Care In Ukraine Research Articles

Високоспеціалізована стоматологічна допомога в Україні в умовах трансформації системи охорони здоров’я

Поетапна трансформація системи охорони здоров’я з 1 квітня 2020 року торкнулася реформування вторинної (спеціалізованої) медичної допомоги. Планування моделі трансформації лікарняної мережі має враховувати потреби населення та забезпечити створення багатопрофільної лікарні з фокусом на пацієнта. У статті проведений аналіз кадрового потенціалу та інфраструктури медичних закладів, що надають стоматологічну допомогу, у тому числі й у багатопрофільних лікарнях. Також визначені основні аспекти, які необхідно врахувати при плануванні трансформації лікарняної мережі, з урахуванням міжпрофесійної взаємодії стоматологів, щелепно-лицевих хірургів із лікарями загальної практики для підвищення якості надання медичної допомоги.

Implementation of innovations in the public administration system for the social sphere: reform of the deinstitutionalization process in Ukraine

The main purpose of the research is to identify problems of public administration in the context of achieving strategicgoals of the deinstitutionalization process for children’s social care in Ukraine to ultimately implement innovative changes inthe children’s social care. In terms of the theory and practice of public administration in Ukraine these issues remainunresolved and require further development and research. The article examines the reform of the national system ofinstitutional child care in the following logical sequence: analysis of the main stages of the reform of the deinstitutionalizationprocess for the children’s social care starting from the Ukraine’s independence; assessment of the results of the reform andthe level of its efficiency; identification of problems of public administration in the context of achieving the strategic goalsof the reform of the deinstitutionalization process for children’s social care in Ukraine; development of proposals for theadaptation of public administration system for the children’s social protection to comply with the European standards. Thearticle provides an analytical review of the implementation of the reform of deinstitutionalization process of child care andshowed the gap between the current model of child care deinstitutionalization in Ukraine with today's needs that requires aradical change in the priorities of public policy for the social care sphere. As the results of the research process the authorshave proposed the main directions for the implementation of innovations in the public administration system for the children’ssocial care, namely: introduction of multilevel governance; creation of a new network of social care institutions both in theterritorial dimension and in the functional direction; introduction of new tools for social investment. The achieved results mayserve as a basis for further research on modernization of public administration for the children’s social care.

Problems and prospects of radiation oncology development in Ukraine

The problem of cancer incidence in Ukraine in the socio-demographic aspect in comparison with the data of the Western European region is considered. The role of radiation technologies in the system of oncological care to the population of Ukraine, their technological level and clinical efficiency are analyzed. The main directions of increasing the possibilities of the branch of radiation therapy in Ukraine with the involvement of mechanisms of national planning and coordination of the modernization process are offered. The availability of the latest technologies of radiation therapy will not only improve the quality of cancer care in Ukraine, but also increase the potential of research and raise the professional level of staff of cancer centers. Key words: radiation oncology, radiation therapy, linear accelerator of electrons, radiation treatment modalities

Алгоритм надання паліативної допомоги лікарями загальної практики – сімейними лікарями

