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A bill to establish a comprehensive and universal national healthcare system for the Kodiak Republic; to ensure that all citizens have access to high-quality healthcare services that are free at the point of access; and to provide for the regulation and administration of healthcare services in the Kodiak Republic.

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Article 1 - Definitions

 * 1.1 - This Act may be cited as the "Universal Healthcare Act (651)".
 * 1.2 - In this Act, unless context otherwise requires –
 * 1.2.1 - "the Minister" means the Minister of State for Health and Education, or any person appointed by the Minister to perform the functions of the Minister under this Act;
 * 1.2.2 - "UHS" means the Universal Healthcare Service henceforth established by this Act;
 * 1.3 - In this Act, "primary healthcare" means:
 * 1.3.1 - the services provided at the first point of contact that a person has with the healthcare system;
 * 1.3.2 - including but not limited to General Practice, community pharmacy, denistry, and optometry; and
 * 1.3.3 - any addiitonal preventative, diagnostic, curative, and management services as necessary.
 * 1.4 - In this Act, "secondary healthcare" means:
 * 1.4.1 - the services provided more specialised than those available in primary care;
 * 1.4.2 - including but not limited to emergency care, ambulance services, specialist care provided at a hospital or another specialist centre.
 * 1.5 - In this Act, "tertiary healthcare" means:
 * 1.5.1 - the highest level of medical care that is provided to individuals with complex or specialized health needs;
 * 1.5.2 - including but not limited to complex surgeries, advanced diagnostic procedures, rehabilitation services, and highly specialised care.
 * X - Upon the implementation of this Act, The Public Hospitals and Healthcare Act (635) is henceforth repealed.
 * X - Upon the implementation of this Act, it shall henceforth be illegal to provide any treatment associated with acute illness outside the scope and commission of the UHS within the Kodiak Republic.

Article 2 - Duties of the Minister

 * 2.1 - The Minister shall have the power –
 * 2.1.1 - to establish a national and comprehensive health service that secures the improvement in the physical and mental health of the people of Kodiak;
 * 2.1.2 - to provide such services as they consider appropriate for the purpose of the prevention, diagnosis, and treatment of illness;
 * 2.1.3 - to provide such services as they consider appropriate for the purposes of the implementation of the provisions of this Act;
 * 2.1.4 - to create regulations that may provide for the making and recovery of charges for provisions implemented by this Act.
 * 2.2 - It is the duty of the Minister to provide throughout Kodiak, to such extent as they consider necessary to meet all reasonable requirements of this Act–
 * 2.2.1 - hospital or other necessary accommodation for the provision of healthcare;
 * 2.2.2 - medical, nursing, dental, and ambulance services;
 * 2.2.3 - facilities for the care of pregnant and nursing individuals and young children as they deem appropriate;
 * 2.2.4 - facilities for the prevention of illness, the care of persons suffering from illness, and after-care of persons who have suffered from illness in coordination with the Minister of State for Social Services; and
 * 2.2.5 - any other service or health authority that may be required for the diagnosis and treatment of illness.
 * 2.3 - It shall be the duty of the Minister to afford the provision of medical and dental inspection at appropriate intervals of pupils in attendance at educational centres maintained by local education authorities and for the medical and dental treatment of any such pupil.
 * 2.4 - It shall be the duty of the Minister to afford the provision of family planning services, as they deem is appropriate to meet all reasonable requirements of this Act:
 * 2.4.1 - advice on contraceptive methods;
 * 2.4.2 - medical examination of persons seeking advice on contraceptive methods;
 * 2.4.3 - the treatment of such persons; and
 * 2.4.4 - the supply of contraceptive substances and appliances, including the making and recovery of charges for such substances and appliances.
 * 2.5 - It shall be the duty of the Minister to bring before the General Assembly a report on the functioning of the UHS, where it is deemed appropriate and reasonable by the Minister and the Executive that such a report would not compromise the national interests of the Kodiak Republic.

