost 14% of the experts said that the source of payment for the medical insurance should be the state and none of the respondents indicated that the employee should be the source of payment for medical insurance. The experts have rather realistically assessed the situation, being aware of the fact that for the majority of the population, which is already below the poverty line, particularly in rural areas, medical insurance payments will become an unbearable burden. The change in the distribution of the experts’ estimates of the idea to involve commercial insurance companies to operate within the OSMSI system demonstrates that they are pessimistic in this respect. Thus, at the same time, the proportion of those who believe that such an involvement is desirable has halved, and the proportion of those who are convinced that such participation is desirable, has increased. By 21% (from 38% to 51%) grew the number of those who can’t answer this question. Assessment of the potential impact of the introduction of medical insurance on the work of local medical workersIn this question we observe, mostly, two-vector trends in the changes in the assessment of the potential impact of the introduction of medical insurance on the work of medical workers of the rayon. On the one hand, by 8% (from 38% to 46%) grew the number of experts who believe that introduction of medical insurance will stimulate the work of medical workers. None of the experts believes that this impact will have a negative effect on the quality of work of medical workers. On the other hand, by 11% increased the proportion of those who are convinced that medical insurance won’t have any impact on the work of medical workers in their rayon. Assessment of the actual impact of the change in the business status of the hospital: on hospital financingThis question was not included in the previous study. Half of the experts believe that the change in the business status of the hospital of the rayon had a positive impact on the financing of the hospital (the options "positive" and "rather positive" were chosen respectively by 18% and by almost 32% of the respondents). More than one third (36%) of the experts are convinced that the change in the business status of the hospital had no effect on the financing of the hospital. 14% of the experts believe that such an impact was negative (alternative options "negative" and "sooner negative" were chosen by 5% and 9% of the respondents, respectively). Assessment of the actual impact of the change in the business status of the hospital on the material status of medical workersThis question was not included in the previous study. The expert assessment of the impact of the change in the business status of the hospital of the rayon on the material status of medical workers indicated the following: a bit less than two thirds of experts (64%) believe that there was no such effect. Opinions of the rest of the experts split equally - 18% of the experts are convinced that the impact was positive (4%- positive, 14% - sooner positive), and 18% believe that such an impact was negative (9% - negative and 9% - sooner negative). Assessment of the actual impact of the change in the business status of the hospital on the quality of medical servicesThis question was not included in the previous study. More than half of the experts (55%) believe that the change in the business status of the hospital of the rayon did not effect quality of medical services. 27% of the experts are convinced that such an impact has taken place and that it has been rather positive (9% - positive, 18% - rather positive), and 18% of respondents believe that the change in the business status of the hospital of the rayon had an impact on the quality of medical services which was negative (negative and sooner negative – by 9% each option). As usual, almost two thirds of the experts of the respondents in Popilniansky the rayon called themselves supporters of the system of medical insurance, provided that medical services are paid by the state, and by private insurance companies, and apparently these are those who acknowledge the need in changes for improvement of the existing situation. And less than one third are the supporters of the existing healthcare system. Assessment of the interest of the government authorities in changes in the financing of medical facilitiesThis parameter was not explored in the previous study. Most of the experts of the rayon (46%) found it difficult to assess the interest of the central government authorities in (their commitment to) changes in the financing of medical facilities. More than one third of the expert respondents (36%) believe that central government authorities are not interested in making changes in the financing, and 18% of the experts, on the contrary, are convinced that the central government authorities are interested in making such changes. Majority of the experts of the rayon (45%) found it difficult to assess the interest/commitment of the oblast-level government authorities in/to changes in the financing of medical facilities. Less than one third of the respondents of the experts (almost 32%) believe that the oblast-level government authorities are not interested in changes in the financing, and almost a quarter (23%) of the experts, on the contrary, are convinced that the oblast-level government authorities are interested in such changes. 27% of the experts could not assess the interest of the government authorities in such changes. Majority of the experts (almost 41%) believe that local authorities are interested in changes in the financing of medical facilities. Almost one third (a bit less 32%) of the experts are convinced that local authorities are not interested in changes in the financing of medical facilities. Here can be observed a certain linearity in the responses of experts, which means that on the whole the experts believe that the central government authorities are the least interested in such changes, the oblast government authorities – a bit more interested, and the local government authorities – are much more interested in the changes in question. Familiarity with the functions of the communal not-for-profit enterpriseThis question was not included in the previous study. Surprise, but almost 55% of the experts know nothing of the functions of the communal not-for-profit enterprise. Some consolation is provided by the fact that at least 36% of the experts have heard something of them, and 5% of the experts were involved in the discussions of the functions of the communal not-for-profit enterprise. 4% of the experts did not answer this question. Alternative options regarding this question may be grouped into the following three subject categories: confidence/trust in government authorities, confidence in relatives, and confidence in other social sources. As regards the government authorities, here we observe a low level of trust of the respondents: information received from the central government authorities is fully or partly distrusted by almost 73% of the respondents, and the information received from the local government authorities is distrusted by 55%, while trusted respectively by only 27% and 45%. As usual, relatives demonstrate a high level of trust: thus, relatives and friends are trusted by 77% of the respondents, and distrusted by 23%. Among the so-called social sources of information the least trusted are neighbors, who are fully or partly trusted by 45% of the experts versus 55% of those who distrust them. Mass media are trusted and distrusted by 50% of the expert respondents. Information, received from the church, inspires trust in 59% of the experts, whereas almost 32% fully or partly do not trust it. It is interesting that the unusually high level of trust to therapists or family doctors (68%) can be explained by at least two factors: first, a large part of the experts are medical workers themselves, and, second, according to the survey workers, experts meant preferably the confidence in professional, rather than in any other information. Of the information sources, which provided experts of the rayon with the information on implementation of changes in the healthcare sector, the first position (77% of the respondents) is held by the newspapers. The second position is shared by the „project activities/measures" and „television" (each is supported by 27% of the experts). 18% of experts received information on the implementation of changes in the healthcare sector from the radio. Although this question did not allow for mutually non-exclusive alternative options, respondents took it as such that did, which is why the coding took this into account. Majority of the experts received information on the implementation of changes in the healthcare sector in the rayon from national newspapers (almost 55%). A bit less than one fifth got it from the oblast newspapers, and 14% - from rayon newspapers. Almost 14% of the experts who received information on the implementation of changes in the healthcare sector in the rayon from the radio, have listened to the national radio, while 5% - to the rayon radio. Almost 14% of the experts, who received information on the implementation of changes in the healthcare sector in the rayon from the television, have been watching national television. Results of sociological survey 2006 in Zolochiv rayonIn March-April 2006 the comparative data analysis of the sociological surveys on population’s expectation and awareness of health care reforms in Zolochiv rayon, Kharkiv oblast, carried out in 2004 and in 2006, was held by Sociology and Psychology Department, Taras Shevchenko National University. The goal of this comparative analysis of empirical data obtained in 2004 and 2006, is to identify changes that occurred, on the whole, during the year when the pilot experiment was being carried out in Zolochiv rayon, in connection with the medical insurance in the rayon (population’s awareness of its features, goals and means of implementation), etc. One of the goals of the sociological study was to identify the frequency of Zolochiv rayon population’s asking for medical assistance . The 2004 survey demonstrates that just slightly more than one third of the population (37.3%) request medical assistance rather rarely – once a year. Other population visits medical facilities once a quarter (26.0%) and once a month (20.8%). A significant share of the population (15.7%) chose the response "other", where roughly half of the responses include such as "never call for help", "less than once a year", "if necessary", and the small proportion indicated "call more often than once a month" According to the 2004 survey data, over 40% of the respondents declared that they rarely call for medical help – approximately once a year. Slightly more than quarter of the respondents (almost 27%) need such assistance once a quarter, 17% - even more often, once a month. At the same time 13% of those surveyed chose the alternative "other". Of those who clarified this response, another 1.6% need to see a doctor more often than once a month, and less than 0.5% - on the contrary, less than once a year. At the same time, almost 3% call for medical help not regularly, but on the need basis. The comparative analysis of the 2004 and 2006 surveys demonstrates an insignificant increase in the number of people requesting medical assistance " once a month" (by 4%) and, respectively, a decrease in the number of those who request medical assistance "once a year"( by 6.5%). One of the central tasks of the sociological study concerned identifying assessment of the population’s view of the quality of services provided by the state medical facilities of the rayon . Unfortunately, according to the 2006 survey, only 6.6% of the respondents viewed the quality of services provided by the state medical facilities of the rayon as high. Almost equal numbers of respondents found them medium-level (44.4%) or low (42.6%). 5.9% of the respondents did not answer this question, and approximately the same number of respondents did not visit a doctor in that year. There have been no statistically significant differences in assessments of the quality of services by respondents living in residential areas of different types. These empirical data may be a cause for concern since the population’s view of the quality of services provided by the state medical facilities of the rayon in 2004 was much more favorable. Thus, responding to the question regarding the quality of services provided by the state medical facilities of their own rayons, the prevailing majority of respondents in 2004 assessed it as average (55%). 18% and 17% of the respondents found it high and low, respectively. At the same time, one tenth of respondents were undecided regarding this parameter. Therefore, majority of the population evaluated the of the quality of services provided by the state medical facilities in their rayons as low, which, obviously, may cause dissatisfaction with the existing situation. An important evaluation characteristic of the existing healthcare system is the structure of population’s spending on medical treatment . The empirical data of the 2006 survey indicate that in the structure of the population’s spending on healthcare the most important component is the spending on medical drugs – 41.6% of respondents spend on medical drugs "much" and "very much" money ( 13.2% - spend "very much"). A small proportion of respondents "do not spend anything" on medical drugs in the course of medical treatment (3.0%) or spend "very little" (7.6%) – these are respondents who rarely visit a doctor or, possibly, the share of the population that is entitled to applicable privileges concerning medical drugs. It should be noted that in the structure of population spending on healthcare, based on the 2006 and 2004 surveys, there are no significant differences. However, in 2004 the number of respondents spending on purchasing medical drugs "much" and "very much" money was somewhat higher (69%), whereas in 2006 it was 43.1% of those who answered this question. The structures of spending on charitable contributions for medical facilities and bribes for medical workers , based on the 2006 survey data, do not differ much. In both cases one may see that over one third of the respondents (34.1% and 39.2%, respectively) do not spend money for this purpose, or spend little or average amounts. Of those who answered this question in 2004, the prevailing majority of respondents (57%) indicated that they spend most money on purchasing of medical drugs. Very small proportion of the respondents indicated that they spent most on charitable contributions for medical facilities and on bribes to medical workers (roughly 2% each). At the same time 3% of the respondents indicated that they spent nothing for this purpose. Assessment of quality of services of medical facilities is affected by a variety of factors, one of which is the medical workers’ attitude to patients, who was the subject of the following question - "How would you assess the attitude of medical workers of your rayon hospital, polyclinic, village dispensary to you as a patient?" Unfortunately, according to the 2006 survey, half of the respondents (50.2%) evaluated the attitude of medical personnel of medical facilities as not good enough. 23.3% of the respondents find it unsatisfactory. At the same time only 17.3% estimated medical workers’ attitude as very good. 8.3% respondents are undecided. According to the correlation tables’ data, there are statistically significant differences in the evaluation of the medical workers’ attitude to the patients depending on the type of the residential area (coefficient Õ³-squared= 12.65 is significant at the 5% level). First of all we should note that most of the residents regardless of the residential area type evaluated it as insufficient (see Table). However, there exists the statistically significant difference in this evaluation for options "very good" and "unsatisfactory", and assessments of residents of small villages and rayon centers differ (respectively, 22.4% and 13.2% - "very good" and negative estimates, respectively, 12.2% and 27,8% - " unsatisfactory"). This situation can be explained, in particular, by mentality of rural population, by the fact that in small villages majority of the population know each other and common opinion matters. Besides, the "insufficient" evaluation is caused, first of all, by the lack of proper transport communication between villages and the rayon center, where the hospital and polyclinic are located There is no statistically significant dependence between the assessment of the attitude of medical workers of the rayon hospital, polyclinic, village dispensary, to patients, and age of respondents. In the course of the 2004 survey, assessing the attitude of local medical workers to them as patients , almost half of the respondents identified it as very good (46%). Practically the same number of respondents is unsatisfied with this parameter: almost 40% believe that the attitude to the patients is insufficient, and another 8% is unsatisfactory. At the same time another 8% of respondents were undecided on this matter. Based on the data of those who conducted the survey, this parameter has been evaluated by respondents very subjectively, actually based on the personality of a doctor, that is that if in a particular village the doctor is a very pleasant person, then the majority of respondents will give a very high estimate of this parameter. Therefore, comparing the empirical data of the 2004 and 2006 surveys demonstrates the increasing dissatisfaction among the respondents of the rayon with the medical workers’ attitude toward the patients. The next characteristic of the quality of the existing system of medical services is the time that the population spends in waiting lines to doctors . According to the 2006 survey data, roughly one third (32.6%) of the respondents stay in the queue approximately 5-15 minutes. Almost the same number of respondents spends in waiting lines up to half an hour. The largest proportion part of the population - 35.8% - spends an hour or more than an hour, which causes certain dissatisfaction among the patients. The patient’s waiting time as a function of the type of the residential area, according to the correlation tables’ data, statistically significant are at the level of 5%, X-squared= 13.594. The least time in waiting lines is spent by residents of small villages, specifically - "up to 15 minutes" (51%). At the same time, 22.4% of the respondents – residents of small villages, indicated, that they spend in waiting lines to doctors an hour and 8.2% - more than one hour. When asked directly, the respondents said that they distinguish between the time spent in waiting lines in rayon hospital and in village dispensaries. Usually in villages they spend less than 15 minutes in waiting lines. Type of residential area/ How much time do you normally spend in the queue to a doctor ? (Total number of questionnaires - 408) According to the 2004 survey, over 40% of respondents spent in waiting lines 5-15 minutes. At the same time one third of the respondents (35%) had to spend in waiting lines approximately half an hour. One fifth of the respondents spend on this even more time: 13% - approximately an hour, 8% - even more than one hour. This distribution may indirectly demonstrate that there were no big problems with recruiting/hiring staff for the rayon’s medical facilities. A comparative analysis of the average time spent by the patients in the doctor queues indicates that the queues have grown longer, and the relevant proportion of the population, which spend an hour and more in waiting lines, have almost doubled. The next question was "Do you use services of private medical facilities and doctors, and how often? " It