Health Care System Of Ukraine Research Articles

Identifying gaps in healthcare: a qualitative study of Ukrainian refugee experiences in the German system, uncovering differences, information and support needs

BackgroundThe 5.8 million Ukrainian refugees arriving in European countries must navigate varying healthcare systems and different and often unknown languages in their respective host countries. To date, there has been little exploration of the experiences, perceived differences, information and support needs of these refugees regarding the use of healthcare in Germany.MethodsWe conducted ten qualitative interviews with Ukrainian refugees living in Germany from February to May 2023, using Ukrainian, English and German language. The transcribed interviews were analysed using the qualitative content analysis method according to Kuckartz and Rädiker with the MAXQDA software.ResultsIn general, participants consistently had a positive experience of the German healthcare system, particularly regarding the quality of treatments and insurance. Differences have been reported in the structure of the healthcare systems. The Ukrainian healthcare system is divided into private and state sectors, with no mandatory insurance and frequent out-of-pocket payments. Pathways differ and tend to focus more on clinics and private doctors. General practitioners, often working in less well-equipped offices, have only recently gained prominence due to healthcare system reforms. Initiating contact with doctors is often easier, with much shorter waiting times compared to Germany. Interviewees often found the prescription requirements for many medications in Germany to be unusual. However, the mentioned differences in healthcare result in unmet information needs among the refugees, especially related to communication, navigating the healthcare system, health insurance, waiting times and medication access. These needs were often addressed through personal internet research and informal (social media) networks because of lacking official information provided during or after their arrival.ConclusionsDespite the positive experiences of Ukrainian refugees in the German healthcare system, differences in the systems and language barriers led to barriers using healthcare and information needs among refugees. The dissemination of information regarding characteristics of the German health care system is crucial for successful integration but is currently lacking.Trial RegistrationGerman Clinical Trials Register: DRKS00030942, date of registration: 29.12.2022.

Behavioural determinants of the healthcare providers in Ukraine: Focus on competition context

The development of the healthcare system is an important task for every country, given that long-term economic and social development is absolutely impossible without a healthy nation. Therefore, improving public health and ensuring that the maximum number of people have access to quality healthcare services is one of the state's strategic priorities. In this regard, the authors of the paper set a goal to establish how the reform of the healthcare system in Ukraine has led to changes in the behavioural determinants of healthcare providers and recipients in the domestic healthcare market. The paper uses such research methods as comparison, visualization, graphical data visualization tools, and statistical methods of data analysis. The study revealed that Ukrainian citizens got a chance to freely choose their physicians by signing declarations with them, which led to increased competition among physicians and other doctors and healthcare facilities; at the same time, the number of declarations signed with private healthcare facilities increased significantly. Furthermore, the developed econometric model allows us to identify statistically significant relationships between the amount of state funding and lifestyle and environmental indicators, which will allow us to improve the mechanisms and amount of funding in the sector, improving the health of the nation in the new competitive environment.

Comparative analysis of availability and affordability of hypoglycaemic medicines for Ukrainian patients during the war 2022-2023

Purpose: Diabetes care, particularly type 2 diabetes (T2D), is recognised as a growing challenge in emergency situations. During the humanitarian crisis of war in Ukraine, it is important to focus on ensuring that patients have access to essential medicines for T2D. Since 1 April 2017, the Ministry of Health of Ukraine has been implementing the government programme "Affordable medicines". The List of reimbursed medicines necessary for the treatment of hypertension, diabetes and bronchial asthma includes 3 glucose lowering medicines (GLMs) - gliclazide, metformin, glibenclamide. From 01 April 2019, electronic prescribing has been implemented as part of the "Affordable Medicines" programme. It is important to investigate changes in the availability and affordability of GLMs for the treatment of T2D during the war and future directions in 2022-2023 in Ukraine. Methods: Information from the State Register of Medicinal Products of the Ministry of Health of Ukraine from March 2023 and February 2022 (before the start of the war) was the subject of the study. Marketing, analytical, graphical, generalisation analyses were applied. Analysis of the cost of 1 DDD GLM according to the WHO ATC/DDD index and solvency ratio analysis were applied. Results: This study is based on actual data from before the war in Ukraine and now shows that the affordability and availability of GLMs during the war in 2022-2023 has not changed dramatically. The 'Affordable Medicines' program was stably implemented, with €111.9 million allocated in 2023 and within 6 months of 2023. The National Health Service of Ukraine reimbursed €42.8 million to pharmacies for the Reimbursement List. Most Ukrainian manufacturers and foreign GLMs are very affordable due to the reimbursement system. From October 2023, 23 names of test stripes were included in the Reimbursement list of the "Affordable medicines" programme. However, foreign GLMs of innovative groups are moderately affordable for the working population based on the calculated solvency ratio. Conclusions: Our study revealed that despite the challenges of war, the healthcare system in Ukraine remains robust, particularly in ensuring stable access to pharmaceuticals for diabetes treatment. The "Affordable Medicines" programme and the Reimbursement List are updated twice a year, and the introduction of the new drugs for T2D and diabetes insipidus was completed in 2022. Thus, the innovative GLMs, despite being registered on the market in 2022, such as Semaglutide, Semaglutide and Dapagliflozin, are not affordable in 2023. A prospective trend is the inclusion of innovative GLMs for diabetes better care on the reimbursement list.