Article 3 - Provision of funds

 * 3.1 - The Minister may allocate funding to the UHS as they deem necessary to fulfill all obligations and provisions outlined by this act.
 * 3.1.1 - Upon the implementation of this Act, the UHS will be granted a budget of ₣18.5 billion for the first year and will be henceforth subject to yearly budget review.
 * 3.2 - This Act will introduce a new flat income levy of 2% on all citizens who –
 * 3.2.1 - earn over 15,000 per fiscal year; and
 * 3.2.2 - are over the age of 18.
 * 3.3 - Any persons who independently finance a private health insurance plan may apply for a tax rebate equal to the cost of their insurance premium not exceeding an amount of ₣1,000 per annum.

Article 4 - Entitlement to access

 * 4.1 - All persons within the territories of Kodiak shall have a natural and uninfringeable right to access the services of the UHS.
 * 4.2 - All residents of Kodiak shall have access to the services of the UHS that are free at the point of contact.
 * 4.2.1 - Residents may be required to make co-payments towards any such services they have accessed as is deemed appropriate by the Minister through the creation of regulation under subsection 2.1.4.

Article 5 - Abolition of previous health authorities

 * 5.1 - With the implementation of this Act, all prior local health authorities will be henceforth dissolved.
 * 5.1.1 - This dissolution shall take place gradually over the course of a period not exceeding one year to allow for the creation of new authorities and the transfer of facilities, staff, property, and associated assets to such new authorities.
 * 5.2 - The staff, property, and associated assets of former local health authorities shall be divided between the Minister and local governing authorities such that –
 * 5.2.1 - facilities, staff, property, and associated assets for the provision of primary, secondary, or tertiary healthcare are transferred to the Minister; and
 * 5.2.2 - facilities, staff, property, and associated assets for the provision of community and social care are transferred to the local governing authorities.
 * 5.3 - Any facilities, staff, property, or assets transferred to the Minister will be distributed to the necessary parties according to the provisions of this Act.

Article 6 - National Health Authority

 * 6.1 - There shall be established by the Minister a National Health Authority, henceforth referred to as the NHA, which shall be an executive non-departmental public body under the Ministry of State for Health and Education, for the purposes of –
 * 6.1.1 - the oversight of the general operation and function of the UHS;
 * 6.1.2 - ensuring the overall quality and consistency of healthcare services provided by the UHS and overseeing the management of UHS trusts;
 * 6.1.3 - outlining an overall direction and providing administrative function for the UHS;
 * 6.1.4 - overseeing the national distribution of funding, facilities, staff, property, and associated assets afforded to the UHS by the Minister;
 * 6.1.5 - overseeing the donation, storage and transportation of the supply of blood, organs, tissues and stem cells for use in the provision of healthcare services.;
 * 6.1.6 - ensuring the adequate provision of high-quality training to further develop the clinical workforce; and
 * 6.1.7 - providing statistical information to support the health and care systems of the Kodiak Republic;
 * 6.2 - The NHA shall be empowered to –
 * 6.2.1 - take any reasonable action that is deemed necessary to ensure adequate provision of the purposes of the NHA as outlined in subsections 6.1.1-6.1.7;
 * 6.2.2 - take any reasonable action on behalf of the Minister to ensure the proper implementation fo the provisions of this Act;
 * 6.2.3 - commission specialist healthcare provision where it is appropriate due to the rarity or complexity of the diagnosis, treatment, or management of an illness or condition such that the commission of these services is only practical on a national scale; and
 * 6.2.4 - regulate and license medications, substances, and appliances for distribution within Kodiak, including –
 * 6.2.4.1 setting limits on the maximum pricing that any healthcare provider may be charged for the purchase of such items; and
 * 6.2.4.2 providing guidance for practitioners and healthcare providers on best practices for the implementation of such items to ensure a consistent national standard of practice.

