Historical and chronological development of public administration in the healthcare sector: national dimension

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Historical and chronological development of public administration in the healthcare sector: national dimension

Kyrylko Viacheslav Oleksandrovych Graduate student of the Department Management and Public Administration, O.M. Beketov National University of Urban Economy in Kharkiv, Kharkiv

Kalashnikova Khrystyna Ihorivna Candidate of Economical Sciences, Associate Professor, Associate Professor of the Department of Management and Public Administration, O.M. Beketov National University of Urban Economy in Kharkiv, Kharkiv

Abstract

The article defines the stages of historical and chronological development of public administration of the health care sector in the context of the national dimension, taking into account the current challenges for independent Ukraine. In particular, the emphasis is placed on the stages of reforming the national health care system and improving the relevant management component. At the initial stage, the legal, organizational, economic and social foundations of the national health care system of Ukraine were defined. The next stage was characterized by the identification of directions and ways of development of the national healthcare sector with the development of key mechanisms for managing the sector, but no large-scale healthcare reforms were carried out in the country. The third stage was the shortest and outlined ways to make a decision on the testing of health care reform. The last stage, which continues to the present day, is characterized by comprehensive healthcare reform and an updated concept of public administration flexibility on the path to European integration. At each of the stages, the authors outline the legislative and regulatory documents that are crucial in the history of the development of public administration in the healthcare sector. The authors emphasize the impact of the electronic healthcare system, which is characterized by the lack of compatibility of healthcare information systems, imperfect information infrastructure and interaction between national registries, etc. The beginning of the health care system reform by building the eHealth system turned out to be a landmark. It is proved that the EU4Health Agreement between Ukraine and the European Union is intended to expand opportunities to support the Ukrainian healthcare system and finally modernize the national healthcare system to European standards and facilitate sectoral integration. The article focuses on the Healthcare System Development Strategy until 2030, which has a positive impact on the public administration of the healthcare sector and is actively being filled with new stakeholders and players that require regulation, implementation of certain rules and establishment of a balance of interests.

Keywords: healthcare, public administration, comprehensive transformation, sectoral European integration.

Кирилко Вячеслав Олександрович аспірант кафедри менеджменту і публічного адміністрування, Харківський національний університет міського господарства імені О.М. Бекетова, м. Харків

Калашнікова Христина Ігорівна кандидат економічних наук, доцент, доцент кафедри менеджменту і публічного адміністрування, Харківський національний університет міського господарства імені О. М. Бекетова, м. Харків healthcare public administration

ІСТОРИКО-ХРОНОЛОГІЧНИЙ РОЗВИТОК ПУБЛІЧНОГО УПРАВЛІННЯ СФЕРИ ОХОРОНИ ЗДОРОВ'Я: НАЦІОНАЛЬНИЙ ВИМІР

The problem statement

In the modern world, the issue of healthcare is becoming increasingly relevant in the context of rapid development of science and technology, demographic and socio-economic challenges. Professional public administration in this area is the implementation of appropriate healthcare policy and a key factor in ensuring the efficiency and quality of healthcare services. The current public administration of the national healthcare sector is in a state of active transformation, taking into account the trends and requirements determined by the European integration processes in the territory of the Ukrainian state and sets itself an important task aimed at preserving and strengthening the health of the country's population today and in the post-war period.

Overview of recent research and publications

Important aspects of the formation and development of the national health care system and public administration in this area are highlighted by such Ukrainian scientists as A. Barzilovych, V. Lekhan, L. Kryachkova, M. Zayarsky, Z. Buryk, N. Podalchak and others, but the issues of improving the efficiency of management and regulation in the health care sector require constant monitoring by the authorities and related discussions.

The purpose of the study (task statement).

The purpose of the article is research on the historical and chronological development of public administration of the health care sector in the context of the national dimension.

Research results

After Ukraine achieved its independence in 1991, it became quite clear that the old Soviet model of health care management needed to be changed, as the market economy is not able to fully ensure the existence of free medicine at all levels of the health care system.

Having got rid of the post-Soviet chains, the development of the healthcare sector in independent Ukraine can be divided into four stages.

Stage I. Analyzing the first stage, which lasted from 1991 to 2000, it can be argued that there were practically no manifestations of reforms in the healthcare sector, as well as no innovations in the context of management structures in this area. The main criteria during this period were the legal, organizational, economic and social foundations of the national health care system of Ukraine.

Among the legislative and regulatory acts of this stage, which formed the basis for adjusting management activities in the health care sector, the following can be identified:

- The Constitution of Ukraine [1], which guarantees that everyone has the right to health care, medical assistance and health insurance;

- The Law of Ukraine "Fundamentals of the Legislation of Ukraine on Health Care" [2] defines the legal, organizational, economic and social principles of health care in Ukraine, regulates social relations in this area in order to ensure the harmonious development of physical and spiritual strength, high efficiency and long active life of citizens, elimination of factors that adversely affect their health, prevention and reduction of morbidity, disability and mortality, improvement of heredity;

- Order of the Ministry of Health of Ukraine of July 27, 1998, № 226 "On Approval of Temporary Sectoral Unified Standards of Medical Technologies for Diagnostic and Treatment Process of Inpatient Care for the Adult Population in Health Care Facilities of Ukraine and Temporary Standards for the Scope of Diagnostic Studies, Treatment Measures and Quality Criteria for Children's Treatment" [3].