helped to find out that in 2006 the prevailing majority of respondents (43.6%) never used services of private medical facilities and doctors. Almost the same number (42.9%) – occasionally use services of private medical facilities and doctors, and 11.3% use them constantly. There is no statistically significant difference in responses depending on the type of residential areas, in which respondents live. According to the survey carried out in 2004 among the respondents of the Zolochiv rayon, two thirds (66%) responded that they do not use services of the private medical facilities and private medical workers. At the same time one third of respondents responded positively to this question, with 17% using medical services regularly, and another 17% - occasionally. This situation can be explained, apparently, by the fact that the respondents use services of the doctors they know and who are not their district doctors, rather than by the fact that they really officially purchase services of private clinics and doctors (except for, perhaps, dentists). Comparison of the data of the surveys carried out in 2004 and 2006 indicates that there is a significant increase in the number of the population, which use services of private medical facilities and doctors "occasionally"(16.7% to 42.9%, respectively). The existing healthcare system apparently needs urgent changes, which is why one of the goals of the survey was to identify the population’s opinion regarding what radical changes they consider appropriate (several options of the responses were allowed, which is why the percentage sum exceeds 100%). The most appropriate, in the view of the population of Zolochiv rayon of Kharkiv oblast, based on the 2006 survey, is the increase in the financial revenues in the healthcare system (55.1%). The second and the third places were given to, respectively: increasing legal, financial and moral responsibility of medical workers for quality of medical services (40.2 %) and improving access to medical assistance (39.7,7%) Almost every third (29.4%) found it necessary to ensure free-of-charge delivery of the specified by the state the most essential of medical services and the official payment by the population for the part of medical services, which belong to the category of "medical luxuries". The same number of respondents pointed to the need to improve the efficiency of the available within the healthcare system financial, personnel and technical resources. Approximately every fifth (20.8%) believes that it is necessary to grant financial and managerial autonomy to the state medical facilities and to reorganize them into the communal enterprises. The most necessary radical change (from the standpoint of the respondents in Zolochiv rayon in the course of the 2004 survey) was the traditional increasing of funding – two thirds of the respondents supported this view. Almost a half of the respondents referred to the improved accessibility of medical assistance. The third of the leading changes was the increased responsibility of medical workers for quality of services (almost 40% of respondents). One third of the respondents find it necessary to ensure free-of-charge provision of the clearly specified by the state most essential services, and a bit more than one third of the population preferred the increased effectiveness of the resources available in the system. A comparative analysis of the 2004 and 2006 surveys demonstrates the increasing importance of the increased financial revenues (which was also supported by the responses to open questions of the questionnaires), and the relative stability of the structure of the necessary, from the standpoint of the respondents, changes in the healthcare system. One of the goals of the survey was to assess the awareness of the population of medical insurance . Characteristics included awareness of the population of the goal of obligatory and voluntary medical insurance. It should be noted, that to counterweigh the state universally obligatory social insurance, the voluntary medical insurance is aimed at the financially secure part of the population. Thus the two sectors of the market are separated and do not compete with each other. Majority of the population (45.6%) believes that the goal of the obligatory medical insurance is to make all medical services accessible for all population groups; on the second place - accessible for those who pays contributions (21.8%) on the third place — to cover costs of only the most essential (both from the medical and social points of view) medical services and not to cover the costs of the services, which belong to the category of "medical luxuries" (15.4%). 14.0% of the respondents believe that obligatory medical insurance has to cover absolutely all medical services. In their responses to the question about the goal of the obligatory medical insurance , respondents in Zolochiv rayon were practically consolidated – practically two quarters believe that the goal of the OMI was to make all medical services accessible to all people: it is natural, that in the existing difficult conditions people want to have accessible/affordable and quality healthcare. Besides, another almost 8% preferred "to cover absolutely all medical services", which also may be included in the previous item. Almost 10% of the respondents find that the goal of the OMI is to make medical services accessible only to those who pays contributions, and another 7% believe that the OMI should be covering only the most essential medical services. As we can see, the comparison of the 2004 and 2006 survey data indicates certain changes in the structure of the population’s view of the goal of the obligatory medical insurance: greatly increased is the number of the respondents, according to the 2006 survey, who maintain that the goal of the obligatory medical insurance is to make all medical services accessible for people (respectively 45.6% in 2006 and 74.07% in 2004), and the number of the respondents maintaining that the goals of the obligatory medical insurance is "to cover only the most essential medical services" and "to cover absolutely all medical services" (respectively 15,4% ; 14% in 2006 and 7,07% , 7,47% in 2004). The goal of the voluntary medical insurance , as half of the population believes, according to the 2006 survey (50.5%), is to cover costs of the medical services not covered by the obligatory medical insurance. 41.4% of respondents are certain that the goal of the voluntary medical insurance is to cover absolutely all medical services. As to the goal of the voluntary medical insurance, only one third of respondents think that the VMI ought to cover the medical services not covered by the OMI. At the same time almost 2/3 of the respondents believe that the VMI should cover absolutely all medical services. Such a situation sooner indicates the lack of understanding of differences between VMI and OMI, rather than anything else. We admit that there are significant changes in the assessment of the goal of the voluntary medical insurance, since the number of those thinking that the goal of voluntary insurance is to cover absolutely all medical services lowered compared to the 2004 data (respectively 62,67% and 41,4%). Introduction of the generally obligatory medical insurance ("OMI") requires additional targeted contributions. Based on the 2006 survey, 47.6% of the respondents agreed to pay 10% of the amount of the insurance, 36.5% do not want to pay anything, and only 12.9% agree to pay 30% of the cost of insurance, and only 2.5% - 50% of the insurance amount. This distribution does not depend on gender, age, education, social status and place of residence of the respondents. It is worth mentioning here that there was a reference to a hypothetical and not quite understandable amount of insurance contributions, which is why people were cautious about this question. As regard the issue that may have a direct practical financial impact on the respondent, the distribution was (based on the 2004 survey) as follows. Only 4% of respondents said they were ready to pay 50% of the insurance contribution. One tenth of the respondents agree to pay 30% of the contribution. However, over half of the respondents agree to pay 10% of the contribution. And practically one third of the respondents do not want to pay anything – it can be explained, first of all, by the fact that elderly people do not have money to pay, and, secondly, by the fact that they believe that they have already earned enough for medical services over their lives. Again, 10% in the eyes of the average citizen may not seem a lot, particularly if we remember that even approximate amounts of contributions were not specified. Therefore, over the time that has passed between the surveys opinions of respondents did not change significantly. Source of funding for medical insuranceBased on the 2006 data, a majority of respondents (36.8%) believe that funds for payments for medical insurance must be provided from the country’s budget and the oblast’s budget (11.3%). A bit more than one quarter of the respondents believe that medical insurance must be paid for by the employer and employee jointly (26.2%). Every fifth respondent believes that medical insurance must be paid for by the employer (20.6%), and only 2.2% - by the employee. According to the data of the 2004 survey, almost 60% of the respondents in Zolochiv rayon believe that medical insurance must be fully paid by the employer, whereas the opposite opinion (that insurance must be paid by the employee himself) is supported by one tenth of this number of respondents - 6%. And another almost one third of the respondents chose the compromise approach of joint payment by employer and employee. This response structure is in agreement with the previous question: people are simply unprepared to take this extra financial burden, particularly when they do not know the size of it. Should be noted that in "Questionnaire-2006" the following alternatives were added - "from the country’s budget" and "from the oblast’s budget", which is consistent with international standards and, in its turn, caused changes in the structure of responses of the respondents. Availability of medical insuranceBased on the 2006 survey data, the majority of respondents or their relatives (87.6% of those who responded) do not have medical insurance, and only 12.3% of those who responded to the question have the insurance. Of the respondents surveyed in 2004, almost 20% indicated that they or their relatives have medical insurance, whereas ? indicated that they did not have such an insurance. 