Health Care System Of Ukraine Research Articles

State Policy for the Private Healthcare Sector Development of Ukraine

The need to ensure quality and comprehensive healthcare at the world standard level determines the establishment and importance of private medicine in the healthcare system. It forms the task to reform, develop, and implement targets for private medicine. This article aims to investigate the measures by state policy in promoting private medical services. The methodological basis of this study is the dialectical method of scientific knowledge, system approach, and methods of logistic analysis. The empirical research involved retrospective, structural and comparative analyses. To achieve the study goal, the following tasks were solved: 1) determination of the theoretical basis of the state policy in private healthcare based on scientific background; 2) the analysis of the state policy in Ukrainian healthcare; 3) identification of the role of private medicine in the health care system; 4) the comprehensive analysis of the medical institution activities on the example of a private clinic «L-MED Clinic»; 5) determination of the connection between the effectiveness of activities and the marketing activities in promoting medical services. is study determined the importance of private medicine in the healthcare system of Ukraine. Private treatment and prevention facilities relieve the burden on public hospitals and clinics. The main competitive advantages of private healthcare institutions include availability, sufficient admission time, responsibility and organized attitude to the treatment process, quality diagnosis, full-range medical services, courtesy and attentive staff, comfortable and pleasant interior, etc. Based on the findings, the authors provided practical recommendations for improving the state policy, state regulation of private medical activity, and implementing the best world practices of branching out of the health care sector. The obtained results could be useful to the Ministry of Health of Ukraine, the Ministry of Social Policy of Ukraine, the Cabinet of Ministers of Ukraine, and the Verkhovna Rada of Ukraine in state regulation of healthcare reformation in Ukraine.

Legal regulations of digital economy during pandemic

The actual state of legal support for the digital economy significantly lags behind the needs of society in its social aspect, which includes not only stimulating the positive properties of digitalisation and their widespread use in all spheres of social existence but also ensures the minimisation of the risks generated by it and their negative consequences. The study aims to develop a solid base for the legal regulation of the digitalisation of the economy, public administration and healthcare system in Ukraine. During the study, authors used modelling, dialectical, comparative and historical-legal methods. The authors analysed the state of relations and their legal regulation from the perspective of the natural interaction of digitalisation, economics, and law as phenomena of public life. Problems that need to be solved were identified and respective solutions were proposed.

THE STATE’S ROLE IN PROVIDING HEALTH CARE PERSONNEL OF UKRAINE TOWARDS EUROPEAN INTEGRATION

The role of the state in the process of the health care system formation and provision with highly qualified personnel in the context of Ukraine’s integration into the European space has been outlined in the paper. The state support programs for the health care sector at the world and European levels, priorities for the medical education development have been analyzed. The problems of the Ukrainian health care system have been identified and suggestions regarding the transformation of the mechanism of personnel support in the field of health care by bringing medical education closer to European standards have been made.

Public Health Projects in Ukraine

Public systems are constantly searching for new management approaches to have better performance and be more transparent to society. The public health systems are not an exclusion. Governments in some countries have started to use the project approach in this area. The dominant purpose of this research is to analyze the advantages and disadvantages of operating projects in public health systems worldwide and in Ukraine. Systematization of literary sources and articles connected with a public health projectification indicates that project management has many valuable tools to control and impact public health, including stakeholder management, team management, risk management, and result management. In contrast to the positive impact of using projects, researchers have been concerned about the wrong success factors in the health projects and the unavailability to make long-term programs to make a systematic influence on society. The present study analyzed the domestic and foreign approaches to implementing healthcare projects to analyze public health project fulfilment worldwide and provides the systematization of public health project types in Ukraine, with illustrations of each type of project made by the Center of Public Health by the Ministry of Healthcare. On top of that, the current legal condition of the Ukrainian healthcare system was analyzed due to the strategy of healthcare reformation. The object of the study is the projects implemented by the Center for Public Health by the Ministry of Healthcare as the central institution of public health execution in Ukraine. The author has emphasized that healthcare reformation requires the use of project-management staff since changes in public health are designed to create conditions for the operation of patient-oriented medical institutions. The research results can be helpful for further development of the Ukrainian health system or any other healthcare system or for future research in the projectification of the public sector.

