Legal Nature of Public Medical Services Contract
Abstract
The World Health Organization declares that the possession of
the highest achievable standard of health is one of the fundamental
rights of every human being. Health is a state of complete physical,
mental and social well-being and not merely the absence of disease
or infirmity [1]. The number similar provisions are extrapolated
also in the national legislation of Ukraine, in particular in the
Constitution of Ukraine and the Fundamentals of the Ukrainian
legislation on health care [2]. Fundamentals of Health Care
Legislation: Law of Ukraine No. 2801-XII of 19.11.1992 [3].
Keywords: Medical Care; Public Medical Services Contract; Protection of Patients’ Right; Medical Declaration
Introduction
The World Health Organization declares that the possession of
the highest achievable standard of health is one of the fundamental
rights of every human being. Health is a state of complete physical,
mental and social well-being and not merely the absence of disease
or infirmity [1]. The number similar provisions are extrapolated
also in the national legislation of Ukraine, in particular in the
Constitution of Ukraine and the Fundamentals of the Ukrainian
legislation on health care [2]. Fundamentals of Health Care
Legislation: Law of Ukraine No. 2801-XII of 19.11.1992 [3].
On October 19, 2017, the long-awaited Law “On State Financial
Guarantees for Medical Care of the Population” was adopted in
Ukraine, which in fact was the initial medical reform [4]. The law
under discussion radically changes the principles of providing
medical services in Ukraine. These changes reflect Ukraine’s
perceptions of the world trends that are inherent in the European
community. It is a question of increasing the proportion of privatelaw
methods of regulation of healthcare relations and the general
expansion of dispositive principles in medical law, as opposed to
the administrative levers of the Soviet era.
Materials and Methods
In scientific circles, for a long time now, there is a discussion of
the nature of the relations that arise with regard to the provision
of medical services. And if in the part where the participants are
private entities providing medical services on the basis of civil
contracts, the opinion on the private-legal nature of the relations
that arises between the patient and the doctor / the medical
institution is generally accepted, then in cases where the medical
services are provided by a public health care institution for public
funds, the opinions of scientists are divergent. Some researches of
them consider medical law as a social right (sub-branch of social
security law), others claim that it is a sub-branch of administrative
law, while others argue the existence of a complex industry -
medical / medical / healthcare law [5]. The nature of relations in
the field of providing medical services with the participation of
public institutions has its own characteristics and needs detailed
research.
Results and Discussion
The medical reform in Ukraine is based on the introduction of
the principle of “money following the patient,” and, therefore, the
state undertakes to deliver a certain range of medical services for
the state budget, and all other services are provided by state medical
institutions on a contractual basis, the payment for which the
patient carries on his own. To this end, the state through a specially
authorized body - the National Health Service of Ukraine (NSZU)
on a competitive basis concludes a special contract with medical
organizations, under which the latter undertake to provide medical
services under the program of medical guarantees to patients,
and the customer (NSZU) pays such services in accordance with
the established tariff and correction coefficients [6]. By its legal
nature, this contract is an agreement in favour of a third person -
the immediate patient to whom the service is provided. The patient
receives the status of a third person under the agreement after
signing the relevant declaration. The legal nature of this declaration
needs to be clarified.
The essence of the declaration is to establish the will of the
patient to consent to obtain the medical services provided by a
particular medical institution and the choice of the immediate
provider of service, that is a doctor. Thus, the above declaration
confirms the establishment of contractual relations between the
medical institution and the patient, regardless of the form in which
such an agreement is concluded, either verbally or in writing.
The practice of concluding numerous contracts shows that public
medical institutions of Ukraine usually conclude oral contracts for
the provision of medical services, while private institutions choose
written agreements. As soon as the parties enter into the contract
their relations, including all the rules, rights and obligations, are
regulated under both civil and special legislation and the procedure
of medical activity in Ukraine, apply
The contract for the provision of medical services has its own
characteristics, due to the special trusting relations between its
parties (so-called fiduciary transaction). The parties to the contract
are a professionally trained servant who has special knowledge and
skills, and a patient who does not have such knowledge, therefore,
has the right to choose a medical facility and his/her doctor and
trust him/her or choose another in the event of a loss of confidence,
but is not entitled to interfere in the procedure for the provision of
medical services by a doctor.
Conclusion
Thus, we can state that in the scientific discussion about the
nature of the relationship with the provision of medical services there
are more arguments in favour of their civilized nature,
based on which the contract, regardless of the mechanism of
their financing at the expense of the state or the patient. With the
introduction of medical reform in Ukraine, the volume of medical
services regulated by civil rather than public law [7] is expanding
considerably. The indicated above is evidence of the increase in
the proportion of public participation in civil relations, based on
the principles of legal equality, free expression of will, property
independence and freedom of contract.
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