Integrating psychophysiological technologies for stress management: Challenges and solutions in the Ukrainian healthcare system

This article analyzes the mechanisms of legal support for the training of professional and managerial staff for the pathology service and the health care system of Ukraine. There is also analyzed regulatory and legal support of public policy on training for the health care system and pathology service in Ukraine. There is in study result was revealed that the formation of public policy on training for the health care system in Ukraine involves the creation of legal, organizational, and other conditions that determine the formulation of legal acts for regulating these activities and appears in the study of organizational and regulatory framework of such policy. It is also proven that the regulation of the process forming public policy of on the training of professional and managerial staff for the health care system requires the existence of both laws and regulations acts. Keywords: pathological anatomical service, normative-legal regulation, personnel of pathological anatomical service, leading personnel of the health care system.

Introduction. An important component of an effective health care system both in Ukraine and in the world is timely access of the population to medical services, especially for patients with chronic diseases. In the conditions of a full-scale war between Russia and Ukraine, this problem is gaining significant relevance. Purpose and objectives of the article. The purpose of the article is to analyse the population's access to medical services in the health care system in Ukraine in the conditions of a full-scale war between Russia and Ukraine. Method (methodology). An interdisciplinary approach was applied, which includes system analysis, content analysis of scientific sources, empirical modelling and comparative analysis. Results. The article analyses the general dynamics of the population's access to medical care in the presence of chronic diseases in patients in 2022–2024, characterizes the main problems and obstacles to access to medical services for the population with chronic diseases in 2023, analyses access to medical care for chronic diseases depending on the status of the displaced person (with their differentiation into internally displaced persons and those who remained in their native communities) in 2022–2024.

The article proposes scientific and methodological provisions regarding the evaluation of the effectiveness of the health care system of Ukraine in the conditions of accelerated development of medical innovative technologies. This model is based on the application of neural network modeling tools. The application of the developed model of the evaluation of the effectiveness of the health care system makes it possible to identify the state of public financing of health care and the research and development, to cover a large amount of data and to carry out a comparative analysis of national health policy in terms of the developed countries of the world. During the formation of the neural network model, the relationship between the different factors and the level of GDP is established. For the purposes of the present study, the results of the Ukraine’s social, economic, innovation policy for 2000-2017 have been used as the most predictable element of available data on impact on GDP growth. The proposed methodological provisions make it possible to predict the best option for the development of the health care system and the research and development work in Ukraine, facilitate the possibility of making informed decisions regarding the health policy, optimize the management decision-making regarding the future directions of the research and development work. Public healthcare financing and research and development financing have the biggest influence over the GDP growth. The increase of expenditures of the state budget on public healthcare and research and development is important for socio-economic and innovative growth of Ukraine. The main provisions can be adopted by an executive bodies of the government of Ukraine, local and regional authorities of the national economy. The analysis is the basis for formation of methodological approaches to evaluation of the effectiveness of health care system and other spheres of economic activity and creation of strategies and programs for development of health care system and innovative activity of Ukraine at different hierarchical levels.

The functioning of the health care system is undergoing reform, which requires a detailed study of its formation and functioning at the current stages. The authors conduct an analysis of the organizational structure of the health care system, including levels of management, medical facilities, funding, and human resources. The article examines the organization of management levels in the health care system of Ukraine, including the Ministry of Health, regional and local governing bodies, and medical institutions at the level of cities, villages, and regions. The role and functions of each level of management, their interaction and responsibility in regulating and coordinating the activities of the health care system are described. The financing of the health care system in Ukraine is also analyzed, including sources of financing, mechanisms for the distribution of funds, financial stability, and challenges faced by the health care financing system in the country. The article examines in detail the organization and functioning of medical institutions in the health care system of Ukraine, including hospitals, polyclinics, dispensaries and other medical institutions. The authors describe the role and functions of various medical institutions, their interaction and the organization of the provision of medical services at different levels of the health care system. In addition, the personnel potential of the healthcare system of Ukraine is considered, including personnel resources, training and qualification of medical personnel. Describes the role of medical personnel in the health care system, including doctors, nurses, pharmacists, and other health workers. Challenges and prospects in the field of development of personnel potential of the health care system in Ukraine are analyzed. Attention is drawn to the challenges and prospects of reforming the health care system in Ukraine, including the role of regulation, financing, organization of medical facilities, and development of personnel potential. The authors draw conclusions about the need for further efforts to improve the functioning of the health care system in Ukraine, in particular by expanding access to medical services, improving the quality of medical care, effective use of financial resources, and development of human resources.

