Having identified empirical objects, the researcher usually needs to develop a direct method of content analysis for each individual study. This technique involves the use of different categories, which should be adequately reflected in the content of the studied document. It is these verbal reflections and become units of analysis. Formalization, systematization and rigor of content analysis is manifested in the procedure of its implementation. It is with the help of content analysis that it is possible to find in the document what falls out of the superficial view in its traditional study, but has an important social and managerial content.
In the first stage, we identified the issues discussed in the reports – qualitative content analysis, and in the second – calculated the proportion of the number of terms devoted to a particular problem throughout the text and then in the third stage compared both the qualitative composition of the problems and the quantitative weight each of them.
The data obtained on the document were grouped in the form of a table, based on calculations for certain units of analysis (research), which were the main problems of health care. In the work on the analysis of the content of reports we used the historical approach in combination with analytical, statistical, graphic methods of processing of the received information:data grouping; subtraction of relative indicators of structure and coordination; comparison of data vertically and horizontally.
The object of the study was the health care system in different historical periods of its existence (1920-1924 and 2004-2005), and the subject of the study were the characteristics of public health (demographic indicators, incidence of infectious and socially related diseases , diseases affecting mortality) and management of the health care system of Ukraine (structure, financial and staffing), which were provided in the reports of the People’s Commissar and the Minister of Health in different years.
The Ukrainian Soviet health care system in the first years of its existence
The First All-Union Congress of Soviets was held in Moscow on December 30, 1922, which considered the creation of the Union of Soviet Socialist Republics, which included Ukraine as one of the republics of the USSR. There was a question of coordination of measures in the field of health care of all republics of the USSR.
The Second All-Ukrainian Congress of Health Departments (1923) stressed the need to pay attention to the creation of a network of clinics, women’s and children’s clinics, the expansion of preventive measures not only in the activities of sanitary doctors, but also medical doctors … Polyclinics were given increasing importance in the organization of treatment and preventive care for the population .
Great difficulties were caused in establishing the sanitary condition of cities and towns of Ukraine, which is explained by the chaos during the civil war and foreign military intervention. Immediate measures were taken to establish a sanitary organization, which at that time posed enormous difficulties due to the huge shortage of sanitary doctors.
Soviet power in Ukraine was proclaimed on December 12, 1917 in Kharkiv by the First All-Ukrainian Congress of Soviets. Almost a year after this event, in January 1919, the first People’s Commissar for Health, Professor of Psychiatry PP Tutishkin, was appointed. But a month later, from February 16 to April 1919, this department was headed by OM Vinokurov, a professional Bolshevik revolutionary sent from Moscow [1, 6]. He held this position for only two months and, on his way to Moscow, handed over the management of Ukrainian health care in the government of Soviet Ukraine to his deputy, MA Kost, with whom he arrived in Ukraine.
Nikolai Andreevich Kost, a graduate of the Medical write lab report for me Faculty of Moscow University, participated in the organization and publication of the Social Democratic newspaper "Murom Region" published in Murom, Vladimir Province in 1913-1915, was drafted into the army during the First World War … , was a member of the Council of Medical Boards in 1918, headed the Department of People’s Commissariat of Health of Russia. He, on behalf of the party, and was entrusted to perform the duties of People’s Commissar of Health from April 1919 to April 1920. Then this position was held by MG Gurevich from April 20, 1920 to the end of 1925, about which little is known .
The first report of the People’s Commissar of Health M. Gurevich to the All-Ukrainian Central Executive Committee said that the work of the People’s Commissariat of Health in Ukraine was marked by the fight against epidemics that lasted from 1918 to 1923 .
As a result of extensive work carried out by health workers, smallpox vaccinations were able to cover 10% of the population, which significantly reduced the incidence of smallpox from 10 cases per ten thousand population in 1010 and 5.4 cases in 1913 to 1.8 cases per ten thousand population in 1923.
Despite the successful operation of the health care system to control typhus and smallpox, malaria continued to pose a serious threat to the population, which has not become widespread. The causes of the typhus epidemic have not been completely eliminated. Poor water supply could not be eliminated, housing congestion remained, and the general sanitary condition of the republic remained unfavorable.
The conducted sanitary census of the peasant population with the involvement of qualified medical staff covered 1.2% of the population living in rural areas, showed the presence of serious demographic problems. These data showed that the population had not yet recovered from the imperialist and civil wars and that the population of the republic was declining. The picture of natural population decline was supplemented by high infant mortality, which was one and a half times higher than in the pre-war period.
According to the People’s Commissariat of Health, medical care for workers and employees was provided much better than in peacetime, while medical care for peasants was much worse than in peacetime. The lag of rural health care compared to urban areas has been attributed to unequal health care provision in urban and rural areas.
The report says that if the distribution of funds in the local budget between urban and rural areas was more even, the peasantry would be in a better position than it is now. In addition, there was a redistribution of the bed stock of hospitals in favor of urban residents and its lack in the countryside.
It was also noted that the restoration of normal life in the countryside lags behind the city by one or two years after the military devastation of the imperialist and civil wars. Among the regions of the republic, the worst medical care was organized in the Chernihiv province, where, as they said, "essentially nothing can be taken."
Social insurance is a complex economic and legal phenomenon. As a legal category – a form of social protection, a system of measures for material security and social services in old age, in case of temporary or permanent disability, loss of breadwinner, unemployment and in other cases provided by law.
Separated from civil law, social insurance, like any other important area of human activity, began to actively develop and require a certain structural and logical order. The main means of such ordering is classification, which allows you to divide the whole set of relations on social insurance into interconnected structural units of the social insurance system.
The main criteria for classification in the social insurance system are the form of insurance and the object. The latter, in turn, became a factor in separating social insurance from civil law. In modern conditions, its importance does not decrease. The object of social insurance is the basis for the organization of its individual types.
Object identification is a complex process that requires a careful, scientifically sound approach to the optimal organization of a particular type of social insurance. Discussions on the introduction of compulsory state health insurance in Ukraine have been going on for a long time. We believe that most of the problems of organizational and legal nature of this type of social insurance are related to the definition of the object of insurance, its separation or the possibility of combining with the object of compulsory state social insurance in case of temporary disability.
During the formation of a developed system of social insurance for legal science of particular interest is another criterion for classification – a form of social insurance. Many years of experience in countries with socially oriented market economies show the widespread use of two forms of social insurance: compulsory and voluntary.
The prevailing opinion among Ukrainian scholars is that social insurance exists only in the obligatory form. The basis for this conclusion was the legislation of Ukraine on social insurance. It is believed that the issue of voluntary social insurance is regulated by providing the opportunity to participate in the system of compulsory state social insurance on a voluntary basis of persons who are not subject to it. The question arises: can such participation be considered a voluntary form of social insurance?
Studies of the experience of foreign countries on the organizational and legal framework of compulsory and voluntary social insurance allow us to formulate the features of the distinction between these two forms.
Mandatory form of social insurance on the basis of distribution (application) is preferred.