Modern practice of development of public administration mechanisms in the health protection sphere: regulatory aspect

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Modern practice of development of public administration mechanisms in the health protection sphere: regulatory aspect

Karpenko Lidiia Mykolayivna

Doctor in Economics, Professor, Professor of the Local Self-Government and Territorial Developmen Department, Educational and Scientific Institute of Public Service and Management of the OdesaPolytechnic National University, Odesa

Izha Mykola Mykolayovych Doctor of Political Sciences, Professor, Director, Educational and Scientific Institute of Public Service and Management of the Odesa Polytechnic National University, Odesa

Zarzhytskyi Bohdan Olegovich Post Gradueted Student of the Local Government and Territorial Development Department, Educational and Scientific Institute of Public Service and Management of the Odesa Polytechnic National University, Odesa

Abstract

In order to create an effective system of functioning of state mechanisms, an important step is the partial restructuring of the national institute of the health care system, which should be aimed at creating infrastructure and ensuring the resource and legislative basis for the functioning of the medical services market on the basis of free competition, but under the control of the regulatory influence of the state.

It is worth noting that recently there are many questions about what exactly an effective mechanism of medical care should look like and in which directions it is necessary to move in order to reform it in the necessary way. That is why the problem of state regulation of social relations in the area of health care is becoming particularly relevant in Ukraine today. The reason for this is not only the lack of perfect mechanisms of state regulation of this industry, but also the insufficient number of scientific studies that would cover the entire spectrum of legal relations in various spheres of activity for the private medical industry.

The purpose of the article is to deepen the theoretical and methodological foundations of the public management mechanisms development in the area of health care, the organization of the principles in the formation of the quality for medical care, the regulatory aspect of state institutions. The subject of the research is the theoretical-methodical and applied principles of formation and practical application of the toolkit for improving the mechanism of public management of the strategic potential of the security system.

Among the unresolved components of the general problem is the issue of reforming the state management of the financing for the health care system in the period of change, especially in the issues of developing the unified vision of building the Ukrainian model of health care in the market economy conditions.

In the work, authors researched theoretical approaches to the development of sustainable mechanisms for public administration in the sphere of health care. The main parameters and characteristics of state management mechanisms are considered. The methods and tools of state regulation of the medical sphere are covered in detail. It has been proven that with the effective application of the necessary methods and tools, the proper functioning for the mechanisms of management and regulation in the state is ensured. The authors have systematized the main groups of state management mechanisms in the sphere of health care, given a meaningful description of state management and regulatory influences in the sphere of health care for each group.

The conducted analysis of the selected research issues provides the conceptual basis for the formation of an effective financial mechanism for public management of strategic potential in the sphere of health care; forms the platform for the development of the stabilization macroeconomic policy. There are prospects for further research which consist on the improvement of state targeted programs in the sphere of health care, the implementation of state policy priority areas, one of which is the fight against cancer incidence and mortality. The development of the state target program allows ensuring the concentration of financial, material and technical resources and scientific potential, coordination of the activities for central and local executive institutions and organizations to solve the certain problem in the sphere of health care.

Keywords: health care industry, state policy, sources of financing, health care system, mechanisms of public administration, mechanisms of state administration.

Карпенко Лідія Миколаївна доктор економічних наук, професор, професор кафедри місцевого самоврядування та розвитку територій, Інститут публічної служби та управління, Національний університет «Одеська політехніка»

Іжа Микола Миколайович доктор політичних наук, професор, Директор, Інститут публічної служби та управління, Національний університет «Одеська політехніка»

Заржицький Богдан Олегович аспірант кафедри місцевого самоврядування та розвитку територій, Інститут публічної служби та управління Національного університету «Одеська політехніка»

СУЧАСНА ПРАКТИКА РОЗВИТКУ МЕХАНІЗМІВ ПУБЛІЧНОГО УПРАВЛІННЯ У СФЕРІ ОХОРОНИ ЗДОРОВ'Я: РЕГУЛЯТОРНИЙ АСПЕКТ

Анотація. Для створення ефективної системи функціонування державних механізмів, важливим кроком є часткова реструктуризація національного інституту системи охорони здоров'я, що має бути спрямована на створення інфраструктури та забезпечення ресурсних та законодавчих підґрунть функціонування ринку медичних послуг на засадах вільної конкуренції, проте під контролем регуляторного впливу держави.