Introduction. In the conditions of COVID-dependent socio-economic space, martial law, energy and economic crisis threats, it is important to support and ensure resistance to challenges, search for new opportunities for business initiatives, in particular for the health care system of Ukraine. Problem Statement. In the process of reforming the health care system of Ukraine, in addition to changes in the eco-environment of medical organizations, the medical sector has faced a number of crises which are the trigger for the implementation of a radically new approach to conducting business. The use of an entrepreneurial pillar will lay the foundation for the implementation and management of strategic changes in the medical sector. The purpose of the article is to determine the prerequisites for reforming the health care system of Ukraine and the inertial direction of its development in modern economic conditions. Materials and methods. In the process of writing the article, methods of general scientific, empirical and theoretical knowledge were used. They found their place in considering the historical stage of the health care system, providing comparative characteristics, the analysis of current eco-environment situation and so on. Results. The article considers the goals of the health care system and its relevance at the macro, meso- and micro levels, archaic formation and historical formation of the preconditions for the formation of the modern health care system of Ukraine, as well as prospects for its development. An analysis of the world health care systems, comparative characteristics, opportunities and threats of their use. Emphasis is placed on current trends and expertly predicted changes in the living environment of society, its service sector and producers, which require special attention in the areas of nature protection, life and health of the population of each country. The existing pillars and the mechanism of leverage control to influence the blocks of internal goals of the organization, within the implementation of the external goal of the world approved by the WHO, and the block of consumer needs are emphasized. The importance of further direction of reform and ways of flexible response in the conditions of existential challenges of the ecological environment is substantiated. Conclusions. Healthcare facilities in Ukraine need to introduce an established pattern - organizational and management mechanism - for the efficient use of financial resources and strategic development.

Introduction: Nowadays there is the transformation of the national health care system in Ukraine, the ultimate goal of which is to create a modern, competitive model of medical care of citizens on the basis of forming packages of free medical services. However, the model adopted by Ukraine is in contradiction with national legislation in part of free medical aid guaranteed by the Art. 49 of the Constitution of Ukraine, and fragmentary considers positive international practices. The aim of the paper is to determine the mistakes of the reform of the Ukrainian health care system and to reveal the positive international practices of the organization of health care systems that can be implemented in Ukraine. Materials and methods: National and international legislation, official web resources of the executive authorities of Ukraine, statistics of the World Health Organization, materials of journalistic and scientific periodicals are the materials for the research of the health care system in Ukraine in comparison with international practices. Research methods are cross-sectoral, complex statistical, comparative, generalization, analysis and synthesis. In order to obtain the results, the authors have conducted a critical analysis of the current norms of the national Ukrainian legislation in the health care sector. Review: The authors of the article have studied the main disadvantages of the national health care system in accordance with the concept of reforming the medical sector. Positive international practices that can be implemented into Ukrainian system for the real improvement of medical human rights in Ukraine have been revealed. Conclusions: It has been proved that the ongoing reform of the health care system in Ukraine needs to be reviewed and optimized. It has been offered to consolidate a perspective model of the Ukrainian health care system, its principles and guarantees of immunity at the legislative level.

