State obligations in provision of the primary physician's right to medical practice as entrepreneurship in light of transformation of the health care system in Ukraine

Abstract

In the article issues of state obligations to ensure the right of a doctor- entrepreneur providing primary medical care to such a type of business activity in the healthcare sector as general medical practice are under study. The attention is focused on the fact that the relevance of the research of this issue is challenged by the lack of comprehensive theoretical investigations, as well as practical necessity in the light of the transformation of the healthcare system of Ukraine. Attention is drawn to the fact that in 2018 the National Health Service of Ukraine was established as the central executive body. The having existed model for pay- ing for every single place in the hospital in Ukraine is being replaced by a new model for financing the health system. The National Health Service of Ukraine being the Budget distribu- tor implements basic principle of the medical reform “money goes after the patient”. The commanding-administrative model of relations has been replaced by a contractual one: The National Health Service of Ukraine pays for the provision of guaranteedpackage of primary medical care services along with medical institutions and doctors as individual-entrepreneurs having be- come partners of the Service. The purpose of the article is to identify the obligations of the state to ensure the right of a doctor being individual-entrepreneur providing primary medical care to carry out such a type of business activity in the healthcare sector as general medical practice in the light of the transfor- mation of the Ukrainian healthcare system. The object of the study is social relations that arise when the state ensures the right of doctors-entrepreneurs providing primary medical care. The methodological basis of the study is the general and spe- cial methods of scientific knowledge (formal logical method, comparative legal, structural logical). The system of obligations of the state to ensure the right of doctors-entrepreneurs having become partners of the National Health Service of Ukraine car- rying out such a type of business activity in the healthcare sector as general medical practice is determined. The legal and orga- nizational mechanisms for ensuring this right are analyzed. The assessment of their effectiveness is given. Attention is paid on the practice of the European Court of Human Rights, which is the source of law for member-states of the European Council. The concepts of “legitimate anticipation” or “legitimate expec- tation” are analyzed, which often relate to government payments that depend on economic and social policies in each sphere. It is argued that the doctor-entrepreneur having become a partner of the Service, has a “legal anticipation” so that funds should be transferred to his bank account on the basis of declarations signed with patients to provide them with a package of primary medical care services guaranteed to these patients. The state is obliged to provide such payments. If payments fail to be pro- vided, the county’s economic, social, or health policy cannot be an excuse for the state.