Implementation Of Health Care Reform Research Articles

Resilient health reforms in times of permacrisis: the Greek citizens’ perspective

This study investigates Greek citizens’ attitudes toward the current healthcare system and their perspectives on healthcare reforms. Additionally, it explores the role of both endogenous and exogenous crises in accelerating the implementation of long-overdue structural reforms that might otherwise be challenging to achieve. To this end, the research examines the level of trust in institutions and the implementation of healthcare reforms following the fiscal crisis and during the COVID-19 pandemic. The findings reveal that while most Greek citizens recognize the necessity of structural reforms within the healthcare system, approximately half of the population views these changes negatively. The primary obstacles to successful reform are identified as a lack of political will and resistance from specific interest groups. The contradiction within Greek society concerning healthcare reform is largely driven by low levels of institutional trust and social capital. Although there is a clear need for radical reforms, public perception tends to be negative when these changes are framed within political discourse. However, when reforms align with the actual needs of society, citizens’ trust in institutions increases, thereby improving the likelihood of successful policy implementation. This underscores the critical role of institutional trust in facilitating significant healthcare policy transformations.

This time is different? Lessons from past reform initiatives in the Irish health system

Abstract The publication of the Sláintecare report in May 2017 is a landmark in Irish healthcare policy. For the first time in the history of the state, the Irish political system produced an agreed long-term vision for the health system. The Irish healthcare system has attracted considerable negative comment over a long period and satisfactory healthcare reform had appeared to be impossible to achieve. The history of Irish healthcare reform is replete with policy difficulties. This paper seeks to assess the likelihood that Sláintecare will be implemented given that it is the first long-term, multielectoral cycle healthcare initiative that is agreed by all the main political parties. The paper uses a game theoretic model developed by Dal Bó, Dal Bó, and Di Tella to develop an understanding of the impact of the electoral cycle on politicians and interest groups in negotiating and implementing healthcare reform. It uses a case-study methodology, with previous Irish healthcare reform initiatives as the unit of analysis. Finally, it shows that politicians are at a distinct disadvantage due to the short-term horizon imposed on them due to the electoral cycle and that the adoption of a long-term agreed policy, like Sláintecare, is more likely to be implemented.

1.X.1. Achieving universal health coverage: international lessons from Irish policy implementation

Abstract Health systems all over the world are struggling to meet population health needs and provide timely access to universal healthcare in the context of the COVID-19 pandemic. COVID-19 occurred in Ireland in the early years of implementation of a national plan for universal healthcare, called Sláintecare. While many health systems are experiencing a retrenchment on universalism in the context of COVID-19, in Ireland despite tediously slow Sláintecare implementation, the pandemic provided a boost to reform implementation and universalism. The reason for this workshop is to draw on a publicly funded Health Research Board Applied Partnership Award, entitled ‘Foundations’, harnessing lessons from the Irish COVID-19 health system response to inform Sláintecare’s implementation https://hrbopenresearch.org/articles/3-70/v1 The objectives of the workshop are to 1) provide academic research evidence from the Irish experience of universal health system reform during and since COVID-19; 2) to give participants space to reflect on the implications of the Irish universal health system reform on international health systems and policy; 3) to actively involve workshop participants in an engaged discussion on implementing universal health coverage in the context of COVID-19. The added value of the workshop is to share learnings from an academic research programme, which is coproducing evidence in partnership with the Irish health system, in a worldwide context, providing relevant and thought-provoking discussion and analysis for an international audience. Four separate inter-related presentations will draw on aspects of the Foundations’ research project. Presentation 1, Prof Sara Burke will outline recent academic literature on universalism and the politics of reform implementation in the context of COVID-19 and present a timeline of universal healthcare reform implementation since 2018 when Sláintecare was adopted by the Irish government (14 mins). Presentation 2, Dr Sarah Parker will detail a specific study which set out to advance understanding of how and to what extent COVID-19 has highlighted opportunities for change that enabled better access to universal, integrated care in Ireland, with a view to informing universal health system reform and implementation (10 mins). Presentation 3, Dr Katharine Schulmann and Carlos Bruen will present findings on the governance of reform implementation and implications for all health systems (10 mins). Presentation 4, Dr Philip Crowley, Health Service Executive (HSE) National Director of Strategy and Research and Chair of the Foundations’ research steering group will reflect how research findings can inform implementing reform and their implications for all health systems (6 mins). There will be four presentations totalling 40 mins, followed by questions and discussion chaired by an international expert/academic on universal health systems. Key messages • COVID-10 has highlighted how universal health coverage is more important than ever, however the pandemic has resulted in some retrenchment on universalism. • While data and research drove health system decision making during the pandemic, embedding research evidence into health system and policy reform remains challenging and can be politically opposed.