Relevance. The paper examines the issues of the health care system development of Ukraine in the context of modern challenges. Today, there are many global environmental, socio-demographic, and economic problems threatening the existence of human civilization. One of the problems was the spread of coronavirus infection COVID-19, which demonstrated unpreparedness of Ukraine and post-socialist countries' health care systems. These countries are undergoing health care transformations, but they do not meet modern world norms and standards. The purpose of the article is to establish the key features of the health care system of Ukraine during its transformation given the positive experience of medical systems in the world, from the positions of human geography to identify current challenges and to assess the ability to respond to social demand and the threat of the global crisis in the form of new diseases, the spread of epidemics threatening to human health, quality and life expectancy. Methods. This research is conducted on the basis of human-geographical approach with use of the set of methods and tools to analyze the health care system, which is extremely important for obtaining verified and scientifically sound results. In particular, the authors used methods of induction and deduction, comparison, formalization, analogy, analysis, systematization, including ranking and grouping, historical, graphical, mathematical and statistical, SWOT-analysis methods. Results. Scientific novelty and practical significance. The features, advantages and disadvantages of existing models of health care systems in different countries were identified. In particular, models of medical systems were considered: a model of the single-payer, model of obligatory insurance, and hybrid system. The peculiarities of the formation of the health care system of Ukraine were determined, the key features and principles of the M.O. Semashko’s system were identified, its positive and negative features preserved to this day were outlined. The distribution of European and post-socialist countries was analyzed according to the indicators of state budget expenditures on health care and GDP, number of doctors, hospital beds per capita. The transformational processes in the health care system of Ukraine, the peculiarities of the medical reform in Ukraine were revealed, the peculiarities of the development of the medical system in the conditions of the pandemic were characterized. The SWOT analysis identified the strengths and weaknesses of the Ukraine’s health care system in terms of reform and transformation, its opportunities and threats in the light of current challenges.

The aims of this Article is analyzing the health care system in Ukraine and compare the budget allocated for this sector with total Gross Domestic Production (GDP) of the Country. We present through this research the financial payments and compensation of Employees in health sector compared with other sector workforces compensation, in addition to evaluating the budget of the departments of health sector. It's clear that developed countries supporting health sector to develop their economic investment, due to the health care of individuals leads to more prosperity of the country According to the legislation adopted by parliament, in Ukraine the health care sector in the responsibility of the ministry of the health, following the centralized system depending on the national budget, under this system all the tasks and costs will be implemented. Its been noted that the most negative aspects in health sector in Ukraine is bureaucracy , In spite of increasing the budget allocation for the ministry of health by ( 16.2%) in 2014 comparing with 2013, but it was not reached the national demands. The results of this research are: 1- The unbalanced of health sector employees compensation comparing with other sectors in Ukraine that’s affected their performance and violating the policies. 2- Health care system in Ukraine is in need to be reformed in term of management and financial aspects and finding new mechanisms to implementation. 3- Reorganizing the health care sector structure in Ukraine by increasing allocating budget.