Article 7 - Provincial Health Authorities

 * 7.1 - There shall be established by the Minister Provincial Health Authorities, henceforth referred to as PHAs, for each province of the Kodiak Republic for the purpose of –
 * 7.1.1 - overseeing the administration of Local Health Authorities;
 * 7.1.2 - providing support to Local Health Authorities;
 * 7.1.3 - coordinating the resources of the Local Health Authorities within any given province such that funding and provision are distributed in a way that reduces health inequalities; and
 * 7.1.4 - facilitating the integration of the UHS, local governing authorities, charitable organisations, private healthcare service providers, and other stakeholders in the provision of healthcare within a province.
 * 7.2 - The PHAs shall be empowered to –
 * 7.2.1 - commission the provision of primary healthcare from primary healthcare providers through the use of Primary Health Service Contracts;
 * 7.2.2 - establish and oversee the administration of Clinical Advisory Committees as necessary to inform and advise Local Health Authorities; and
 * 7.2.3 - provide delegates to aid in contract negotiations with healthcare service providers on behalf of Local Health Authorities.

Article 8 - Local Health Authorities

 * 8.1 - There shall be established by the Minister Local Health Authorities, henceforth referred to as LHAs, for each constituency within the Kodiak Republic for the purpose of –
 * 8.1.1 - commissioning secondary and tertiary care on a local level;
 * 8.1.2 - ensuring the delivery of adequate healthcare services to meet the needs of the local population;
 * 8.1.3 - developing and implementing local healthcare policies and plans, in conjunction with the relevant Provincial Health Authority; and
 * 8.1.4 - coordinating the resources of the UHS, local governing authorities, charitable organizations, private healthcare service providers, and other stakeholders in the provision of healthcare within a constituency.
 * 8.2 - The LHAs shall be empowered to –
 * 8.2.1 - commission secondary and tertiary care from healthcare providers through the use of Secondary and Tertiary Care Service Contracts;
 * 8.2.2 - work in collaboration with their respective Provincial Health Authority to ensure the adequate distribution of resources and funding; and
 * 8.2.3 - request the support of Clinical Advisory Committees as necessary to inform and guide the commissioning of secondary and tertiary care.

Article 9 - Clinical Advisory Committees

 * 9.1 - The Minister shall establish Clinical Advisory Committees, henceforth referred to as CACs, for the purpose of –
 * 9.1.1 - providing clinical advice for LHAs, PHAs, and NHA;
 * 9.1.2 - advising on the commissioning of specialist services and treatments;
 * 9.1.3 - ensuring the best utilization of healthcare resources; and
 * 9.1.4 - guiding the bodies of LHAs, PHAs, and NHA to make the best clinical decisions.
 * 9.2 - The CACs shall be composed of –
 * 9.2.1 - clinical experts and specialists from relevant fields of medicine and healthcare;
 * 9.2.2 - representatives of the relevant LHAs, PHAs, and NHA; and
 * 9.2.3 - other stakeholders as deemed appropriate by the Minister.
 * 9.3 - The CACs shall be empowered to –
 * 9.3.1 - provide clinical advice and guidance to LHAs, PHAs, and NHA;
 * 9.3.2 - provide recommendations for the commissioning of specialist services and treatments;
 * 9.3.3 - ensure the best utilization of healthcare resources; and
 * 9.3.4 - ensure the implementation of best clinical practices.

Article 10 - UHS Hospital Trusts

 * 10.1 - There shall be established by the Minister, a number of publicly owned corporate bodies to be henceforth referred to as UHS Hospital Trusts, as the Minister deems appropriate and reasonable, for the purpose of providing high-quality, hospital-based secondary and tertiary healthcare services to the people of the Kodiak Republic upon the commission of such services by the empowered authority.
 * 10.2 - The UHS Hospital Trusts shall be empowered to –
 * 10.2.1 - acquire, hold, and dispose of property and assets, both moveable and immoveable;
 * 10.2.2 - appoint and employ staff, including medical, nursing, and administrative staff;
 * 10.2.3 - receive donations and funding through private means; and
 * 10.2.4 - enter into contracts for the provision of healthcare services both secondary and tertiary to the public with the relevant commissioning body.
 * 10.3 - Each UHS Hospital Trust shall consist of –
 * 10.3.1 - a board of directors, consisting of no more than nine members, five of which must be non-executive directors, all to be appointed by the NHA;
 * 10.3.2 - a Chief Executive Officer, to be appointed by the board of directors; and
 * 10.3.3 - other officers and employees, to be appointed by the board of directors, as required for the efficient performance and function of the UHS Hospital Trust.
 * 10.4 - A UHS Hospital Trust cannot –
 * 10.4.1 - provide any such healthcare service that is funded by private means, including co-payments; or
 * 10.4.2 - provide any such healthcare service that it is not commissioned for by contract with a relevant empowered authority.