Варто відзначити, що останнім часом виникає багато питань щодо того, як саме має виглядати ефективний механізм роботи медичного обслуговування та в яких напрямках необхідно рухатися для того щоб його реформувати необхідним чином. Саме тому на сьогодні в Україні особливої актуальності набуває проблема державного регулювання суспільних відносин у сфері охорони здоров'я. Причиною цього є не лише відсутність досконалих механізмів державного регулювання даною галуззю, а й недостатня кількість наукових досліджень, які б охоплювали весь спектр правовідносин у різних сферах діяльності приватної медичної галузі..

Метою статті є поглиблення теоретико-методичних засад розвитку механізмів публічного управління у сфері охорони здоров'я, організації засади формування якості медичного обслуговування, регуляторний аспект державних інституцій. Предметом дослідження є теоретико-методичні та прикладні засади формування та практичного застосування інструментарію удосконалення механізму публічного управління стратегічним потенціалом системи охорони.

Серед невирішених складових загальної проблеми є питання реформування державного управління фінансуванням системи охорони здоров'я в період змін, особливо в питаннях вироблення єдиного бачення побудови української моделі охорони здоров'я в умовах ринкової економіки.

У роботі авторами досліджені теоретичні підходи щодо розвитку сталих механізмів публічного управління у сфері охорони здоров'я. Розглянуто основні параметри та характеристики механізмів державного управління. Детально висвітлені методи й інструменти державного регулювання медичної сфери. Доведено, що при ефективному застосуванні необхідних методів та інструментів забезпечується належне функціонування механізмів управління і регулювання в державою. Авторами систематизовано основні групи механізмів державного управління у сфері охорони здоров'я, наведено змістовну характеристику державно-управлінських та регуляторних впливів у сфері охорони здоров'я за кожною групою.

Проведений аналіз за обраною проблематикою дослідження забезпечує концептуальною базою формування дієвого фінансового механізму публічного управління стратегічним потенціалом у галузі охорони здоров'я; формує платформу розбудови макроекономічної політики стабілізації. Перспективами подальших досліджень виступає вдосконалення державних цільових програм у галузі охорони здоров'я, реалізація пріоритетних напрямів державної політики, одним з яких є боротьба з захворюваністю і смертністю від раку. Розробка державної цільової програми дозволяє забезпечити концентрацію фінансових, матеріально-технічних ресурсів та науково- технічного потенціалу, координацію діяльності центральних і місцевих органів виконавчої влади, установ та організацій для розв'язання певної проблеми галузі охорони здоров'я.

Ключові слова: галузь охорони здоров'я, державна політика, джерела фінансування, система охорони здоров'я, механізми публічного управління, механізми державного управління.

Problem setting

public administration health protection

Health care is one of the priority areas of state activity. The state forms the health care policy in Ukraine and ensures its implementation. The relevance of this work lies in the fact that the health care system plays a particularly important role in ensuring the proper standard of living. Human health, as we know, is recognized in the world as so important that the indicator of its condition is the first to be included in the index of human development - the universal indicator, the level of development of the society in a country, on the one hand, and on the other - the sensitive indicator of the effectiveness of the state system management. This is one of the arguments that public health protection is one of the important state functions.

The development of relations in the sphere of health care during recent years, unfortunately, cannot be considered stable. This is a consequence of misunderstanding and stereotypes regarding the implementation of market relations, lack of effective forms of state regulation for the industry.

Industry researchers emphasize that the existing models of health care in most countries of the world are based on the market principle: need - satisfaction of need - profit - stimulation of need - need. Thus, modern medicine, the pharmaceutical industry and other associated sectors of the economy as business entities are directly interested in increasing the need for medical care [1]. But in the context of consideration of the right to health care, it is also worth touching on the extremely painful problem of preserving the gene pool of the Ukrainian people, the solution of which in accordance with Art. 16 of the Ukraine Constitution is the duty of the state.

The list of economic functions of the state shows that its economic role involves regulation of all sectors of the economy as a single system. The fact of state regulation of the economy in any country is indisputable. And the favourable state with the dynamics of life expectancy existing in economically developed countries is only to a small extent related to successes directly in medicine; it is mainly explained by strict and effective measures of state authorities.