The author carried out an analysis of the existing legal framework and the state of implementation of the reform in the field of health care in Ukraine for the period until 2020, the formation of new aspects of state policy in the field of health care and the determination of priorities in the development of the provisions of the Strategy for Reforming the Health Care System me until 2030. It was established that the need to reform the health care system in Ukraine and search for legal ways to overcome the problem of providing poor-quality medical care, which violates the rights of citizens under Art. 3, 48, 49 of the Constitution of Ukraine, led to the formation of the main directions of state policy in the field of health care. The years 2014-2015, when the Program of Activities of the Cabinet of Ministers of Ukraine and the Sustainable Development Strategy "Ukraine-2020" were adopted, where the goal of state policy in the field of health care and the main strategic goals were defined reforms During the analysis of a number of normative legal acts that form the basis of health care reform, it was established that the formation of the Health Care Reform Strategy in Ukraine was influenced by such factors as: the need to define the main strategic goals of state policy in the health care sector ; search for legal ways to overcome the problem of providing low-quality medical care to the population and protect the rights of patients; combating and preventing corruption in the field of health care, in particular in the field of public procurement; creation of a single three-level system of medical institutions; regulation of the pharmaceutical market; the need to implement "e-medicine"; financing according to the "money follows the patient" system. The author summarizes the main ways of implementing the reform of the health care system for the period until 2020: the initiation of the Program of Medical Guarantees at the level of secondary medical care with the help of contracts with the National Health Service; establishment of a system for concluding declarations with primary care doctors; use of the "Affordable Medicines" program for patients; ensuring the operation of "eHealth" in 24/7 mode, etc. The expediency of legislatively enshrining the provisions of the strategy is related to the urgency of reforming the health care system in Ukraine. It was established that the planned measures for the development and adoption of the Strategy for the Development of the Health Care System were not carried out within the stipulated time due to a number of factors, in particular complicated by the situation with the COVID-19 pandemic. It was determined that among the priorities and expectations from reforming the health care system due to the practical implementation of the provisions of the "Strategy-2030" are the following: patient orientation (priority of the patient's rights, increased standard of living, reduction of the patient's own expenses for medicine); availability and quality of medical services (introduction of the principle of safety of medical services, quality control systems, maximum coverage of medical services, improvement of legislation in the field of circulation of medicinal products); optimization of the structure of medical institutions and personnel protection (by developing rules of conduct for health care workers, introducing a new model of internship and medical residency).

B a c k g r o u n d . Studying the financing of the health care system in the context of modern challenges and comparing models will help identify the key problems inherent in the system and identify ways to overcome them, in particular, regarding the availability of quality medical care for all segments of the population at the expense of various sources of funding. Russia's large-scale war against Ukraine has disrupted access to health care through infrastructure damage, loss of personnel, security issues, mass displacement of the population, and increased costs of medical resources, combined with a decrease in the population's ability to pay for medical services. Even before the war, the healthcare system needed significant reforms and transformation of its financing model. In view of the above-mentioned problems, it is advisable to study the foreign experience of health care financing models and implement the best practices in Ukraine in the post-war period. M e t h o d s . The materials of the research are regulatory and legal support for the financing of the health care system in Ukraine and the work of domestic and foreign scientists who carry out their scientific and practical research in the field of models, sources and problems of financing the health care system in the conditions of new challenges. In the process of carrying out the research, the following scientific methods were used: theoretical generalization and grouping (to characterize the main economic models of health care financing, sources of financing, delineation of health care expenditures between budgets, as well as determination of health care expenditures by software feature); formalization, analysis and synthesis (for the analysis of total health care costs in % of GDP in OECD countries); logical generalization of results (formulation of conclusions). R e s u l t s . Different models of health care systems exist in the world, and theoretical and practical aspects of financing the health care system in Ukraine in the conditions of new challenges are highlighted. The dynamics of budgetary financing of the health care system, the structure and composition of expenditures of the State and local budgets for health care are analyzed. The peculiarities of health care expenditures in the conditions of the Covid-19 pandemic and large-scale war are highlighted. The peculiarities of health care expenditures in the conditions of the Covid-19 pandemic and large-scale war are highlighted. The main problems were revealed and the ways of improving the health care financing system in the post-war period were formed. C o n c l u s i o n s . The global Covid-19 pandemic and the large-scale war on the territory of Ukraine significantly affected the financing of the health care system. The hostilities caused an increase in the costs of financing the health care system, and only an increase in this group of costs is predicted in the future. Healthcare financing in Ukraine in the post-war period plays a key role not only in the restoration of the medical infrastructure, but also in the general system of providing medical services. The post-war reconstruction of health care requires significant investments, the involvement of international aid, public-private partnerships and effective management of internal resources to restore and modernize the infrastructure, the introduction of modern medical technologies and digital solutions to improve the efficiency of the provision of medical services.

