Organizacija primarnega zdravstvenega varstva v državah nastalih na območju Jugoslavije

Klančar, Darinka (author), Rotar Pavlič, Danica (mentor)

Izhodišča: Leta 2009 je Svetovna zdravstvena organizacija (SZO) na svoji 62. konferenci znova izpostavila usmeritve glede krepitve zdravstvenih sistemov v smeri primarnega zdravstvenega varstva (PZV). Republike nekdanje Jugoslavije so poznale posebno organizacijsko obliko, prek katere so v zdravstvenih sistemih razvijale načela PZV(zdravstveni dom). V literaturi ne zasledimo raziskave, ki bi sistematično proučila, kaj se je zgodilo z uveljavljanjem načel PZV po razpadu socialističnega sistema in posledično z organizacijskim preoblikovanjem zdravstvenih domov. Namen in cilji: Namen doktorske disertacije je ugotoviti, ali so bila v organiziranosti primarnega zdravstvenega varstva v novonastalih državah na ozemlju nekdanje Jugoslavije v obdobju 2000–2010 uveljavljena načela primarnega zdravstvenega varstva in kakšna je bila pri tem vloga zdravstvenega doma.Cilja dela sta: ugotoviti skupna načela primarnega zdravstvenega varstva in razlike med državami (kvalitativni del); potrditi in ovrednotiti ugotovitve kvalitativnega dela raziskave (kvantitativni del). Hipoteze: V nalogi bom preverila naslednje hipoteze: 1. Načela primarnega zdravstvenega varstva so v novonastalih državah na ozemlju nekdanje Jugoslavije prisotna na deklarativni ravni. 2. Ključni informatorji poročajo o velikih razlikah v uveljavljanju načel. 3. Države so razvile različne sisteme, katerih usmerjenost se je oddaljila od v skupnost usmerjenega primarnega zdravstvenega varstva ter vodila v organizacijsko preoblikovanje zdravstvenih domov in uveljavitev samostojnih pogodbenikov. Metode: Za oceno uveljavljanja načel PZV v novonastalih državah na ozemlju nekdanje Jugoslavije sem uporabila kombinacijo kvalitativne in kvantitativne raziskave. Kvalitativni del je potekal v treh krogih. Stališča in mnenje ključnih informatorjev sem nato preverila v drugem, kvantitativnem delu raziskave. Rezultati: Obe raziskavi sta potrdili hipotezo, da so načela PZV prisotna v glavnem na deklarativni ravni. Zdravstveni dom je v nekaterih novonastalih državah na ozemlju nekdanje Jugoslavije prevladujoča organizacijska oblika za zagotavljanje storitev v primarnem zdravstvu, v nekaterih pa počasi, vendar zanesljivo izgublja prevladujoči položaj v primerjavi z zasebnimi ambulantami, ki nastajajo kot posledica liberalizacije zdravstvenega sistema. Med novonastalimi državami na ozemlju nekdanje Jugoslavije obstajajo velike razlike v uveljavljanju načel PZV, kar so potrdili že ključni informatorji, potrditve pa sem našla tudi v kvantitativni validaciji. Neuveljavljanje načel PZV ni povezano z razgradnjo zdravstvenih domov, ampak je primarno odvisno od politične in ekonomske stabilnosti v državi ter od stabilnosti financiranja sistema zdravstvenega varstva. Zaključki: Primerjalna raziskava med državami, nastalimi na ozemlju nekdanje Jugoslavije, je pokazala nekatere razlike v pogledu strukturnih in procesnih značilnosti nacionalnih sistemov PZV ter rezultatov, ki jih imajo slednji v konkretnih okoliščinah. Ugotovila sem, da so države z urejeno organizacijsko strukturo in več finančnimi sredstvi za zdravstvo učinkovitejše na področju uresničevanja načel PZV od držav, ki nimajo urejene organizacijske strukture in imajo nižje proračune za zdravstvo.

• Language: Slovenian
• Keywords: primarno zdravstveno varstvo, zdravstveni dom, bivša Jugoslavija, Jugovzhodna Evropa, zdravstvena reforma
• Work type: Doctoral dissertation
• Organization: MF - Faculty of Medicine
• Year: 2022
• PID: 20.500.12556/RUL-134319
• COBISS.SI-ID: 118879747
• Publication date in RUL: 06.01.2022

Secondary language

• Language: English
• Title: Primary health care organisation in the countries in the area of Yugoslavia

Abstract

ABSTRACT Background: In 2009 the World Health Organisation(WHO) reexposed orientations on strengthening health systems towards primary health care(PHC) at its 62 conference. The republics of former Yugoslavia had the special organisational form through which the principles of the primary health care were developed (health centre). In literature there is no study to examine systematically what happened with the implementation of PHC principles after the desintegration of the socialist system and therefore the organisational transformation of health centres. Purpose and goals: The purpose of research is to determine whether the principles of primary health care were implemented in the organisation of primary health care in the territory of the former Yugoslavia during 2000-2010 and what was the role of the health centre.The goals are: to identify common principles of primary health care and the differences between countries(qualitative part); to confirm and evaluate the findings of the qualitative part of the research (quantitative part). Hypotheses: In disertation I will test the following hypotheses: 1.The principles of the primary health care are present at the declarative level in the countries created in the territory of the former Yugoslavia. 2. Key informants report significant differences in the enforcement of principles 3.Countries have developed various systems the orientation of which has deviated from community-oriented primary health care and that led to the organisational transforrmation of health centres and the enforcement of private entrepreneurs. Methods: To evaluate the implementation of the primary health care principles the combination of qualitative and quantitative approach was used. The qualitative part took place in three rounds. In the quantitative part of the the views and opinions of the key informants were checked. Results: In both studies the hypothesis that the principles of the primary health care are mainly present at the declared level was confirmed. In some countries of the former Yugoslavia the dominant organisational form is health centre and in other countries it is slowly but surely loosing its dominant position compared to private clinics which are the results of the liberalisation of the health system. There are significant differences in application of the principals of the primary health care between the emerging countries of the former Yugoslavia which has been confirmed by the key informants and I have also found the confirmation in quantitative validation. The non-implementation of the principles of the primary health care is not linked to the decommissioning of health centres but primarily depends on political and economical stability of the country and on the stability of the financing of the health care system. Conclusions: The comparative study between emerging countries in the territory of the former Yugoslavia has shown some of the differences in structural and procedural characteristics of the national systems of the primary health care and the results which the systems have in concrete circumstances. I gathered that the countries with orderly organisational structure and more health funding are more effective in implementing the principles of the primary health care than countries that do not have a regulated organisational structure and have lower health budgets.

• Keywords: Primary health care, Health centre, Ex Yugoslavia, Southeast Europe, Health reform