Актуальність. В Україні, як і у всьому світі, більшість людей, які стикаються з захворюваннями, що загрожують або обмежують життя та потребують паліативної допомоги, перебувають вдома [1]. За оцінками, паліативна допомога необхідна в 40–60% усіх випадків захворювань, що призводять до смерті [2]. За даними Державної служби статистики України, у 2020 р. смертність становила 616 840 осіб [3], відповідно, надання паліативної допомоги в Україні потребували орієнтовно від 250 до 370 тисяч пацієнтів. Ведення пацієнтів впродовж прогресування/розвитку хвороби та заключної фази життя покладається на лікарів, які найбільш наближені до пацієнта – лікарів загальної практики – сімейних лікарів. Головною метою надання паліативної допомоги є забезпечення найбільш досяжної якості життя пацієнтів. При цьому лікар повинен вчасно визначити, коли обсяг надання паліативної допомоги виключно лікарем загальної практики – сімейним лікарем є недостатнім, та своєчасно залучити спеціалізовані служби паліативної допомоги. Мета роботи: розробити алгоритм надання паліативної допомоги лікарями загальної практики – сімейними лікарями з визначенням пацієнтів, для яких обсяг надання паліативної допомоги виходить за межі первинної медичної допомоги. Матеріали та методи. Чинна нормативно-правова база, яка регламентує надання паліативної допомоги лікарями загальної практики – сімейними лікарями, наукова література, опитувальники соціологічного дослідження пацієнтів (п=25). Використали методи системного аналізу, синтезу, абстрагування, соціологічний та медико-статистичний методи. Результати. Вивчено чинні накази МОЗ України та галузеві стандарти надання медичної допомоги, якими керуються лікарі загальної практики – сімейні лікарі при наданні паліативної допомоги, та виявлено відсутність послідовності виконання норм, визначених різними нормативами. Встановлено, що використання засобів для визначення рівня якості життя (ЯЖ), як основної мети паліативної допомоги, не запропоновано. Обов'язком лікаря загальної практики – сімейного лікаря є своєчасне залучення до надання паліативної допомоги спеціалізованих служб. При цьому, певний показник або критерій, що може свідчити про недостатність обсягу надання паліативної допомоги на рівні надання первинної медичної допомоги, відсутній. Запропоновано опитувальники для визначення ЯЖ пацієнтів (EORTC QLQ-C30) та самооцінки депресії (PHQ-9). Показано, що показники менше 50 балів за функціональними шкалами опитувальника EORTC QLQ-C30 та/або 10 або більше балів за шкалою депресії PHQ-9 є свідченням про необхідність супроводу пацієнта психологом, священнослужителем та соціальним працівником, тобто підставою залучення мультидисциплінарної команди мобільної паліативної допомоги. Розроблено уніфікований алгоритм дій надання паліативної допомоги лікарями загальної практики – сімейними лікарями. Висновки. Для забезпечення виконання норм та правил, визначених для лікарів загальної практики – сімейних лікарів різними нормативними документами, інструкціями та галузевими стандартами, необхідне впровадження Уніфікованого алгоритму (уніфікованої схеми) дій лікаря при наданні паліативної допомоги. Тому лікарям загальної практики – сімейним лікарям необхідно вчасно застосовувати алгоритм визначення пацієнтів, для яких обсяг надання паліативної допомоги виключно лікарями загальної практики – сімейними лікарями є недостатнім та налагоджувати взаємодію з мультидисциплінарними мобільними паліативними службами.

Preparation of social workers for professional activity in the field of health: implementation of progressive ideas of the USA in Ukraine

The relevance of the study is due to the growing importance of health in the value system of modern society, as well as the deteriorating health of the population not only in Ukraine but in the world as a whole. The situation has especially deteriorated in the context of the coronavirus infection pandemic, which has led to the emergence of numerous new and exacerbation of "old" social problems of the population. Social workers cannot stay away from the problems faced by ordinary citizens, especially when it comes to achieving social justice and respect for human rights, in particular in such a sensitive area as health. To ensure the effective provision of social services and to address the social problems of the population on the basis of health, social workers must be properly prepared for this type of professional activity. The training of social workers for health activities in Ukraine is a fairly new and not very common area of training in higher education institutions, and the practice of social workers in the field of health care in Ukraine is not yet a typical phenomenon. The use of progressive foreign developments is a good basis for quality preparation of future and already practicing social workers for health activities. Of particular importance is the American experience in training social workers to work in health care, based on more than a century of practice in this area. In order to borrow and adapt the valuable ideas of foreign experts, a comparison of the training of social workers for health activities in the United States and Ukraine was made. On the basis of the revealed common and distinctive features the ways of introduction of the best achievements of the American high school in domestic practice of preparation of social workers are offered.

