REFORM OF DENTAL CARE TO THE POPULATION OF UKRAINE: PROBLEMS OF THE PRESENT
The article discusses the current problems of dental care reform. Key issues identified features of the need to determine the minimum amount of free dental care services; development of standards and protocols for the provision of all types of dental care; creation of a register of dental morbidity in the country's population; determination of the model of reorganization of state and municipal dental institutions by changing the form of management with the status of non-profit institutions; development of pricing methods for dental services; introduction of a maxillofacial surgeon and a dentist to a dentist; the need for approval of state postgraduate dental education. Dental care is one of the most popular types of medical care. By the number of dentists (18857, which is 11% of the total number of doctors in Ukraine) and patient visits (32.5 million per year), dentistry takes the second place among all medical specialties. Provision with dentists is 6.1 per 10 thousand people and corresponds to the European level. Also in Ukraine there are approximately 5500 state and friendly dental institutions and offices. However, with such significant amounts of care and powerful staffing, the problem of access to dental care is exacerbating. This situation can be explained by many reasons related to the reform of medical care in general in the country. Now all dentists are referred to the secondary level of medical care, although the real majority of them provide primary dental care, that is, this issue is not legally regulated. In the most European countries, 80-85% of dentists are general practitioners. Recently, there has been significant progress in the diagnosis and treatment of dental diseases, dental prosthetics, but dental care is gradually losing its mass availability. The situation is even worse in rural areas, where the position of dentist has been eliminated at the primary level. The decrease in the availability of dental care and the reduction of the preventive dentistry sector is causing an increase in dental morbidity, which in Ukraine is one of the highest in Europe. Many dental diseases at the initial stage are asymptomatic and patients seek medical help too late. Therefore, preventive examinations are an important component of the prevention system not only of dental diseases, but also of the mucous membrane of the oral cavity, that is, there must be oncological alertness. Reforming is not only the order of medical care, but also the dental institutions themselves. Optimization consists of providing territorial communities with medical care without making a profit by creating communal non-profit enterprises, that is, transferring them to self-sufficiency (with partial support from local budgets). Dentistry actually remains without financial support from the state, with the exception of planned dentistry for children under 16 years of age and urgent dental care for adults and children. Paid dentistry will reduce the number of visits to insolvent citizens, which will entail, accordingly, costlier services. The second stage of reforming medical institutions involves not only their partial reduction (optimization by enlargement), but also the reduction of medical posts. One of the possible ways out of this situation was the proposal to introduce medical self-government (administration of the dental industry by representatives of the profession). The study of the needs of the population in dental care is based on the results of a study of the incidence rate for circulation and data from examinations. But in fact, it is not so much the incidence that is studied as the volumes of dental care, which is associated with outdated registration forms that are filled out in dental institutions. A specific method for studying the incidence in dentistry is the method of stratification cluster samples, which, unfortunately, is complex in design and is carried out exclusively by scientists. Dentistry is an expensive worldwide, so dental care pricing is an important. The economic rationale for the cost of treatment is directly related to the standards of care and clinical protocols, which also require revision according to the principles of evidence-based medicine.
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