Neurological Practice in the Time of War: Perspectives and Experiences from Ukraine.

The full-scale Russian invasion of Ukraine has significantly impacted the country's healthcare system. Insufficient infrastructure, destruction of medical facilities, and barriers to prevention and treatment efforts hinder the provision of timely, high-quality care to our patients. We aim to describe the impact of the war on neurological care across Ukraine. In this article, leading national experts in stroke, epilepsy, multiple sclerosis, and movement disorders describe their personal experience and efforts in organizing and providing care since the war started in February 2022. A neurologist who cared for patients in Mariupol recounts the first weeks of the war when the city was under constant attacks. An international stroke expert describes the role of Task Force for Ukraine, a European Stroke Organization initiative to support the Ukrainian stroke community. We discuss a series of critical challenges facing Ukraine's neurologists, patients, and healthcare delivery system, including shortages of personnel and medical supplies, disrupted logistics, and lack of funding. In addition, we highlight various interventions and strategies aimed at counteracting these challenges, including international support, collaborations within Ukraine, and initiatives enhancing the resilience of the Ukrainian neurology community. As the war is ongoing, this article emphasizes the pressing need for continuous support and investment in the Ukrainian healthcare system to preserve guaranteed access to high-quality healthcare for the Ukrainian people during the war and in its aftermath. Insights from the essays can inform the development and implementation of effective strategies and interventions tailored to such extraordinary circumstances.

SYSTEM OF STATE REGULATION OF PROFESSIONAL TRAINING OF MANAGING STAFF OF HIGHER MEDICAL EDUCATION IN UKRAINE

The article addresses the topical issue of public administration of professional training for higher medical education management personnel in Ukraine. It explores the current state and development prospects of the training system for managers of higher medical education institutions, and identifies priority areas for its improvement. The relevance of the research is determined by the need to provide the Ukrainian healthcare system with highly qualified managers capable of effectively managing higher medical education institutions in the context of dynamic changes and integration into the European and world educational and scientific space. The article defines the main approaches and mechanisms for implementing state policy in the field of healthcare and higher medical education. It identifies the directions for improving the organizational, legal, and economic mechanisms of state regulation of professional training for management personnel of higher medical institutions in Ukraine in terms of clarifying the content of the key research concepts "management personnel of higher medical education institutions" and "state administration of professional training for management personnel of higher medical education institutions". It is determined that the reforming and development of the healthcare and higher medical education sector of Ukraine in the context of integration into the European and world educational and scientific space requires the preparation of a new generation of managers - healthcare managers. It is determined that this category of managers includes vice-rectors and heads of relevant scientific, educational-methodological and educational commissions, deans and vice-deans of faculties, heads of departments and other structural units. The formation of a comprehensive mechanism of state administration of professional training for management personnel of higher medical education institutions should be carried out on the basis of such principles as scientific justification, legality, common interests and values, consistency, comprehensiveness, systematicity, subsidiarity, transparency, innovation, adequacy, efficiency, and responsibility. The article analyzes the features of the system of state administration of professional training for management personnel of higher medical education institutions in Ukraine and abroad. Based on a comparative analysis of management training systems in 6 developed countries of the world, it is proved that the system of professional training and advanced training of management personnel of higher medical education institutions should function in accordance with the current trends in the healthcare sector and the field of higher medical education, comply with the implementation of state policy principles, and be systematic. Statistical analysis of the dynamic changes in the indicators of provision with higher medical education institutions and medical institutions over the years of Ukraine's independence demonstrates the need for joint coordination and cooperation to coordinate the efficiency of the healthcare system. Thus, the article reveals the essence and features of state administration of professional training for management personnel of higher medical institutions, analyzes the regulatory framework governing this area, and identifies the main areas for improving the training system for managers of higher medical education institutions, namely: Updating the content and forms of training; Introduction of innovative teaching methods; Improvement of teachers' qualification; Strengthening the practical focus of training; Development of international cooperation.