Попытки реформирования вторичной стационарной медицинской помощи в пилотных регионах Украины и их результаты

Актуальность научного исследования обусловлена необходимостью аналитического обобщения наработанного опыта реформирования отечественной вторичной медицинской помощи. Пилотным проектом реформирования вторичной стационарной медицинской помощи в Украине были охвачены Винницкая, Днепропетровская, Донецкая области и г. Киев, где происходили определенные Законом «О порядке проведения реформирования системы здравоохранения в Винницкой, Днепропетровской, Донецкой областях и городе Киеве» от 07.07.2011 г. № 3612-VI [2] и постановлением Кабинета Министров Украины от 24.10.2012 г. № 1113 «Об утверждении Порядка образования госпитальных округов в Винницкой, Днепропетровской, Донецкой областях и городе Киеве» [1] структурно-организационные и функциональные преобразования системы медицинского обслуживания, в частности ее стационарного сектора. Целью определенных преобразований стало расширение возможностей оказания доступной качественной медицинской помощи населению через повышение эффективности использования бюджетных средств, внедрения новых подходов к организации работы учреждений здравоохранения. Целью исследования стало проведение анализа результатов реформирования вторичной стационарной помощи в пилотных регионах для планирования правильных постепенных шагов регионального реформирования с учетом полученных результатов пилота в определенных областях и городе Киеве, в частности. Материалы и методы. В процессе исследования были использованы методы структурного и логического анализа, семантического оценивания медицинских, научных и нормативно-правовых документов. Результаты. Для эффективного оказания вторичной медицинской помощи, в частности ее стационарного сектора, на территории пилотных регионов законодательно было определено образование госпитальных округов с функциональным объединением учреждений здравоохранения, оказывающих вторичную стационарную медицинскую помощь. Значительная работа была проведена по разделению функций первичной и вторичной медицинской помощи, но не во всех пилотных регионах были образованы такие функционально-структурные единицы, как госпитальный округ, каждая область имела свои особенности организации оказания вторичной стационарной медицинской помощи, которые в дальнейшем необходимо учитывать. Выводы. Установлено, что выбранное направление реформирования вторичной медицинской помощи, в частности ее стационарного сектора по модели госпитальных округов не нашло широкого внедрения в пилотных регионах. В Винницкой области образованные госпитальные округа не обеспечили положенную на них функцию повышения качества медицинской помощи при условии рационального использования материально-технических ресурсов, поскольку мощность больницы интенсивного лечения (БИЛ) и больницы планового лечения (БПЛ) и численность населения, которое они обслуживают, не соответствуют экономически обоснованным рекомендованным европейским нормативам.

Unified Scale for Assessing the Risk of Thromboembolic Complications – Family Doctor’s Tool for COVID-19 Pandemic

At present one of the most discussed medical problem is a COVID-19 pandemic. The world has already registered 274 408 291 cases of infection, and 5 365 361 lethal consequences. This disease is already known for almost two years, but there are still no clear understanding of its pathophysiology, clinical course and optimal therapeutic tactics. In Ukraine during this period, 3,324,999 patients with COVID-19 were registered, 92,929 people died. It is known that in the course of the COVID-19, severe thromboeembolic complications are often observed. That is why the most important element of therapy in case of acute thromboembolic complications is the timely use of thromboprophylaxis. The objective: is to develop an integrative scale that will summarize the conditions associated with the risk of thrombogenic complications. Materials and methods. The literature was analyzed on the E-library, PubMed, Scopus and Web of Science Core Collection databases to study questionnaires that were previously used in the patients with a therapeutic profile. 143 patients were examined, including 119 healthy people of all ages and 24 patients with metabolic syndrome (MS) over 60 years. General clinical, neurological, instrumental and laboratory examination were conducted. Results. The «Unified scale for assessing the risk of thromboembolic complications» was developed, containing 17 questions and allowing to assess the presence of risk factors and the prognosis of thromboembolic complications. The idea of creating arose on the basis of many years of experience in studying the issues of hemorheological properties of blood, microcirculation and endothelial function in persons of different ages on the basis of the Department of Clinical Physiology and Pathology of Internal Organs of the State Institution «D. F. Chebotarev Institute of Gerontology NAMS Ukraine» under the leadership of acad. NAMS of Ukraine Korkushko O.V. The questions used in the «Thromboembolic Complications Risk Assessment Scale» are intuitive and self-explanatory. It can be used in the form of a survey with a doctor, a nurse, and also independently in the form of a patient survey. The most convenient form of use is independently in the form of a questionnaire, and the most promising is when studying the health status of individuals in large samples, for example, in communities. The link to this questionnaire (https://forms.gle/XZwsGp5GaVuNqZeS9) was presented for the first time at the Ukrainian scientific and practical conference with international participation «Primary health care – the main component of health care in Ukraine (for the World Family Doctor Day)» of the P. L. Shupik (May 19–20, 2021). Conclusion. Blood circulation disturbances are accompanied by considerable number of pathological conditions, where early interventions and understanding of pathological mechanisms will reduce the risk of complications and prevent fatal consequences. The developed questionnaire allows, from the standpoint of both a doctor and a patient, to assess the risk of thromboembolic complications and identify risk factors for the development of thrombosis in routine clinical practice.

