samedicino dazRvevis ekonomikuri modelebi

doc. m. kereseliZe, doc. n. CixlaZe

dReisaTvis samedicino dazRveva funqcionirebs praqtikulad yvela ekonomikurad ganviTarebul qveyanaSi. samedicino dazRvevaze dafuZnebuli janmrTelobis dacvis sistema e.w. sadazRvevo medicina ekonomikuri TvalsazrisiT yvelaze efeqturia:igi naklebi danaxarjebiT maRali xarisxis samedicino daxmarebis gawevis saSualebas iZleva. erTi da imave xarisxis samedicino momsaxurebis donis SesanarCuneblad amerikis SeerTebul StatebSi jandacvis sistemis funqcionirebisaTvis yovelwliurad erovnuli Semosavlis 14% gamoiyofa, xolo sadazRvevo medicinis sistemis mqone ekonomikurad ganviTarebul sxva qveynebSi _ erovnuli Semosavlis 6-8%. mTels msoflioSi am etapze savaldebulo samedicino dazRvevis organizaciis sami yvelaze gavrcelebuli sami sabaziso modeli arsebobs:

_ decentralizebuli, (germaniaSi);

_ centralizebuli, (safrangeTSi);

_ Sereuli, (iaponiaSi).

aRiarebulia, rom samedicino dazRvevis organizaciis sferoSi yvelaze did warmatebebs:germaniam, safrangeTma da iaponiam miaRwia, amitom mizanSewonilad migvaCnia aRniSnuli qveynebis samedicino dazRvevis sistemebis ganxilva. germaniaSi socialuri dazRveva ganixileba rogorc Semosavlebis gadanawilebis meqanizmi, romelic socialur problemaTa gadaWris mniSvnelovan saSualebas warmoadgens.

1990 wels socialuri uzrunvelyofis asignaciebma 650 miliardi germanuli marka Seadgina. aqedan 216,5 mlrd. gamoiyo sapensio uzrunvelyofaze, 134,9 mlrd. germanuli marka ki _ samedicino dazRvevaze, romlis programac moicavs pensionerebs, moswavleebs, studentebs da im momuSaveebs, romelTac xelfasi dadgenil zRvarze dabali aqvT. avadmyofobis SemTxvevaSi maTTvis samedicino momsaxureba, stacionarebSi mkurnaloba, medikamentebi da samedicino procedurebi ZiriTadad ufasoa. es exeba ara mxolod dazRveuls, aramed misi ojaxis wevrebsac, romlebic avtomaturad arian dazRveuli. 1990 wels sadazRvevo Sesatani rogorc damsaqmeblisaTvis, aseve dasaqmebulebisTvis xelfasis 6%-s Seadgens.

germaniis gaerTianebamde dasavleT germaniaSi jandacvaze yovelwliurad ixarjeboda 277 mlrd. germanuli marka, aqedan - 167 mlrd. daavadebaTa mkurnalobaze, 17 mlrd. - profilaqtikur RonisZiebebze da avadmyofis movlaze; 7,6 mlrd. - avadmyofobis Semdgom sareabilitacio periodze, 12 mlrd - administraciaze; 5 mlrd - samedicino ganaTlebasa da samecniero kvlevaze.

gaerTianebis Semdeg savaldebulo samedicino dazRveva moicavs mosaxleobis 90%-s romlis 2/5-s dazRveulTa ojaxis wevrebi warmoadgenen. maRali fenis warmomadgenlebs (moqalaqeTa daaxloebiT 10%) azRvevs mxolod kerZo samedicino dazRveva. savaldebulo samedicino dazRvevaSi dazRveulTa 3% monawileobs kerZo dazRvevaSic, rac maT maRali servisisa da xarisxis samedicino daxmarebis miRebis saSualebas aZlevs.

germaniaSi jandacvis sistemis funqcionirebisaTvis gamoiyofa erovnuli Semosavlis 8,1%. jandacvis sistemis dafinansebis 60%-s uzrunvelyofs samedicino dazRvevis fondebis Senatanebi, 10%-s kerZo dazRvevis Tanxebi; 15%-s saxelmwifo saxsrebi da 15%-s moqalaqeTa piradi finansuri danazogebi.