HEALTH TECHNOLOGY ASSESSMENT AS A TOOL FOR HEALTHCARE POLICY MAKING

Background. The article briefly describes the genesis of the concept of health technology assessment, which emerged in the 60s of the XX century. This was due to the emergence of technologies that gave rise to social, ethical, legal and political problems.
 Aim:To highlight the role of health technology assessment (HTA) in providing evidence-based information for health policy making. 
 Materials and methods. The object of the study was the information obtained from the relevant regulations and foreign and domestic literature sources describing the HTA process in terms of its impact on policy making.
 The basics of the HTA process and its purpose, which is to help develop safe and effective health care policies that focus on the needs of the patient and seek to achieve the best value for money, are established.
 Results. The list of factors that contribute to the use of HTA in health policy development, as well as the variety of models of real-world policy processes, is briefly reviewed. 
 It is emphasized that the interaction between policy makers and researchers, as well as the role of each party in the HTA process, especially the application of the results, depends on the social model of society. The introduction of a scientific approach inevitably leads to increased openness and accountability of government decisions and actions. In such a society, social and economic reforms become more successful. 
 Conclusion. It has been determined that the introduction of the HTA institute in Ukraine provides healthcare policy makers with a reliable resource for implementing healthcare reform.

The experiences of people with type 2 diabetes in communicating with general practitioners in China \u2013 a primary care focus group study

BackgroundWith the implementation of health care reforms in China, primary care is on a journey to provide care for most patients with type 2 diabetes. While Chinese general practitioners (GPs) have described challenges in communication with diabetes patients in their daily practice, little is known about patients’ experiences in communicating with their GPs.MethodsFive focus groups (of 4–5 participants each) were used to explore views from patients with type 2 diabetes. Purposive sampling was used to recruit a spread of participants from general practices in Guangzhou city, China. Focus groups were audio-recorded, transcribed, and thematically analyzed using the Framework Method.ResultsTen males and 12 female patients from five general practices participated in focus group discussions, with a mean age of 57.3 years and 7.3 years of diabetes duration. Five main themes emerged: patients’ understanding about diabetes, diabetes medication, communication with GPs, physician-patient relationships, and healthcare systems and context. Patients generally searched for information on the internet, but they weren’t always sure if it was trustworthy. Several communication needs were described by diabetes patients, such as explanation of blood glucose monitoring, medication information support, communication in the risk of diabetes complications and cardiovascular disease, and language barriers. Communication was frequently brief and not tailored to their concerns, and some described being scolded or panicked by GPs. Participants acknowledged the pressures within the health system, such as short consultation times, an incoherent GP-hospital interface and high demand.ConclusionsKey issues from the patients’ perspective for the development of primary care based management of diabetes in China were identified. People with type 2 diabetes require more access to trustworthy diabetes information and wish for better channels of communication with their GPs. Strategies may be required to improve GPs’ communication skills with their patients that also consider the context of the wider health system environment in China.