Features of administrative and legal regulation of healthcare in Ukraine

The article is devoted to the study of the peculiarities of the administrative and legal regulation of health care in Ukraine and the definition of priority areas for its improvement. It was found that the rules of administrative law occupy a dominant position among the rules of other branches of law in the field of public health. It is determined that legal regulation and administrative-legal regulation are correlated as species and generic concepts, but administrative and legal regulation is limited to social relations governed by the rules of administrative law. Emphasis is placed on the norms of the Constitution of Ukraine, which determine the direction of administrative and legal regulation of health care in Ukraine. The concept of «legislation» in a broad and narrow sense is revealed. The normative-legal acts and by-laws, which play an important role in the administrative-legal regulation of health care in Ukraine, are singled out. Emphasis is placed on bylaws of general bodies, including acts of the President of Ukraine and the Cabinet of Ministers of Ukraine, departmental bylaws - the Ministry of Health of Ukraine, the National Health Service of Ukraine, acts of local governments on health care. It is emphasized that the presence of a wide range of health management entities the authority to adopt bylaws has led to the existence of a significant number of the latter, which raises the question of systematization of legislation in the field of health care. Two approaches to the systematization of acts of Ukrainian legislation in the field of health care are considered - codification, the result of which should be the Medical Code of Ukraine, and consolidation, which aims to determine the structure of the future codified act, identify contradictions, inconsistencies, gaps in health care legislation. It is concluded that the systematization of legislation in the field of health care is inexpedient because, first, the existing traditions of lawmaking and law enforcement in Ukraine indicate the need for laws that establish formal provisions in the field of health care and bylaws that specify and provide practical implementation of legislation, secondly, the ongoing reform of the health care system in Ukraine requires the adoption of a number of regulations that supplement existing legislation, thirdly, the right of a number of entities to adopt regulations raises the question of reviewing the latter’s powers to regulate reducing the number of their acts.

HISTORICAL AND LEGAL ANALYSIS OF THE HEALTH CARE WORKERS’ LEGAL STATUS DEVELOPMENT

The article is devoted to historical and legal analysis of the health care workers’ legal status development. The paper analyses the beginning of the establishment of the first rules of behavior and professional responsibilities of medical workers in Ukraine, as well as regulations governing the legal status of medical workers in different years in Ukraine. It has been emphasized on the importance of research in the context of the modern health sector reforms for the formation of its directions of implementation.
 The administrative and legal status of a medical worker makes it possible to determine their place and role in public administration and other public relations. The rights and responsibilities of health care workers are of great scientific and practical importance, especially in view of the ongoing health care reform processes in the country. In view of this, it is important to study the peculiarities of the formation of certain rights and responsibilities of medical workers, which constitute their current legal status, over a significant period of the Ukrainian history.

Ukraine: Legal Forms for Private Practice in Oral Surgery and Dentistry

During the last 30 years of Ukrainian independence the private dental businesses are flourishing what is a very good sign not only for patients and dental professionals, but also for economy. As of January 1, 2019, 4,584 privately owned dental institutions were registered Ukraine. Among them, 669 were dental clinics and 3,915 – dental offices.1 Generally, dental care in Ukraine (as of January 1, 2019) was provided by 25,651 dentists of six specialties.1 According to these 2019 data, we can hypostatize that every sixth dentist in Ukraine is an owner of a private clinic/office.1 Moreover, as of January 1, 2021, the number of private dental practices for the first time in history of this country increased to 5,084 (ie, showed a 8.72 percent growth during a 2019 to 2021 period).