avadmyofobisagan dazRveva gulisxmobs samedicino momsaxurebis Semdeg saxeebs:ambulatorul da stacionarul mkurnalobas, daavadebaTa profilaqtikas, viwro specialobis eqimebTan konsultaciebs, sameano-ginekologiur daxmarebas, sarebilitacio RonisZiebebs, medikamentebiT uzrunvelyofas.

samedicino dazRvevis fondis Semosavlevi sami ZiriTadi wyarosagan Sedgeba:saxelmwifo biujeti, dasaqmebulTa da damsaqmebelTa Senatanebi (miznobrivi gadasaxadi).

1992 wlis 1 ianvridan samedicino dazRvevisaTvis Senatanebis odenoba Seadgens 13%-s, romelic Tanabrad nawildeba dasaqmebulsa da damsaqmebels Soris.

savaldebulo samedicino dazRvevasTan erTad germaniaSi viTardeba metad didi Rirebulebis nebayoflobiTi anu kerZo samedicino dazRveva, romelic ar aris xelmisawvdomi mosaxleobis didi nawilisaTvis. nebayoflobiTi samedicino dazRvevis sistema gulisxmobs Tanagadaxdis princips, anu samedicino daxmarebis Rirebulebis garkveul nawilis gadaxdas.

savaldebulo samedicino dazRvevis organizaciaSi didi mniSvneloba eniWeba saavadmyofo sadazRvevo salaroebs da saavadmyofo salareobis eqimTa asociaciebs. saavadmyofo salaroebi warmoadgenen ZiriTadad sadazRvevo-finansur organizaciebs, romlebic anazRaureben samedicino daxmarebis Rirebulebas da akontroleben samedicino momsaxurebis xarisxs. germaniaSi arsebobs sxvadasxva tipis 1200-ze meti saavadmyofo salaro:sawarmoo, adgilobrivi, sazRvao, soflis meurneobis da sxva. saavadmyofo salaroebis saqmianoba kontroldeba federalur doneze. eqimTa interesebs icaven sazogadoebrivi organizaciebi, rogoricaa "saavadmyofo salaroebis eqimTa asociaciebi", romlebic akontroleben samedicino momsaxurebis xarisxs, gaweuli samedicino daxmarebis Rirebulebas da angariSsworebas.

germaniaSi arsebobs samedicino momsaxurebaze faswarmoqmnis mTeli sistema. faswarmoqmnis erTeuls e.w. "punqti" warmoadgens. samedicino daxmarebis sirTules asaxavs punqtebis raodenoba, punqtebis fasebi stabiluria, cnobilia samedicino dazRvevaSi monawile mxareebisTvis da warmodgenilia specialur cnobarebSi. punqtebis fasebis gadasinjva xdeba saWiroebisamebr yovelwliurad (an ufro xSirad fasebis donisa da samedicino momsaxurebis konkretul pirobaTa cvlilebebis gaTvaliswinebiT). faswarmoqmnis aseTi sistema ekonomikuri pirobebis Sesabamisad samedicino momsaxurebaze fasebs operatiulad cvlis.

germaneli specialistebi savaldebulo samedicino dazRvevas metad maRal Sefasebas aZleven, Tumca idealur sistemad ar Tvlian. Tanamedrove etapze samedicino dazRvevas germaniis jandacvis sistemaSi mniSvnelovani adgili uWiravs.

samedicino dazRveva farTod aris gavrcelebuli safrangeTSic, sadac mas rigi Taviseburebebi axasiaTebs. samedicino dazRvevis organizacia centralizebuli xasiaTisaa. safrangeTSi sawarmoebis yovelTviuri anaricxebi socialur dazRvevaze Seadgens xelfasis fondis 36%-s, romlis nawili momuSaveTa xelfasebidan aris dakavebuli. koleqtiur sadazRvevo xelSekrulebebs deben msxvili warmoebebis xelmZRvanelebi, xolo individualur dazRvevaSi monawileoben mcire koleqtivis wevrebi da Tavisufali profesiis mqone pirebi. savaldebulo dazRveva koleqtiuri an individualuri saxiT xorcieldeba.