Готовність закладів охорони здоров’я України до автономізації

Розглянуто рівень готовності та спроможності організаторів охорони здоров’я та працівників закладів охорони здоров’я різних рівнів надання медичної допомоги до проведення автономізації закладів охорони здоров’я. Доведено низький рівень готовності та спроможності організаторів охорони здоров’я та працівників закладів охорони здоров’я різних рівнів надання медичної допомоги до проведення автономізації закладів охорони здоров’я. Визначено, що цей рівень готовності організаторів охорони здоров’я та працівників фінансово-економічних служб не дозволить ефективно провести автономізацію закладів охорони здоров’я.

The efficiency of provincial government health care expenditure after China's new health care reform.

ObjectiveWe aim to estimate the total factor productivity and analyze factors related to the Chinese government’s health care expenditure in each of its provinces after its implementation of new health care reform in the period after 2009.Materials and methodsWe use the Malmquist DEA model to measure efficiency and apply the Tobit regression to explore factors that influence the efficiency of government health care expenditure. Data are taken from the China statistics yearbook (2004–2020).ResultsWe find that the average TFP of China’s 31 provincial health care expenditure was lower than 1 in the period 2009–2019. We note that the average TFP was much higher after new health care reform was implemented, and note this in the eastern, central and western regions. But per capita GDP, population density and new health care reform implementation are found to have a statistically significant impact on the technical efficiency of the provincial government’s health care expenditure (P<0.05); meanwhile, region, education, urbanization and per capita provincial government health care expenditure are not found to have a statistically significant impact.ConclusionAlthough the implementation of the new medical reform has improved the efficiency of the government’s health expenditure, it is remains low in 31 provinces in China. In addition, the government should consider per capita GDP, population density and other factors when coordinating the allocation of health care input.SignificanceThis study systematically analyzes the efficiency and influencing factors of the Chinese government’s health expenditure after it introduced new health care reforms. The results show that China’s new medical reform will help to improve the government’s health expenditure. The Chinese government can continue to adhere to the new medical reform policy, and should pay attention to demographic and economic factors when implementing the policy.

The experiences of Chinese general practitioners in communicating with people with type 2 diabetes\u2014a focus group study

BackgroundChina has more ascertained cases of diabetes than any other country. Much of the care of people with type 2 diabetes (T2DM) in China is managed by GPs and this will increase with the implementation of health care reforms aimed at strengthening China’s primary health care system. Diabetes care requires effective communication between physicians and patients, yet little is known about this area in China. We aimed to explore the experiences of Chinese GPs in communicating with diabetes patients and how this may relate to communication skills training.MethodsFocus groups with Chinese GPs were undertaken. Purposive sampling was used to recruit 15 GPs from Guangzhou city in China. All data were audio-recorded and transcribed. A thematic analysis using the Framework Method was applied to code the data and identify themes.ResultsSeven males and 8 females from 12 general practices attended 4 focus groups with a mean age of 37.6 years and 7.5 years’ work experience. Four major themes were identified: diversity in diabetic patients, communication with patients, patient-doctor relationship, and communication skills training. GPs reported facing a wide variety of diabetes patients in their daily practice. They believed insufficient knowledge and misunderstanding of diabetes was common among patients. They highlighted several challenges in communicating with diabetes patients, such as insufficient consultation time, poor communication regarding blood glucose monitoring and misunderstanding the risk of complications. They used terms such as “blind spot” or “not on the same channel” to describe gaps in their patients’ understanding of diabetes and its management, and cited this as a cause of ineffective patient-doctor communication. Mutual understanding of diabetes was perceived to be an important factor towards building positive patient-doctor relationships. Although GPs believed communication skills training was necessary, they reported rarely received this.ConclusionsChinese GPs reported facing challenges in communicating with diabetes patients. Some of these were perceived as being due to the patients themselves, others were attributed to system constraints, and some were seen as related to a lack of clinician training. The study identified key issues for the development of primary care-based management of diabetes in China, and for developing appropriate communication skills training programs for the primary care workforce.