The need for palliative and hospice care in Ukraine in 2018–2020

The provision of palliative and hospice care (PHC) is associated with significant material costs of the budgetary funding of countries, provided that these countries pay the necessary attention to these types of care. Ukraine strives for a model of increasing PHC coverage of those categories of patients recommended by WHO as best practices. This is especially important in the context of the growing number of patients in need of PHC both in Ukraine and around the world. The purpose of the study is to determine the need for the main types of PHC for the population of Ukraine in 2018–2020 according to the methodology proposed by the Ukrainian Center for Public Data. The methodology involves the use of data from national statistics centers (the State Statistics Service of Ukraine and the Center for Medical Statistics of the Ministry of Health of Ukraine), national cancer and tuberculosis registries (mainly on the number of deaths and those discharged from hospitals with the corresponding diagnosis), to which empirical coefficients from 0.2 to 0.9 are applied, determined by experts. As a result of the research, we determined the absolute values and trends regarding the need for the main PHC types for adults and children of Ukraine in 2018–2020. The need in absolute values among adults was 227,143; 212,199 and 190,179; among children – 61,355; 49,002 and 45,357; respectively. The greatest need for PHC among adults during this period was noted for malignant neoplasms and cardiovascular diseases, and among children – for congenital malformations, certain perinatal conditions, cerebral palsy, and malignant neoplasms. The overall need for PHC had a steady downward trend both among adults (by 16.27%) and among children (by 26.07%). The largest relative declines among adults during this period were recorded for rheumatoid arthritis, diabetes, and HIV/AIDS, and among children – for congenital malformations, inflammatory diseases of the central nervous system, and cardiovascular diseases. Keywords: palliative and hospice care for children, palliative and hospice care for adults, PHC, state medical statistics.

The feasibility of using immunocytochemical research in the preoperative diagnosis of thyroid tumors

Background. Thyroid cancer has long been an urgent problem of health care in Ukraine and requires both improved timely detection of the disease and increased coverage by special treatment of this category of patients to improve its results. Objective. Investigate the complex of immunocytochemical and ultrasound characteristics of thyroid tumors to improve diagnostic algorithms in the preanalytical stage. Methods. During the the research work the results of diagnostics of 60 patients with thyroid neoplasms aged 21 to 83 years who underwent fine-needle aspiration. Patients were divided into three groups according to the Bethesda System (BSRTC) classification category. The 1st group included 18 patients of category II BSRTC (Benign. Group 2 included 20 patients with category V BSRTC (Suspicious for Malignancy – SFM). And other 22 patients with category VI BSRTC (malignant tumor) formed the 3rd group). Patients of all groups underwent questionnaires, ultrasound examination with FNA, cytological and immunocytochemical examination. Results. There is no clear link between E-cadherin expression and neoplasia. Negative expression occurred in 36.4% of cases of metastatic lesions. This partially satisfies the requirements of timely preoperative diagnosis. That is why E-cadherin cannot be used as a separate marker. The expression of cytokeratin-19 with different degrees of intensity of cytoplasmic staining of tumor cells was determined in all studied neoplasms of V and VI category on the BSRTC scale. Strong expression of cytokeratin-19 was observed in 40.0% of cases with BSRTC-5 and 45.4% with BSRTC-6, moderate - in 50.0% and 36.4% of cases, respectively, weak - in 10.0% and 18.2%, without significant differences between groups (p> 0.05). At the same time, in the benign process in 55.6% of cases there was no reaction of cytokeratin-19, and in 44.4% - weak expression (p <0.001 in comparison with the 2nd and 3rd groups). Conclusion. Benign thyroid disease (category II BSRTC) is likely to be associated with younger patients (46.6 ± 3.7 years), low serum REA (less than 0.95 ng / ml), poor thyroglobulin expression (77.8 %), negative reaction with TTF-1 (100%) and cytokeratin-19 (55.6%). Differential-prognostic markers of thyroid cancer with risk of malignancy (V category BSRTC) include elevated serum REA (0.95 ng / ml and above), the presence of a moderate reaction with antibodies to thyroglobulin (80.0%), a positive reaction - to TTF-1 (100.0%) and E-cadherin (90.0%), with moderate or strong expression of cytokeratin-19 (90.0%).