The article analyses the construction of the health care system of Ukraine, the historical preconditions of its current state. The reasons that hinder the development of the industry, one of which is the urgent need for effective management, the development of which is complicated by a number of subjective and objective factors, including gaps in the legal field, insufficient competence of management, and their undesirable development and implementation of new management technologies. Positive changes in government regulations, promising areas of training have been identified. The educational and scientific program “Management in health care” (specialty 073 “Management”) and the requirements for the competence of specialists are also analyzed. The issue of the need to build and develop a new model of health care, which should correspond to the modern market economy, comprehensive and intensive reform of the health care system, related to the methods of management, financing, reorganization of medical institutions. In Ukraine, the heads of health care institutions are staffed mainly by doctors who, undoubtedly, have significant experience and high qualification in medical specialization, no longer have special training in management and economics of health care. It becomes obvious that the presence of special education is NOT a priority sign during the appointment to the position of head of a medical institution. Health care reforms in Ukraine began much later than in other post-Soviet countries, almost two decades after independence. Transformations in this area, first of all, the acquisition of autonomy by institutions in administrative activities, the ability to raise funds from various sources, etc., necessitate effective management of medical organizations. The international experience of countries with developed health care systems shows that it is expedient to lead organizations and institutions with specialists in the field of management, economics and health care. The inconsistency of the training of specialists with the needs of practical health care and the tasks of structural adjustment of this type of economic activity is the main thing that hinders the effective management of health care organizations, as a result of which the quality of medical care deteriorates. Improving the management of health care organizations in Ukraine will allow you to effectively manage human resources and financial flows, which will result in both economic and social results of the individual, team, organization and the country as a whole.

The promising financing scheme of health insurance in Ukraine should be found at the present stage of its development. The health care system in Ukraine is cumbersome and outdated. It is based on the Semashko model with rigid management and financing procedures. The disadvantages accumulated in the national health care system due to lack of modernization, disregard of the population needs, non-use of modern global trends, the inefficient operation of the system and the high level of corruption cause the underlying situation. The decision of new government policy in the sector is introduction of new financial mechanisms, in order to ensure human rights in the health sector. Methodology. The study is based on a comparison of systems of financing of medicine in Ukraine and in other countries, provided advantages and disadvantages of each model. Results showed that the availability of medical services is the key problem in any society. The availability of health care services is primarily determined by the proportion of services guaranteed by the government (government guarantees). In some countries such as the United States, practically the whole medicine is funded by voluntary health insurance (VHI). In Europe the mandatory health insurance (MHI) and government funding are the most significant source of funds. Practical importance. The improvement of the demographic situation, the preservation and improvement of public health, improvement of social equity and citizens' rights in respect of medical insurance. Value/originality. Premiums for health insurance are the source of funding. Based on the new model requirements it is necessary to create an appropriate regulation, which would determine its organizational and regulatory framework. This process is primarily determined by identification and setting rules governing the relationship between patients, health care providers and insurers, creation of the conditions and the implementation of quality assurance mechanisms and the availability of medical care in accordance with the available resources and the expectations of patients. For the further development of the health care system in Ukraine, of the introduction of multi-channel financing will be appropriate.

