Ukraine:Health system context

In 2014,public spending accounted for 50.8% of total spejnding on health,with OOP payments and VHI accounting for 46.2 and around 1%,respective(WHO,2016)

Substantiation of components of availability and integration of primary health care associated with ambulatory care sensitive conditions in Ukraine

The study lists and assesses the impact of the main components of primary care availability and its integration withsecondary care associated with ambulatory care sensitiveconditions that can be used for potentially preventablehospitalizations. Te study showed the directions of prioritization of measures aimed at strengthening the primaryhealth care system in Ukraine. Te results of the study canbe used to develop a specifc action plan for further reformof primary health care, the implementation of which willreduce rates of ambulatory care sensitive hospitalizationsand increase the efcient use of limited resources withina health care system of Ukraine

Global burden of disease due to ambulatory care sensitive conditions, 1990-2019

Disability-adjusted life years (DALYs) due to ACSC over 30 years in Ukraine averaged 5145.4 years per 100,000 population (95% CI 4731.1 -5559.7), which is approximately 14% of DALYs of all reasons without a clear trend of change - compound annual growth rate (CARG) of 0.14%. These five causes – angina pectoris, chronic obstructive pulmonary diseases (COPD), lower respiratory infections, diabetes, and tuberculosis – account for 90% of the disease burden associated with ACSCs. There was an increasing trend in DALYs (CARG varied for different ACSCs in the range of 0.59-1.88%), except for COPD, where the decrease in CARG reached -3.16%. This longitudinal study found a small trend toward increased DALYs due to ACSCs. State measures to influence modified risk factors to reduce the burden of losses from ACSCs proved to be ineffective. To significantly reduce DALYs, a more clear and more systematic healthcare policy regarding ACSCs is needed, which includes a set of primary prevention measures, and organizational and economic strengthening of the primary healt

Reforming the Ukrainian Health System at a time of crisis

Ukraine has retained the extensive Semashko model health care system it inherited on gaining independence from the Soviet Union in 1991 and it is largely unreformed. A large proportion of total health expenditure is paid out of pocket (42.8% in 2013) and households face inadequate protection from impoverishing and catastrophic health care costs. These weaknesses have been exacerbated by the strain of caring for conlict-affected populations since 2014. The government faces the challenge of implementing fundamental reform in the health care system to rebuild universal health coverage against a background of resource constraints and ongoing conlict

Ukraine: Health system review. Health Systems in Transition

This analysis of the Ukrainian health system reviews recent developments in organization and governance, health financing, health care provision, health reforms and health system performance. Since the country gained independence from the Soviet Union in 1991, successive governments have sought to overcome funding shortfalls and modernize the health care system to meet the needs of the population’s health. However, no fundamental reform of the system has yet been implemented and consequently it has preserved the main features characteristic of the Semashko model; there is a particularly high proportion of total health expenditure paid out of pocket (42.3% in 2012), and incentives within the system do not focus on quality or outcomes. The most recent health reform programme began in 2010 and sought to strengthen primary and emergency care, rationalize hospitals and change the model of health care financing from one based on inputs to one based on outputs. Fundamental issues that hampered reform efforts in the past re-emerged, but conf lict and political instability have proved the greatest barriers to reform implementation and the programme was abandoned in 2014. More recently, the focus has been on more pressing humanitarian concerns arising from the conflict in the east of Ukraine. It is hoped that greater political, social and economic stability in the future will provide a better environment for the introduction of deep reforms to address shortcomings in the Ukrainian health system

Assessment of appropriateness of hospitalisations in Ukraine: analytical framework, method and fndings

The proposed method is robust in assessing the appropriateness of hospitalisations and duration of inpatient stays. The quantifed levels of unnecessary hospital care indicate the need for improving effciency and quality of care and optimising the excessive hospital capacities in Ukraine

National health expenditure trends, 2000 to 2019

The aim: To assess the lo n g-term dynam ics o f health spending in Ukraine from the standpoint o f readiness to m ake progress in the universal health coverage (UHC) Materials and methods: Data from the Global Health Expenditure D atabase, European H ealth for All database, World Bank Open Data, collected du rin g 2 000-2019 were used. The research w as conducted using bibliosem antic, historical m ethods and benchm arking. Results: All indicators o f health spending in Ukraine show ed som e gro w th: total and governm ent health spending o f % Gross D om estic Product (GDP) by 3 4 % (9 5 % CI 13-55) and 2 8 % (9 5 % CI 8 -4 8 ), total and governm ent health sp en d in g per capita in US $ by 7.1 and 6.5 tim es and in Purchasing pow er parity (PPP) - by 4 and 3.8 tim es. Growth was interrupted during the glo b al (2008) and national (2017-2019) financial crises. O u t-of-pocket sp en d in g in Ukraine grew and am ounted to 5 1 .1 % in 2019, w h ich is by 2.1 tim es m ore than in the European region - 2 4 .0 % (15.5; 36.6). In 2019 Ukraine ranked am o n g 1 0 % o f the countries w ith the worst com bination o f governm ent health spending per share o f GDP and share o f OOPS in total health spending. Conclusions: The study found an u nsustainable upw ard dyn am ic in health spen d in g. In the last decade, there has been a clear trend tow ards an increase % OOPS in total health sp en d in g a gain st low, aim ed at reducing governm ent health sp en d in g as % o f GDP, w h ich could n egatively affect UHC

Ukraine: Health system review.