6% did not answer this question. It should also be noted that the significant proportion of hospital mutual fund consists of employees of the state agencies of this rayon – for them this step was a mandatory one. As we can see, over the time that passed between the surveys the number of those who have had medical insurance has not changed significantly. Type of available medical insuranceOf those who has medical insurance (based on the 2006 survey data) the majority are insured thought the hospital mutual insurance fund (54.4%), whereas private insurance is had by 45.6% of those who responded to the issue. Of those who indicated that they or their relatives have medical insurance, based on the 2004 survey data, two thirds are insured through the mutual hospital fund (66.67%). Almost 30% indicated that this insurance is private (possible what was meant is that these people shall be contributions themselves). And 4% of insurance holders did not respond to the question about the type. A comparative analysis of the data indicates changes in favor of private insurance, and, respectively, reduction of those who is insured though the mutual insurance fund (hospital mutual fund). One of the tasks of the survey was to assess the level of confidence/trust that the population has toward the information received from various sources . The alternatives regarding this issue may be split into the following three groups: confidence in government, confidence in relatives, and confidence in other social sources. Based on the 2006 survey data, the most trusted are relatives – "to a certain degree" the received from them information is trusted by 81.9% of respondents; then come friends (74.3% of respondents trust information received from them); and the third (in terms of the degree of trust) are therapists of family doctors, whose services are used by respondents ( 69.4% of the respondents). 56.6% of respondents trust "to a certain degree" the information received from church – the fourth place, and 54.2% of respondents trust information received from neighbors. Central and local government authorities are not very trusted by the population. Information provided by mass media also does not inspire particular trust. Information provided from these services is to a certain degree trusted by 42.1% (local government), 40.2% (central government only); and by 37.1% (mass media) of the respondents living in Zolochiv rayon of Kharkivska oblast (respectively, the sixth, seventh and eights places). Based on the 2006 survey data, the following distribution of responses took place. Trust to information received from government authorities – roughly equal numbers of respondents (about 40%) of Zolochiv rayon fully or partly trust the central and local government authorities. At the same time slightly fewer respondents (approximately by 30%) indicated that they fully or partly distrust the central and local government authorities. The category of relatives has the highest indicators of trust: relatives are trusted fully or partly by 63% of respondents, and not trusted by only 5%, and, respectively, friends are trusted by 55%, and distrusted by 13% of respondents. A rather high level of trust the respondents have toward the church: almost half of the respondents trust information received from church (and only 20% do not trust such information). At the same time neighbors as a social source of information are fully or partly trusted by only 37% of the respondents (not trusted by 27%). Mass media – are the only source of information that is predominantly distrusted (trusted by only 27%, and distrusted by 33%). Interestingly, the unusually high level of trust to therapists or family doctors (68%) can be explained at least by two reasons: first of all, by personal characteristics of one’s doctor, and second, according to those who conducted the survey, the respondents meant predominantly the trust to professional information, rather than to any other information. Based on the aforementioned, we can make a conclusion, that on the whole the situation with respect to the medical insurance in the rayon (awareness of the population of its characteristics, goal and means of implementation) over the course of the year when the pilot was carried out, has not changed significantly. The results of the survey were latently affected by the population’s state of mind due to elections to the Verkhovna Rada, oblast and local Radas, on the one hand, and, by the usually unfavorably perception by the population of implementation of innovations – that is where the more critical attitudes and assessments of respondents (compared to the 2004 data) are coming from. The Roll-out Training Module N3 Global Budget for HCF and Performance Indicators (Zhytomyr) On February 8th – 9th, 2006 the Roll-out Training Module N3 Global Budget for HCF and Performance Indicators was held in Zhytomyr. In the course of the module the following presentations were done:
The roll-out Training Module 2 "Cost accounting for HCF & Data entry process" (Kharkiv) February 1-2, 2006 the roll-out Training Module 2 "Cost accounting for HCF & Data entry process" was held in Kharkiv The following presentations were given in the course of the module:
Conference-training for journalists "How to use funds for
health effectively"
 To disseminate the experience related to contractual relations implementation between the healthcare provider and purchaser as well as the autonomous status of healthcare facilities, a two-day conference-training for journalists What should be done for medical funds to work effectively was held within the PR-strategy of the Project Health Financing and Management in Ukraine together with the Ukrainian Educational Centre of Reforms (UEDR) 2-3 November 2005 in Zhytomyr. 22 journalists from oblast and rayon mass-media took part in the conference. Eero Linnako, the Deputy Team Leader of the Project, talked about the tasks of the EU Project Health Financing and Management in Ukraine. Hryschuck,V.O., the Head of the Administration and Treatment-preventive Department of Healthcare Department of Zhytomyr Oblast State Administration, informed the present on the state of healthcare system in Zhytomyr oblast and on the progress of the health reform. V. Rudyi, the Ukrainian Project Director, explained in details what the autonomous status of healthcare facilities is and how the transfer from command-and-control administration model to the contractual one was carried out in Popilnya rayon, who can act as a healthcare purchaser and provider and how modern IT support the implementation of new administration methods. After presentations being made by main speakers, journalists asked a lot of questions regarding healthcare reform in general and the Project implementation in Popilnya rayon, in particular. Thus representatives of rayon mass-media were interested why it was necessary to decrease the number of beds and if the experiment didn’t violate patients’ rights, what functions the rayon healthcare department had; how a family doctor worked under conditions of the reform and how to begin similar reforms in other rayons. During the second day of the training the journalists and Project experts visited Popilnya Central Rayon Hospital, talked to its doctors and patients, got acquainted with the software provided by the Project. The main achievement of the seminar is the change of all the participants’ attitude to the health reform itself and their readiness to disseminate the information received among their readers. Conference-training for journalists "How to use funds for
health effectively?"   To promote a healthcare reform effectively it is extremely important that both healthcare workers and general public should be informed on its core. Mass media play an important role in this process. A two-day conference-training for journalists "How to use funds for health effectively?" was held within the PR-strategy of the Project Health Financing and Management in Ukraine together with the Ukrainian Educational Centre of Reforms (UEDR) 19-20 October in Kharkiv. 26 journalists from oblast and rayon mass-media, Olexander Serdyuk, the Deputy Head of the Healthcare Department of Kharkiv Oblast State Administration, Antonis Malagardis, the Team Leader of the EU Project Health Financing and Management in Ukraine, Volodymyr Rudyi, the Ukrainian Project Director, Olexiy Gavva, the Head Doctor of Zolochiv CRH, Kateryna Dyakova, the acting head of the Healthcare Department of Zolochiv Rayon State Administration, Lyubov Batih and Natalia Luchsheva, PR-experts of the Project, Iryna Shynkaryova, the Project Coordinator in Kharkiv Oblast took part in the conference. The following issues were touched at the conference:
The Head Doctor of Zolochiv CRH Olexiy Gavva told journalists about the results achieved by the pilot region in the course of the experiment. Then journalists asked experts questions. The mass-media representatives were interested in the following issues:
after receiving the status of a communal enterprise if there is a steering committee controlling the work of the enterprise. During the second day the journalists went to Zolochiv where they visited rayon hospital and talked to doctors and patients, exchanged their impressions.