Article 11 - UHS Teaching Hospital Trusts

 * 11.1 - There shall be established by the Minister, a number of publicly owned corporate bodies to be henceforth referred to as UHS Teaching Hospital Trusts, as the Minister deems appropriate and reasonable, for the purposes of –
 * 11.1.1 - providing high-quality, hospital-based secondary and tertiary healthcare services to the people of the Kodiak Republic upon the commission of such services by the empowered authority; and
 * 11.1.2 - providing high-quality, hospital-based clinical education for students of clinical subjects requiring practical placement at associated State Universities as established by the Kodiak Higher Education Rebuild Package (649).
 * 11.2 - The UHS Teaching Hospital Trusts shall be empowered to –
 * 11.2.1 - enact all powers of UHS Hospital Trusts as outlined in 10.2.1 - 10.2.4; and
 * 11.2.2 - appoint and employ relevant staff for the instruction, mentorship, and teaching of students.
 * 11.3 - Each UHS Teaching Hospital Trust shall consist of –
 * 11.3.1 - a board of governors, consisting of no more than nine members, five of which are to be appointed by the NHA, the remaining four by the combined decision of any associated State Universities;
 * 11.3.2 - a Chief Executive Officer, to be appointed by the board of governors; and
 * 11.3.3 - other officers and employees, to be appointed by the board of governors, as required for the efficient performance and function of the UHS Teaching Hospital Trust.
 * 11.4 - A UHS Teaching Hospital Trust cannot –
 * 11.4.1 - provide any such healthcare service that is funded by private means, including co-payments; or
 * 11.4.2 - provide any such healthcare service that it is not commissioned for by contract with a relevant empowered authority.

Article 12 - UHS Emergency Trusts

 * 12.1 - There shall be established by the Minister, only where absolutely necessary, and under the guidance of a committee consisting of members from the Ministry of Health and Education, the NHA, and the relevant PHAs and LHAs, a number of publicly owned corporate bodies to be henceforth referred to as UHS Emergency Trusts, as such a committee deems appropriate and reasonable, for the purpose of providing high-quality, hospital-based emergency healthcare services to the people of the Kodiak Republic upon the commission of such services by the empowered authority.
 * 12.2 - The UHS Emergency Trusts shall be empowered to –
 * 12.2.1 - acquire, hold, and dispose of property and assets, both moveable and immoveable;
 * 12.2.2 - appoint and employ staff, including medical, nursing, and administrative staff;
 * 12.2.3 - receive donations and funding through private means; and
 * 12.2.4 - enter into contracts for the provision of emergency healthcare services to the public with the relevant commissioning body.
 * 12.3 - Each UHS Emergency Trust shall consist of –
 * 12.3.1 - a board of directors, consisting of no more than nine members, five of which must be non-executive directors, all to be appointed by the NHA;
 * 12.3.2 - a Chief Executive Officer, to be appointed by the board of directors; and
 * 12.3.3 - other officers and employees, to be appointed by the board of directors, as required for the efficient performance and function of the UHS Hospital Trust.
 * 12.4 - A UHS Hospital Trust cannot –
 * 12.4.1 - provide any such healthcare service that is funded by private means, including co-payments; or
 * 12.4.2 - provide any such healthcare service that it is not commissioned for by contract with a relevant empowered authority; and
 * 12.4.3 - enter into contracts for the provision of any healthcare service beyond the scope of providing hospital-based emergency care.

