Legal Regulation For Sustainable Health Care Systems: International Experience


The article focuses on the problems of building the sustainable health care systems at the national and international levels. The relevance of the chosen topic is determined by the condition of the national health care systems in connection with the spread of the COVID-19 pandemic and the need for international cooperation in overcoming the consequences of new infectious disease on a global scale. To this end, the study took the form of a comprehensive review of the theory and practice of national health care systems in Switzerland, Germany, France, Poland and the Russian Federation. To achieve this goal, the main institutions of the existing health systems were considered. The extensive research proves that national health policies have a similar nature and similar variability in public health reform: increasing state funding, improving health insurance methods and introduction of the latest information technology. It is noted that national interests and strategic national priorities in the field of health care are pursued with a full-fledged effective cooperation of the above-mentioned countries with the European Commission for Health and Sustainable Development and the WHO Regional Committee. In response to the need to improve the legal mechanism for the sustainable health care system, the authors addressed those issues from a cross-sectoral perspective by correlating separate branches of law (medical, informational, financial and international) to provide comprehensive legal support for the modernization of the national health care system.

Keywords: Correlation, health care, legal support, sustainable system


The dynamic development of sustainable health care systems at the national and international levels is associated with the global spread of the coronavirus infection COVID-19 (Gupta, 2021). In this regard, the international community has prioritized the mobilization of scientific and practical achievements in the formation of modern sustainable health systems adequate to the posed threats (Yang & Lo, 2021). The reforming process of national health care systems is directly linked to the necessity of regulatory and methodological platform creation. The international cooperation on health care issues remains high on the international political agenda especially with regard to the planning of unified approaches to the implementation of treatment and prevention programs, their support by the pharmaceutical industry (Derqui et al., 2021), the rapid exchange of relevant information through proactive integration of information and communication technologies (Munier-Marion et al., 2017) into the national health system.

Analysis of international experience (Ippolito et al., 2020) has revealed positive and forward-looking aspects of national health-care models:

International legal cooperation between different states in creating sustainable health care systems would address public health concerns both within different countries and internationally (Abbas, 2021; Guldbrandsson & Bremberg, 2020).

Problem Statement

There is a need to develop and implement a new framework of international legal and recommendatory instruments to build sustainable health care systems at the national and international levels.

Research Questions

The main focus of this study is institutional and legal measures for establishing the adequate principles for sustainable health care systems at the national and international levels through the integration of the conceptual framework for the development of public health care in different states.

Purpose of the Study

The purpose of study is to analyze the process of public health care modernization and the formation of sustainable health care systems at the national and international levels, to characterize the development of medical care legal regulation and the establishment of the latest standards in modern health care systems.

Research Methods

The rationale for creating sustainable health care systems at the national and international levels is based on the following methodological framework: a general scientific method and a specific method of knowledge which should include comparative legal, environmental, sociological and empirical methods. The article analyzes the degree and level of sustainable health care development in some European countries and in the Russian Federation. Consideration was given to the elaboration of the legal regulatory framework of scientific and technological support for the implementation of information and communication methods that model innovative approaches to sustainable health care systems.


In recent years the world community has paid special attention to the operation of the national healthcare systems. The polycentricity of the principles governing the provision of medical care to the population changes considerably due to the spread of the COVID-19 coronavirus infection (Negrini et al., 2021), which has altered the established structures of international relations and cooperation in basic forms of health care. The strengths and weaknesses of the public health national models became apparent. These contradictions are particularly evident in different approaches to ensuring sanitary epidemiological well-being in the countries located in the contiguous territories. Disagreements in the efficiency assessment of the national health care systems affected such key issues as infection treatment methods, pharmaceuticals and other therapeutic measures.

Most of the conflicts were related to vaccine research and production as well as methods of massive vaccination campaigns that compromised the international cooperation progress in preventing the spread of a new infectious disease. The flagship projects of the World Health Organization (Ogbu & Arah, 2017) were activities to form adequate principles of a sustainable international health system through the integration of the conceptual framework for the development of public health in various states. The international standards, common to the public health of any state, are the indicators of a population’s health status, which depends on the efficiency of social and economic policy of every country. The accessibility of high-technology medicine (Naumann et al., 2021), introduction of science intensive equipment and research activities in all branches of medicine are largely determined by state funding. Table 1 shows total health expenditure as a percentage of national GDP. The authors give the list of the countries according to the certain criteria. Switzerland and the Russian Federation are not members of the European Union; Germany, France and Poland are.

