Attempts of reforming secondary inpatient medical care in pilot regions of Ukraine and their results

Abstract

Background. The relevance of scientific research stems from the need for an analytical synthesis of the experience gained from the reform of the national secondary medical care. The pilot project for the reform of secondary inpatient care in Ukraine covered Vinnytsia, Dnipropetrovsk, Donetsk Regions and Kyiv, where structural & organizational, functional rearrangements of the health care system, in particular its inpatient sector took place owing to the Law "On the Procedure for Reforming the Health Care System in Vinnytsia, Dnipropetrovsk, Donetsk Regions and the City of Kyiv" dated July 07, 2011 #3612-VI [2] and the Resolution of the Cabinet of Ministers of Ukraine dated October 24, 2012 No. #1113 "On Approval of the Procedure for the Establishment of Hospital Districts in Vinnytsia, Dnipropetrovsk, Donetsk Regions and Kyiv" [1]. The purpose of these transformations was to expand the possibilities for providing affordable, quality medical care to the population thanks to increasing the efficiency of using budget funds, introducing new approaches to the organization of work of health care institutions. The purpose of the study was to analyze the results of the reforming secondary, in-patient care in pilot Regions in order to plan the correct progressive steps for regional reform, taking into account the results of the pilot project in these Regions and the city of Kiev, in particular. Materials and methods. In the process of research, methods of structural and logical analysis, semantic evaluation of medical, scientific and regulatory documents were used. Results. For the effective provision of secondary medical care, in particular of its inpatient sector, the creation of hospital districts with functional associations of health care facilities providing secondary inpatient care was legally determined within the pilot Regions. Considerable work was done on differentiating the functions of primary and secondary medical care, but not in all pilot Regions such functional and structural units as the hospital district were created, each region had its own peculiarities of the organization of provision of secondary inpatient medical care, which should be considered in the future. Conclusions. It was established that the chosen direction of reforming secondary medical care, in particular its inpatient sector, based on the model of hospital districts, was not widely implemented in pilot Regions. Hospital districts established in Vinnytsia Region did not perform the function assigned to them concerning the improvement of the quality of medical care provided that rational use of material and technical resources was present, since the capacity of the Intensive Care Hospitals (ICH) and Planned Treatment Hospital (PTH) and the population they serve did not comply with economically justified recommended European standards.