Literature review

Issues of methodology and organization of management tools for public administration in the sphere of health care were studied by various scientists. Researches of many foreign and domestic scientists and specialists are devoted to the study of problems associated with the financial and economic mechanisms which ensure state guarantees in the area of medical cares. A wide range of issues related to research in the sphere of medical services market and financial system of health care. For example, Karpenko and Zhylinska in 2019 research the human development in the context of provision of the society social safety. Golovanova and Krasnov in 2015 present actual problems of medical insurance development during the period of market reform. Thomson and Jun in 2018 explore International Profiles of Health Care Systems, etc. However, some issues, in particular, modern practice of development of public administration mechanisms in the sphere of health protection, development of the financial mechanism for providing the state guarantees of population medical service remain insufficiently explored. There is a need to improve and expand the study of this issue.

Issues of methodology and administration tools of public management in the sphere of health care were studied by various scientists, including which I.A.Bilobzhetskyi, P.T.Voronchuk, A.M.Gerasimovych, E.P.Dedkov, R.T.Dzhoga, V.P.Zavhorodnii, L.M.Kindratska, M.V.Kuzhelnyi, A.M.Kuzminskyi, L.M.Karpenko, M.M.Kalensky, V.I.Krysyuk, V.M.Onyshchuk, E.V.Mnykh, M.S.Pushkar, V.S.Rudnytskyi, V.V.Sopko, V.O.Shevchuk, M.T.Senchenko, N.S.Vitvytska, and others.

At the same time, despite the considerable number of scientific works, the problem of formation and normalization of the optimal system for the development of mechanisms for public management in the area of health care in Ukraine requires a deeper study. Agreeing with the undoubted value of scientific research by scientists, it should be noted that at the current stage of development of state administration and local self-government, as well as in the existing conditions of a full-scale war with russia, there is a need for a deeper study of modern technologies and innovative forms of strategic management of the health care industry.

Research goal

The mechanism of public management of the health care system - the integrity of states and processes of complex state action implementation (using political, economic, social, organizational and legal means, practical measures, levers, incentives) in the process of solving national issues.

The goal of the article is to deepen the theoretical and methodological foundations of the development of public management mechanisms in the sphere of health care, the organization of the principles of the formation of the quality of medical care, the regulatory aspect of state institutions. The subject of the research is the theoretical-methodical and applied principles of formation and practical application of the toolkit for improving the mechanism of public management of the strategic potential of the security system.

General theoretical and economic-statistical methods were used in solving the tasks. The methodological basis forms a number of the following methods: scientific abstraction, classification and systematization - to identify the main components of health systems of leading countries according to three basic models; methods of dialectical and formal logic, analysis and synthesis, systematic approach, decomposition method - for the development of managerial tools and methodological support for the modelling the financial mechanism for providing the state guarantees of population medical service and the budgetary efficiency system in Ukraine's state policy.

The application of an interdisciplinary approach allowed to comprehensively considering the legal regulation of the development of public health management, as well as the laws and principles of reforming the mechanisms of public health management in Ukraine in the context of the European dimension. The systematic approach was used to develop and justify modern improvements in the mechanisms of public management of the health care system in Ukraine, taking into account foreign experience in the formation of mechanisms for public management of the health care system.

Key research findings

Legislation is the most important category of state regulation tools, with the help of which the state requires the subjects of social relations to implement their decisions. From the point of view of some domestic researchers, the tasks of state regulation in the sphere of health care have two aspects. On the one hand, regulatory measures should ensure the solution of political tasks, and on the other hand, the improvement of management mechanisms. The political aspect consists on the achieving social and economic goals. By its nature, it has a normative character, based on the system of values accepted in society, and concerns certain political tasks and interests of society.

At the same time, the socio-political problems of health care are common to all modern countries and consist in the fairness and equality of access to health care; social solidarity by providing health care through the national health service or the social health insurance system; cost-effectiveness by ensuring financially reasonable health care costs; ensuring healthy environmental conditions thanks to safe working conditions, safety of drinking water, food, etc.; awareness and education of citizens regarding health care issues; individual choice of a provider of health care services. The second governance aspect concerns health governance arrangements, which are hybrid in nature, reflecting the complexity of relationships between multiple service providers.