Features of physical education and sports rehabilitation for combat veterans with traumatic brain injury

Traumatic brain injury (TBI) is a common consequence of combat actions, leading to significant disability of military personnel. The purpose of the article was to characterize the features of physical culture and sports rehabilitation of combatants with TBI. Scientific publications on medical and physical rehabilitation of individuals with traumatic brain injuries were analyzed. It was found that the integrated use of kinesitherapy, physical exercises, motor learning, sensory stimulation and cognitive training is effective. It is indicated that mine-explosive injury, which dominates among combat injuries, is often combined and accompanied by damage to several anatomical areas. It is the main cause of military casualties. Combat traumatic brain injuries cause severe and combined injuries, which causes high mortality and disability due to the development of a wide range of disorders. This significantly worsens the quality of life of victims. Emphasis is placed on the fact that the Ukrainian health care system will continuously face the consequences of war for the civilian population and military. Veterans will need not only timely and highly qualified medical care, but also long-term rehabilitation, which will contribute to their full reintegration into post-war society. The features of the development of long-term consequences of TBI in combat veterans have been insufficiently studied and need to be investigated to improve the rehabilitation and quality of life of victims, return them to labor and social activity. It is concluded that it is necessary to develop a special program of physical culture and sports rehabilitation for this category of combat veterans.

Bridging gaps: improving the access of primary health care in rural Ukraine through mobile health units

Rural healthcare is an integral part of the Ukrainian healthcare system. However, access to healthcare for the rural population is uneven due to poor development of medical infrastructure and staffing. The problem of access to medical care in rural areas has been exacerbated by the full-scale war.The objective: to study and analyze the current state of accessibility of primary health care in rural areas in Ukraine, followed by a discussion of promising areas for the introduction of mobile health units as a tool for implementing the “Medical Guarantees” program in hard-to-reach regions of Ukraine.Materials and methods. The study included data from official statistical reports, regulatory documents and scientific sources. The methodology includes bibliosemantic, medical and statistical methods and the method of structural logical analysis.Results. It has been established that the low level of access to primary health care for the rural population of Ukraine has been significantly exacerbated by the devastating impact of the war on medical and transport infrastructure, especially in the frontline and recently de-occupied rural areas, and by migration processes. The situation is complicated by the fact that most patients in rural areas are elderly people who are physically unable to use public transportation, even if it is available. The analysis of international practice has shown that mobile health units can be introduced into the public healthcare system as a temporary measure to meet the urgent needs of the Ukrainian population, especially in rural areas. Integration of mobile health units into the state program “Medical Guarantees” can effectively address the urgent health care needs to increase access to health care for the rural population of Ukraine. State regulation of the division of these units will eliminate problems such as duplication and uneven service delivery and will create a transparent system of remuneration for the staff included in these units.Conclusions. The results of the study suggest that the practice of mobile medical units should be introduced as a tool for implementing the “Medical Guarantees” program for regions/locations of Ukraine with low access to medical infrastructure, namely remote rural areas and areas that have been devastated by the war. Mobile medical units will ensure the stability of access to primary health care services and contribute to improving the health of the population.

