Implementation of the cluster approach in the practice of the territorial organization of health care: theoretical, institutional and practical aspects

Abstract

Introduction. The reform of the health care system in Ukraine ensured the creation of a multi-level provision of medical services, which covered medical institutions of all forms of ownership, which are not only competitors on the regional and local markets, but also had the full opportunity to participate in contractual relations with the National Health Service of Ukraine (NSZU) regarding the provision of medical care packages. Despite the positive consequences of transformational changes, a number of problems arose in the regions regarding the formation of optimal communications between different levels of providing medical services, the availability of services for patients, logistics related to medical care, the effectiveness of the use of budget funds, material and human resources, the availability of special medical care in separate regions (primarily regions of military operations), territorial organization of the network. According to government decisions, to solve these problems, the process of forming hospital districts and hospital clusters has been initiated, which, as practice shows, requires ambiguous management decisions. The above actualizes the problem of scientific support (analytical assessments, monitoring, design of possible further changes) of modern processes of the territorial organization of health care and its public management at the regional and local levels.
 The purpose of the research is a systematic analysis of the processes of cluster formation in health care and, on this basis, the development of theoretical and methodological provisions and justification of directions for further improvement of the established models of territorial organization of the industry.
 Methods. Applied methods of system analysis - to evaluate the process of establishing regulatory and legal prerequisites for starting cluster initiatives in health care, comparative analysis - in order to identify theoretical approaches to the interpretation of the phenomenon of territorial clusters in domestic and foreign scientific opinion. General scientific and empirical methods of economic science are used: methods of analysis and synthesis, comparison, summary and grouping - to identify the potential, opportunities and threats in the implementation of management decisions regarding the further functioning and development of clusters in health care of the regions of Ukraine.
 The results. Using a number of arguments, the expediency of using the cluster approach in the territorial organization of health care has been proven. The process of establishing the institutional basis for the formation of clusters in health care in Ukraine is evaluated. The peculiarities of the organizational structure of the territorial hospital cluster are determined. An empirical analysis of the prerequisites for the formation of hospital clusters in certain regions of Ukraine was carried out. The expected results of the formation of a capable network and the formation of territorial hospital clusters and risks in the implementation of management decisions regarding the selected model of the territorial organization of the medical space are determined. Based on the modeling of the possible influence of institutional, industrial, infrastructural and financial factors on the functioning and development of newly formed structural entities in the health care of the region, possible options for prevention and leveling of negative effects and development of relations between local self-government bodies and medical institutions of various levels are proposed for the purpose of optimization synergistic effect of cluster formation.
 Prospects. It is advisable to focus further scientific research on the issues of monitoring the work of the network of primary and specialized medical care institutions within the framework of newly formed hospital clusters and the introduction of information systems into the practice of strategic and operational management of a capable health care network.