A one-day seminar on roll-out of the experience by the
EU Project  To present the advanced world concepts, practical methods, and tools for introduction of contracting relations and setting-up autonomous health care facilities, and experience developed within the implementation of the EU Project in Zolochiv Rayon, as well as to include other rayons of Kharkiv Oblast to the experiment of introducing the best practice in their administrative locations, on 30 September, 2005 there was held a one-day seminar on roll-out of the experience by the EU Project "Health Financing and Management in Ukraine" in the big collegium hall of the Council building. The participants of the seminar were the Head of the Healthcare department of Kharkiv Oblast State Administration (Mr. B. O.Volos), Deputy Head of the Healthcare department of Kharkiv Oblast State Administration (Mr. O. I. Serdyuk), deputy heads of rayon state administrations, heads of village councils, chief doctors of rayon hospitals in Kharkiv Oblast, members of the Kharkiv Oblast Commission on health care issues, and the representatives of the EU Project "Health Financing and Management in Ukraine". The seminar participants had an opportunity to get acquainted with modern methods of effective decision making on resource allocation, healthcare management optimization, and introduction of information technologies. In addition to that, they had an opportunity to be involved in discussion of practical results of autonomization and introduction of contracting relations that were achieved in the Project pilot region (Zolochiv Rayon of Kharkiv Oblast), and evaluate possibilities for promotion of similar reforms in other rayons. The third issue of the "Family Doctor+" (ѳìåéíèé ë³êàð+) newspaper has been issued. The following articles are included into the issue: Strategic Planning for efficient resource allocation &
management of health care services in Ukraine Setting-up autonomous health care facilities and contracting:
Legal & Administrative aspects Costing of Health Services New payment mechanisms of medical services & requirements for
implementation Contracting as a tool of improving performance of health care
providers
IT role in expanding self-government of the hospitals
The Second Meeting of Regional Project Steering Committee in Zhytomir Pilot Region On August 11, 2005, the second meeting of Regional Project Steering Committee in Zhytomir pilot region took place. The following officials took part in this meeting: I. Synyavska, Deputy Head of Oblast State Administration and the Chair of the RPS Committee; O. Tolstanov, Head of Health Administration of Oblast State Administration and Deputy Chair of the RPS Committee; M. Borschivskiy, Chief Doctor of the Oblast Hospital; L. Minich, Deputy Head of the Main Financial Administration of the Oblast State Administration; V. Dimova, acting as Chief Doctor of Communal Enterprise "Zhytomir Oblast Medial and Consulting Diagnostic Center"; V. Shushpan, Deputy Head of the Main Department of Labor and Social Protection of Population of the Oblast State Administration; T. Uzhegova, Head of Oblast Information and Analytical Center of Medical Statistics; N. Slobodenyuk, Head of Planning and Economic Department of Oblast Health Administration; V. Grischuk, Head of Department of Organizational Work of Health Administration; N. Tsyganchuk, lawyer of the Oblast Health Administration; V. Stanislavchuk, Chief Doctor of Popilnya CRH: V. Kostyuk, Head of Rayon Healthcare Department of Popilnya Rayon State Administration; A. Malagardis, the Project Team Leader. V. Stanislavchuk, Chief Doctor of Popilnya CRH, made a report about the Project implementation process in Popilnya Rayon, acceptance of the reformations by different population groups in the rayon, and about concrete achievements by this time. The economy of finances in CRH, due to financial autonomy and effective use of funds, was called the main achievement of reforms. Later on, the participants of the meeting discussed the issue of implementing similar reforms in other rayons of the oblast by way of expanding those Project achievements that have already proved their efficiency, namely: creation of RHCD, CE CRH with global budget system, and transfer to contracting relations between the provider and the purchaser of health services. T. Uzhegova, Head of Oblast Information and Analytical Center of Medical Statistics made a report about installation of IT equipment, provided by the Project, and informed the Committee about further steps in IT intrusion in the Pilot region. Particularly, in the framework of further co-operation, by 15 September 2005, the approbation of software complexes MedReg and MedControl is planned based on the actual data with further generation of statistical forms, approved by the MOH. The data transfer flows from Popilnya CRH should be worked out first for that. The sixth Training Module "Quality Management" 30 June - 1 July, 2005 the sixth Training Module Quality Management was held in Zhytomyr and 14-15 July in Kharkiv. The following presentations were given in the course of the module:
Practical work in groups was devoted to the definition of quality of services from purchaser and provider point of view, additional enclosure to contract with measurement of services quality and patient satisfaction, and strategy to introduce total quality management - the main step in its development. Discussion Club ¹ 3 "Implementation of IT technologies" in Popilnya 
On 14 June, 2005 the third meeting of the Discussion Club "Implementation of IT technologies" took place in Popilnya, Zhytomyr Oblast. The participants of the meeting were Tetiana Kravchuk, the Deputy Head of Popilnya Rayon State Administration; Valeriy Stanislavchuk, the Head Doctor of Popilnya Rayon Central Hospital, Volodimyr Kostiuk, Head of Rayon Healthcare Department, Project experts Prof. A. Kovalenko, L. Batih, N. Louchsheva, journalist of newspapers "Ïóëüñ" Emma Budnyk. During the meeting, the following issues were covered:
Prof. A. Kovalenko spoke about medical register of the rayon's population; maintenance of basic electronic medical documents from which patient's movements during the treatment process can be traced. Hereupon expert answered questions of hospital staff. The fifth PTM Information Communication Technology On 8-9 June, 2005 the fifth PTM "Information Communication Technology" was held in Zhytomyr and jy 21-22 June, 2005, in Kharkiv. In the course of th module work the following presentation were given:
Meeting of the Regional Steering Committee in Zhytomyr 31 May 2005 the first meeting of the Regional Steering Committee of the EU Project "Health Financing and Management in Ukraine" was held in Zhytomyr pilot region. The participants were I. Synyavska, Deputy Head of Oblast State Administration, Head of the Committee, O. Tolstanov, Head of the Health Administration of Oblast State Administration, Deputy Head of the Committee, V. Bernatovych, Head of Popilnya Rayon Council, M. Borschivskyi, Head Doctor of Oblast Hospital, L. Minich, Deputy Head of Central Financial Administration of Oblast State Administration, V. Pariy, Head Doctor of KP ZOMKDC, Y.Protsenko, Head of Popilnya Rayon State Administration, V. Shushpan, Deputy Head of Central Public Labour and Social Protection of Oblast State Administration, V. Stanislavchuk, Head Doctor of Popilnya Central Rayon Hospital, V. Kostyuk, Head of the Rayon Health Department of Popilnya Rayon State Administration, K. Golovakova, Regional Project coordinator, Dr. A. Malagardis, Project Team Leader, V. Ananyev, local training expert. V. Stanislavchuk briefed the present on the results of the Project's work in Popilnya, in particular, in which departments hardware had been installed and the way the system Kashtan would work. O. Tolstanov asked if it would be possible to install the system Kashtan in other rayons. Dr. A.Malagardis told about the program of patient registration and stressed the importance of this issue. Meeting of the Regional Steering Committee in Kharkiv  20 May 2005 the first meeting of the Regional Steering Committee of the EU Project Health Financing and Management in Ukraine was held in Kharkiv pilot region. The participants of the meeting were Vasyl Pylypovych Tretetskyi, Deputy Head of Khariv Oblast State Administration, Volos Bohdan Omelyanovych, Head of the Health Administration of Kharkiv Oblast State Administration, Serdyuk Olexander Ivanovych, First Deputy Head of the Health Administration of Kharkiv Oblast State Administration, Rogulya Ivan Olexandrovych, Head of Zolochyv Rayon Administration, Yeremchuk Raisa Arsentiivna, Head of Central Economy and Market Relations Administration of Kharkiv Oblast State Administration, Yermolayev Serhiy Ivanovych, Head of Public Health and Social Protection Standing Committee of Kharkiv Oblast Council, Ovsyannikov Serhiy Ivanovych, Head of Central Financial Administration of Kharkiv Oblast Administration, Rudik Lyobov Illivna, Head of Oblast Organization of Healthcare Workers Unions in Kharkiv Oblast, Atroschenko Konstyantyn Vasylyovych, Head of Legal Work Administration of Kharkiv Oblast State Administration, Gavva Olexiy Volodymyrovych, Head Doctor of Zolochiv Central Rayon Hospital, Eero Linnakko, Natalia Luchsheva, Vasyl Ananyev, Iryna Shynkaryova, Project representatives. The meeting was opened by Vasyl Pylypovych Tretetskyi, Deputy Head of Kharkiv Oblast State Administration. Then Eero Linnakko, Deputy Team Leader of the Project, briefed the present on the results of the Project's work for the six months. Then Serdyuk Olexander Ivanovych reported on the results of the Project's work in Kharkiv pilot region. Gavva Olexiy Volodymyrovych told about changes that took place in the healthcare structure of Zolochiv rayon. Pilot Training Module 4 Accounting  18-19 May 2005 the fourth Pilot Training Module Accounting was held in Kharkiv and 31May -1 June in Zhytomyr. Within the seminar the following presentations were given:
Eero Linnakko's presentation Financial (external) and Management (internal) Accounting was devoted to such issues as:
Mrs Savchenko covered different issues concerning the work of a nonprofit enterprise. In particular, she covered the following issues:
S. Dyachenko defined main tasks of accounting at the enterprise, legislative requirements and reporting systems, drawbacks of manual accounting, new possibilities, which software installation will bring, principles and stages of introducing the accounting system. "Training on PC skills in the health sector"  On 16-17.05.2005, in the city of Komsomolsk, Poltava oblast, the training workshop "Promotion of Communication Skills for Working with Public Sites Communities. The Role of Mass Media in Reforming the Healthcare System and Their Impact upon Shaping the Public Opinion". The training was carried out in cooperation with the EU project "Preventive and Primary Healthcare in Ukraine, Kyiv and Oblasts", which contributed into exchange of experience and results achieved not only between the two projects but also with the both projects' five pilot sites. The EU project "Support for Development of the Medical Standards System in Ukraine" was also invited to participate in the workshop. The location, the city of Komsomolsk (at present -
the only real example of the healthcare system reforming at the level of local
self-government, in particular: creating health services purchaser and
provider, implementing contracting between them, as well as extensive
involvement of the public into decision making on healthcare quality and
accessibility), was selected due to requests of pilot sites' experts who wished
and needed to make a closer acquaintance with the changes that would take place
in their regions as well. More than 70 persons participated in the seminar. The project's both pilot regions - Zhitomir and Kharkiv oblasts - were represented by 20 persons (authorities, medical specialists, journalists). The city of Komsomolsk was represented by the city Head Î.Popov, representatives of local authorities, family doctors and members of the public committee. 2 journalists from central mass media also participated in the workshop ("Urjadovy Kurier", "Simejny Likar+"). The project was represented by 3 experts: the Ukrainian Director V.Rudy and PR experts L. Batih, N. Luchsheva. In the course of the workshop, the following issues were analyzed:
During the workgroups' plenary meeting, 12 problems
in the sphere of healthcare typical for each pilot site were singled out, their
solution requires public support. These are: 2 nd Meeting of the Discussion Club in Zolochiv , Kharkiv Oblas On 28 April, 2005 the second meeting of the Discussion Club "Implementation of contracts between purchaser and provider of health services " took place in Zolochiv, Kharkiv oblast . The participants of the meeting were Valeriy Ryzhankov, Deputy Head of Rayon State Administration; Olexiy Gavva, the Chief Physician of Central Rayon Hospital; Kateryna Dyakova, Head of Zolochiv Healthcare Department , heads of village councils, managers of rural ambulatories, Project experts and journalists of Kharkiv oblast TV "  ñòèëå óòðà ", newspapers " Çîðÿ ", " Ìåäè÷íà ãàçåòà " , " Ñëîá³äñüêèé êðàé ". The Ukrainian Project Director Volodymyr Rudiy made a short speech on importance of contracting between purchaser and Provider of medical services. After the speech was over, a lively discussion has started. In particular people were interested in such issues as: • what are advantages of contracting for regular Ukrainian; • how healthcare departments will be financed; • if medical and obstetrician stations have to suffer from the new way of resource distribution Pilot Training Module #3 (Kharkiv) Pilot Training Module #3 Global Budgeting Under Contracting Relationship took place in Kharkiv 26 – 27 April 2005. Heads of healthcare facilities of Kharkiv Region, representatives of Rayon State Administration, rayon and rural councils of Zolochiv Rayon, family doctors, accountants, economists, journalists from newspapers Sloboda, Medychna Gazeta (the Medical Newspaper), TV-program Syogodennya (Present Days) , international and local experts of the EU Project Health Financing and Management in Ukraine took part in the seminar. The following presentation were given at the seminar: • Crucial Differences Between Budgetary and Autonomous Healthcare Facilities ( Galayda Viktor ) • Budget Setting and Monitoring: The Changing Roles from Hospital "Administrator" to Hospital "Manager" ( Manfred Stoermer ) • Practical Steps in Introducing Global Budgeting (Dr. Antonis Malagardis) • Health Insurance in Estonia . Change of a Healthcare Facility Status: From a Budgetary Facility to an Autonomous Unit. Examples for Ukrainian Healthcare Facilities (Helvi Tarien) • Budgeting Software Programme for Pilots (Dyachenko Sergiy) • Policy Options for Re-orienting the Healthcare Funding from Input-based Budget Funding to Output-related Resource Allocation (Victor Galayda and Manfred Stoermer)
Manfred Stoermer, a German expert, defined budgeting as determining of resources needed and allocating of resources to line-items which is an essential part of financial management. Budgets are allocated along line-items. Correct utilisation of funds along line-items is controlled by a funding organisation .