АНАЛІЗ СУЧАСНОГО СТАНУ ТА ТЕНДЕНЦІЇ РОЗВИТКУ СФЕРИ ОХОРОНИ ЗДОРОВ’Я УКРАЇНИ

The paper analyzes the current state of the healthcare sector in Ukraine. The development of the healthcare sector in Ukraine is analyzed, the peculiarities and prospects of reforming the healthcare system in Ukraine, methods of management in emergency situations, in particular the Russian-Ukrainian war, and the latest research on this topic is analyzed. The author assesses the development of the public and private sectors of the health care market, identifies the main trends in health care reform, and assesses the impact of the Russian-Ukrainian war on this process. The management of the healthcare system in wartime is defined as a complex process, and ways to improve the management of this area to organize quality medical care for the population of Ukraine are proposed. Namely, the development of e-health, telemedicine, qualified personnel, and the introduction of innovative technologies. The author characterizes the public and private sectors of the healthcare market and the medical tourism market. The article presents a classification of obstacles to reforming the health care system, substantiates the use of the Organizational Structure of the public administration system based on the cluster model, and identifies key aspects of managing the development of health care in war conditions, based on an assessment of investment attractiveness, level of economic independence and stability of the relevant structures. Prospects for further research based on the development of new management models are presented, including the study of the impact of war on the health care system, evaluation of the effectiveness of reforms and the development of new models of medical care in conflict.

PRACTICAL TRAINING OF HIGHER EDUCATION LEARNERS IN SPECIALTY STOMATOLOGY AT BUKOVINIAN STATE MEDICAL UNIVERSITY

Considerable changes have taken place in the health care system of Ukraine. Theseprocesses produce a great influence on higher medical education, and therefore, it issignificantly transforming. Comprehensive mastering of a substantial amount of practicalskills, continuous advance of professional training quality is one of the important tasks athigher medical educational institutions. Training of a dentist involves practical trainingof essential common medical manipulations as well as special skills in diagnostics,prevention, and treatment of dental diseases.Objective structured clinical exam (OSCE) is a leading one in training of highereducation learners in the field of dentistry. The exam stimulates learning and concentratesstudent attention on acquiring clinical competence, increases the quality of educationalexperience of those taking the exam. It provides validity and reliability of assessment,qualitative feedback relations with current assessment of knowledge and skills of students.Objective – to analyze the educational- professional program «Stomatology» anddirections of its implementation among higher education learners at the departments ofstomatology.Materials and methods. Analysis of the educational- professional program «Stomatology»,psychological- pedagogical and methodological literature, materials of educationalmethodological conferences, methodological work of the departments. To achieve theaim, to specify the content and peculiarities of implementation of up-to-date pedagogicalmethods in the educational process the following theoretical methods of the research areapplied: analysis, synthesis, generalization, comparison, and systematization.Conclusions. Implementation of the educational program 221 «Stomatology» atBukovinian State Medical University is based on current scientific achievements ofstomatology and dentistry aid system. The program considers special distinctive featuresin the development of the regional health care system under conditions of labor markettransformation. Education is focused on a qualified practical dentistry training oflearners by means of integration of international innovation educational technologies.OSCE produces a positive effect on the educational process, since it stimulates learning.The attention of learners is concentrated on mastering clinical competence. Studentknowledge is assessed under conditions as close as possible to clinical ones. It helpsaccurate assessment of their skills and abilities necessary in professional work.

ДЕРЖАВНЕ РЕГУЛЮВАННЯ СФЕРИ ОХОРОНИ ЗДОРОВ’Я

The article conducted a comprehensive analysis of the current state of state regulation of the health care system in Ukraine, including reforming the financial system and the development of primary care. The main directions of state regulation are outlined, strategic priorities and prospects for further development are determined. Particular attention is paid to innovative approaches and the use of international experience in order to improve the quality of health care and to ensure the availability of medical services to all categories of the population. The need to focus on improving the availability of medical services and optimization of medical procedures is proven. It is found that innovative approaches and technologies in the health care system, including the development of telemedicine and electronic health, contribute to improving the quality of medical care and expanding the possibilities of remote medical treatment. The benefits of implementing electronic health technologies and their importance to ensure the availability of medical information and improve diagnostics are highlighted. Innovations in the treatment and diagnosis that cover personalized medicine and robotic technologies are considered. It is concluded that integration of innovative approaches and technologies into the health care system will help to improve the quality of medical services and health of the population as a whole.