PLACE OF INFORMATION TECHNOLOGY IN THE PERFORMANCE OF MEDICAL ACTIVITIES

The state's policy is to integrate information systems into a single information space within the electronic health care system. The state plans and coordinates information systems that are implemented at the expense of the state or local budgets in order to rationalize the use of available resources and to avoid duplication of information systems functionality. With regard to information systems implemented through private funds, the function of the state is to build infrastructure (standardization, certification, market surveillance) for quality management in the market. The state provides single entry of information and its further processing in many information systems, storage of basic patient information within the central component of the WHO, and expanded information (eg data in clinical registers) in decentralized specialized information systems.&#x0D; The purpose of this study is to study the place of information technology in the implementation of medical activities. I would point out that medical activity is a set of actions of medical and pharmaceutical workers in providing medical care or service to a patient within the legal (subject to obtaining a license) and ethical (oath of Hippocrates) norms, ie compliance with the stages of treatment in accordance with the established standards of the Ministry of Health. We used in research scientific methods to analise in an objective and systematic way the information technology in the performance of medical activities, describe it with empirical. formal-logical, comparative-legal methods.&#x0D; It should be noted that e-Health is an electronic system that helps patients to receive and to doctors to provide quality medical services. All medical records throughout 2019 will be transmitted electronically. The main purpose of implementing an electronic healthcare system is to minimize fraud and corruption. In the future, e-Health will enable everyone to get their medical information quickly and doctors will be able to diagnose correctly with a holistic picture of the patient's health. The aim of the MoH is to launch a full-fledged eHealth by 2020, which would not only reflect the relationship between the hospital and the state but also be a register of medical records of all Ukrainians.&#x0D; Results. Thus, with the advancement of information technology, the growing share of medical research that relies on mathematical (computer) modelling has become commonplace in clinical practice, making it clear that IT capabilities are becoming a major contributor to medicine and health care. To date, many serious studies and projects are being implemented in the world to implement IT in the medical field. Due to medical reform, continuous computerization necessitated the need for medical staff to have computer skills. Today, in the medical field, services such as electronic medical record, electronic prescription, electronic referral, etc. are included in daily life. Electronic automated preparation of appointments, prescriptions, statements, hospital letters and other standardized documents for patients. In particular, there are automated databases of medical, pharmaceutical and scientific-pedagogical staff of the Ministry of Health of Ukraine.&#x0D; Conclusion. The impact of IT on health care plays an extremely important role, as with the implementation of health care reform in Ukraine there is complete computerization of all branches of the medical field.

Medical and demographic trends in Moscow during the implementation of health care reforms

Medical and demographic trends in Moscow during the implementation of health care reforms

INFORMATIZATION OF HEALTH CARE ON THE EXAMPLE OF A UTILITY COMPANY

The aim to provide valid, relevant, permanent, timely information to all health care institutions, as well as citizens of Ukraine in the framework of public health management processes for quality medical care. Sociological method - allows you to study the social structure and its impact on health. Systems analysis as a scientific method of cognition, which makes it possible to establish structural connections between system elements. Medical information system is a type of information system that differs in a set of methodological techniques, techniques and management algorithms designed to collect, store, process and transmit information in health care facilities. An single information system ensures the provision of reliable information in the right amount, in the right place, at the right time for members of the health care system. One of the important factors in the implementation of health care reform is the electronic health care system (E-Health). E-Health consists of two interconnected parts, one of which - the central database - will be controlled by the state. Institutions will have access to it through the second part, which is called privately developed medical information systems. The National Health Service of Ukraine ensures the functioning of the electronic health care system and awebsite containing information on the electronic health care system. Health care informatization today is an integral, perhaps the main, component of any health care reform in today's world. Creating a single information space has many advantages.

Health-care reform implementation challenges at suburban areas in Isfahan province: A qualitative study.