Table 1 - Total health expenditures (% of GDP)
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It should be noted that according to experts, the Swiss health care system (Eggli et al., 2019; Vaidya, 2021) is universal and meets the highest standards. Switzerland has one of the highest rates of health care funding. The Swiss Confederation allocated the highest percentage of national GDP to its own health care system which is different from the European-wide health care. For Germany, France and Poland (Lach & Beckerman, 2019) it is typical that health care as an object of legal regulation appears in the European Union legislation only in connection with the Maastricht Treaty (1993). This treaty defines the legal platform that allows the European Union to take legal measures and unify approaches in the development of national public health system. The Russian Federation has its own national health care system (Gerry et al., 2017) which has been in reform mode in recent years. Nevertheless, Russia actively cooperates with European Commission for health and sustainable development of the World Health Organization Regional Office for Europe. In this regard the work to harmonize the national normative legal framework in the health care sphere should be done by Russian legislation on the basis of global trends. To this end, the Russian Federation uses sustainable methodologies of the World Health Organization. Russian updated medical legislation is based on fundamental national and global principles, such as legal regulation of medical care and legal regulation in establishing progressive standards of public medical care. International health care experts point out that one of the quality indicators of public health care is the level of development of national health insurance. In this regard, we are interested in the experience of Switzerland as the owner of the most modern and legally regulated health insurance. Table 2 shows the Swiss model of the health insurance structure.

Table 2 - The current health insurance model structure in the Swiss Confederation
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The difference between Swiss health insurance and the countries of the European Union is in the lack of subsidies from tax deductions to the national budget for insurance. The main financial source is the system of health insurance premiums paid by citizens. To control the public relations in the medical insurance system is the duty of Federal health care department. The state provides social and economic support to certain categories of low-income citizens by reducing the cost of insurance. Insurance covers 90% of medical expenses. The obligations of insured persons include an independent annual payment that are not covered by the insurance. This amount is usually 10 % of medical services cost. All insurers are mandated to recognize citizens as subjects of insurance, regardless of age and established chronic diseases. It is noteworthy that Swiss medical insurance covers separate types of alternative medicine such as homeopathy, different types of Chinese medicine as well as phytotherapy. The attention of experts has recently been drawn to the World Health Organization initiative on the implementation of IT structures in the national and global health care systems. These information structures are specialized information and communication networks for the timely and rapid exchange of medical information between interested countries and organizations. Innovative technologies as a scientific and technical direction unite all types of information related to public health protection and capable of defining unified approaches to resolving the public health problems.


The conducted studies, their analysis and synthesis lead to the following conclusions and proposals. In this article, the authors singled out countries according to a certain criterion: Switzerland and the Russian Federation are not members of the European Union; Germany, France and Poland are members of the European Union. The states represented are interested in securing national interests and implementing national health priorities. In this regard, a methodology should be devised for improving operational collaboration in resolving critical issues of providing high-technology health care to the population of these countries through bilateral and multilateral interaction. Taking into consideration that the effectiveness of the health care systems is defined by the scope of their funding, some countries should reconsider the balance of methods for increasing the financial provision of high-quality public medical services. Only in this way, the state will be able to ensure equal guarantees in the protection of public health and access to quality health services and innovation in the promoting of sustainable health care systems. The harmonization of legal regulation in order to determine the appropriate medical support modalities and establish up-to-date health care standards is a new trend in international cooperation. In this area, the work of the World Health Organization is particularly noteworthy in developing the range of measures in order to form the basic principles of the creation and functioning of a sustainable international health system by integrating the conceptual framework for public health development in various states. Indicators of the public health level depending on the effectiveness of social and economic policies of each state are common to the public health of any country in accordance with international standards. The legislator should pay special attention to the development and implementation of preventive measures in accordance with emerging epidemiological threats. The development of sustainable health care systems is impossible without the formation of the health insurance institution. Progressive types of health insurance should include a combination of public, private (with state support) and entirely private health insurance Basic health insurance should be expanded to include knowledge-intensive methods in the practice of emergency, outpatient and inpatient medical care. As a result of the analysis of the materials studied, significant differences in the practice of infectious disease treatment, pharmaceutical support, and other types of medical activity were identified. The development of modern medicine as a branch requires systemic and in-depth approaches in the convergence of the advances in natural sciences with the discoveries in information and communication technologies that form the theoretical and applied framework for building sustainable health care systems that meet the needs of today’s world.


