Neurosurgery in Ukraine: nowadays and perspectives

Abstract

In 2016 in Ukraine 111 neurosurgery units with hospital bed capacity amounted to 3118 functioned. Over last 4 years (2013-2016) the level of hospitalization to neurosurgical units has increased by 7%, the volume of neurosurgery interventions rose by 9%. Surgical activity increased by 3.4%.Overall in Ukraine some reduction in general and post-operative lethality is observed.Whereas bed capacity in the SI Romodanov Neurosurgery Institute is 11.6% (361 out of 3118) of the total quantity of neurosurgery patient capacity the Institute performs two thirds of all high-technology (endoscopic, endovascular, laser interventions and those using neuro-navigation etc.) neurosurgery interventions with total and postoperative lethality indices 1.3% and 1.4% in 2017, respectively, which are the lowest indices ever the Institute has been existing and the history of nueroservice in the country. The number of high-technology interventions of IV and V degree of complexity out of total interventions in Neurosurgery Institute amounts to 72%.In 2017 the task of the Government on implementation of innovative mechanisms of financing the institutes of NAMS of Ukraine so called pilot project was brought off.The care at life threatening conditions (in different period from 50% to 74% hospitalized patients) – severe brain and spinal injuries, acute strokes is of top-priority for neurosurgery service.Limitedness of budget financing determines the three directions in the development of specialty and activity of the Institute: 1) determination of priorities with full costing of certain neurosurgical units at the expense of reduced budgeting of others; 2) non-budgetary funding on the basis of public-private partnership with self-financing structures development; 3) the Institute functioning as an autonomous budgetary establishment (access to credits, self-financing activity etc.) is most perspective.Certification of neurosurgical units, residency implementation by unified training module according to the recommendations of the European Association of Neurosurgical Societies (EANS) followed by licensing of professionals by the Ukrainian Association of Neurosurgeons and top neurosurgery physicians in the world are the necessary condition for improving secondary care.