Medical reform: initial institutional, organizational, economic principles and regional peculiarities of implementation (on the example of Luhansk region)

Abstract

Medical reform is a complex systemic, not only purely professional, but also socio-economic, legal and in general institutional phenomenon. In many respects, under modern conditions, medical reform is becoming a kind of barometer of socio-economic and political stability of Ukraine and a criterion of its development level. At the same time, the medical sphere directly affects the life of every family, every person and every administrative-territorial unit of the country. However, at present, domestic science and state regulation practice leave out of consideration the relationship between health care and local government reform. Such a systemic professional, socio-economic and institutional phenomenon requires the appropriate systemic interdisciplinary analysis. The last years of medical reform in Ukraine have already provided the epistemological and empirical basis for such analysis. The authors, on the basis of the interdisciplinary approach in the generalized form, reveal the institutional content of medical reform with the separation of its – the cause-effect sequence of implementation. This logic is reflected in the proposed cognitive pentagram: «formation of the family doctor institution» – «introduction of health insurance» – «connection with local government reform» – «formation of the network of hospital districts» – «equality of public and private medicine», based on the peculiar triangle «inbuilt» in the pentagram (the first, second and fourth elements of the pentagram). Emphasis is placed on the need for institutional, economic and professional projection of the selected pentagram and triangle on the “health care institution” as a defining organizational and sectoral basis for providing high quality medical services to citizens, which should be the generalizing criterion for medical reform. The example of Luhansk and Donetsk oblasts also are considered as the regional features of medical reform in the context of hospital districts formation (objective possibility / impossibility of compliance with the norms of the Ukraine Ministry of Health on determining the parameters of hospital districts) and some relevant problems which arose taking into account the war in the east.