ECONOMIC POLICY OF THE STATE IN CONDITIONS OF INFORMATIZATION OF HEALTH CARE IN UKRAINE AS AN INTEGRAL PART OF THE SOCIAL SPHERE

The purpose of the article is to analyze domestic and international legal norms on the protection of medical information in order to improve the system of national legislation in the field of health care. The methodological basis of this study is a system of methods, the set of which is determined by the purpose and features of the study: dialectical, systemic, system-structural, analytical-synthetic, comparative-legal methods of analysis of domestic and international legal regulation of economic policy of the state in the conditions of informatization of health care of Ukraine. It argues that Ukraine, seeking to integrate into the European space and building its own strategy of economic development, must be clearly aware of both its capabilities and external factors of influence. The choice of possible alternatives is too complex a task, but the leading idea of socio-economic policy should remain the desire to ensure sustainable economic development of the country. In particular, the following is analyzed: recent international and domestic normative acts regulating state economic policy activities in the field of health care informatization in Ukraine: in particular, General Data Protection Regulation of the European Union (GDPR), CMS Interoperability and Patient Access Final Rule, ONC's Cure Act Final Rule, Order of functioning of the electronic health care system of Ukraine; materials of judicial practice, including materials of cases of the European Court of Human Rights, the results of sociological research. A comparative analysis of the GDPR and the Health Insurance Portability and Accountability Act (HIPAA) was conducted. The main problematic issues of state economic policy in the context of health informatization in Ukraine are highlighted. Compared to previous regulations governing medical data, the GDPR pays much more attention to the implementation of new requirements that have arisen due to the growing digitalization of healthcare, and therefore may contribute to strengthening their protection. Results. It is theoretically substantiated that quality medical reform is possible only with the introduction of modern methods of informatization and, consequently, information protection. As the analysis has shown, currently in Ukraine the legal system providing information protection in the medical sphere needs immediate improvement. This requires: systematizing and codifying national legislation in accordance with European legal norms and international law; developing a comprehensive legislative act, which would regulate the collection, protection and transition of medical information at the legislative level, following the example of GDPR (for structuring the medical information system, ensuring mandatory certification for information protection, development of cryptography/encryption technologies, delimitation of rights of access to information for medical workers, ensuring access to information with mandatory use of electronic signature, medical workers need to take short courses and register with information security specialists (defined access rights and the ability to change the level of access, provide input for identification and authentication), correcting data and entering new information is carried out with a confirmation of electronic signature, develop an algorithm for transferring information between medical institutions).

Характеристика стосунків органів місцевого самоврядування із закладами первинної медичної допомоги

At the current stage of the development of health care systems, it is believed that local governments should be included in any reform plans. The World Health Organisation emphasizes the important role of local governments in reforming primary care while maintaining the primary responsibility for building national central government health systems. The purpose of the study is to characterize the relations of primary health care facilities with local governments by the heads in the context of reforming the health care system in Ukraine and identifying problem areas in them that require improvement. Materials and methods. The study was carried out in two stages: focusing interviewing heads of primary health care facilities with a high level of competence to determine the set of characteristics that form the relationship between of the local governments and primary health care facilities; a survey of 100 heads of primary care facilities using a questionnaire drawn up based on the results of the first stage of the study. Statistical analysis was carried out using descriptive and analytical statistics. Results and discussion. Comprehensive reform of local self-government and primary health care in Ukraine faces certain difficulties and requires coordination of relations between the local governments and primary health care facilities. Twelve main characteristics of the relationship between local governments and primary health care system of the community were identified. Of the total number of respondents, 72% did not give a satisfactory assessment of the competence of the representatives of local governments in the organization of medical services; 36% – the attitude of local governments to primary care facilities; 32% – response of local governments to the needs of primary health care facilities; 78% – understanding by the owner of the contribution of the primary health care to the prosperity of the community; 52% – priority of health development for community; 12% of the respondents noted that their facilities did not receive additional funding from local budgets for the development of the institution and improvement of the quality of medical care. In general, 68% of the surveyed primary health care managers assessed positively the relationship with the owner; 19% – negatively. Conclusion. The study identified problems in the relationship between the local governments and primary care facilities during the reform of the health care system, which need to be addressed. It was revealed that the main problem is the lack of awareness of the local governments of the importance of primary health care for the community, which is primarily due to the low competence of representatives of local authorities on health issues