ПЕРСПЕКТИВИ РОЗВИТКУ КОРПОРАТИВНОГО МЕДИЧНОГО СТРАХУВАННЯ В УКРАЇНІ В СУЧАСНИХ УМОВАХ

The article examines the evolution of the health insurance system in Ukraine, and also analyzes the advantages and disadvantages of using corporate insurance to expand voluntary health insurance programs. It is noted that the Ukrainian health care system is at the stage of reform, and mandatory health insurance has not yet been implemented. The main participants of voluntary health insurance are corporate clients. The purpose of medical insurance is to provide guaranteed medical care in the event of an insured event at the expense of accumulated funds. In addition, the insurance system is aimed at financing preventive measures and improving the quality and expanding access to medical services. A significant outflow of labor from Ukraine and, as a result, increased competition for qualified personnel forces companies to use new strategies to ensure employee loyalty. This is especially relevant for those who have survived the crisis in recent years and intend to strengthen their positions in the market. The successful management experience of companies, their practices, including personnel management, serve as an example for other participants in Ukrainian business. The medical reform that began in the country is the subject of active discussions in social networks and mass media, it is difficult to assess its direct impact on market growth indicators. In our opinion, while waiting for the changes, employers are showing much more interest in paying for medical treatment for their employees, and more and more employees are getting an insurance policy from their employer. The purpose of medical insurance is to provide guaranteed medical care in the event of an insured event at the expense of accumulated funds. In addition, the insurance system is aimed at financing preventive measures and improving the quality and expanding access to medical services. In connection with the ambiguity of the legislation regarding the mandatory form of health insurance in Ukraine, within the framework of our study, we will focus on its voluntary form. Thus, voluntary medical insurance is a type of insurance designed to provide the policyholder with a guarantee of full or partial reimbursement by the insurer of additional costs associated with contacting a medical institution for a service provided in accordance with the voluntary medical insurance program. Demand for voluntary health insurance products in Ukraine is very low. Insureds are mainly corporate clients, namely employers who insure their employees. Thus, it is possible to consider corporate health insurance as a separate segment of health insurance, which is part of the system of ensuring the human right to health.

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

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.

Strategy and Methodology of Modern Preventіve Physіcal and Rehabіlіtatіon Medіcіne іn the Health Care System of Ukraіne

The main sense of the preventive physical and rehabilitation medicine (PRM) strategy is the development and implementation of medical and social projects, which are based on certain backgrounds, principles, tasks and strategies. The purpose of a quality life formation is to promote the achievement of well-being and health at all levels and for all persons and the main mechanisms of its formation are the creation of conditions for individuals, groups of people, communities and a positive impact on health problems. The disease and its consequences, which disturb the necessary balance of medical, psychological and social components, lead to a change in the quality of a person’s life, to his partial or complete isolation from social life, which causes social disintegration. This necessitates the development and implementation in the health care system of Ukraine of promising preventive rehabilitation/habilitation technologies to improve the quality of life, which includes a person’s assessment of his physical, mental and social well-being. The article deals with modern views on preventive PRM as a disease prevention strategy, which includes the technology and organization of diagnostic and health-improving methods. The modern PRM strategy is determined by the priority of the systemic approach, the use of biopsychosocial models, the focus on the personalization of the individual, and provides for changes in the basic paradigm of the implementation and assessment of rehabilitation measures. Modern technologies in education and training have a positive impact on health promotion, rehabilitation and prevention, medical diagnosis, functional assessment, treatment and rehabilitation management for persons of any age who have experienced limitations in daily functioning due to health conditions. Preventive PRM is person- and functioning-oriented (as opposed to organ- and disease-oriented specialties or specialties that focus on specific age groups) and aims to improve activity, quality of life, improve healthy behaviors, and promote the positive influence of personal and environmental factors on functioning. Preventive PRM allows to manage person’s health. A person does not passively learn about the state of his health, but with the help of modern rehabilitation diagnostic technologies, a multidisciplinary approach, information support, specialists capable of implementing a complex of rehabilitation technologies, gets to know his body, understands what negatively affects his health, and which improves him, and most importantly, learns to manage these processes by himself.

