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Particularities of primary health care organization under mandatory health insurance in Chisinau

Author: Buta Galina
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 14 December, 2011
Approved by NCAA on the 16 February, 2012


Adobe PDF document3.35 Mb / in romanian


population health, demographic indicators, mandatory health insurance, primary health care, quality of medical services, criteria for evaluating the activities.


Thesis structure. The thesis comprises the introduction, literature review, materials and methods, 4 explorative chapters, general conclusions, practical recommendations, bibliography with 246 references, 25 applications, 133 pages of main text, 35 figures and 13 tables. The achieved results were published in 16 scientific works.

Field of study. Analysis of primary medical services in Chisinau in the period before and after the introduction of mandatory health insurance, and the identification of existing problems. Purpose. The purpose is evaluation of primary health care services of the Chisinau municipality, in the context of the introduction of mandatory health insurance (MHI), and the development of main directions of its improvement.

Research objectives: the assessment of health of the population of Chisinau in the process of implementation of MHI; assessment of the organizational peculiarities and the activity of primary health services in Chisinau in the conditions of MHI; database analysis concerning funding of services offered in PHC sector; quality assessment of medical service at the PHC level; development of directions for the improvement of PHC services in the municipality.

Research problem. Evaluation of PHC services under mandatory health insurance, including working conditions of FM team in terms of occupational medicine, highlighting negative repercussions on functional and health status, occupational stress factors and states.

Scientific novelty and originality of the investigation is that for the first time there were evaluated the activities of the primary health service of Chisinau in the context of implementation of MHI, identified organizational and structural features, as well as the financing of primary health services of the Chisinau municipality.

As a result of the study were identified: the impact of ongoing reforms in the health care system on the basis of primary health services; the main risk factors that lead to the development of professional stress for family physicians. Group indicators have been expanded and developed new criteria for assessing the quality of care. New data were received for the scientific substantiation of organizational measures to improve the quality of MHI. Research is original in its dynamics and complexity, as they reveal the effectiveness of the family doctor and his or her abilities in the fields of medicine, assessing occupational risks, analyzing factors influencing patient satisfaction level in the field of services. Theoretical significance and the applicative value of the work is that the results are used as didactic material and information support in medical activities. Elaborated criteria are an effective tool for managers in carrying out the internal audit of the medical institution.

The results completed knowledge concerning peculiarities of organizational structure of the PHC in Chisinau. The abovementioned data will serve as arguments in the process of prediction, monitoring and evaluation of activities related to the control of diseases and PHC services, the final objective of which is to strengthen the health of the population.

Implementation of the scientific results in undergraduate and postgraduate education of medical personnel at the State Medical and Pharmaceutical University "Nicolae Testimitanu" and in the self-evaluation practice of PHC institutions in Chisinau.