Russian aggression has caused and continues to cause enormous damage to the economy of Ukraine and incalculable suffering to the population of the country. The war took national health reform by surprise. The three-level system of medical care (primary, secondary and tertiary) did not have time to take root. And health insurance, in the face of economic collapse, has led to skyrocketing medical costs. The uncontrolled rise in prices for medicines has turned budgetary medical institutions into bankrupt structures that live solely on volunteer assistance.
A mistake in the training of medical personnel became obvious when military departments were closed in universities, which allowed university graduates to have an additional special military medical education.
Colossal migration processes disrupted the system of preventive vaccination of children and adolescents, which increased the pool of the population unprotected from mass infectious diseases.
And finally, the huge number of disabled and internally displaced persons revealed the insufficiency of psychological and social support services.
All of the above problems will rise to their full height after the end of the war in a destroyed country, and therefore, already now, it is necessary to start discussing future steps to restore our national health care.
We can distinguish, in order of importance of the tasks to be solved, the following line of problems:
1) financing of health services with adequate support for a multilevel system of medical care;
2) fairness in the distribution of health care resources;
3) search, training and distribution of medical personnel;
4) a modern system of education in medical schools of II, III and IV levels;
5) choice of the national healthcare system:
- government system
- compulsory or voluntary health insurance,
- market system or
- mixed form.
6) restoration and implementation of digital information systems.
When planning the financing of primary, secondary and tertiary health care, it is necessary to consider the rapid growth in the energy supply of the direct link. A modern family doctor has the opportunity to perform an ECG and X-ray examination on an outpatient basis, he has at his disposal a pulse oximeter, an infrared remote thermometer, a rhino-oto-ophthalmoscope, a glucometer and several laboratory rapid test kits. All this technical equipment allows for solving up to 90% of the problems of patients who seek medical help at the primary level. The last 4-5 years have reflected a trend towards a significant decrease in referrals to hospitals by family doctors, who have been able, based on diagnostic standards, quickly and accurately, at the early stages of diseases, to establish a diagnosis and prescribe the correct treatment.
Accordingly, planned funding should reflect this growing trend in the importance of primary care. In this case, reducing the number of hospitalizations will release the financial resources spent on the notorious second-level beds, and allow them to be transferred to the level of highly specialized medical care, providing services or care at the most modern level.
The correct solution to the first problem will solve all subsequent issues. The main determinant of future decisions should reflect the ideology of improving the quality of medical care and medical services. The current system of accreditation of medical institutions is far from perfect. It consists in checking the presence in the medical institution of several mandatory documents of the "Quality System", as well as in the accuracy of drawing up reports of internal auditors on the raids carried out by the institution's departments.
It should be noted that all modern quality management systems are based on the concept of identifying leading and supporting processes in the organization. The contradiction is that is impossible for employees of international audit companies independent of the Ministry of Health of Ukraine since their auditors are not medical professionals. Due to these circumstances, they do not have the skills to assess the actual work of staff with patients, the adequacy of treatment and medical expenses, the skills of nurses, the reliability of laboratory and instrumental examination methods, and the correctness of medical reports. The existing assessment of the quality of the medical institutions' activities suffers from a superficial approach and does not provide real competitive advantages over European institutions. It is necessary to move away in the future from such a bureaucratic formal approach, distracting staff to write unnecessary commitments and endless reports. It is necessary to develop such rating indicators that would significantly affect the further work of personnel, stimulate them to master modern methods of communication and should affect a significant increase in wages, and improve working conditions and social guarantees.
References
1. Health financing in Ukraine: resilience in the context of war. Copenhagen: WHO Regional Office for Europe; 2022 (https://apps.who.int/iris/handle/10665/361645).
2. Principles to guide health system recovery and transformation in Ukraine. Geneva: World Health Organization; 2022 (https://apps.who.int/iris/handle/10665/358446).
3.Recovery plan. In: Ukraine Recovery Conference 2022, 4–5 July 2022, Lugano, Switzerland. Ukraine Recovery Conference 2022 (https://www.urc2022.com/urc2022-recovery-plan).
4. Про схвалення Стратегії розвитку системи охорони здоров’я до 2030 року та затвердження операційного плану її реалізації у 2023 році
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