BACKGROUND:Health system reform plan in public health sector in Iran in the first phase focused on improving primary health care in suburban areas in and around big cities. The present study was conducted to assess the implementation process challenges of the reform plan in comprehensive health service centers at suburban areas of Isfahan in 2019.MATERIALS AND METHODS:This qualitative study with conventional content analysis approach was conducted in 2019. Participants were purposefully selected and interviewed at provincial levels from Isfahan University of Medical Sciences health department and health-care providers of comprehensive health services centers. The saturation point was reached after 21 face-to-face semi-structured interviews. Thematic analysis was employed to analyze transcribed documents assisted by MAXQDA version 10.RESULTS:The results revealed four main themes; the human resource management, the executive management, the electronic infrastructure, and the resource management. The major challenges in the implementation planning process included: the referral system, monitoring and supervision, electronic services infrastructure in the design and development of the EHR called the SIB system, lack of instructions guide, salaries and benefits, inconsistent financial and human resources and inappropriate allocation of theses resources.CONCLUSION:Despite the achievements in the development of the Iran health system reform plan, there were many challenges in the implementation planning process. It is recommended that theses challenges be reviewed and amended by health system managers and policymakers.

'Hybrid' top down bottom up health system innovation in rural China: A qualitative analysis.

China has made considerable progress with health system reforms in recent years. Rural China, however, has lagged behind as the diversity of needs of China's 3,000 rural counties were not always well addressed by national top-down reforms. China's Rural Health Reform Project Health XI (HXI) piloted a hybrid process of top down and bottom up implementation of health system reforms which were tailored to rural county level needs and covered a population of more than 21 million. Different studies provide evidence that HXI counties have achieved substantial benefits given the relatively limited investment. The Effectiveness of HXI subsequently raises the question how the hybrid approach may have resulted in effective implementation of interventions. We answer this question to advance understanding of hybrid approaches in general and in the rural Chinese context in particular, where the bottom-up elements might match poorly with the traditional organisational culture and learning style. We conducted an in-depth qualitative analysis in three 'best practice' counties, performing document-analyses, observations, semi-structured individual and group interviews. In alignment with the research question, this study is of an explorative nature and follows a sequence of deductive and inductive steps. HXI struggled initially as counties had difficulties to take initiative and autonomously select and adapt their own reforms. The initial reforms required multiple improvement iterations before achieving the planned results. The effectiveness of these bottom up reform processes has been aided by tight top down supervision and extensive domestic expert involvement. County level leadership is seen as essential to align the top down and bottom up structures and processes. Where successful, HXI has changed mind-sets and counties developed generic health improvement capabilities. Tailoring innovations to fit local needs formed a severe challenge for the three 'best practice' counties studied. A 'change of mindset' to actively take initiative and assume autonomy was needed to advance. Top down supervision and extensive support of experts was required to overcome the barriers. The studied counties finally achieved sustainable improvements and developed double loop learning capabilities beyond HXI objectives. Taken together, the above findings suggest that the continuum of healthcare reform implementation approaches in which hybrid approaches reside-from bottom up to top down-has two dimensions: a content dimension and a procedural dimension. Enabled by top down procedures, counties were able to bottom up tailor the content of best practice innovations to fit local needs.

The role of Ukrainian local budget expenditures on health in conditions of decentralization

Relevance of the research topic. The implementation of medical reform in Ukraine, which provides radical structural changes in the health care system, the transformation of financing mechanisms for services, and at the same time the implementation of budgetary reform, an integral part of which is budget decentralization, makes the issue of assessing the role of local budget spending on health care. Formulation of the problem. In conditions of limited budgetary funds, growing debt and budgetary decentralization, successful implementation of health care reform is impossible without increasing the role of local budgets in financing the industry of development priority areas. Analysis of recent research and publications. The works of I. Chygynova, V. Makogon, M. Pasichnogo, Ju. Markuts, I. Kogut, Y. Pasichnik, V. Tropina [1-6] and others are devoted to the study of issues related to the problems of the article. The results of their own research of some of the indicated problems are presented in [6-8]. Segregation of unexplored parts of a common problem. In the context of deepening budget decentralization, strengthening the financial base of local budgets, expanding the functional powers of local governments, it is necessary to further search for ways to increase the role of local budgets in health care financing. The purpose of the article is to assess the role of expenditures of local budgets of Ukraine on the health care sector in the context of deepening budget decentralization and to develop proposals for improving its financing. Duringresearch, general scientific and special methods were used: analysis and synthesis, the method of generalization, statistical, etc. The article analyzes and evaluates the total expenditures of local budgets for health care, as well as for the regional program "Health of the population of the Dnipropetrovsk region for 2020-2024". The attention is focused on increasing the role of local budget expenditures in the process of changing the health financing model. The basis for expanding the capacity of local governments to finance health care was the deepening of budgetary decentralization, changes in the distribution of taxes to local budgets, etc. Conclusions. In conditions of acute limited financial resources, success in the formation and effective use of funds from local budgets of Ukraine for the development of an appropriate health care system is associated, first of all, with the consistent implementation of the financial and budgetary policy of the state, the coherence of medical and budgetary reforms, priorities, increasing the efficiency of the use of budgetary funds in format of target program budgeting. The results of this study can be applied in the process of forming and implementing social and budgetary policies for the development of the health care system in the country.