Development of industrial technology of plant substance of viburnum opulus fruit liquid extract

Nowadays, the development of domestic herbal medicines for the treatment of diseases of the cardiovascular system remains one of the current problems in the health care system of Ukraine. Some types of plant raw materials that can be successfully used in the complex therapy of cardiovascular diseases include viburnum fruits (Viburnum opulus L.). Pharmacological activity, the antimicrobial, antioxidant and cardioprotective properties of the extract developed on their basis from the fruits of the viburnum opulus fruit liquid extract (VOFLE) have studied by preclinical in vitro researches.
 The aim of the work was the development of industrial technology of the domestic plant substance Viburnum opulus fruit liquid extract (VOFLE) for the purpose of it further introduction into the tablet dosage form.
 Experimental samples of viburnum opulus fruits of domestic origin were used as object of research, harvested in the experimental fields of the Institute of Vegetable and Melon growing of the National Academy of Agrarian Sciences of Ukraine (Kharkiv region) to obtain the plant substance VOFLE. Physicochemical and pharmacotechnological methods of research have been used in our work.
 As a result of physical, chemical and pharmacotechnological researches, a domestic plant substance – Viburnum opulus fruit liquid extract (VOFLE) has been developed and standardized by extracting viburnum fruits (Viburni opuli fructus) by water-ethanol mixture 50% at the general ratio of raw material: extractant – 1:10, the analysis of each production stage of the technological process was carried out in order to establish the main technological parameters that are subjected to monitoring during the introduction of plant substances in industrial production and during the validation of the technological process.
 The technology of the domestic herbal substance viburnum opulus fruit liquid extract (VOFLE) obtaining was theoretically justified and experimentally developed with the aim of its further introduction into a tablet medicinal form of cardioprotective and membrane-stabilizing activity. A technological block diagram was developed with the definition of its main critical stages of the production process of the herbal substance, as well as a production equipment scheme, which was tested in industrial conditions of the LLC «Pharmaceutical Company "Zdorovya"», Kharkiv.

ОБЛІК БЮДЖЕТНИХ АСИГНУВАНЬ В ЗАКЛАДАХ ОХОРОНИ ЗДОРОВ’Я: ОРГАНІЗАЦІЙНО-УПРАВЛІНСЬКІ ТА ЦИФРОВИЙ АСПЕКТИ

The healthcare sector of Ukraine needs special support at the national level of governance under martial law. An important priority in the context of the implementation of the Plan for the Recovery of Ukraine's Healthcare system from the consequences of war until 2032 is the introduction of effective governance tools that will ensure professional sustainability in the healthcare sector, as well as the formation of an effective management system for healthcare institutions in general. Building an effective management system for healthcare institutions requires high-quality accounting and analytical support for the management of budget allocations, in particular, when they are distributed and used by subordinate institutions. All stated issues determined the relevance of the chosen problem. The aim of the research is to study and substantiate peculiarities of the budget allocation accounting in health care institutions, taking into account organizational, managerial and digital aspects, in order to improve the efficiency of their activities and ensure the security of the accounting system as a whole. In the course of the study, general scientific theoretical methods of cognition were used, namely: tabular - for analytical assessment of the dynamics and structure of budget allocations of the health care institution under study; visual interpretation - for visualization of the process of organizing the accounting of budget allocations and their management system; analogy, abstraction and formalization - to reveal the features of financial and management accounting of budget allocations. The article attempts to substantiate the need to improve the synthetic and analytical accounting of budgetary allocations of a health care institution, taking into account organizational, managerial and digital aspects in the context of the post-war recovery of the national economy. Practical significance is in the fact, that based on the scientific and theoretical results of the study, actual proposals have been developed to improve the accounting of budgetary allocations of a health care institution, taking into consideration organizational, managerial and digital aspects. Prospects for further research consist in implementation of theoretical substantiation of the need to change the priorities of health care institutions within the framework of the Plan for the Restoration of the Health Care System of Ukraine until 2032, in particular, to increase medical services to meet the needs of internally displaced persons (IDPs) and people with special needs caused by the hostilities in Ukraine (rehabilitation, intensive care, development of "Specific Medical Guarantee Packages" for war victims) and disclosure of the peculiarities of their accounting reflection.

Maxillofacial Surgery inUkraine During a War: Challenges andPerspectives-A National Survey.