The article examines the institutional foundations of the formation and implementation of the state policy for the development of the health care system in Ukraine in the context of European integration. It is emphasized that the formation of an effective European model of state policy for the development of the health care system in Ukraine requires a systematic restructuring of the industry and improvement of its state regulation mechanisms based on a strategic vision of its functioning capacity and competitiveness under transformational conditions. Based on this, Ukraine has a chance to become the first country of a united Europe, where joint opportunities will be worked out and appropriate mechanisms will be implemented to build a convergent pan-European model of state regulatory policy regarding the functioning and development of the health care system. It was found that the processes of institutionalization of the state policy of the development of the health care system in the conditions of European integration involve the definition and consolidation of European social norms, as well as ensuring feedback with the relevant non-governmental and national ones, including public structures and will generally consist of the following successive stages: understanding and identification of needs, the satisfaction of which requires joint actions; formation of common goals and objectives; in accordance with the defined health care policy in the European Community; definition of clear norms and rules, which are possible for implementation in the short-term, medium-term and long-term perspective; definition of procedures related to norms and rules; institutionalization of norms and rules, procedures, their adoption and practical application; search and installation of tools to support norms and rules, differentiation of their application; streamlining the system of institutions, the functioning of which will contribute to the introduction and implementation of relevant norms and rules, as well as the introduction of relevant regulatory mechanisms. It is justified that in the process of institutionalization of the state policy of the development of the health care system in the conditions of European integration, the results-consequences of the activity of health care as a social institution should be clearly divided into functions and dysfunctions, where the functions should be understood as those results-consequences that contribute to the preservation , strengthening, development and self-regulation of a complex system, that is, useful for society as a whole. Dysfunctions, on the contrary, are the results-consequences that lead to destabilization, disorganization of the system, changes in the structure, that is, harmful to society. To ensure the superiority of the functional influence in the health care system over the dysfunctional and positive results-consequences of the activity of the corresponding system on the state of public health, it is necessary to stimulate social investment activity at the state, regional, local, corporate and personal levels of its functioning.

Inroduction. Due to the fact that the reform of the healthcare system in Ukraine is in transition phase at the moment and, in addition, from April 1, 2020 changes are introduced at the second level of healthcare, it is advisable to describe the current state of medical reform in Ukraine, plans and prospects for further implementation and development, as well as the establishment of the features of various health financing systems and comparing the level of expenditures on the medical industry between countries, experience of which should be taken into account. Materials and Methods. The article uses the reports of the Ministry of Health of Ukraine and the analytical materials of medical experts. In addition, when analyzing various models of financing the health system and their features, quantitative indicators of expenditures of the countries surveyed are used. A comparison is made of the level of expenditures on the health care system between Ukraine and some European countries: Great Britain, the Czech Republic, Poland and Germany. Discussion. The main achievements of the first stage of the health care reform and plans for further changes are described. The strengths and weaknesses of each model of financing the health system are identified. It is proved that the level of government spending on the health care system in Ukraine is the smallest among the other countries examined, but one of the largest in terms of payments out of pocket. In addition, a model has been established for financing the health care system in Ukraine, which most fully meets it in modern conditions.

Determining the level of efficiency of the socio-economic system is a subjective process for each researcher, because the quantitative characteristics that determine the level of effective operation of the system are different. Successful selection of indicators and method of data processing provides an opportunity to conduct an assessment. The ability to determine the efficiency of processes within the system provides a number of advantages, such as functionality, flexibility, scaling, performance. The article proposes to use the method of frontal analysis, which is widely used in assessing the quality of banks. The proposed methodology provides a positive result when working with data from the health care system of different countries to identify applicants for analysis of differences from the existing health care system in Ukraine. The urgency of solving the problem of analyzing the quality of the health care system of countries with relatively effective indicators is a step towards a fundamental reform of the existing system and choosing the direction of further development and possible options for change in the wrong course of this development. Qualitative and quantitative indicators that shape the effectiveness of the health care system are proposed to use the costs of health care, life expectancy and the use of the health care system by citizens of the country. When analyzing medical indicators, it is very important to determine their effectiveness. With frontal analysis, this capability is realized on the basis of one input value – health care costs, and output values, such as life expectancy and health care use. As a result of the analysis, the open free software Frontier Analyst Application and the information base of the Organization for Economic Cooperation and Development were used to compare the performance of countries according to the benchmark in the group and determine which country and by how many deviations of efficiency indicators. The study allowed to process the important socio-economic experience of the countries, which serves as a basis for the reform of the health care system in Ukraine in order to improve and enhance it.