Financing of medical services: experience of foreign countries and Ukraine

Introduction. Research into the sources of health care funding is necessary to develop an effective policy to improve the domestic health care system and improve the accessibility and quality of medical care. The purpose of the article is to assess the sources of funding of medical services in foreign countries and in Ukraine in order to identify and analise current trends and prospects for financing the domestic health care system in the implementation of health care reform. Results. An analysis of trends in the financing of health services in foreign countries has shown that there is a certain imbalance between the country's economic growth and its health care expenditures. The share of health services expenditures in GDP averaged 8.8 % or almost $ 4,000 per OECD citizen in 2018 y . This cost figure is 24 times higher than the per capita health care costs in Ukraine and can be a guide to the amount of funding for medicine in the world community. Citizens of OECD countries, unlike Ukrainians, pay an average of 21 % of all health care costs. The priority sources of funding for one group of countries are budget funds (Norway, Denmark, Sweden, Great Britain, Canada), and for another – compulsory health insurance (Germany, Japan, France, etc.). Сonclusion. Funds of the population are the main source of funding for medical services in Ukraine – 53 %. This indicator is critical for the country, as low-income citizens are unable to pay for medical care and the number of chronic diseases, disability and mortality are increased. The transformational reform of the health care system in Ukraine was started in 2015 and according to international experts is successful and meets international practices of accessibility, quality and efficiency of medical services. Further consistent implementation of health care reform can provide financial protection for the population from excessive out-of-pocket spending, improve access to health care, and improve public health.

Current trends in the implementation and development of communications in the Ukrainian model of public governance in health care

The article looks at the processes of capacity building and improvement of the quality of communicative interaction in the national model of public health management. The development of the information infrastructure, the increase of the level of computer literacy and the information culture of the community allow to transform the managerial approaches and forms of interaction concerning health between the state authorities and the population. The author highlighted and analyzed the main characteristics of health communication models in the historical context. An organizational and functional analysis of the current state of the regional health care system has been made, the communicative content of managerial branch problems identified, and a description of the main subjects, stakeholders and communication channels in the management of health care in the implementation of health care reform in Ukraine provided. Taking into account the world experience, proposals regarding strengthening of the integration of the Ukrainian model of the health care system and its management system into the European medical space on the basis of improving communication and organizational relations have been made. The theoretical basis for improving the public health care management system in Ukraine is the provision on the feasibility of embedded integration in the complex of communicational and organizational links in the health care system in the institutional, organizational and managerial environment of interaction of the subjects of management in the local, regional, national and international levels, based on the distribution of power and responsibilities in relationships between state bodies, local self-government bodies, entities of health care, the public and others take holders in the development of the medical sector, is designed to ensure a sustainable increase in the health-care efficiency for the Ukrainian population as a result of medical reform.