Article 13 - UHS Ambulance Trusts

 * 13.1 - There shall be established by the Minister, a number of publicly owned corporate bodies to be henceforth referred to as UHS Ambulance Trusts, as the Minister deems appropriate and reasonable, for the purposes of
 * 13.1.1 - providing high-quality, pre-hospital, emergency healthcare services to the people of the Kodiak Republic upon the commission of such services by the relevant empowered authority; and
 * 13.1.2 - providing high-quality, clinical education for students of clinical subjects requiring practical placement at associated State Universities as established by the Kodiak Higher Education Rebuild Package (649).
 * 13.2 - The UHS Ambulance Trusts shall be empowered to –
 * 13.2.1 - acquire, hold, and dispose of property and assets, both moveable and immoveable;
 * 13.2.2 - appoint and employ staff, including medical, nursing, administrative, and teaching staff;
 * 13.2.3 - receive donations and funding through private means; and
 * 13.2.4 - enter into contracts for the provision of pre-hospital emergency healthcare services to the public with the relevant commissioning body.
 * 13.3 - Each UHS Ambulance Trust shall consist of –
 * 13.3.1 - a board of directors, consisting of no more than nine members, five of which must be non-executive directors, all to be appointed by the NHA;
 * 13.3.3 - a Chief Executive Officer, to be appointed by the board of directors; and
 * 13.3.4 - other officers and employees, to be appointed by the board of directors, as required for the efficient performance and function of the UHS Ambulance Trust.
 * 13.4 - A UHS Ambulance Trust cannot –
 * 13.4.1 - provide any such healthcare service that is funded by private means, including co-payments; or
 * 13.4.2 - provide any such healthcare service that it is not commissioned for by contract with a relevant empowered authority.

Article 14 - Transfer of assets from the Minister

 * 14.1 - Upon the establishment of a UHS Trust, it shall be the duty of the Minister to transfer to said UHS Trust all facilities, property, staff, and associated assets that had been transferred to the Minister under subsection 5.1 of this Act, as is deemed relevant and appropriate for the establishment and effective function of said UHS Trust under the guidance of the NHA.
 * 14.2 - Wherein the Minister has authority over the facilities, property, staff and associated assets of an emergency department that was formerly owned by a private care institution prior to the, it shall be the duty of the minister to create a committee to take action to –
 * 14.2.1 - create a UHS Emergency Trust to which the facilities, property, staff, and associated assets shall be transferred, in the case and only the case that there are multiple such emergency departments which can be transferred to such a UHS Emergency Trust within a reasonable geographic area; or
 * 14.2.2 - return the facilities, property, staff, and associated assets to the private institution under a Special Health Service Contract commissioned by the NHA, wherein the private hospital must provide all services associated with emergency care and acute illness under UHS commission.

Article 15 - Health Service Contracts

 * 15.1 - The UHS will be authorised to commission the provision of healtchare services from providers through Health Service Contracts (HSCs) which shall be awarded by the appropriate health authority.
 * 15.2 - HSCs shall be legally binding agreements between a healthcare service provider and the commissioning authority.
 * 15.2 - There shall be four categories of HSCs:
 * 15.2.1 - Primary HSCs shall be awarded for the provision of primary healthcare services;
 * 15.2.2 - Secondary HSCs shall be awarded for the provision of secondary healthcare services;
 * 15.2.3 - Tertiary HSCs shall be awarded for the provision of tertiary healthcare services; and
 * 15.2.4 - Special HSCs shall be awarded for the provision of any additional specialist services.
 * 15.3 - HSCs shall be awarded for a set duration not exceding five years, and may be renewed or renegotiated upon expiration.
 * 15.4 - Any healthcare service provider that enters into a HSC –
 * 15.4.1 - must comply with all terms and conditions outlined in any HSCs they are bound by, as well as adhering to all relevant laws, regulations, and guidelines established by the Minister and the NHA; and
 * 15.4.2 - shall be subjected to regular quality assurance inspections at the discretion of the NHA in all services provided, including those services which are not under commission by any UHS body.
 * Failure to comply with 15.4.1 or 15.4.2 may result in the termination of any and all HSCs awarded to the provider.

Written by Tom Westbrook, Minister of Health and Education.