Організація нефрологічної допомоги в Україні: сучасний стан і перспективи

Подана оцінка сучасних статистичних показників нефрологічної допомоги в Україні, їх неповноти й невірогідності. Вказано на необхідність законодавчої та організаційної оптимізації розвитку трансплантології.

Criminal law and criminological threats in the Internet during a pandemic

A general description of criminal law and criminological threats on the Internet, which have become particularly common or arose during the pandemic in Ukraine and the world have been analyzed in the scientific paper. It is noted that during this pandemic people began to rely more than ever on computer systems, mobile devices and the Internet for remote working, education, communication, shopping, sharing and receiving information, minimization the influence of the social distancing, etc. Increasing of the number of Internet users and the time spent them online, combined with the feelings of confusion, anxiety and fear has become an enabling environment for criminal activity in the cyber space. The risks associated with the digitalization of health care in Ukraine and abroad have been identified. It is noted, that Interpol has identified three the most common types of cyberattacks at the international level, which affected individuals and legal entities during the pandemic: 1) the functioning of malicious domains; 2) distribution of malicious software; 3) download extortion programs. Phishing and other types of cyber fraud, related to COVID-19, were analyzed. It is emphasized, that the perception of fake information (depending on its content) can lead to the panic spreading among the population, the formation of aggression against certain groups of people and so on. It was determined, that during the COVID-19 pandemic, the increasing of the amount of "screen time" among both adults and children contributed to the intensification of actions aimed at sexual abuse of children on the Internet, cyberbullying, incitement to risky online behavior, distribution of potentially dangerous content. It is stated, that according to experts opinion, the implementation of criminal law and criminological threats on the Internet in 2020 caused losses of more than 1% of world GDP.

Barriers to Evidence‐Based Colorectal Cancer Care in Ukraine

The incidence of colorectal cancer (CRC) is increasing in many low- to middle-income countries, including Ukraine. Ukraine reports high mortality rates in CRC patients. To identify potential areas for targeted interventions to improve CRC care in Ukraine, we investigated Ukrainian clinician perspectives on evidence-based CRC treatment guidelines. An explanatory sequential mixed-methods study design was used. A survey was administered to attendees of a regional surgical conference. Semi-structured interviews were subsequently performed with practicing clinicians in Ukraine. Interviews were coded to identify prominent themes. Quantitative: 105 clinicians completed the survey. 76% of respondents reported using guidelines in daily practice. Lack of English proficiency was cited by 28.6% of respondents as a barrier to guideline use. Improved knowledge and additional financial resources were reported as factors that would be helpful in providing evidence-based care. 15 clinicians were interviewed. Two major themes were identified: limitations in access to the medical literature resources (language barriers and financial barriers), and sense of clinician initiative and willingness to learn despite hardships. Clinicians in Ukraine have positive perspectives on utilization of evidence-based CRC treatment guidelines. However, they face major barriers in accessing resources needed to keep up-to-date on the current literature. Fortunately, there exists both willingness and initiative on the clinician level to pursue continuing education. Efforts should be made on the international society level to improve open-access and foreign language translation availability to support physicians in Ukraine and other low- to middle-income countries.

