Institutional and legal mechanisms of medical self-government: a comparative legal analysis of the experience of Poland, Slovakia and the Czech Republic as a reference point for Ukraine

Abstract

Purpose. The aim of the article is to conduct a comparative legal analysis of the institutional frameworks governing medical selfregulation in Poland, Slovakia, and the Czech Republic, with particular focus on the organizational structure of medical chambers, the maintenance of physicians’ registers, systems of continuing professional development, and disciplinary procedures, in order to identify those elements of European practice that are most appropriate for adoption in the development of a medical self-governance institution in Ukraine. Materials and methods. The research materials were the provisions of draft laws of Ukraine, regulatory legal acts of Poland, Slovakia and the Czech Republic in the field of medical self-government and professional regulation of medical activities, scientific publications from open sources (PubMed, Google Scholar), analytical materials, official EU documents and web resources of state authorities of the studied countries. In the process of research, general scientific and special scientific methods were used, in particular institutional, systems analysis, axiological and comparative law method. Results. The comparative analysis showed that in Poland, Slovakia and the Czech Republic, the regulation of the medical profession is carried out through legally established professional chambers with mandatory or quasi-mandatory membership, which maintain public registers of doctors and are vested with powers in the field of disciplinary liability and continuous professional development. It was established that in all the countries studied, the system of continuous professional development is a formalized obligation of a doctor associated with the right to practice, and disciplinary procedures are characterized by a two-tier review, the presence of an independent body initiating proceedings and a graduated list of sanctions. The two-tier institutional structure characteristic of the Polish and Czech models is particularly relevant for Ukraine given the significant territory of the state, the uneven distribution of medical personnel across regions, and the need to bring administrative procedures closer to the place of professional activity of a physician, including in regions adjacent to the zone of hostilities. It was also established that in Ukraine there is currently no single public register of physicians functionally equivalent to the central registers of NIL, SLK or ČLK, whereas the national continuous professional development system, in turn, does not fall short of the models of the states under study in terms of key quantitative parameters, although it is administered by the state rather than by self-governing professional structures. It was determined that the experience of Poland, Slovakia, and the Czech Republic can be used in finalizing the draft law of Ukraine “On Self-Government in the Sphere of Healthcare in Ukraine” No. 10372 in terms of consolidating the model of membership in chambers, introducing a public register of doctors with information on disciplinary practice, and transferring the administration of continuous professional development to the competence of future chambers with integration into a unified public register of physicians. Conclusions. Borrowing institutional and legal mechanisms of medical self-government from EU member states is an important tool for Ukraine’s integration into the European healthcare space, but it requires taking into account the specifics of the national legal system, constitutional restrictions, and challenges caused by the armed aggression of the Russian Federation against Ukraine.