Experience of the USA concerning an organization of healthcare system for the pharmaceutical provision for privileged categories of citizens

Abstract

Introduction. Nowadays there is no ideal healthcare system for medical and pharmaceutical provision for privileged categories of citizens in the world. Healthcare systems for medical and pharmaceutical provision for different categories of population of every country, which are the result of historical conditions and economic development, are continuously reformed.

Economic approaches to planning of healthcare and pharmaceutical provision as a commodity system threaten the adverse impact on a health of privileged categories of citizens and the functioning of the healthcare system in general. Thus, the best approach is to learn the experience of other world countries in reforming of the healthcare system for medical and pharmaceutical provision for privileged categories of citizens, with a constant assessment of the changes, that taking place and readiness to adapt the system to changing external conditions, with the obligatory observance of all ethical requirements

Materials and methods. Conducted a retrospective analysis of healthcare system reform, which applied in the USA during the period from 2000 to 2018. During a research used the following methods of analysis: normative and legal, documentary, comparative. Results and discussion. The United States of America is practically the only country in the world with a developed economy where there is no publicly available medical care. According to the WHO, the American health system ranked 37^th out of 191 countries by the level and effectiveness of overall healthcare, although USA healthcare costs are 15.7% of gross domestic product. The United States, with its global leader, leading economies, annual budget, several times the budget of any other state, cannot provide the appropriate level of provision and availability of medical care and pharmaceutical provision for the population and its privileged contingents. In addition, part of the USA public spending in total healthcare costs is only 45%, much lower than in any other country of the Organization for Economic Cooperation and Development. That is why there is a need to analyze of healthcare system of the USA and the realization of the rights of the privileged categories of citizens for getting quality medical care and the provision of medicines. The main sources of financing of the American health system are private and non-commercial insurance, which covers approximately 85% of the population (about 50% are insured by their employers, 10% are self-insured, the rest are insured under the state programs). In addition to having a limited income, the applicant applying for the program must belong to specific privileged categories of citizens according to the relevant criteria (age, pregnancy, disability, blindness, USА citizen status or legal immigrant, finding a home for the elderly, children with disabilities, HIV-infected, etc.). The main disadvantage of the healthcare system in the United States of America is the high cost of medical and pharmaceutical care. Per capita costs in the United States of America are 7,290 USD for a year that is more than 2 times higher than the average for industrially developed countries. However, the high level of legal and organizational support for the protection of patients' rights, which manifests on developing lawyers` services in the area of medical and pharmaceutical law, the prevalence of the institutions involved in the protection of consumers' rights, the particular attitude towards the privileged categories of citizens, the senior citizens, the disabled and some other categories of socially disadvantaged sections of the population are unconditional benefits in providing health care in the United States of America.  Conclusions. The analysis of the USA experience in organizing of health care system has revealed positive and negative aspects that need to take into account for reforming the system for the provision of medicines and medical services in Ukraine. The main advantages of the American model of the healthcare organization are determined, among them the availability of strategic planning of the activity of healthcare institutions; introduction of modern information technologies; protection of patient's rights; priority attention to the prevention of diseases; the desire to achieve the highest possible level of provision of medical and pharmaceutical services at moderate financial costs. The necessity of preserving public administration in the healthcare system in Ukraine for pharmaceutical provision of privileged categories of citizens substantiated. Obligatory health and social insurance must play a supporting role in financing healthcare system.