The HiT profiles are country-based reports that provide a detailed description of a health system and of policy initiatives in progress or under development. HiTs examine different approaches to the organization, financing and delivery of health services and the role of the main actors in health systems; describe the institutional framework, process, content and implementation of health and health care policies; and highlight challenges and areas that require more in-depth analysis. The Ukrainian health system has preserved the fundamental features of the Soviet Semashko system against a background of other changes, which are developed on market economic principles. The transition from centralized financing to its extreme decentralization is the main difference in the health system in comparison with the classic Soviet model. Health facilities are now functionally subordinate to the Ministry of Health, but managerially and financially answerable to the regional and local self-government, which has constrained the implementation of health policy and fragmented health financing. Health care expenditure in Ukraine is low by regional standards and has not increased significantly as a proportion of gross domestic product (GDP) since the mid 1990s; expenditure cannot match the constitutional guarantees of access to unlimited care. Although prepaid schemes such as sickness funds are growing in importance, out-of-pocket payments account for 37.4% of total health expenditure. The core challenges for Ukrainian health care therefore remain the ineffective protection of the population from the risk of catastrophic health care costs and the structural inefficiency of the health system, which is caused by the inefficient system of health care financing. Health system weaknesses are highlighted by increasing rates of avoidable mortality. Recent political impasse has complicated health system reforms and policy-makers face significant challenges in overcoming popular distrust and fatigue in the face of necessary but as yet unimplemented reforms

INFLUENŢA CALITĂŢII SERVICIILOR MEDICALE ASUPRA CONSUMULUI DE RESURSE SANITARE

BACKGROUND: It is considered. that quality health care, compared with low quality, should cost more expensive. International scientific researches prove that high quality of care can save resources; low quality, on the contrary, is more resource-intensive. AIM: A comprehensive study of the factors, reasons and components of resources cosns is associated with low quality of care for the further development of measures to reduce it. METHODS: Using a systems approach and analysis, bibliographic method, graphical method for determining the cause-and-effect relationships between the factors and consequences (Ishikawa diagram), method of conceptual modeling allowed to process more than 500 sources, 86 of which, were selected for in-depth study. RESULTS: As a result, comprehensive analys of components of the costs associated with low quality of care, found that it should be considered at the micro and macro level,in health care system (health care costs and the costs associated with the shortcomings of the system, respectively) and outside (costs of patients, their families and the cost of society). Among the shortcomings of health care system, most of problems are associated with fragmentation of activities . CONCLUSION: Improving quality of care is closely associated with improving health system efficiency and cost savings. Keywords: Health Care Quality, Health Care System, Health Care Economics and Organizations, Costs.CONTEXT: Se consideră că asistența medicală de calitate, în comparație cu una de o calitate scăzută, ar trebui să fie mai scumpă. Cercetările științifice internaționale demonstrează că îngrijirile de înaltă calitate pot economisi resursele; o asistență medicală de calitate scăzută, dimpotrivă, este mult mai consumatoare de resurse. SCOP: Efectuarea unui studiu comprehensiv cu privire la cauzele, componentele de cost a resurselor și factorii asociați cu o calitate scăzută a îngrijirii medicale, în vederea dezvoltării ulterioare a măsurilor de reducere a acestora. METODE: S-a utilizat o abordare sistematică ce a cuprins: metoda bibliografică; metoda grafică pentru determinarea relațiilor cauză-efect între factori și consecințe (diagrama Ishikawa); respectiv metoda de modelare conceptuală ce au permis să se proceseze mai mult de 500 de surse, dintre care 86 au fost selectate pentru studiul detaliat. REZULTATE: Ca rezultat, analiza comprehensivă a componentelor costurilor asociate cu o calitate scăzută a îngrijirilor, a arătat că aceasta ar trebui să fie luată în considerare la nivel micro și macro, în sistemul de asistență medicală (costurile de îngrijire a sănătății și, respectiv, costurile asociate cu deficiențele sistemului) cât și în afara acestuia (costurile pacienților, familiile lor și costul societății). Printre deficiențele sistemului de asistență medicală, cele mai multe probleme sunt asociate cu fragmentarea activităților. CONCLUZIE: Îmbunătățirea calității asistenței medicale este strâns legată de îmbunătățirea eficienței sistemului de sănătate și de reducerea costurilor. Cuvinte cheie: Calitatea Îngrijirilor de Sănătate, Sistem de Sănătate, Economie și Organizare Sanitară, Costur

Personal potential successof the modern health care manager

The purpose of the article was to study the psychological components of the personal potential of the success of the health care manager at the present stage of industry modernization and the formation of new archetypes of management. A psychodiagnostic survey of 65 managers of healthcare institutions in the Dnipropetrovsk region was conducted. It was determined that it is possible and necessary to influence the formation of a modern archetypal management strategy in health care, since this is the key to successful transformation of the industry. З метою визначення психологічних складових особистісного потенціалу успішності керівника охорони здоров’я на сучасному етапі модернізації галузі та формування нових архетипів управління проведено психодіагностичне обстеження 65 керівників закладів охорони здоров’я Дніпропетровської області. Визначено, що можливо і необхідно впливати для формування сучасної архетипічної стратегії управління в охороні здоров’я, оскільки це є запорукою успішної трансформації галузі. С целью определения психологических составляющих личностного потенциала успешности руководителя здравоохранения на современном этапе модернизации отрасли и формирования новых архетипов управления проведено психодиагностическое обследование 65 руководителей учреждений здравоохранения Днепропетровской области. Определено, что возможно и необходимо воздействовать на формирование современной архетипической стратегии управления в здравоохранении, поскольку это является залогом успешной трансформации отрасли