The issue of patient-oriented organization of palliative and hospice care in Ukraine

The quality of the provision of palliative and hospice care (PHC) depends on regulatory, legal and logistical support, the practice of implementing laws, and the support of society. The need for PHC is growing both worldwide and in Ukraine, which is associated with the aging of the population and global medical advances, thanks to which people live to a greater age and continue to live even with serious diseases and severe disabilities. Patients with incurable diseases most often need analgesia, which in low- and middle-income countries the population either does not receive at all, or has limited access to narcotic analgesics. The task of the PHC organization corresponds to the European integration obligations of Ukraine at a high level, and is in the sphere of responsibility of the Ministry of Health. The insufficient level of development of the national PHC system depends on imperfect legislation, non-implementation of adopted laws, lack of public results of calculating the need for PHC among adults and children. The system of training medical workers to work in hospices and palliative care departments, which concerns both doctors and nurses, also needs improvement. The routes of movement of palliative patients during the provision of assistance to them in the institutions of the health care system require public discussion. Instructions regarding the movement of these patients should be understandable to a doctor of any specialty, and contain step-by-step algorithms of actions. The practice of euthanasia, which is not allowed in Ukraine, is important for palliative patients. The PHC system should become one of the key components of the health care system, provided at the place of residence of patients (in hospices and palliative departments of hospitals) in the area where they live, or in "hospices at home". The development of the national PHC system, in which all known shortcomings will be taken into account and corrected, will be able to reduce the level of suffering of terminally ill patients and their relatives, and ensure their standard of living at the average European level. Keywords: PHC, need for medical assistance, health care financing.

On the procedure for providing palliative and hospice care in Ukraine

Palliative care, and hospice care as part of it, are designed to improve the quality of life of patients ending in incurable disease and to help members of their families. In only 20 count­ries around the world are Palliative and Hospice Care (PHC) properly integrated into the health care system. Proper PHC organization requires efforts at the public and political levels, a system of regulations. The study was conducted to determine the procedure for providing PHC in Ukraine and to establish its compliance with the needs of the medical community and Ukrainian society. The hierarchical system of legislative acts of Ukraine of PHC provision (Constitution of Ukraine, laws of Ukraine, orders of the Ministry of Health of Ukraine), which is comparable to the guidelines of the World Health Organization, was studied by the method of systematic analysis. Ukraine belongs to the group of countries with separate specialized PHC institutions, but the work of these institutions does not show signs of systemic organization at the state level (Group 3a according to the modified classification of Wright, Lynch & Clark, 2008/2011). In terms of the number of beds, Ukraine is provided with palliative care by 40.5% (1,500 instead of 3,700, which is calculated as 100 beds per 1 million population), with virtually no hospices at home. It is established that not all the main directions of PHC system development meet the modern needs of the medical community and Ukrainian society. It is considered necessary to study the experience of more successful PHC organization in Group 4b by Wright, Lynch & Clark’s countries classification. Keywords: public health, legal support, incurable diseases.

New approaches to financing the health care system

Main areas of state budget expenditures have been identified in the article. They include financing the staff of the Ministry of Health of Ukraine, the State Service of Ukraine for Medicines and Drug Control, the National Health Service of Ukraine, the Ministry of Health of Ukraine. It has been emphasized that the adoption of the Concept of Health Care Financing Reform at the legislative level was important during the reform of the health care system of Ukraine, according to which the implementation of a large-scale transformation of health care system financing has begun. The initial provisions of the concept of health care financing reform have been studied, namely: the purpose of health care financing reform and its principles. The directions of the health care system's reforming that affected the financial mechanism of public administration have been proposed. One of the key reasons for the successful implementation of the health care financing reform is the stable political commitments and high-quality interdepartmental relations between the Cabinet of Ministers, the Ministry of Health, the National Health Service of Ukraine and the Ministry of Finance. It has been noted that the main problem of imperfection of financial provision of health care in Ukraine is the lack of clear criteria for assessing the effectiveness of the use of budget resources at different levels of government and health care facilities. The transformed system of financing of primary medical care in Ukraine has been presented and characterized, the algorithm of calculation of budgetary financing of the medical sphere has been given. It has been found out that the implementation of the concept of health care financing reform took place together with the development of the legal mechanism, which provided for the adoption of regulations. The main directions of improving the financial mechanism of public administration of the healthcare system have been identified: at the level of public administration of the healthcare system, at the level of reforming the state regulation of healthcare institutions.

