Сonclusion of the treaty from the side of family doctor: detailed examination from lawyers

The Ministry of Health of Ukraine introduced changes in the health system in January 2018. The first stage of the reform is an updated mechanism for financing medical institutions providing primary medical care (hereinafter referred to as PMD). After all, family physicians, therapeutics and pediatricians - these are physicians, to whom the Ukrainians primarily consulted.

Who has the right to provide primary medical care?

It can be provided by medical institutions and sole proprietorships, who have the relevant license.

In accordance with Section 1 of Article 8 of the Law of Ukraine "On State Financial Guarantees of Medical Care of the Population", medical care is provided under the program of medical guarantees (stipulated in the contract on medical care services of the population).

Such a contract is concluded between a medical institution or a sole proprietorship (who obtained a license for conducting business activities in the sphere of medical practice) and the National Health Service of Ukraine.

What requirements must a provider of medical services comply with in order to conclude a contract between the main budget funds holders and him?

List of mandatory requirements:

• License for conducting medical practice and other permission documentation (required by the law).
• Material and technical base, which complies with the requirements of industry standards in the sphere of medical care (namely: regulatory list of material and technical equipment approved by the Ministry of Health of Ukraine).
• Free access to buildings and premises, as well as the necessary conditions for medical care services for people with disabilities and other people with limited mobility (according to the law dated 01.01.2019)
• Registration of a provider of the PMD as a legal entity (except a state or municipal institution) or as a sole proprietorship.
• Comply with the criteria, which are set in the order of using the funds of corresponding budget program.

After completing all of the above-mentioned points, a provider concludes a contract on medical care services (under the program of medical guarantees with the National Health Service of Ukraine (NHSU).

What is an order, in compliance with which a PMD is provided?

The providers of medical care can be:

A practice of PMD is a physician who provides a PMD and people who voluntarily chose this physician.

The optimal scope of PMD practices is:

• 1,800 people on family physicians/general practitioners;
• 2000 persons per therapeutic;
• 900 people per pediatrician.

The scope of practice may differ from the optimal, based on the infrastructural, social-demographic and other features of the territory (within which there are people, who are involved in the relevant practice).

Where can a PMD be performed:

• In the premises or in a separate building owned by a provider of a  PMD on the right of ownership and lease (or on other grounds not prohibited by the law). [1]

The physician can provide these services separately, at the place of residence or stay of a patient (either by telephone, on the Internet or by other means). However, the services are provided within the framework of the physician's work.

Change in a schedule of the physician's work

In the case of a change in the regime, the physician must inform people on this (whom he provides medical care services) in advance, not later than one week prior to the first day of temporary absence.

If an absence was unplanned, a notification should be no later than the first day of absence (for instance, in such circumstances: an accident, illness etc.).

In this case, the PMD provider must:

• inform people on another physician, who will temporarily replace the absent physician;
• provide an appointment to a physician in any way: personally, by telephone, by e-mail or by other means.

The PMD provider can independently or in cooperation with other providers create a regular room to provide PMD. Such a room can work outside of the set visiting hours, as well as provide medical care in non-working days, weekends and public holidays.

Signing of a contract on medical care services of the population and registration in the electronic system

If a medical institution or a sole proprietorship (who has a license for medical practice) complies with the set requirements and wants to provide primary medical care to the population and receive money for patients, he will need to sign a contract on medical care services of the population (according to the program of medical guarantees from the National Health Service of Ukraine).

A documents circulation, which is associated with the conclusion, alteration and termination of a contract takes place through an electronic medical system (hereinafter referred to as the system), complying with the requirements of the legislation on electronic documents and electronic documents circulation.

A medical institution or a sole proprietorship, who wants to conclude a contract with the National Health Service of Ukraine, must register in the system. Furthermore, authorized persons and medical workers (who will be involved in implementation of the contract in the future) have to be registered in the system. To complete the registration procedure they must submit a digital electronic signature or a signature equivalent to their manual signature (in accordance with the law).

For doing this, a head of a medical institution and medical workers (who will be involved in the implementation of the contract) will need to register an electronic signature in the Accredited Centers of Keys Certification.

Registration in the electronic medical system is performed in accordance with the Procedure for functioning of the electronic medical system. [2]

The National Health Service of Ukraine provides functioning of the system and the website, which contains information about this system.

A documents circulation in the system is carried out in accordance with the requirements of the legislation on electronic documents and electronic documents circulation. An electronic signature of an author (or a signature equivalent to a manual signature in compliance with the law) shall be imposed for each electronic document, which is submitted to the central database.

After registration of a user, a register entry is formed and an electronic cabinet is created.

Consequently, the National Health Service of Ukraine posts an announcement regarding conclusion of a contract on the official website. It states the program of medical guarantees, as well as a term for submitting applications for conclusion of a contract, an application form and documents attached thereto. [3]

Final stage of concluding a contract

An entity, who wants to conclude a contract with the National Health Service of Ukraine, submits an application for conclusion of the contract in electronic form to the body, as well as adds to the application the documents provided for in Subsection 7 of the aforementioned procedure.

If the National Health Service of Ukraine does not comment on the application and the attached documents, the National Health Service of Ukraine will send its decision to the entity within 30 calendar days (from the date of submitting the application). The decision refers to an intention to conclude a contract in electronic form. The contract specifies the medical services, which the National Health Service of Ukraine plans to order from this entity.

If there are any comments or inconsistencies in the application and other documents, the National Health Service of Ukraine will send a proposal to correct errors in the application, or to add the necessary information and documents within three working days (from the date of exposal of the inconsistencies).

A business entity must correct flaws and submit the necessary documents by the end of the submitting period. Thereafter, the entity sends a draft of this contract to the National Health Service of Ukraine, filled in an electronic form within ten calendar days (from the day of obtainment of the notification). The final version of the draft must be agreed between the parties within 30 calendar days.

The authorized representatives of the National Health Service of Ukraine and the entity sign the contract by using the electronic system after agreement on the draft. The contract comes into force from the date of its signing and is published on the official website of the National Health Service of Ukraine within five working days

Final result

After conclusion of the contract on medical care services (under the program of medical guarantees from the National Health Service of Ukraine), a medical institution or a sole proprietorship will receive funds on accounts of the institution for each patient (if the patient signed the relevant medical certificate with the institution and his medical worker).

The state will pay a physician for each patient on the declaration. This is the principle of "money walking on the patient heels."

If you want to provide a primary medical care, find out where to start this activity, please call by a number

[1] According to the list of places of business activity (stated in the license for conducting business activities in the sphere of medical practice).

[2] Approved by the Resolution of the Cabinet of Ministers of Ukraine number 411, dated April 25, 2018.

[3] According to Subsection 6 of the Procedure for the conclusion, alteration and termination of the contract on medical care services under the program of medical guarantees (approved by the Resolution of the Cabinet of Ministers of Ukraine number 410, dated April 25, 2018).