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CNAA / Theses / 2011 / June /

Socio-economical and juridical aspects of the mandatory health insurance implementation

Author: Buga Mircea
Degree:doctor of medicine
Speciality: 14.00.33 - Social Medicine and Management
Scientific adviser: Constantin Eţco
doctor habilitat, professor, Nicolae Testemitanu State University of Medicine and Pharmacy of the Republic of Moldova
Institution: Nicolae Testemitanu State University of Medicine and Pharmacy of the Republic of Moldova
Scientific council: DH 50-14.00.33-26.02.04
Nicolae Testemitanu State University of Medicine and Pharmacy of the Republic of Moldova


The thesis was presented on the 22 June, 2011
Approved by NCAA on the 5 October, 2011


Adobe PDF document0.46 Mb / in romanian


mandatory health insurance, national public health system, medical services, financing, health of population.


Thesis structure. The thesis comprises the introduction, four chapters, general conclusions and recommendations, bibliography from 179 titles, 14 attachments, 124 basic text pages, 10 figures, 34 tables. The achieved results are published in 12 scientific works.

The thesis field of study is the analysis of the mandatory health insurance (MHI) system, of the existing problems in the system and elaboration of recommendations on the basis of the scientific proofs for the amelioration of the MHI system.

Purpose of the research is the scientific analysis of the medico-social, economical and legal aspects of the MHI implementation and the identification of the new methods for solving current problems of this system.

Research objectives: the analysis of the health insurance systems and their efficiency; the evaluation of the economical effects, stewardship and impact of the MHI on the level of the population’s health; the analysis of the legal aspects of the MHI implementation; the argumentation of the new methods for solving current problems of this system.

Scientific novelty and originality of the investigation consists of the initial research of the economical, legal and health effects of the mandatory health insurance implementation, elaboration of the new methods to encrease efficiency of the national public health structures. Based on a very original methodology there has been evaluated the opinion of the experts and partners of the MHI system. This evaluation allowed us to identify the fundamental directions for the medium term development of the mandatory health insurance system.

Theoretical significance and the applicative value of the work comprises the study of the different models of the mandatory health insurance in many countries, the analysis and the argumentation of several conclusions on the results of the health providers’ activity in 1998- 2009, the aspects of the MHI funds collecting, the populations’ coverage with health insurance, the study of the domain legislation. There have been identified the problems within MHI implementation, irregularities in the evaluation of the activity results under the new conditions and have been argumented the revisions of the existing legislation, changes in the contracting mechanisms for qualitative health services, in using funds and tools for the universal health coverage, active enrolment of the population in the MHI scheme.

Implementation of the scientific results. The results of the research have been used at the elaboration of the following acts: Laws on revision of some legislative acts No.286-XVI from 20.12.2007 and No.259-XVI from 05.12.2008; Laws on MHI funds for 2008-2010; Law No.22-XVI from 03.02.2009, according to which the insurance for social help beneficiaries is covered by state; Law No.108-XVIII from 17.12.2009, that allows uninsured people to have acces to a minimum package of helath services; MHI Basic Package for 2007, approved by Governmental Decree No.1480 from 25.12.06; Instruction for population registration at the primary helath care institution (Common Order of the MoH and NHIC No.316/138-A from 04.08.08). The results of the study serve as didactic material for university and post-university teaching of the medical staff.