Regulatory and legal ensuring the ophthalmic services and assistance provision in Ukraine

The main legislation defining the legal, organizational and socio-economic principles of ensuring the health care of citizens are analyzed, the normative basis for the development of standards and clinical protocols for the treatment of diseases of the organ of vision are considered. The issue of the quality of ophthalmic services was analyzed from the point of view of their compliance with standards, cost efficiency, absence of negative consequences and priority orientation to the needs of the patient. The peculiarities of the legal regulation of ophthalmology in the conditions of war have been studied and ways of improving the regulatory and legal regulation have been proposed to ensure citizens’ access to high-quality ophthalmic care, especially in the conditions of martial law and post- war reconstruction of regions affected by hostilities and occupation.

Formulation of the problem. The creation of effective mechanisms for state regulation of the medical services quality and assistance is one of the main tasks of the Ukrainian health care system development. Public relations in the medical field are aimed at ensuring the harmonious development, working capacity and active life of Ukrainians, eliminating factors harmful to their health as well as reducing the level of morbidity, disability and mortality. Such a situation actualizes the issue of analyzing the adequacy and effectiveness of regulatory and legal support for the provision of ophthalmic care to the population of Ukraine, its integration into the reformed medical services system and guarantees to ensure quality treatment of patients based on individual needs.

Analysis of recent research and publications. Features of the program and strategic policy of the WHO regarding the prevention and treatment of ophthalmic diseases were studied by V. Dufynets, the analysis of the resource provision of ophthalmologists was carried out by S. Saksonov, T. Gruzieva and O. Vitovska, the personnel support system was the focus of attention of S. Rykova, N. Medvediovska and Yu. Barinov. Modern requirements for the quality of ophthalmic medicines were described by L. Andryukova et al. Ya. Hrytsenko outlined separate areas of improvement of the system of providing ophthalmic care to the population. At the same time, the issues of reforming the financing ophthalmic system remained out of the attention of researchers, there are no organizational conclusions to improve the regulatory and legal support for the functioning of the industry. Such a limited and fragmented appeal of scientists prompted us to carry out a targeted analysis of the main regulatory and legal basis for providing ophthalmic care to the population of Ukraine, identify institutional gaps or insufficiently regulated areas of management of this medical branch and develop recommendations for improving the functioning of the specified area.

Presentation of the main research material. The main system of providing ophthalmic care and the legislation defining the legal, organizational, and socio-economic principles of ensuring the health care of citizens are analyzed. The main principles of providing ophthalmic services in inpatient and outpatient settings in accordance with standards and clinical protocols for the treatment of diseases of the organ of vision have been analyzed. It was revealed that a review of existing protocols is planned to prevent the use of unregistered or prohibited means and technologies with unproven clinical effectiveness.

The advantages and problematic points of reforming the medical industry, which were reflected in the conditions of providing ophthalmic services and assistance to the population were studied. The regulatory and legal basis for providing ophthalmic care to patients at three levels within the state guaranteed package of medical services is analyzed. The primary, secondary and tertiary levels and the peculiarities of their financing based on contracts with the National Health Service of Ukraine were considered. The main challenges and problems of ensuring a high level of quality were analyzed, in particular, the need for regulatory regulation of the scope of pre-medical ophthalmic screening at the primary level, as well as 24-hour emergency care for injuries, burns and acute manifestations of eye diseases at all levels of medical care were identified.

The changes in the regulatory direction adopted to ensure the functioning of the medical system in wartime conditions, in particular regarding the rules for the use of electronic tools, medical equipment for budget support of health care needs, and the methodology of payments under medical guarantees are analyzed. The management regulations of the Medical Forces of the Armed Forces, unified with the standards of the four-level system of medical and evacuation measures of NATO were studied. The recommendations of the Ministry of Health of Ukraine on pre-medical ophthalmic care for the population in the conditions of war were analyzed, and the need for the introduction of additional instruments of regulatory and legal support for the provision of ophthalmic care was identified.

Conclusions. The conducted analysis allows us to assert the general effectiveness of the regulatory and legal support for the provision of ophthalmic services and assistance in Ukraine. The criteria and scope of providing ophthalmic services at the primary and secondary levels of medical care are clearly defined. A high level of legal support for the provision of ophthalmic care to wounded soldiers and civilians affected by hostilities or occupation was revealed. It is proposed to improve the regulatory and legal assurance of the quality of ophthalmic care, to regulate the ratio of its quality and cost. Proposals are given to ensure citizens’ access to high-quality ophthalmic care in conditions of martial law and post-war reconstruction of regions affected by hostilities and occupation.

It is recommended to focus further scientific research on the areas of regulatory support for early detection and prevention of pathologies, reducing the number and complexity of complications, and preventing disability due to therapeutic and traumatic eye injuries.