Stage ІІ. This period is dated from 2000 to 2010 and is characterized by the definition of directions and ways of development of the national healthcare sector with the development of key mechanisms for managing the sector, but no large-scale healthcare reforms are carried out in the country. The only exceptions are local reforms in some sectors of the sector, and they were rather fragmentary. However, a special feature is the beginning of the introduction of the Institute of Family Medicine and attempts to work out the issue of implementing the insurance medicine project. In addition, the introduction of evidence-based treatment standards and the development of the non-governmental healthcare sector are also significant.

The legislative and regulatory documents of the second stage of the Ukrainian state, which formed the basis for adjusting management activities in the health care sector, include the following:

- The Decree of the President of Ukraine "On the Concept of Development of Public Health Care in Ukraine" [4] of December 07, 2000, № 1313/2000, which is aimed at implementing the provisions of the Constitution and laws of Ukraine to ensure accessible qualified medical care to every citizen of Ukraine, introducing new effective mechanisms of financing and management in the health care sector, creating conditions for the formation of a healthy lifestyle;

- The Resolution of the Cabinet of Ministers of Ukraine "On Approval of the Inter-sectoral Comprehensive Program "Health of the Nation for 2002-2011" [5] of January 10, 2002, № 14, which aims to improve the demographic situation, preserve and strengthen the health of the population, improve the quality and effectiveness of health care, ensure social justice and the rights of citizens to health care;

- The Decree of the President of Ukraine "On Urgent Measures to Reform the Public Health Care System" [6] of December 6, 2005, № 1694/2005, which aims to ensure the effective development of the health care system, preserve the nation's gene pool, implement profound structural changes in the medical sector, and introduce European standards for ensuring the right of citizens to medical care.

And although most experts in public administration in the field of health care and relevant specialists note that throughout the entire period of Ukraine's independence, reforms in the national health care sector have not been carried out at all or have been extremely ineffective, yet the next stage, according to the authors, can finally be allocated to health care reform in some of the regions identified for this purpose (for example, Dnipropetrovs'k, Donetsk, Vinnytsia regions and Kyiv).

Stage ІІІ. The period lasted only three years (2010-2013), and by that time, indeed, Ukraine had no experience of large-scale reforms and transformations in the healthcare sector, but in order to develop forms and mechanisms of reform and minimize possible negative consequences, it was decided to test the healthcare reform in the above-mentioned pilot areas within the framework of the Economic Reform Program (2010-2014) "Prosperous Society, Competitive Economy, Effective State" [7]. In particular, the third stage is characterized by the development of primary health care based on family medicine, as well as standardization, licensing and accreditation of medical institutions and facilities.

The most influential legislative and regulatory acts of the third stage, which influenced the further impetus for development in the healthcare sector, were:

- Resolution of the Cabinet of Ministers of Ukraine "On Approval of the National Plan for the Development of the Health Care System for the Period up to 2010" of June 13, 2007, № 815 [8];

- The Law of Ukraine "Fundamentals of the Legislation of Ukraine on Health Care" [2].

Stage IV. It started in 2014 and continues to this day. It is characterized by a comprehensive reform of the healthcare sector and an updated concept of flexibility in the management of this sector. This stage is marked by key transformations in the national healthcare system, including the transition to a contractual model of healthcare procurement, the introduction of new forms of financing medical institutions and the formation of healthcare workers' salaries. Another striking feature is the autonomy of health care providers, the introduction of social health insurance, and the development of a modern health information management system. The principle of "money follows the patient" has been introduced, which means replacing funding for the infrastructure of medical facilities and other service providers.

The legislative framework of the current stage of development of public activity in the healthcare sector is based on the following:

- National Strategy for Reforming the Healthcare System in Ukraine for 2015-2020 [9], which aims to identify key problems of the healthcare system, potential directions and ways to solve them to formulate a new state policy in the sector, including deep regulatory transformations and introduction of new financial mechanisms, in order to ensure human rights in the healthcare sector;

- The Law of Ukraine "On Amendments to Certain Legislative Acts of Ukraine on Improving Legislation on the Activities of Healthcare Institutions" [10] of April 06, 2017, № 2002-VIII, which was adopted in Ukraine, actively launched the implementation of the automatization of healthcare institutions;

- The Law of Ukraine "On State Financial Guarantees of Medical Care for the Population" [11] of October 19, 2017, № 2168-VIII, which introduced changes in the system of financing health care institutions, as well as changes in the process of preparing the latter for autonomy;

- Order of the Cabinet of Ministers of Ukraine "On Approval of the Concept of Healthcare Financing Reform" [12] of November 30, 2016, № 1013. The purpose of the Concept is to reform the financing of the healthcare system, create and implement a new financing model that provides clear and transparent state guarantees on the amount of free medical care, better financial protection of citizens in case of illness, efficient and fair distribution of public funds and reduction of informal payments, and creation of incentives to improve the quality of medical care provided by state and municipal healthcare institutions.

