ANALYSIS OF PATTERNS OF THE FINANCIAL SUPPORT OF THE HEALTH CARE SYSTEM IN UKRAINE UNDER DECENTRALIZATION REFORM AND THE COVID-19 PANDEMIC

Abstract

In Ukraine, the coronavirus disease (COVID-19) pandemic partially overlapped in time with such critically important transformational processes as the second stage of the financial decentralization reform and the integration stage of the health care system reform. In this regard, the study of the main peculiarities of the change in the model of financial support of the health care system in Ukraine in these conditions, as well as the determination of which of these processes had the greatest impact on the volatility of the health care public expenditures, becomes relevant. The research involves the implementation of two stages - bibliometric analysis and statistical analysis. According to the results of the bibliometric analysis of Scopus publications concerning financial support of the health care system and COVID-19, six contextual clusters of scientific research were identified, focused on determining the impact of health care expenditures on the effectiveness of anti-coronavirus measures, age, gender, social and medical prerequisites and consequences of the spread of the COVID-19, relationship between the cost of medical services and outpatient treatment, socioeconomic, financial-economic and institutional prerequisites for ensuring the quality of the health care system and its resistance to shocks caused by the pandemic, key determinants, tools and measures to combat the spread of COVID-19. As part of the second block of bibliometric analysis, aimed at identifying the relationship between health care expenditures and decentralization reforms, five contextual clusters are identified, which are focused on the study of approaches and models to optimize health care expenditures taking into account socio-demographic factors and decentralization reform priorities, fiscal, economic and ecological determinants and factors of public health, age and geographical prerequisites that determine the peculiarities of the formation of the health care financing system, the influence of micro-financial and managerial prerequisites for financial assurance of the quality of the health care system I, effectiveness of insurance medicine. According to the results of the statistical analysis, it is established that during the period of active implementation of the financial decentralization reform (2015-2018), the share of health care expenditures in the State Budget of Ukraine was relatively stable and fluctuated within 2%, while in 2019 the share of this group of expenditures has been increased to the level of almost 3.6%. At the same time, there was a reduction in health care expenditures in the expenditures of local budgets of Ukraine: during 2015-2019, their share gradually decreased by 3-5% annually, and in 2020-2021, the reduction amounted to almost 33% and 45% to the level the previous year respectively. The specific weight of this group of expenditures in the Consolidated Budget of Ukraine is relatively stable (9–11.1%). In general, according to the results of the analysis, it can be noted that the reform of financial decentralization did not lead to a significant transformation of the structure of spending powers, while the medical reform and the COVID-19 pandemic caused a redistribution of the expenditure burden in the field of health care from the local to the state budget, although the specific weight of these expenses in the structure of the Consolidated Budget of Ukraine did not increase significantly even during the pandemic period.