ОБЛІК ДОХОДІВ НЕПРИБУТКОВИХ КОМУНАЛЬНИХ МЕДИЧНИХ УСТАНОВ ТА ШЛЯХИ ЙОГО УДОСКОНАЛЕННЯ

The implementation of an effective healthcare system is the main task of state administration because it is through the healthcare system that the state fulfils the basic constitutional law and respects human rights. A legal and democratic state with a socially-oriented market economy actively ensures the quality of medical services to the population, therefore, the financial resources that are allocated from the state budget for medicine and health care require constant study and improvement. Particularly acute is the issue of financial support for non-profit communal medical institutions, this problem is of particular relevance in the fight against the global COVID 19 pandemic, which actualizes the search for ways to improve income accounting. As of today, Ukraine has taken a number of effective steps towards reforming the healthcare system, namely, in accordance with the Concept of Health Care Financing Reform and a number of laws signed by the President of Ukraine in December 2017. Since 2018, the implementation of a large-scale transformation in the financing the healthcare system has started. The proposed financing model is a patient-centred focus and is also aimed at ensuring the implementation of state guarantees for medical care and allows for clearly defining the roles and obligations of the Government, local governments and management of medical institutions. Available debatable issues in the activity of non-profit communal medical institutions concerning their income accounting are connected with the introduction of the medical reform in Ukraine. Organizing income accounting remains problematic, including its documentation, analytical and synthetic accounting, which determined the goal, objectives, subject and structure of scientific research. The priority areas for the development of non-profit communal health care institutions are increased rates of income, expanding the range of services provided, as well as their timely confirmation and recognition in the accounting system. The question of the sufficient budget financing level for the healthcare institutions remains relevant since the proper quality of medical care depends primarily on financial support. Volumes of the budget financing are determined according to scientifically based standards per capita, the State Budget of Ukraine, budgets of local and regional governments finance the public healthcare institutions. The article examines the income accounting of non-profit communal health care institutions and identifies ways to improve it under the influence of reforms in the health care system of Ukraine. In the study of the current state of financing the healthcare sector in Ukraine, the methods of observation and detailing were used; in the study of statistical material and data of the enterprises surveyed the methods of grouping and comparison were implemented, as well as the methods of synthesis and analysis.

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.

The Importance of Reformation of Ukrainian Medical Higher Education

Nowadays Ukrainian healthcare system is in search of ways to overcome the crisis and trying to build a new model which is close to world standards. Such kind of process requires a change in the paradigm of general basic secondary education and higher medical education. So, in the context of rapid development the issue of reforming the medical industry is urgent. It represents innovative technologies and evidence￾based medicines, the introduction of new methods of treatment and diagnosis of diseases, the latest information, and modern medical technologies which could be turned into practice. In the context of globalization, the necessity to integrate the Ukrainian system of medical education requires studying the foreign experience of professional training of future doctors in the leading institutions in the world. In particular, the main way to become more professionally competent is the improvement and development of the level of Medical English in preparation of medical students and postgraduate students in Medicine.

Особливості психічного здоров'я громадян України в умовах епідемічної небезпеки та реформування системи охорони здоров`я на сучасному етапі

Relevance. The global pandemic caused by the prevalence of COVID-19 (SARS-Cov-2) has become a trigger for the formation of a wide range of problems in the medical, socio-psychological, and rehabilitation spheres. The frequency of neurological or psychiatric diagnosis in patients after SARS-Cov-2, in the next 6 months, was 33.62%; the frequency of first diagnosis is 25.79%, and the mental health disorders themselves are diverse and affect almost all aspects of mental functioning, significantly worsening the quality of life. In addition, the extreme burden of the healthcare system in Ukraine in the context of a prolonged socio-economic and political crisis requires immediate реформування reform. Therefore, it is important to study the peculiarities of mental health of Ukrainian citizens in the context of epidemic danger and reform of the healthcare system at the present stage. Goal. To study the peculiarities of mental health of Ukrainian citizens in the paradigm of reforming the healthcare system in conditions of epidemic danger at the present stage. Materials and methods. Subject to informed consent in compliance with the principles of Bioethics and deontology, for the period from March to September 2021, 80 people aged 20 to 80 years were examined, who suffered covid-19 in 2020-2021 in mild (Group 1) and moderate severity – Group 2 (lung damage from 25 to 60%) and did not previously have a psychiatric diagnosis. The clinical and psychopathological method and screening diagnostics were implemented in the form of a semi-structured psychopathological interview, the main purpose of which was a comprehensive assessment of the patient's mental status. The psychodiagnostic method was used using the hospital scale of anxiety and depression HADS; the quality of life questionnaire SF-36; Being Activity Mood (BAM); The scale of C. D. Spielberger – Yu.L. Khanin. Results. The most common mental and behavioral disorders (MBD) using the HADS method are analyzed. The results showed that clinically expressed anxiety occurred in 33.7% of respondents (groups 1 and 2), and its subclinical variant – in 6.3%. The dominant plot of anxiety was phobic thoughts, fears of severe or fatal consequences of a viral disease in yourself or your loved ones. Clinically expressed depression was observed in 29.7%, and subclinically – in 68%. Assessment of the quality of life according to the SF-36 questionnaire revealed clinical indicators of the average score on the "vital activity" scale – 32.0 and 43.0 in groups 1-2, respectively. According to the BAM methodology, the self-assessment of the individual indicated a low assessment of all indicators in both groups. 75% of patients on the C. D. Spielberger–Yu.L. Khanin scale had high levels of situational and personal anxiety, and 25% had moderate levels. The level of situational anxiety was 56.70±0.48, and personal anxiety – 43.86±0.34 points. The Law of Ukraine "On rehabilitation in the field of healthcare " and the resolution of the Cabinet of Ministers of Ukraine "Issues of Organization of rehabilitation in the field of healthcare" are legislative and executive innovations of the present, which differ: pronounced" patient-centricity"; stages; multi-level; multicomponent influences; a significant range of rehabilitation coverage; interdisciplinarity; consistency; organizational and informational integrity; management efficiency; modernity, innovation. That is, the implementation of this law, if the necessary funding is available, will provide rehabilitation assistance to the population of Ukraine, including in conditions of epidemic danger, at the proper level. Conclusions. Thus, according to our study, as a result of the covid-19 viral disease, there was an increase in the number of patients with MBD: adaptive, anxiety-phobic and depressive. Organizational and methodological aspects of comprehensive medical and psychological care for patients with MBD in the framework of the development of the corresponding algorithm included: unity of measures, manageability of impacts; integrality; holistic approach; continuity, etc. However, an algorithm should be developed and brought into line with the presented innovations of healthcare reform in Ukraine for the terminology and formation of rational, effective directed routing of patients with anxiety-phobic disorders in conditions of epidemic danger in order to improve and increase the level of medical and psychological care and improve their quality of life. Keywords: COVID-19 (SARS-Cov-2) pandemic, mental disorders, behavioral disorders, health system reform.