These measures, aimed at more efficient and rational use of human and material resources, are mainly of a technical nature and involve regulation:

- the quality and efficiency (evaluation of the cost-effectiveness of clinical interventions, i.e. the ratio of cost and efficiency of services, etc.);

- the access of patients to services (including through the introduction of appropriate tax policy);

- the supplier behaviour (transformation of hospitals into state enterprises, regulation of hospital loans, interaction between hospitals and primary care services);

- the behaviour of payers (establishment of contracting rules, development of planned markets for hospital services, establishment of prices for medical services in the public sector, etc.);

- the pharmaceutical market (setting approximate prices, profit control, etc.);

- the activity of doctors and other medical workers (salary setting, licensing requirements, etc.).

The National Health Service notes that the transformation of the health care system creates conditions for the sustainable development of medical institutions, the growth of wages and the improvement of working conditions of medical workers. The management of the institution and its owners must be able to take advantage of these opportunities, properly allocate resources and develop their institutions for the needs of patients and taking into account the interests of medical professionals. The Ministry of Health of Ukraine draws attention to the fact that the transformation of health care is not a one-step transition from the Semashko system to European standards of medical care. This is a step-by-step plan of complex changes, enshrined in the Law of Ukraine "On State Financial Guarantees of Medical Services of the Population".

The reform of the health care system is the introduction and development of new organizational, legal and financial and economic mechanisms aimed at increasing the efficiency and accessibility of medical care for the population and are necessary for the development of the health care system in Ukraine. Today, scientists in the sphere of health care propose to form and develop various mechanisms of public (state) management for the industry.

Since 2015, scientists have been paying a lot of attention to the possibilities and necessity of changes in public management mechanisms in various spheres of economy and society. The health care reform was no exception. Although the strategy and directions of health care reform are updated every five years, in modern conditions there is a need for a deeper transformation of all management mechanisms. The state is trying to establish the work of public mechanisms as effectively as possible, which will make it possible to implement strategic directions of development in the sphere of health care of Ukraine. In the order of the Cabinet of Ministers of Ukraine "On the approval of the concept of the reform of the financing of the health care system" dated November 30, 2016 No. 1013-r, it is stated that the reform of the health care system should provide for radical qualitative changes in all functions of the health care system - management this system, providing it with appropriate resources, financing and providing the services produced by this system [2].

The new concept of the reform of the health care system financing recorded the main provisions regarding changes in the financial provision of the industry, which is one of the main tasks of the priority action plan of the Government for 2016, approved by the order of the Cabinet of Ministers of Ukraine (CMU) dated May 27, 2016 No. 418, and became the main trigger for the initiation of complex reforms in this vital area and the creation of a modern, worthy European state of medicine in Ukraine. The concept contains the main stages and a step-by-step plan for implementing the reform [3].

This reform should ensure the creation of an effective and accessible health care system that meets the modern needs of the population of Ukraine, a higher level of life quality based on the expansion of accessibility, improvement of the quality and safety of medical care, productive employment of personnel involved in the sphere of health care, as well as increasing the level of social security, development and optimization of the system of social support for medical workers.

The tasks of reforming the health care system are the introduction and development of new organizational, legal and financial and economic mechanisms aimed at increasing the efficiency and accessibility of medical care for the population and is necessary for the development of the health care system of Ukraine [4]. Scientists in the sphere of health care propose to form and develop various mechanisms of public (state) management for the industry. Domestic researchers divide the tasks of state regulation in the sphere of health care into two aspects. Firstly - the solution of political tasks, and secondly - the improvement of management mechanisms.

Political tasks consist on achieving social and economic goals. In fact, they have a normative character and are based on the acceptance by society of a certain system of values, which is connected with certain political goals and interests of the society itself. Currently, the social and political problems of health care are common to all modern countries and consist on:

- the justice and equality of access to health care;

- the social solidarity;

- the ensuring a healthy environment thanks to safe working conditions, safety of drinking water, food, etc.;

- the awareness and education of citizens;

- the individual choice of a provider in health care services.

Management tasks relate to health care management mechanisms that have a

mixed interdisciplinary nature. They aim at the most efficient and rational use of human and material resources, are mainly technical in nature and provide for regulation:

- the quality and efficiency (price/quality ratio);

- the access of patients to services;

- the behaviour of suppliers through the transformation of health care facilities into state enterprises, regulation of hospital loans, interaction between hospitals and primary care services;

- the behaviour of payers by establishing contracting rules, developing planned markets for hospital services, setting prices for medical services in the public sector, etc.;

- the medicine market;

- the activity of doctors and other medical workers [5].

Thus, the legal basis of state regulation of the industry is its functions:

- management function, which can be carried out by direct and indirect means;

- control function;

- the function of applying sanctions.