  • Abbas, J. (2021). Crisis management, transnational healthcare challenges and opportunities: The intersection of COVID-19 pandemic and global mental health. Research, 100037.

  • Bertens, R. M., & Vonk, R. A. (2020). Small steps, big change. Forging a public-private health insurance system in the Netherlands. Social Science & Medicine, 266, 113418.

  • Derqui, B., Filimonau, V., & Matute, J. (2021). Assessing the scale of adoption of sustainability practices by community pharmacies in Spain in the time of COVID-19. Sustainable Production and Consumption, 27, 1626–1636.

  • Eggli, Y., Stadelmann, P., Piaget-Rossel, R., & Marti, J. (2019). Heterogeneity in the drivers of health expenditures financed by health insurance in a fragmented health system: The case of Switzerland. Health Policy, 123, 1275–1281.

  • Gerry, C. J., Kaneva, M., & Zasimova, L. (2017). Reforming voluntary drug insurance in Russian healthcare: does social solidarity matter? Health Policy, 121, 1177–1185.

  • Guldbrandsson, K., & Bremberg, S. (2020). Cross-sectoral cooperation at the ministerial level in three Nordic countries – With a focus on health inequalities. Social Science & Medicine, 256, 112999.

  • Gupta, P. (2021). A review: Epidemiology, pathogenesis and prospect in developing vaccines for novel Coronavirus (COVID-19). Indian Journal of Tuberculosis, 68, 92–98.

  • Ippolito, G., Lauria, F.N., Locatelli, F., Magrini, N., & Montaldo, C. (2020). Lessons from the COVID-19 Pandemic—Unique Opportunities for Unifying, Revamping and Reshaping Epidemic Preparedness of Europe’s Public Health Systems. International Journal of Infectious Diseases, 101, 361–366.

  • Lach, K., & Beckerman, R. (2019). Negative HTA recommendations for medicines in neurology therapeutic areas – fourfold higher odds in Poland compared with the United Kingdom. Value in Health, 22, S753–S754.

  • Munier-Marion, E., Bénet, T., Dananché, C., Soing-Altach, S., Maugat, S., & Vaux, S. (2017). Outbreaks of health care–associated influenza-like illness in France: Impact of electronic notification. American Journal of Infection Control, 45, 1249–1253.

  • Naumann, L., Babitsch, B., & Hübner, U. H. (2021). Health policy processes from the stakeholders’ viewpoint: A qualitative comparison between Austria, Switzerland and Germany. Health Policy and Technology, 10, 100505.

  • Negrini, S., Mills, J.-A., Arienti, C., Kiekens, C., & Cieza, A. (2021). The “Rehabilitation Research Framework for COVID-19 patients” defined by Cochrane Rehabilitation and the World Health Organization Rehabilitation Programme. Archives of Physical Medicine and Rehabilitation, 102.

  • Ogbu, U. C., & Arah, O. A. (2017). International Encyclopedia of Public Health (2nd ed.). World Health Organization.

  • Vaidya, S. (2021). The impact of premium subsidies on health plan choices in Switzerland: Who responds to the incentives set by in-kind as opposed to cash transfers? Health Policy, 125.

  • Yang, X., & Lo, K. (2021). Environmental health research and the COVID-19 pandemic: A turning point towards sustainability. Environmental Research, 197, 111157.

  • Zhao, G., Hsia, J., & Town, M. (2021). Health-related behavior and health insurance status among US adults: Findings from the 2017 behavioral risk factor surveillance system. Preventive Medicine, 148, 106520.

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31 January 2022

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Cite this article as:

Makhonko, N. I., Tarasova, E. A., Plotnikova, Y. A., Shvetsova, I. V., Varshamova, N. L., & Yashina, E. V. (2022). Legal Regulation For Sustainable Health Care Systems: International Experience. In S. Afanasyev, A. Blinov, & N. Kovaleva (Eds.), State and Law in the Context of Modern Challenges, vol 122. European Proceedings of Social and Behavioural Sciences (pp. 405-410). European Publisher.