Mr Stoermer told about the role of an administrator and manager in an input-based funding system. In particular, managers allocate funds to line-items according to the needs of the hospital for achieving the best possible output, and at the same time in a way that satisfies the demands of the staff. Funding system demands flexibility and autonomy in decision-making from hospital managers. Hospital managers have full autonomy on resource allocation to line items.
Administrators should assure and prove the correct funds utilisation along the pre - defined allocations to line items . It is necessary for administrators to possess skills of executing pre-defined policies under conditions of under-funding.
Dr Antonis Malagardis in his presentation Practical Steps in Introducing Global Budgeting admitted that the main objective of global budgeting is determining the limit of funds to be spent. The Purchaser should aim to equal the number and quality of healthcare services provided with previously set volumes of coverage and standards of healthcare services provision. To achieve the mentioned objectives when setting the budget it is necessary to determine a financial limit, to define facilities which are responsible for budget execution, to develop the procedure of budget setting which is connected with funds receipt (including accessibility and coverage monitoring as well as quality monitoring of provided healthcare services). There are a lot variants of normative approach to global budget setting but all of them have identical features: a mechanism of external price formation defines a cost unit which, in its turn, makes the basis of the budget. A set service price is laid on the volume of services, which is demanded from the Provider by the Purchaser. The global budget has the following advantages: • cheap management • better coordination and planning of healthcare service; • exclusion of groundless services. The main principle of global budgeting is equality . Global budget is based on equitable fund allocation for all patients. Equity is guaranteed by equal possible allocations per capita of the population covered.
The Head of the Healthcare Department of Estonian Health Insurance Fund Helvi Tarien gave a presentation Change of a Healthcare Facility Status: From a Budgetary Facility to an Autonomous Unit. Examples for Ukrainian Healthcare Facilities. She analyzed the ways private and state sources of funding healthcare facilities co-exist in Estonia . Contracting in Estonia is provided by the Law on Health Insurance, which determines the main contract conditions. The Council of Estonian Health Insurance Fund (EHIF) adopts fundamental principles of contracting. The Estonian expert admitted that EHIF contracts facilitate healthcare reform in Estonia : primary healthcare reform, implementation of a general plan of hospital development, structural reforms of EHIF. Contracting must be oriented towards improvement of accessibility, quality and efficiency. EHIF can control and monitor the contract. The health reform in Estonia resulted in: • health insurance implementation • target finacial source of profit • enhancement of decision-making procedure by the hospital authorities • hospital income ceased to be line-item, its dependance on efficient production was determined • the introduction of regulated competition among providers • the contract is a basis of relations between EHIF and hospitals • delimitation of emergency care and long-term treatment
Working groups made exercises in budgeting ( on the example of a block - contract of Zolochiv Central Rayon Hospital ) and developed policies for the purchaser to monitor the contract implementation .
2 nd Meeting of the Discussion Club in Popilnya, Zhytomyr Oblast On 21 April 2005 the second meeting of the Discussion Club "Implementation of contracts between purchaser and provider of health services " took place in Popilnya, Zhytomyr Oblast. The participants of the meeting were Tetiana Kravchuk, the Deputy Head of Popilnya Rayon State Administration; Valeriy Stanislavchuk, the Head Doctor of Popilnya Rayon Central Hospital, Volodimyr Kostiuk, the WHO representative in Ukraine, Yuriy Subotin, the WHO expert, Sergiy Shishkin (Russia), heads of rural councils, managers of rural ambulatories, Project experts, journalists of TV programs «Âàøå çäîðîâ'ÿ», «Åêîíîì³÷íèé â³ñíèê», newspapers «Ïóëüñ» and «Ïåðåìîãà» . The Ukrainian director of the EU Project "Health Financing and Management in Ukraine ", V. Rudiy made a speech admitting that contracting is the main tool for effective allocation of healthcare resources. During the meeting, the following issues were covered: • how healthcare departments will be financed; • financing of healthcare facilities under new conditions; • how the contract implementation will be supervised. The WHO representative in Ukraine , Yuriy Subotin emphasized the importance of every physician participation in the process of reforming the healthcare sector. The training module for pilot regions #2 "Implementation of Health Contractual Relations in Ukraine " The training module for pilot regions #2 "Implementation of Health Contractual Relations in Ukraine " was held in Zhytomyr on 19-20 of April 2005. The participants of the seminar were heads of healthcare facilities of Zhytomyr region, economists, representatives of Rayon State Administration, the representatives of rayon and rural councils of Popilnya rayon, family physicians, accountants, economists, and journalists, international and local experts of the EU Project Health Financing and Management in Ukraine . The following presentations were given in the course of the module: • Role of Contracting in improving of healthcare system's performance: what can be and what should be done in Ukraine . (Volodymyr Rudyj ) • Cross-regional lessons on contracting - A brief overview ( Dr Antonis Malagardis) • Romanian examples of out- and in-patient contracts ( Dr Aurora Dragomiristeanu ) • Future changes in hospitals due to contracting ( Dr Aurora Dragomiristeanu ) • Presentation of Popilnya hospital contract ( Stanislavchuk, V.A.) • Critical analysis of foreign contract usefulness for Ukraine ( E. Orel ) • Standards for health services to be includes in the contract (M. Schevchenko)
After the presentations, the work was devoted to solving practical issues in two working groups. The following issues were discussed:
- future contracts with Primary Health Care Center and Dentists' Center development, contracts monitoring; - internal contracts with ambulatories, family physicians and personnel, - outsourcing, - optimization of personnel
The training module for pilot regions ¹2
21-22 March 2005 the training module for pilot regions #2 Implementation of Health Contractual Relations in Ukraine was held in Kharkiv. The participants of the seminar were heads of healthcare facilities of Kharkiv region, economists, representatives of Rayon State Administration, the representatives of rayon and rural councils of Zolochiv rayon, family physicians, accountants, economists, and journalists, international and local experts of the EU Project Health Financing and Management in Ukraine . The following presentations were given in the course of the module:
• Standards for health services to be includes in the contract (M. Shevchenko)
The Ukrainian Project Director V. Rudiy's presentations covered the following issues: • Why are health contracts necessary? • Basic provisions of Ukrainian conventional law • the Law of Ukraine On Purchase of Goods , Works and Services per State Funds – legal basis for the implementation of state and communal contracts in the sphere of healthcare services purchase • Regulatory possibilities and obstacles on the way to the implementation and effective maintenance of contractual relations in the sphere of healthcare services purchase and provision.