The invasion of Ukraine by Russian troops on February 24, 2022, and the beginning of the full-scale war had huge humanitarian consequences. The major challenges facing the Ukrainian health care system included the disruption of medical infrastructure and logistics, the termination of the supply of expendable materials, significant migration, and a dramatic increase in high-velocity blast and gunshot injuries among combatants and civilians.The aim of the present study was to analyze the challenges and solutions in patient care faced by the Ukrainian system of maxillofacial surgery during the war in different regions of the country. A cross-sectional study was designed and implemented as an online survey to collect national data concerning maxillofacial surgeons' experiences and professional activities. The study was initiated and supported by Bogomolets National Medical University (Kyiv, Ukraine), the Ukrainian representative of AO CMF (Arbeitsgemeinschaft für Osteosynthesefragen Craniomaxillofacial Surgery) and the University of Helsinki (Finland).The questionnaire was developed by specialists in maxillofacial surgery and sociologists and contained 65 close-ended questions. Surgeons who had not worked in this specialty in inpatient departments of hospitals since at least the beginning of the full-scale war were excluded from the study. We received and analyzed 97 responses that met the abovementioned criteria. The geography of respondents covered all the regions and the main cities of Ukraine, expect for the occupied territories. After a year of warfare, the percentage of surgeons who treated patients with blast and gunshot injuries increased from 43.4% to 86.6%. This percentage was higher in military hospitals and in regions located in the vicinity of the front line. We found that, during the war, 78.6% of respondents performed osteosynthesis in cases of high-velocity multifragmented facial bone fractures (in such cases, 58.3% of them strictly followed AO CMF recommendations, while 41.7% performed the fixation based on available hardware, existing technical possibilities and their own preferences). We found that 70.2% of respondents had the opportunity to apply Computer-Aided Design/Computer-Aided Manufacture technology and patient-specific implants for the treatment of gunshot injuries, 38.1% reported that their hospitals were able to perform microsurgical reconstructions for facial defects, 79.4% of respondents reported that their departments received humanitarian aid and support from volunteer organizations (either Ukrainian or international), which significantly facilitated the treatment process. According to this nationwide survey of Ukrainian maxillofacial surgeons during a year of the full-scale war, 86.6% of respondents were involved in the treatment of gunshot and ballistic injuries in civilians and combatants. The main problems reported by the respondents were (1) a lack of experience and knowledge related to the treatment of severe wounds, especially by secondary reconstruction, and (2) a deficit of resources (equipment, materials, and medications) under conditions of disrupted logistics and changes in the numbers and nosological distribution of patients. There were the opportunity to transfer the patients to European clinics (29.9%), online consultations (45.4%), collaboration with foreign surgeons who come to Ukraine asvolunteers (32%).

The Health and Functional Age Trend Self-assessment of the Older Workers and Retirees in Ukraine from Online Data Human Health Passport in COVID-19 Pandemic

For a general health assessment of the workers in organized industries, and unorganized groups of the unemployed and retirees, systematic online health monitoring has been used. Health monitoring includes a scale assessment of functional tests. The actual state of population health is still not included in the registers of National Statistics of Ukraine for example workers, pensioners and unemployment. The purpose of the study was systemic online health monitoring, to assess the impact of professional, demographic, and socio-economic factors in the Covid-19 pandemic condition and the limited capacity of the health care system in Ukraine. Methods: The study used the intrinsic capacity assessment scales, the five-question scale to detect muscle dysfunction in older persons, as well as some questions regarding residual performance, psychophysiological methods, and characteristics of the functional age. The questionnaire Human Health Passport 1.1 includes 70 questions; 21 of them were assessed by 1 point for positive answer and zero for negative case. The screening was carried out online on social media to Internet users aged 31 to 90. In the study 377 respondents of which 83.83% were employees. The Human Health Passport screening showed reliability (Cronbach alfa = 0.737), and correlation relationships of the main estimated indicators are significant. So, 54% of respondents do need health care under a physician’s supervision. The 39% of respondents need should convey the proper individual schedule of workout and labour hours, as well as physical activity and breathing exercises because only 7% of respondents are healthy. Correlation analysis of the scale results showed a significant relationship between age, with static balancing, falls during the last 6 months, and the ability to 5 times sit to stand test within 14 seconds. The optimal management of Human Health Passport screening helps to reduce the harmful influence on the environment, and transport expenses for doctor visits and saves the doctor's time for patient examination and prevention of the exposure and the spread of COVID-19. The screening showed the existing reserves of training for health promotion and, the overstrain of the functional systems of the body in the working population - 76%—by the purpose. _________________________________________________________________________________________ Keywords: remote health screening; retirees; biological age; ageing; elderly workers