At the current stage, a transition to a new model of healthcare is evident, which involves systemic changes and a comprehensive transformation of the entire sector.

With the adoption of the National Strategy for Reforming the Healthcare System in Ukraine for 2015-2020, updated public administration mechanisms were introduced and new strategic approaches were implemented to improve the quality of healthcare services and significantly improve the level of healthcare.

The adoption of the Concept of Healthcare Financing Reform allowed for a transition to insurance-based healthcare financing through the payment of general taxes to the state budget. The Concept envisages a model of state compulsory health insurance. The financing of cost estimates is gradually being abolished and payment by results is being introduced. Thus, the principle of "money follows the patient" has been introduced, which means replacing the financing of the infrastructure of medical institutions and other service providers [13].

The early stage of eHealth implementation, which is characterized by the lack of compatibility of healthcare information systems, imperfect information infrastructure and interaction between national registries, lack of a single unique identifier for patients, imperfections in a number of registries, lack of professional staff for automation and change management, lack of computer and network equipment in healthcare facilities, etc.

Since the beginning of the healthcare reform, the focus of the eHealth system has been on obtaining quick results, from changing the model of financing healthcare institutions to redistributing funds according to the concept of "money follows the patient" [14].

The radical impetus for the development of public administration in the healthcare sector came in June 2023, when the decision to grant Ukraine the status of a candidate for accession to the European Union was approved.

Subsequently, an agreement was signed on Ukraine's accession to the EU4Health program. This Agreement between Ukraine and the European Union is intended to expand opportunities to support the Ukrainian healthcare system and respond to urgent needs, in particular, to contribute to the long-term recovery of our country, and most importantly, to finally modernize the national healthcare system to European standards and facilitate Ukraine's sectoral integration with the European Union [15].

The agreement on participation in EU4Health allows the national healthcare system to integrate into the European space. This process provides significant funding at the European Union level to support Ukraine's healthcare sector. This means a significant contribution to improving the level of access to medical services for the country's population and developing a system of early diagnosis of cancer and cardiovascular diseases.

Ukraine's cooperation with the EU institutions is constantly deepening, in particular, thanks to programs such as EU4Health. That is, this program, along with the implementation of the requirements and standards of the European Union, embodies sectoral integration on the way to protecting the health of our country's population [16].

It can be noticed that with the emergence of new challenges, such as pandemics, the growth of non-communicable diseases and global changes in medical practice, the healthcare sector has begun to require a revision of its management approaches. Reforms have become an active tool for adapting the system to new challenges.

It should also be emphasized that a draft Strategy for the Development of the Healthcare System until 2030 has been developed, but it has not been adopted due to the hostilities in Ukraine.

This document is integrated with the Sustainable Development Goals in the health sector and demographic indicators until 2030, and was developed by the Ministry of Health with the involvement of key healthcare stakeholders and in cooperation with international partners.

The key goals of the 2030 Strategy are to continue healthcare reform, move towards universal health insurance, improve health indicators, improve the quality of healthcare services, etc. [17].

Nowadays, the public healthcare system is being actively filled with new stakeholders and players, who need to be regulated, implement certain rules and establish a balance of interests. Of course, it is worth looking for ways to achieve a balance of interests and clearly choose the best vector in the multidimensional space that would not slow down the development of the health care system as a whole, but create additional triggers and motivators for its evolutionary and innovative development.

Conclusions

A historical and chronological review of the development of the national healthcare sector and the development of public administration in this area shows constant changes and adaptation to new realities. It must be admitted that the reform of the healthcare system in Ukraine was launched with a great delay, and current challenges require high flexibility and readiness for innovation from managers. Exploring these aspects will help to create more effective and progressive healthcare management strategies. Modern public administration of the healthcare sector is conditioned by the challenges of a dynamic global environment. Digital technologies, standardization of medical practice, and the changing role of the patient define new ways of developing the governance system. There are still many problems that need to be addressed to improve the efficiency of healthcare management and regulation to ensure maximum access to healthcare services and increase life expectancy.

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18. Подальчак Н. Ю. Розвиток публічного управління системою охорони здоров'я в Україні на засадах використання адаптивних інструментів менеджменту. Публічне управління та адміністрування у сфері охорони здоров'я : матеріали науково-практичної конференції з міжнародною участю (м. Київ, 20 жовтня 2022 р.). Київ, 2022. С. 24 - 27. URL: https://www.nuozu. edu.ua/zagruzka3/13_02_23-6.pdf

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