Dr. Antonis Malagardis gave a presentation devoted to the topic Cross-regional lessons on contracting – A brief overview . He told about the experience of Baltic countries, Romania , Bulgaria , Hungary , Slovenia , the Czech Republic , Slovakia , Russia , Kazakhstan , Armenia regarding risks and advantages of contracting, he explained why the concept of contracting was regarded differently in Europe and CIS countries. Dr Kristina Charnetska told about ways the contracts were concluded in ambulatories and in-patient healthcare facilities of Poland . The expert described the main stages of in-patient contracting implementation from 1999. The expert from Germany , Bela Kaunzinger shared his experience. He characterized contract types between sick funds and hospitals.
After the presentations, the work was devoted to solving practical issues in two working groups. The first group worked out the functions of a healthcare services payer. In particular, it was suggested that a contract with a healthcare provided should be concluded. Further variants of future contracts with Primary Healthcare Centre and Dental Centre were developed. Working group 2 assumed the role of a healthcare provider and correspondingly drew a model contract with a payer. Then variants of internal contracts with ambulatories, family physicians and personnel were drafted.
Meeting of the Discussion Club in Zolochiv
25 March 2005 the Discussion Club Meeting Control Over the Expenses and Improving Efficient Resource Distribution: Tools of Enhancing the Healthcare System in Ukraine took place in Zolochiv, Kharkiv Oblast. The participants of the meeting were Zaleskyi A., the Acting Head of Zolochiv Rayon State Administration; Bondarenko T.A., the Deputy Head of Rayon State Administration; Gavva O.V., the Chief Physician of Central Rayon Hospital; specialists of the financial department of Rayon State Administration, managers of rural ambulatories, economists, accountants, Project experts and journalists. At first the Project experts, Bela Kaunzinger and Andriy Zelinskyi, briefed the present on the results of work in the working groups. Andriy Zelinskyi said that Working Group 2 worked on improving the contract with family physicians. The issues regarding risks and incentives for family physicians to work as business subjects were discussed. It was agreed that establishment of a public association of doctors would help to solve lots of problems that arise in the course of family physician's work. It was noted that preventive work among population was very important. Besides, the participants of the meeting considered Annex 1 to the Draft Contract (the list of healthcare services) which is to be developed taking into account quantity and quality indicators of healthcare services themselves, their list, definition of the additional indicators of their quality control. The issues regarding the correlation between the number of family physicians and healthcare specialists and healthcare specialists' work were discussed within the pilot project. It was agreed that a healthcare specialist could work both in the ambulatory and in-patient department (clinic). The most optimum type of contract will be a contract with a fixed payment per service in which the number of services is limited. Further, the Ukrainian director of the EU Project Health Financing and Management in Ukraine V. Rudyi presented his report Control Over the Expenses and Improving the Efficient Resource Distribution: Tools of Enhancing the Healthcare System in Ukraine . He noted that the main problem of healthcare in Ukraine is the deficit of financial resources and their irrational utilization. The absence of fast and effective changes in health financing and resource management can lead to the further decay characterized by far bigger increase of inequality, breaking the solidarity principle and general accessibility of healthcare services. After the speech was over, the Project experts answered the Discussion Club participants' questions.
Meeting of the Discussion Club in Popilnya
25 February 2005 the meeting of the Discussion club "Control Over the Expenses and Improving the Efficient Resource Distribution: Tools of Enhancing the Healthcare System in Ukraine" took place in Popilnya, Zhytomyr oblast. The participants of the meeting were Volodymyr Golovakov, the Acting Head of the Healthcare Department of Zhytomyr Oblast State Administration; Svitlana Zapolska, the Deputy Head of Rayon Council; Valeriy Stanislavchuk, the Head Doctor of Popilnya Rayon Hospital; representatives of state treasury, financial administration, economy administration; heads of rural councils, managers of rural ambulatories, Project experts, journalists. The head doctor of Popilnya Rayon Hospital, V.A. Stanislavchuk opened the meeting. He greeted the participants and said that holding such meetings was of great importance for rayon specialists as it provided an extra opportunity to work on some aspects of healthcare reform to be implemented in future. The Ukrainian director of the EU Project "Health Financing and Management in Ukraine", V. Rudyi admitted that the main problem of the Ukrainian healthcare system is financial resources deficit and their irrational utilization. Provision of constant and enough financing guarantees normal healthcare system's performance in any country. But as world experience shows any healthcare system faces the problem of financial resources deficit in a greater or lesser degree. Funds to ensure provision of all healthcare services for everybody always lack. Taking into account the social importance of a healthcare system and corresponding state obligations, the authorities are forced to look for and take different measures directed towards improvement of this sector financing. Adding to V. Rudyi's speech, Volodymyr Golovakov said that it was extremely necessary to set a precise control over the use of funds in the healthcare sector. And it must be everyone's business. He stressed that it was important to take into account public opinion when implementing these or those changes. It is necessary to inform the population on innovations to be introduced into the healthcare system on time and actively. According to V. Golovakov it is important to work on the contents of the guaranteed list of services. And here it is especially reasonable to take into account European countries' experience. Further V. Stanislavchuk, V. Rudyi and V. Golovakov answered the participants' questions. In particular, the present were interested in such issues as
 National Press-Club Meeting in Kharkiv
Within the work of the seminar "EU Practice in Contracting, Pricing and Financial Management of Health Facilities on Local Level" the National Press Club held its meeting "Health Financing and Management in Ukraine" on the 14th of September in Kharkiv. Olexander Serdyuk, the First Deputy Head of Oblast Healthcare Administration, Vasyl Grygorovych, the deputy Head of Strategic Initiatives and New Methodological Technologies Administration of MOH, Antonis Malagardis, the Project Team Leader, Eero Linnako, Deputy Project Team Leader , Volodymyr Rudiy, the Ukrainian Director of the Project, Jiri Nemec and Krystyna Czarniecka (international experts), Olexiy Gavva, the Chief Doctor of Zolochiv Central Rayon hospital took part in the work of the press club. |
