Doroshenko O. Mechanisms of public regulation of financing and providing efficient secondary healthcare in Ukraine.

The thesis overviews the content and mechanisms of state regulation of financing and efficiency of secondary healthcare provision. It defines the place and role of state institutions in the formulation and regulation of providing accessible, quality and efficient medical care. The analysis of functioning of the financing and economic evaluation of provision of secondary healthcare in Ukraine is provided as well as a justification of possible areas of its improvement. The specifics of formulating of the state policy in Ukraine regarding the rights of people to health care is described and areas for its further development identified. The basic methods and tools of financing and economic evaluation for provision of secondary healthcare are reviewed. The international systems of organization and financing of inpatient and specialized outpatient care are characterized and classified. An analysis of the foreign experience of state regulation is conducted and key recommendations are withdrawn in the context of its possible application in Ukraine for the current actions and future development of the national health care system. The need for organizational improvement of public financing of health institutions through the transition from inputs-based financing to the performance-based or results-based funding is articulated. The use of the results-based financing is one of the key measures to address the current issue of public health financing. More freedom in terms of financial management is needed at the level of health facilities. The explicitly defined health benefit package will help to clearly link public resources to guaranteed services without additional or legally defined payment from patients. Additional voluntary insurance schemes to co-finance health and co-payment mechanisms can help cover financial gaps. Efficiency in public procurements and supplies of medicines has to be further improved. The format of the new financing requires establishing the national procurement agency, and the introduction of health facilities funding on a contract basis depending on the volume and complexity of cases. In the transition period it is reasonable to introduce funding for institutions that provide secondary health care based on a global budget. The introduction of financing based on the volume and complexity of cases treated in hospitals is one of the most promising areas of reform and it will imply transformation of financial and economic mechanism for provision of secondary healthcare. The experience of European countries that are applying grouping of hospital cases and align funding to these groups shows that introduction of funding based on diagnostic-related groups (DRG) in Ukraine will require at least 5 years. For the transitional phase, a global budget (or block contracts) can be an optimal mechanism for funding, as this mechanism is effectively used worldwide. A successful use of such a mechanism would require contracting institutions that provide health care and setting targets that will determine the expected performance of these institutions. The thesis is reviewing economic and financial instruments that are applicable for the regulation of the secondary health care in Ukraine. The author has developed a model to describe these instruments. The model includes mechanisms of funding and financial regulation, as well as economic mechanisms of regulation of health care provision, including economic incentives and levers. The mechanisms in the model are defined by sets of tools whose use alone or in combination will influence the financial and economic regulation of the secondary health care in Ukraine.