EMPIRICAL VERIFICATION OF THE STRUCTURAL MODEL RELATING EQUILIBRIUM VALUES OF COSTS, QUALITY, AND COMFORT OF MEDICAL SERVICES WITH INDIVIDUALIZED ELASTICITIES OF DEMAND

The healthcare system in Ukraine is moving to flexible mechanisms to support the quality and comfort of medical services, in particular through the introduction of co-payments. The following necessitates the development of theoretical background and econometric models to support the process evaluation and optimization.
 Aim. The research aims at performing empirical verification of the structural model relating equilibrium values of costs, quality, and comfort of medical services with individualized elasticities of demand.
 Material and Methods. We have performed a combined (retrospective + prospective) study of the cases of uterine fibroids and/or ovarian cysts treated surgically in three city gynecological hospitals/centers in Vinnytsia, Ukraine. An econometric model of D. Dranove and M. Satterthwaite was used as the theoretical basis, the one that describes the dynamic equilibrium of cost, quality, and comfort of medical services together with demand elasticities. Importantly, the system of structural equations models joins moves of equilibrium of the price, quality, and comfort of medical services given shifts in the elasticities of demand. This is of use to analyze factors of efficiency and responsiveness to the demand of health care provision. Unfortunately, we did not find any practical use of this promising theoretical model, possibly due to the lack of empirical verification.
 Results and Disscusion. Therefore, we analyzed 150 case histories of women with uterine fibroids and/or ovarian cysts treated surgically. The data on the costs, quality, and comfort of inpatient care are studied to enable empirical verification of the model. The modern Monte Carlo Markov Chain (МСМС) methods of structural modeling and power analysis were used to estimate the required sample size.
 Conclussion. As a result of the study, the system of structural equations accompanying the theoretical model has been empirically verified for the first time and proved to be valid for ascertaining rational ways to optimize inpatient servicing of women with given gynecological pathology, in particular through the management of demand elasticities.

Determination of the main needs of palliative patients and ways of their provision in the health care system of Ukraine

The organization of medical care for palliative patients of Ukraine, as well as for other categories of patients, should take into account the data on the number of such patients among adults and children, as well as the characteristics of diseases that are included in the list of palliative diseases depending on their stage and the severity of the patients' condition. In Ukraine, the list of palliative diagnoses is smaller than the list recommended by the World Health Organization and adopted in high-income countries. But even those categories of palliative patients, which are included in the list, receive the necessary help in an insufficient amount. This applies both to the therapy of the underlying palliative disease and to effective analgesia. The reform of the health care system of Ukraine, activated since the beginning of the revolutionary events and the beginning of the occupation of Ukrainian territories in 2014, also extends to the provision of Palliative and Hospice Care (PHC). The PHC financing system at the expense of the Medical Guarantee Program has been significantly changed. A greater number of medical institutions are gradually joining the provision of PHC. Therefore, the discussion on clarifying the list of needs of palliative patients is relevant. This short scientific notice is published for the purpose of discussing the list of stated needs. Emphasis is also placed on the connection between the strategy of the reform of the health care system of Ukraine and the possibilities of effective satisfaction of these needs. Keywords: palliative and hospice care, PНC, the need for medical assistance, health care financing.

Current state and prospects of implementation of data standardization in the health care system of Ukraine (literature review)

The orientation of the world medical community, and Ukraine in particular, towards the improvement of the quality of medical services includes the introduction of modern tools and methods for quality regulation in the healthcare system. The focus of research on the modernization of medical services, methods and forms of treatment and diagnosis, as well as focus on global experience in regulating the quality of services provided by relevant institutions, undoubtedly contributes to the transition of the Ukrainian healthcare system to a new level. One of the most powerful and modern ways to improve the medical health care system is to introduce the standardization of the format and content of medical data. Quality implementation of the standardization program is a leading factor in the improvement of the quality of medical services, such as: early detection of diseases and emergencies, setting new therapeutic goals, improving the quality of clinical trials, improving of assessment of the quality of medical services and work of the doctors and nursing staff, improving the efficiency of health care programs, improving the safety of use of medical devices, forecasting medical consequences, reducing administrative costs, integrating artificial intelligence into the healthcare system, etc.