Опыт организации системы здравоохранения Великобритании по фармацевтическому обеспечению лекарствами льготных категорий населения

Актуальность. Здоровье – найвысшая ценность не просто в контексте восприятия конкретным лицом, но и общества и государства в целом. Согласно содержания международных документов, утвержденных Генеральной Ассамблеей ООН, ВОЗ, Всемирной медицинской ассоциацией правительства несут ответственность за здоровье населения, обеспечивют реализацию права человека на жизнь и здоровье. Однако, для формирования мощной и действенной системы здравоохранения в Украине для фармацевтического обеспечения льготных категорий граждан полезным является опыт организации обеспечения здравоохранения в экономически развитых странах. Цель работы заключалась в изучении опыта Великобритании по организации организации системы здравоохранения для фармацевтического обеспечения лекарственными средствами льготных категорий населения. Материалы и методы. Для достижения поставленной цели были использованы общепринятые методы нормативно-правового, документального, ретроспективного и сравнительного анализа. Результаты. Система финансирования здравоохранения Великобритании предусматривает поступление преобладающей части средств из государственного бюджета, при этом распределение осуществляется по управленческой вертикали от высшего звена к низшему. Именно галоги, которые составляют около 90% бюджета здравоохранения, являются финансовым основанием национальной системы здравоохранения Великобритании. Для сравнения, только 7,5% средств поступают от работодателей. Поэтому можно утверждать, что система здравоохранения Великобритании фактически полностью обеспечивается за счет финансовых платежей со стороны плательщиков налогов и собственно государственного обеспечения. В мировой практике принято выделять три основные модели финансирования сферы здравоохранения: частная, бюджетная (модель Бевериджа), смешанная (модель Бисмарка). Частная модель финансирования существует за счет создания устойчивой конкуренции между заведениями здравоохранения. Частное страхование составляет около 40% от общих затрат, а остаток стоимости фармацевтического обеспечения покрывает сам пациент. Частная модель финансирования характерна для таких развитых стран как США и Япония. Бюджетная модель финансирования или модель Бевериджа предусматривает покрытие значительной части затрат на фармацевтическое обеспечение государственными учреждениями. Такая модель характерна и для Великобритании. Смешанная модель финансирования или модель Бисмарка базируется на «трех китах»: государство, предприятия и личные средства гражданина. Данная система финансирования на страховой основе характерна для Германии, Австрии и Франции. Частная медицина Великобритании — одна из наиболее передовых и наиболее дорогих в мире. В этой стране около 300 негосударственных госпиталей, каждый из которых получает лицензию в местном подразделении Национальной системы здравохранения и проходит проверку дважды в год. Здесь отсутствуют очереди, а медицинскую помошь предоставляют в полном и необходимом объеме. Платные услуги врачей и кабинетов оплачивают или страховые компании, или пациенты самостоятельно. В крупных компаниях Великобритании распространено медицинское страхование как дополнительный бонус к зарплате. Выводы. Опыт Великобритании по обязательному мединскому страхованию распространен в странах с преимущественным государственным финансированием. Модель Бевериджа распространена во многих странах, в которых государство обеспечивает компенсацию 80% и более затрат на здравоохранение (Канада, Австралия, Греция, Швеция, Испания). Значительные подвижки в системе здравоохранения Великобритании, возможность выбрать вид страхования и воспользоваться льготами на получение лекарственных средств позволила искусственно повысить конкуренцию между учреждениями здравоохранения, а соответственно – улучшить качество и скорость фармацевтического обеспечения пациентов. Таким образом, бюджетная медицина Великобритании – приоритет для многих стран мира и залог государственного финансирования фармацевтического обеспечения льготных категорий населения, независимо от уровня доходов и социального статуса.