safrangeTSi jandacvis sistemis funqcionirebisaTvis danaxarjebi maRali tempiT matulobs 1990 wels danaxarjebma 538 mlrd franki Seadgena. samedicino dazRveva moicavs mosaxleobis 80%-s, savaldebulo dazRvevis fondidan dazRveuls unazRaurdeba samedicino momsaxurebis Rirebulebis mxolod 75%. Rirebulebis 100%-iani anazRaurebisaTvis aucilebelia damatebiT nebayoflobiT dazRvevaSi monawileoba. avadmyofobis SemTxvevaSi, droebiTi an xangrZlivi Sromisuunarobisas savaldebulo samedicino dazRveva anazRaurebs medikamentebis Rirebulebis 70-90%-s. fasebs samedicino momsaxurebaze aregulirebs mTavroba. fasebi gadaisinjeba weliwadSi 2-jer, rasac xSirad sadazRvevo Senatanebis gazrda mosdevs.

sadazRvevo kompaniaTa raodenobiT safrangeTs, germaniisa da niderlandebis Semdeg, evropaSi mesame adgili uWiravs. safrangeTis sadazRvevo sazogadoebaTa federaciaSi gaerTianebulia 90 sadazRvevo kompania. kerZo sadazRvevo kompaniebi mosaxleobas sTavazobs samedicino momsaxurebis farTo speqtrs, rac savaldebulo socialur-samedicino dazRvevis damatebas warmoadgens. safrangeTSi pacienti mTlianad ixdis mkurnalobis Rirebulebas, romlis nawils savaldebulo samedicino dazRvevis sistema unazRaurebs, rac sabazro ekonomikis pirobebSi, samedicino daxmarebas ufro xelmisawvdoms xdis.

amgvarad, safrangeTis, da evropis zogierTi qveynis jandacvis sistemas afinansebs sami ZiriTadi wyaro:saxelmwifo biujeti, savaldebulo dazRvevis Tanxebi da moqalaqeTa piradi Tanxebi.

gansakuTrebul interess iwvevs iaponiis gamocdileba, sadac samedicino dazRvevis organizaciis sistema Sereuli xasiaTisaa, igi moicavs centralizaciis da decentralizaciis elementebs.

iaponiis jandacvis sistemis organizaciisadmi interesi gamowveulia mosaxleobis janmrTelobis maCveneblebis maRali doniT, rac miRweuli iqna metad xanmokle periodSi. sicocxlis saSualo xangrZlivoba ekonomikurad ganviTarebul qveynebSi, amerikis Seertebul StatebSi, safrangeTSi, germaniaSi _ 78 welia, iaponiaSi ki am maCvenebelma 80 -s miaRwia. (118 gv. 201) iaponiaSi dabalia avadobisa da sikvdilianobis maCveneblebi. ra Tqma unda mosaxleobis janmrTelobis mdgomareoba didad aris damokidebuli cxovrebis wessa da pirobebze. iaponiaSi samedicino dazRveva Camoyalibda 1927 wels, mosaxleobis janmrTelobaze dazRvevis kanonis SemoRebisTanave. aziis qveynebs Soris iaponia pirveli qveyanaa, romelSic 1961 wels SemoRebul iqna erovnuli masStabiT janmrTelobis dazRveva.

dReisaTvis iaponiaSi samedicino momsaxureba finansdeba ZiriTadad janmrTelobis dazRvevis fondebidan. qveyanaSi moqmedebs janmrTelobis dazRvevis ori sistema:janmrTelobis dazRvevis erovnuli sistema, romelic agebulia teritoriul principze da daqiravebul pirTa dazRvevis sistema, romelic agebulia teritoriul principebze da daqiravebul pirTa dazRvevis sistema, romelic agebulia sawarmoo principebze.

