Legal Factors:

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State health care regulatory functions are largely concentrated at the national level. Thus, as noted earlier, the Ministry of Health is responsible for establishing the framework for the mandatory accreditation of public and private health facilities as well as licensing of health professionals and of pharmaceutical manufacturers and distributors. It determines the range of pharmaceutical products that can be purchased by state facilities (subject to approval of the Ministry of Finance) and that are subject to price controls (in association with the Ministry of Economy). However the right to set limits on retail charges for pharmaceuticals and medical devices rests with the regional health authorities, within limits set by the Cabinet of Ministers. The regional health authorities also decide on levels of formal co-payments in state health facilities (see Complementary sources of nance) The procedures for budgetary planning and decision-making by national and regional authorities are regulated by resolution by the Cabinet of Ministers, as are salary scales in health facilities. Terms of employment are set by the Ministry of Health with the approval of the Ministry of Labour and Social Policy and the Ministry of Finance. The actual salary level received by an individual as well as additional payments and increments are set by the heads of the state and community health facilities, within the limits of available funds. Contributions for mandatory social insurance covering temporal disability, occupational accidents and occupational diseases are determined by legislation that is usually revised by the parliament annually. Contributions are determined as a proportion of wages and salaries, with contributions for occupational accidents and diseases borne by employers, at a current (2010) rate of 2.12%, and contributions for insurance against temporal disability paid both by employers and employees at rates of 2.5% and 0.5%, respectively (33). As mentioned earlier, the mandatory state social insurance is supervised by the Ministry of Labour and Social Policy. The Concept of the Development of Health Care in Ukraine, adopted by presidential decree in December 2000, emphasizes the necessity to take account of the populations need for various types of health care, aiming at increasing the level of autonomy of facilities. The Health of the Nation programme of 2002 made provisions to transform these facilities into fully edged economic entities. In addition, a number of mechanisms are being discussed to ensure participation of civil society in planning and management of health services. Thus, if the system was to move towards the insurance principle of health care funding, representatives of the insured would

be involved as members of the supervisory board of the Social Health Insurance Fund. If a funding mechanism is adopted in which the state acts as purchaser of health services on a competitive basis, user representatives would be involved as members of tender committees dealing with the purchase of health services. These measures would complement the mechanisms for increased participation of the public that are, at least formally, already in place. However, once again, the fragmentation of decision-making, involving in this case a presidential decree, highlights a major barrier to effective implementation of any of these ideas. In summary, a number of legal prerequisites have been created recently to change approaches to the planning and regulation of health care, but they are poorly coordinated and no actual steps towards implementation have been taken.

Environmental Factors:

Ukraine has significant environmental problems, resulting from the Chernobyl nuclear power plant disaster in 1986 as well as the industrial pollution. Chernobyl Nuclear Power Plant was permanently closed in 2000 and the necessary measures for radiation safety have been taken. The disaster has had huge negative social impact as of 2007, 2 526 216 people (which is 5.5% of the entire population) have the status of victims. Ukraine is interested in cooperating on regional environmental issues. Conservation of natural sources is stated a high priority although implementation suffers from a lack of financial resources. Ukraine established its first nature preserve, Askania-Nova, and has a program to breed endangered species. Other environmental problems are inadequate supplies of potable water; air and water pollution and deforestation. Environmental laws:
The Water Code of Ukraine is intended to ensure conservation, scientific study, and rational

use of water for the needs of the population and industries. The code is the principal legislation for protecting and improving both the quantity and quality of surface and ground water while also facilitating its use. The Water Code, along with the Oil and Gas Law, regulates disposal of wastewater in subsoil zones.

The Law on Wastes is the principal law for minimizing production of waste and regulating

the safe handling of waste, use of waste as a secondary material, and disposal of both hazardous and non-hazardous waste. The law does not regulate substances discharged in wastewater or air. The Law on Air Protection is the principal law for protecting and improving the quality of

air in Ukraine. The Air Quality Law uses three approaches to regulate air quality: 1) Set regional air pollution limits and restrict pollution based on those thresholds; 2) Require polluters to obtain permits to emit certain chemicals; and 3) Require the polluters to use systems or technologies that reduce pollution. Several laws of Ukraine function to protect natural lands and their biodiversity. These

include the Protected Areas Law, Forest Code, Land Code, Law on Fauna, Law on Flora, and the Plant Protection Law. Biodiversity and natural landscapes and species are protected in part through limitation of the activities that can occur in protected areas and by requiring protection of individual species. The Ecological Audit Law is the principal law for evaluating and ensuring compliance with

the legislation of Ukraine on environmental protection. Through this law, independent auditors conduct voluntary and mandatory audits of compliance with substantive environmental laws. The Environmental Protection Law and individual substantive laws and codes require collection of baseline data on the environment and monitoring of the impacts of development activities. These laws establish limited authority of the government to limit the activities of entities violating the laws and to impose disciplinary, administrative, civil, and criminal penalties for violations