Реформирование системы здравоохранения Украины: насущные задачи современного этапа

Цель исследования: обсудить и определить оптимальные подходы и пути решения кризисной ситуации по обеспечению финансовой доступности населения Украины к вторичной и третичной медицинской помощи в условиях реформы системы здравоохранения и борьбы с пандемией заболевания Covid-19. Материалы и методы. Использовались нормативно-правовые акты, источники научной литературы; методы исследования: системного подхода, системного анализа, сравнения и обобщения. Результаты. Анализ модели реформирования системы здравоохранения свидетельствует о значительной нехватке средств на финансирование медицинской отрасли. На кризисную финансовую ситуацию в области здравоохранения повлияло также существенное перераспределение средств в пользу первичной медицинской помощи (ПМП). Чтобы исправить эту ситуацию, необходимо привлекать объединенные территориальные общины (ОТО) к финансированию медицинской помощи, в том числе дать право ОТО оплачивать лечение жителям общины за счет местных бюджетов. Также очевидной становится необходимость разработки особого механизма медицинской помощи пациентам с хроническими заболеваниями. Целесообразно перепрофилировать какую-то часть учреждений здравоохранения (УЗ) в социально-медицинские центры, где хронические больные, в т. ч. паллиативные пациенты, смогут получать плановую поддерживающую терапию и реабилитацию, а при определенных ситуациях даже изоляцию. Это могут быть учреждения сестринского ухода, где основное внимание уделяется выполнению назначений врача, психологической и социальной поддержке и духовному сопровождению. Еще одним важным и болезненным вопросом является дальнейшая судьба ведущих медицинских центров и клиник Национальной академии медицинских наук Украины, МЗ Украины и Государственного управления делами. Многие направления реформирования системы здравоохранения требуют проведения кардинальных мер по корректировке предварительно запущенных механизмов, а также внедрению инновационных подходов. Выводы. Анализ внедрения Программы медицинских гарантий в рамках реформирования системы здравоохранения позволил выявить существенные недостатки механизмов финансирования УЗ вторичной и третичной медицинской помощи. Необходимо внедрять изменения организационной модели ПМП, где основным звеном должна стать амбулатория семейной медицины на правах юридического лица. Необходимо внедрять инновационные подходы и дополнительные источники финансирования. Для этого нужны дополнения к действующей нормативно-правовой базе, которые бы учли недостатки действующей модели реформирования системы здравоохранения и опыт регионов.

Медико-соціальна складова медичного менеджменту: удосконалення моделі надання медичної допомоги дітям з інфекційно-запальними захворюваннями сечовидільної системи