samedicino dazRvevis yvela programa moicavs samedicino momsaxurebis daaxloebiT erTnair nusxas, maT Soris: medikamentozur uzrunvelyofas, qronikul daavadebaTa mkurnalobas, stomatologiur momsaxurebas, profilaqtikur RonisZiebebs da sxva. kanonmdeblobiT moqalaqes ara aqvs ufleba airCios dazRvevis misTvis sasurveli sqema. TiToeuli moqalaqe izRveva im sqemiT, romelsac gansazRvravs adgilobrivi administracia an profesionaluri asociacia.

iaponiaSi yvela sadazRvevo sqema iyofa sam ZiriTad jgufad:

pirveli sqema gulisxmobs momuSaveTa da maTi ojaxis wevrebis dazRvevas. es sqema Tavis mxriv moicavs dazRvevis oTx jgufs:

a) saSualo sididis sawarmoebis momuSaveTa dazRveva;

b) msxvili sawarmoebis momuSaveTa dazRveva;

g) mezRvaurTa damoukidebeli dazRveva;

d) warmoebis sazogadoebrivi seqtoris momuSaveTa dazRveva.

meore sqema moicavs individualuri SromiT dasaqmebulTa da maTi ojaxis wevrebis erovnul dazRvevas. amave jgufSi Sedian pensionerebi. moxucebulTa garkveuli nawili dazRveulia Svilebis mier rogorc ojaxis wevri. sadazRvevo Sesatani damokidebulia xelfasis doneze. es sqema Tavis mxriv ori jgufisagan Sedgeba.

a) adgilobrivi erovnuli samedicino dazRveva, rodesac damzRvevi erovnuli mTavrobaa.

b) asociaciuri erovnuli samedicino dazRveva, romelic azRvevs calkeul profesiebs.

dazRvevis mesame sqema emyareba iaponiaSi 1882 wels miRebul kanons "geriartriuli daxmarebis Sesaxeb", romlis fondi anazRaurebs 70 wels gadacilebul pirTa samedicino daxmarebas. am fondSi Tanxas ricxavs yvela sadazRvevo organizacia. Senatanis gaangariSeba xdeba sazogadoebaSi xandazmuli mosaxleobis raodenobrivi wilis maCveneblebis safuZvelze. 70 wels gadacilebuli mosaxleobisaTvis samedicino momsaxureba ufasoa.

iaponiaSi sadazRvevo Senatanis agroveba xdeba TviTmarTvelobis adgilobrivi organoebis an janmrTelobis dazRvevis erovnuli asociaciis mier. Senatanebis sidide damokidebulia sacxovrebel adgilze, Semosavalze, uZravi qonebis Rirebulebaze, ojaxis sidideze. droebiT Sromisuunarobaze gacemuli daxmarebis 40%-s Seadgens saxelmwifo dotaciebi. daxmareba gaicema fuladi TanxiT an samedicino daxmarebis Rirebulebaze SeRavaTebis saxiT. dazRveulTaTvis maqsimaluri SeRavaTebi Seadgens mkurnalobis Rirebulebis 90%-s, darCenil 10%-s ixdis pacienti. stacionaruli mkurnalobis 70%-s anazRaureben sadazRvevo organizaciebi, danarCen Tanxas ixdis pacienti.

iaponiaSi saxelmwifo anazRaurebs yvela sadazRvevo sqemis administraciul xarjebs, awarmoebs mcirericxovani kompaniebis TanamSromelTa dazRvevas socialuri dazRvevis saagentoebis meSveobiT. socialur dazRvevaSi monawileobas Rebulobs samasamde sazogadoeba, romelic gafantulia mTels qveyanaSi.