The main function of the state regulation of the health care system of Ukraine is to create comprehensive means of a legal nature, including the financial aspect, taking into account the overload of the state budget with expenditures on the health care system.

State management mechanisms are interpreted as:

- the system of consistent implementation of actions, which are based on basic principles, target orientation, functional activity using appropriate management forms and methods;

- the schematic representation of the structural and functional content of the management process from the point of view of the interaction of the subject and the object, the unity of activity and relations;

- the reflection of the interrelationship of phenomena, actions and measures, for the coordination of interests, definition of goals, development and implementation of solutions with the help of resources.

All considered instruments of state regulation of the private medical sector are characterized as situational, because they are aimed at specific situations and involve the determination of factors that determined a certain situation on the market. The premise of the situational approach is the theory of systems. The system approach allows investigating the peculiarities of functioning, development, structure of the whole object, to determine the properties of its elements, to trace interactions and relationships between them.

Mechanism of state management in the sphere of health care are understood as a set of forms, methods, means, levers, incentives and tools, with the help of which state management and regulatory influences in the sphere of health care are implemented, which are determined by the interaction of political-economic, legal, socio-cultural and ideological factors, depend on the goals and objectives that the state sets for itself regarding the health care of citizens; reflecting the interrelationships and interactions of the needs, interests and incentives of the subjects of this sphere and the level of socio-economic development of the country in specific sets of methods, means and tools.

Different groups of state management mechanisms in the sphere of health care are distinguished (see Table 1).

Almost 10 years of research helped to determine the main mechanisms of public management in the sphere of health care and to invent new scientific approaches to their development in the conditions of reforms and transformations (see Fig. 1).

Table 1.

Main groups of state management mechanisms in the sphere health care

Fig. 1. Mechanisms of public management in the sphere of health care in Ukraine Source: formed by authors on basic of [7; 9; 10; 11]

The main dominant feature of the modern stage of Ukraine's existence is the problem of actively mastering new mechanisms of its socio-economic development. The health care system is one of the priority directions of the state's social policy, since a person, his life and health are the highest social value. Effective functioning of the health care industry is impossible without its proper financial support. However, a simple increase in budget expenditures for health care will not increase the effectiveness of its financing without effective reform of the industry itself and improvement of its management methods.

Taking into account the various views of scientists regarding the development and improvement of state management mechanisms in the sphere of health care, it is necessary to note the further need for modern transformations and reforms in the area, taking into account European integration processes, global trends and pandemic challenges. The development of public mechanisms in the sphere of health care is aimed at the formation of an effective and accessible health care system that meets the needs of the population of Ukraine and international quality standards.

In the article, the authors researched theoretical approaches to the development of sustainable mechanisms of public management in the sphere of health care. The main parameters and characteristics of state management mechanisms are considered.

The methods and tools of state regulation of the medical sphere are covered in detail. After all, with the effective application of the necessary methods and tools, the proper functioning of the mechanisms of management and regulation in the state is ensured. There are different approaches to determining the relationship between the concepts of state management and state regulation.

The universal or ideal healthcare system is not observed in any country in the world, every country has its own difficulties. Thus, paying tribute to the various views of scientists regarding the development and improvement of the mechanisms for state management in the sphere of health care, it should be remembered that taking into account international experience does not exempt the public authorities from inventing and adapting the mechanisms of state regulation in relation to the realities of our country.

When studying the reform of the public administration system in any sphere, the assessment of the results in such reforms is an exceptional component. One of the most important reforms in the last five years was the reform in the sphere of health care. The issue of the medical services quality remains the most urgent for both the population and the state as a whole. The assessment of the consequences of the medical reform is of great importance for scientists from the point of scientific research view, as well as for the formation of new state-management decisions.

Taking into account the various views of scientists regarding the development and improvement of state management mechanisms in the sphere of health care, it is necessary to note the further need for modern transformations and reforms in the sphere, taking into account European integration processes, global trends and pandemic challenges. The development of public mechanisms in the sphere of health care is aimed at the formation of an effective and accessible health care system that meets the needs of the population of Ukraine and international quality standards.

The organization of an adequate health care system is a priority task of the state, because the level of medicine development is one of the main indicators of the state policy success in the developed countries of the world. Thus, the cited international practice makes it possible to provide practical recommendations for improving the mechanisms of public management of the strategic potential of the health care system.

References:

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