The purpose of the study was to substantiate and develop the improved model of the specialized nephrology care for the children with infectious inflammatory diseases of the urinary system at the regional level. Materials and methods. The official statistical data have been studied (reports on the state of medical care for children in the Chernivtsi region and data from the Center of medical statistics of the Ministry of Healthcare from 2006 to 2017), information-analytical and statistical methods have been used. The modern etiological structure of uropathogens – urinary tract infection pathogens among the children of the Chernivtsi region (2009-2016) was studied. Clinical and laboratory examination of 3,089 children (0-17 years old) was conducted in the region; the regional spectrum of sensitivity to antibacterial drugs was determined among the main groups of urinary tract infection pathogens; their age, gender and administrative-territorial differences among the children's population of the region are analyzed. Results and discussion. During 2012-2017 there was a significant increase (by 23.0%) in the incidence of infectious and inflammatory groups of the urinary system diseases among children of 0-14 years old, while among adolescents there was simultaneously an intensive decrease in indicators (by 40.0%) compared to 8.7% in 2006-2011. The ratio of indicators and their dynamics suggests that the growth of sick adolescents is largely due to the insufficient effectiveness of medical care, while children of 0-14 years old is due to their low and insufficient prevention. The data formed the foundation for substantiation and development of an improved functional-organizational model of the system. In addition to the existing and functionally changed elements the model contains new elements: regional/inter-regional center of specialized medical aid for children with infectious-inflammatory diseases of the urinary system. Conclusion. Implementation of the elements of the suggested improved model in a part of a rational approach in distribution of functions concerning medical observation of patients at the stages of providing medical aid enabled to make the period of hospitalization of nephrological patients by 11.40% shorter and an average period of treatment of patients with infectious-inflammatory diseases of the urinary system by 2.93% shorter. Efficiency of implementation of certain elements of the suggested model with its positive evaluation by independent experts and its compliance with the strategy of branch reforms enables to recommend the improved functional-organization model of providing medical aid for children with infectious-inflammatory diseases of the urinary system at the regional level to be introduced into the health care system of Ukraine

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.

Health technology assessment: features of national / regional and hospital-based medical technology assessment

The State Budget of Ukraine in 2021 is 159,2 billion UAH. It is 36.8 % more than in 2020, but this amount is still insufficient to cover all the healthcare needs in Ukraine. Economic hardships, the lack of funds in the healthcare system of Ukraine, as well as COVID-19 pandemic have increased the importance of Health Technology Assessment (HTA) as a tool of cost optimization. The introduction of hospital-based HTA along with national / regional HTA allows providing the use of effective, safe and economically justified health technologies that will give our citizens the access to treatment and the rational use of funds, in particular the budget ones. Aim. To analyze the world experience of using hospital-based HTA and its main differences from national / regional HTA. Materials and methods. The scientific information of international and domestic literary sources was analyzed. The methods of content analysis, historical, system-analytical and generalization were used during the research.Results. The authors reviewed the literature in Pubmed and Google Scholar databases devoted to the international experience of hospital-based HTA and its main differences from national / regional HTA. It has been determined that the transfer of the national / regional HTA results to the hospital level is hindered by a number of differences between the country as a whole and hospitals in particular. These include, first of all, features related to demographic indicators, epidemiology of diseases, the level of resistance, local approaches to treatment, various types of equipment used in hospitals, and others. In order to have practical benefits, HTA must be built taking into account the peculiarities of a medical institution where the health technologies studied will be used in the future.Conclusions. The need of effective management of hospital resources when a number of health technologies is increasing, the desire to improve clinical outcomes, improve the quality of life and its expectancy using health technologies with the proven effectiveness and safety, the need to evaluate medical equipment and consider organizational aspects related to introduction of a health technology, as well as assess the current equipment and treatment methods require to develop the scientific and practical approaches to hospital-based HTA and recommendations on collaboration between national / regional and hospitalbased HTA in Ukraine.