SYSTEM OF FINANCING HEALTH CARE IN THE EUROPEAN UNION COUNTRIES AS AN EXPERIENCE FOR UKRAINE

Purpose. The purpose of the article is to analyse the state of the system of financing health care in the European Union countries and Ukraine, to identify and compare their efficiency. To achieve this purpose, the following tasks were set: to analyse the current state of the system of financing health care in the European Union using up-to-date statistics on health care expenditures; to analyse the state of the system of financing health care in Ukraine for the last five years based on statistical data on expenditures of the Consolidated Budget of Ukraine; to consider what needs the health care sector directs expenditures to; to identify the problems that were prompted medical reform in Ukraine; to identify and compare the efficiency of financing the health care system of the European Union countries and Ukraine. Methodology. During the preparation of the article, the author used the method of analysis and synthesis to review statistical data that provided an opportunity to analyse the current state of the system of financing health care in the European Union countries and Ukraine; the method of comparison was used to determine the efficiency of the models of the system of financing health care in the countries of the European Union, in order to further form useful advice for use in Ukraine during the period of medical reform; generalization method was used to summarize the results of the study. Results. Analysing the state of the system of financing health care among the European Union countries in 2019, it was found that the largest amount of health care expenditures was in Germany (the system of financing was based on the Bismarck model), and the smallest was in Latvia (the system of financing was based on the Beveridge model). Analysis of the dynamics of health care expenditures in Ukraine showed that over the past five years, the volume of expenditures has increased 2.33 times. In terms of the funds of the Consolidated Budget of Ukraine, the largest percentage (85-91%) falls on the expenditures of the general fund. In relation to the total expenditures of the Consolidated Budget of Ukraine, the share of health care expenditures in 2020 has amounted to 11.02%, which is 1.99% higher than in 2016. Despite the growing trend, the amount of budget expenditures is not enough for all the needs of the health sector. To identify the efficiency of the models of the systems of financing health care operating in the European Union countries and Ukraine, a comparison of the average life expectancy among the people of these countries was made. In the countries of Northern and Western Europe, there was the highest rate in the range of 81.1-83.1 years for both men and women; the lowest rate was observed in Ukraine (73 years). Ukraine is currently undergoing health care reform, which should change the Soviet model to one that will be closer to the English, which shows its efficiency on the example of European countries in the post-Soviet space. Practical implications. The results of the study can be used to form practical suggestions in preparation for the next stage of health care reform in Ukraine.

LEGAL REGULATION OF THE STATE PERSONNEL POLICY IN THE FIELD OF HEALTH CARE IN UKRAINE

The purpose of the article is to study the features of regulatory and legal regulation of state personnel policy in the field of health care in Ukraine. The article determines that the formation of the legal framework for the effective functioning and development of state personnel policy of the health care system is a priority for improving the efficiency of the medical sector. The article analyzes scientific developments on improving the staffing of the health care system in Ukraine, in particular: articles of the Constitution of Ukraine, provisions of the Labor Code, articles of the Law of Ukraine "On Employment", articles of the Law of Ukraine "On Collective Bargaining", articles Law of Ukraine "On labor protection", provisions of the Law of Ukraine "On vacations", articles of the Law of Ukraine "On remuneration", provisions of the Law of Ukraine "Fundamentals of legislation of Ukraine on health care", provisions of the Law of Ukraine "On improving accessibility and quality of health care" in the countryside. " It is determined that the main source of labor law and state regulation of labor relations, regardless of the industry, is the Code of Labor Laws. The main elements (features) of the employment contract are studied, namely: individual-personal feature, organizational feature, material feature, regulatory feature, subject feature. The principles of state policy in the field of labor protection are determined. An analysis of the orders of the Ministry of Health for 2020-early 2021 on personnel policy in the field of health care, which confirmed the interest of the direct entity in the form of the Ministry of Health of Ukraine in the formation of regulatory framework for personnel policy of the health care system of Ukraine. Keywords: health care system, normative-legal provision, laws, codes, personnel policy, state regulation.