1984 wlis bolos kerZo sadazRvevo kompaniaTa ricxvma 1711-s miaRwia, dazRveul pirTa raodenobam ki 18 mln-s. 1990 wlis monacemebiT samedicino dazRvevis sistemam moicva 60 mln. adamiani.

samedicino dazRvevis sistemis garda iaponiaSi funqcionirebs sazogadoebrivi fondebi, romelTa meSveobiT warmoebs tuberkulozis, fsiqikur, veneriul da memkvidreobiT daavadebaTa profilaqtikisaTvis aucilebeli Tanxebis anazRaureba da garemos gaWuWyianebiT janmrTelobaze miyenebuli zaralis kompensacia.

sazogadoebrivi fondebidan finansdeba socialuri uzrunvelyofisa da socialuri keTildReobisaken mimarTuli RonisZiebebi Semdegi kanonebis safuZvelze:sasicocxlo uflebaTa dacva, invalidTa da xeibarTa socialuri uzrunvelyofa, bavSvTa socialuri uzrunvelyofa, omSi daWrilTa da atomuri dabobmvis Sedegad dazaralebulTa samedicino momsaxurebis uzrunvelyofa.

iaponiaSi sazogadoebrivi fondebis xarjze arsebobs agreTve dedaTa da bavSvTa dazRvevis sistema.

1947 wels miRebuli konstitucia iaponiis mosaxleobas aZlevs im garantias, rom saxelmwifo xels Seuwyobs da ganaviTarebs mosaxleobis socialur keTildReobasa da usafrTxoebas, sazogadoebriv janmrTelobas.

iaponiis jandacvis politikis mTavari mizania mosaxleobaSi samedicino daxmarebis Tanasworobisa da sayovelTaobis miRweva, risTvisac gamoyenebulia samedicino dazRvevis iseTi principi, rogoricaa sxvadasxva ekonomikuri mdgomareobis adamianTa finansuri urTierTdaxmareba. iaponiis janmrTelobis dacvis sazogadoebrivi sistema moicavs sazogadoebriv higienas, socialur uzrunvelyofas, samedicino dazRvevas, saxelmwifos xarjze mosaxleobis garkveuli kontigentis samedicino momsaxurebas.

marTalia, iaponiaSi samedicino daxmareba fasiania, magram misi ZiriTadi nawilis anazRaureba samedicino dazRvevis sistemis xarjze xdeba.

miuxedavad imisa, rom iaponiis, germaniisa da safrangeTis jandacvis sistemas, iseve rogorc sxva ekonomikurad ganviTarebuli qveynebis jandacvis sistemas, gaaCnia mravali problema, isini dReisaTvis aRiarebulia erT_erT yvelaze efeqtur sistemebad, ramac ganapiroba am qveyanaSi samedicino dazRvevis sistemis organizaciis Seswavlisadmi Cveni didi interesi.

samedicino dazRvevis ganviTarebis saerTaSoriso gamocdilebis Seswavla gvaZlevs saSualebas gamovyoT CvenTvis sasurveli aspeqtebi. saqarTvelos sinamdvilisaTvis samedicino dazRvevis yvelaze misaReb modelad vTvliT iaponurs - Sereul models, romlis mixedviTac dazRveva moicavs mosaxleobas mTlianobaSi. magram aqve dRevandel etapze aucileblad migvaCnia franguli centralizebuli modelis aspeqtebis gamoyeneba, romelic dazRvevis sistemis saxelmwifoebriv marTvas iTvaliswinebs. amave dros yuradsaRebia germanuli decentralizebuli modelis Sesabamisad kerZo – nebayoflobiTi sadazRvevo kompaniebis xelSewyoba da maTi saxelmwifo sadazRvevo programebSi aqtiuri gamoyeneba.

gamoyenebuli literatura

1. Ваганов Н.Н. Гребешева И.И. Комаров Ю.М. Здравоохранение Великобритании: некоторые проблемы и решения // Здравоохр. Рос. Федерации. – 1991. - №8. – С. 25-28.

2.Жильцов Е.Н. Основы Формирования хозяйственного механизма в сфере услуг. –(М.; Изд. МГУ.1992-98с)

3.Интиньяно Б.М. Финансирование здравоохранения в Европе // Сессия ВОЗ, 42-я. – Копенгаген: 1992, - сентябрь. – С. 1-23.

Summary

The article deals with the existing economic models of medical insurance and their comparative analysis. It also focuses on those aspects, which are to be taken into account when working out native models of medical insurance.