Організація медичної допомоги при подіях із масовим ураженням людей

Актуальність. Збільшення кількості надзвичайних ситуацій із масовим ураженням людей, зокрема через аварії на транспорті або терористичні напади, призводить до одночасного надходження значної кількості постраждалих осіб до закладів охорони здоров’я та потребує збільшення готовності системи охорони здоров’я до медичного реагування через постійний перегляд і опрацювання Плану реагування та взаємодії під час виникнення надзвичайних ситуацій і ліквідації їх наслідків. Під поняттям «події з масовим ураженням людей» (для закладу охорони здоров’я) у поданій статті розуміють ситуацію, через яку виникає невідповідність між одночасним надходженням значної кількості постраждалих і можливостями надання їм медичної допомоги без впровадження змін у повсякденні форми та методи роботи, на відміну від надзвичайної ситуації потреба залучення зовнішніх ресурсів закладом охорони здоров’я відсутня або мінімальна. Мета. Оптимізація інформаційного забезпечення системи управління медичною допомогою постраждалим при подіях із масовим ураженням людей. Матеріали та методи. Робота ґрунтується на власному досвіді організації та безпосередньому наданні медичної допомоги постраждалим при подіях із масовим ураженням людей і надзвичайних ситуаціях в Україні та за її межами, участі у міжнародних проектах і навчаннях, зокрема під егідою Європейської комісії гуманітарної допомоги та цивільного захисту. Під час проведення дослідження застосовано бібліографічний і семантичний методи пізнання. Узагальнено організаційні аспекти медичного забезпечення 46 випадків масового ураження людей, які відбулись у світі впродовж 1979–2015 рр., із них унаслідок терористичних нападів з використанням вибухових пристроїв — 33 (71,7 %), вогнепальної зброї проти незахищеного цивільного населення — 6 (13 %), пожежі в закладах відпочинку — 3 (6,5 %), сильнодіючих отруйних речовин — 2 (4,3 %) і внаслідок транспортних аварій — 2 (4,3 %). Результати. Організація медичної допомоги постраждалим внаслідок подій із масовим ураженням має ґрунтуватись на принципах 4С кризового менеджменту відповідно до введеного режиму функціонування органів і закладів охорони здоров’я. В системі охорони здоров’я України доцільно впровадити режими, що існують в країнах Європейського Союзу: 1) готовність до можливого надходження значної кількості постраждалих («зелений рівень»); 2) часткова мобілізація («жовтий рівень»); 3) повна мобілізації («червоний рівень»). Первинне медичне сортування постраждалих на догоспітальному етапі передбачає розподіл на дві основні групи: термінові та нетермінові. Нетермінових постраждалих слід доставити до лікарень, які географічно розташовано недалеко від місця події, але не до найближчого закладу, який має бути готовим до надання екстреної медичної допомоги терміновим хворим і тим, хто звернувся самостійно (самозвернення), кількість яких може суттєво перевищувати тих, кого доставлено бригадами екстреної (швидкої) медичної допомоги. До групи управління закладу охорони здоров’я включають відповідальних чергових — лікаря-хірурга та лікаря-анестезіолога. До форм інформаційного забезпечення системи управління надання медичної допомоги на догоспітальному етапу належать: 1) сили та засоби на місці події; 2) розподіл постраждалих на місці події; 3) потреба підсилення догоспітального етапу. На госпітальному етапі визначають можливості проведення хірургічних операцій та кількість вільних лікарняних ліжок: 1) операційний блок; 2) лікарняні ліжка. Висновки. В систему охорони здоров’я України при подіях із масовим ураженням людей доцільно впровадити відповідні рівні функціонування, що використовують в країнах Європейського Союзу. Перерозподіл наявних ресурсів охорони здоров’я при наданні медичної допомоги постраждалим при подіях із масовим ураженням людей на догоспітальному та госпітальному етапах критично важливе для збереження життя та здоров’я постраждалих. Управління надання медичної допомоги при масовому ураженні людей потребує відповідного інформаційного забезпечення догоспітального та госпітального етапів, впровадження галузевої та міжвідомчої взаємодії.

Межведомственная военно-гражданская унификация экстренной медицинской помощи в соответствии с реформированием системы здравоохранения Украины (аналитический обзор литературы)

На основании положений Военно-медицинской доктрины Украины и Концепции реформы системы экстренной медицинской помощи, с целью формирования единого методологического подхода к оптимизации логистического управления системой провести анализ организации предоставления экстренной медицинской помощи и медицинского обеспечения Вооруженных Сил Украины и гражданского населения в особый период государства, что в рамках единого медицинского пространства рассматривается как ключевой стандарт прав человека и юридический вызов в сфере здравоохранения Украины. На основании концептуального подхода к реформированию системы здравоохранения Украины и практики его реализации, в том числе в особый период государства, проведен анализ международного и национального законодательства, нормативно-правовых актов Украины, управленческих решений правительственного и ведомственного уровней, в том числе протокольного характера, Министерства здравоохранения Украины, Министерства обороны Украины и Государственной службы Украины по чрезвычайным ситуациям, регламентирующих этапы реформирования подсистемы экстренной медицинской помощи, а также определение их соотношения и особенностей межведомственного административно-правового регулирования. Предметом исследования было медицинское обеспечение военнослужащих и гражданского населения в соответствии с требованиями медицинской защиты в условиях чрезвычайных ситуаций военного характера. Аналитический обзор проведен при выполнении научно-исследовательской работы «Разработка принципов отраслевого и межведомственного взаимодействия при оказании экстренной медицинской помощи населению на территориях проведения антитеррористических операций и при чрезвычайных ситуациях с массовым поражением людей», которая утверждена МЗ Украины (№ гос. регистрации 0118U1140, выполнение — 2018–2020 гг. в НМАПО им. П.Л. Шупика, руководитель д.м.н., проф. Рощин Г.Г.), и «Научное обоснование принципов и методов функционирования службы медицины катастроф как механизма военно-гражданского сотрудничества в системе гражданской защиты населения» (№ гос. регистрации 0118U003653, выполнение — 2018–2019 гг. в ГУ «УНПЦ ЭМП и МК МЗ Украины», руководитель д.м.н. Печиборщ В.П.).