Maximizing the academic nursing model in the era of COVID-19 and beyond

Maximizing the academic nursing model in the era of COVID-19 and beyond

ЗАСТОСУВАННЯ ДІАЛОГІЧНОЇ МОДЕЛІ ЗМІН У ПРОЦЕСІ РЕФОРМУВАННЯ СИСТЕМИ ОХОРОНИ ЗДОРОВ’Я В УКРАЇНІ НА ПЕРВИННОМУ РІВНІ

У публікації констатовано підстави проведення реформування охорони здоров’я в Україні зважаючи на кризову медико-демографічну ситуацію та потребу збереження й покращення здоров’я не тільки як факту відсутності захворювань чи фізичних дефектів, а й як факту повного фізичного, психічного та соціального благополуччя населення. &#x0D; Проаналізовано ключові кроки, що були зроблені у контексті впровадження реформи системи охорони на первинному рівні здоров’я з позиції діалогічної моделі змін, яка передбачає орієнтоване на результат структуроване планування та проведення діалогу зацікавлених сторін протягом чотирьох етапів: вивчення та залучення; розбудова та формалізація; впровадження та оцінка; подальший розвиток, відтворення / інституалізація. Кожен із чотирьох етапів діалогічної моделі змін включає кроки, яких варто дотримуватися, щоб будь-яка ініціатива досягла поставленої мети. Діалогічна модель змін пояснює, що потрібно врахувати для однозначного сприяння діалогу та орієнтації на результат. &#x0D; Доведено, що результат реформи системи охорони здоров’я, як і будь-якої іншої, залежить від досвіду управління процесами та змінами, ґрунтовного розуміння концепції змін, вміння всіма зацікавленими суб’єктами процесу реформування аналізувати та оперувати інформацією.&#x0D; Підсумовуючи позитивні досягнення реформи системи охорони здоров’я – забезпечення державних гарантій надання медичних послуг відповідно до видів медичної допомоги; розвиток ефективної та доступної мережі закладів; безперервне покращення якості медичної допомоги; впровадження електронної системи охорони здоров’я; забезпечення пацієнтів лікарськими засобами тощо, акцентовано на потребі комплексного застосування організаційного-управлінського, інформаційно-комунікаційного, фінансово-економічного, нормативно-правового та інших механізмів для ефективного впровадження реформи системи охорони здоров’я через призму діалогічної моделі змін.

The role of Astana primary health care declaration for development of primary health care at postsoviet countryes

The article presents the goals, principles and results of the implementation of the Almaty Declaration of the World Health Organization (WHO) on primary health care (PHC) of 1978; the background and main provisions of the Astana Declaration of WHO on PHC 2018. The article presents the stages of PHC development in the USSR, which was characterized by the widespread introduction of narrow specialists at the primary level of health care, which subsequently had certain negative consequences. In a number of post-Soviet countries, the principles of General medical practice (family medicine) were implemented in health care reform, but some provisions of the Alma-Ata Declaration were introduced with distortions. This has led to a lack of effective functioning of the PHC system, a shortage of General practitioners, especially in rural areas. The implementation of the main principles of the new Astana Declaration will be important for the effective implementation of health care reforms in all post-Soviet countries.

СРАВНИТЕЛЬНЫЙ АНАЛИЗ ФУНКЦИОНИРОВАНИЯ И РАЗВИТИЯ СИСТЕМ ЗДРАВООХРАНЕНИЯ УКРАИНЫ И КАЗАХСТАНА

Currently, Ukraine and Kazakhstan are implementing health care reform, based on the introduction of new approaches to public administration in order to improve the accessibility and quality of providing medical services to the population. Studying the experience of such reform is an urgent task of the theory and practice of post-Soviet socio-economic transformations. A comparative analysis of medical reforms in the countries studied allows us to identify existing problems and propose solutions to them, taking into account their foreign experience in implementing them with a view to justifying and developing an effective mechanism for managing the industry. Analysis of the practice of public administration of the health care system in Kazakhstan and Ukraine concludes with a logical generalization and justification of priority measures of the state in this field. The limitation in the proposed study is the incompleteness of statistical bases, as well as the lack of generally accepted approaches and methods for assessing the health system.