HEALTH CARE AS A SYSTEM-CREATING ELEMENT OF HUMAN CAPITAL: STRATEGIES OF ITS DEVELOPMENT BY THE CASE OF UKRAINE

The main purpose of the paper is to analyze the process of the health care development as the system-creating factor of human capital. Methodology. This study combines economic and managerial analysis of healthcare and human capital. The background for this analysis is the data of the 2020 Human Capital Index in Ukraine and other developed and developing countries. The method of historical and logical analysis of the literature was used. The functional and structural analysis was used with purpose to research the main tools of human capital’s development. Methods of comparative and statistical analysis and their synthesis were used to study dynamics of human capital. Method of summarization was used to make conclusions and recommendations for improving human capital in developing countries. Works of scientists in the sphere of human capital were used as the informational basis for the conducted study. Findings. In the paper it was analyzed the Human Capital Index in Ukraine and its components from the period of 2010-2020. The problems of the development of Ukrainian healthcare sector as the system-creating element of human capital are viewed. Formation of a new model for organizing medical care based on the development of the four P’s model of medicine (predicting, prevention, personalization, participation) is considered as the main basis for developing effective healthcare sector in Ukraine. The authors of the article see the following key areas of necessary actions in Ukrainian healthcare sector: technological breakthrough, strengthening a healthy lifestyle, ensuring the availability of high-quality medical services, developing human resources, creating a system of effective drug provision, increasing the efficiency of financing. Practical implications. The results of this study form the methodological and practical basis for improvement of the state regulation system of Ukrainian healthcare as a system-creating element of human capital. The results of conducted research could be a framework for formation of effective healthcare system in Ukraine, ensuring its constant development. The main proposals could be used by the Ministry of Healthcare of Ukraine while working out the Concept of national healthcare system development, they should be taken into consideration by state and municipal Health Departments for implement them during the process of Ukrainian healthcare sphere’s reformation.

Pharmaceutical provision of affected individuals in conditions of special period

Studied the pharmaceutical support of affected individuals in the conditions of special period. The meaningful meaning is determined: special period; affected individuals and their close relatives. Particularities of the pharmaceutical provision of affected contingents of the population in the conditions of special period were studied. Proved that the analysis of the experience of economically developed countries is useful for the formation of a powerful and effective healthcare system in Ukraine for the pharmaceutical provision of affected and privileged categories of citizens in emergency situations. The necessity of further researches in the field of pharmaceutical provision of persons who suffered in the conditions of the special period is substantiated.

Етичний компас медичних рішень під час пандемії COVID-19

The article actualizes and structures significant problems of the medical sphere that arise in the context of the COVID-19 pandemic, in terms of the relations vectors: global world – state – person, state – clinic – society, clinic – doctor (medical staff), clinic – patient, doctor (medical staff) – the patient. The authors presented the evolutionary context of the norming process of medical resources and emphasized the hierarchical scheme of the regulation process of scarce resources norming in the health care system under the pandemic crisis conditions. The paper substantiates approaches to making medical decisions on “sorting” and applying a number of its forms depending on various regional, national, religious, and local models of the ethical values system formation. Emphasis is placed on American and European models of bioethics. The authors consider the utilitarian approach to preparing medical solutions of “clinical sorting” to level ethical catastrophes in a pandemic based on Catholic ethics. The issues of regulated norming of scarce medical resources and the “clinical triage” of patients during the COVID-19 pandemic in Ukraine have been investigated. The main bioethical dilemma of the COVID-19 pandemic is outlined. The authors actualize criteria and models of ethical medical solutions for equitable allocation of scarce medical resources in the context of the COVID-19 pandemic. These criteria and models are defined in the Ethical Guidelines for Responding to COVID-19 of the Bioethics Committee at the Council of Europe, the US Department of Health and Human Services; in normative documents in the field of ethics of medical decisions during the COVID-19 pandemic of the National Medical Associations, chambers, centres of bioethics of Italy, Hungary, USA, Great Britain; in the guidelines of national, religious and local institutions for the preparation of medical decisions for the levelling ethical catastrophes during the pandemic and the studies of international bioethics experts. The paper identified the need to formalize the fair distribution of scarce resources during the COVID-19 pandemic in Ukraine. The authors suggested recommendations for the implementation of ethical values and priorities for their application in critical conditions of shortage of medical resources and personnel in the COVID-19 pandemic in the health care system of Ukraine.