Thesis for a Candidate Degree in Public Administration. Speciality 25.00.02 – Mechanisms of Public Administration. – Lviv Regional Institute for Public Administration of the National Academy for Public Administration under the President of Ukraine, Lviv, 2018.
The thesis is devoted to the research of theoretical and methodical foundations of mechanisms of public administration. Practical recommendations for improving the state provision of equal access to medical services of the rural population have been developed and scientifically substantiated.
On the basis of the analysis of documents of international organizations, legislative sources, studies of domestic and foreign scientists, the essence of categorical notions of the studied problem is systematized and specified. It has been determined that in order to ensure the equality of the access to medical care for all citizens, the state applies a comprehensive management mechanism by the authorized public authorities, which is to study the needs of the population and form the goals and tasks; launching a set of certain management measures (for example, economic, organizational, legal and motivational) based on certain priorities by making appropriate decisions; influential states through certain levers, methods of action on healthcare institutions of all forms of ownership; the implementation by medical institutions of administrative decisions regarding the satisfaction of medical needs of the population; involvement of the public sector in controlling the implementation of decisions and providing the population with medical services. The author’s model of the complex mechanism of public administration in the field of medical care is formed.
The state-management experience of Australia, Canada, and the USA in the process of replacing the “urban” model of healthcare into the nationwide was explored, taking into account the needs of the rural population. There was characterized the multi-channel financing system of the medical industry in Australia together with the Canadian experience of the cross-sectoral partnership of public authorities in the field of healthcare and territorial communities, aimed at enhancing cross-sectoral integrated responsibility for improving medical care, in particular through the effective use of scarce resources and reducing duplication and gaps in medical services provision to the rural population. There is revealed the mechanism of resource redistribution on the basis of the so-called “rural index” - a scientifically based indicator that takes into account all the problems of remote regions, which is added during the formation of budgets for health protection of the rural population.
Legal and organizational tools for the implementation of the state policy concerning the guarantees of availability and quality of medical care at the level of primary health care in rural areas are determined.
On the basis of the actual material, it has been shown that in Ukraine, for a long time, the financing model was maintained, in which funds collected through general taxes and accumulated in the state budget were spent not on the purchase of medical services, but on the support of the existence of the present network of health care institutions by an itemized principle regardless of the number and quality of the services that actually have been provided by them to patients. It is proved that under such a model of financing there are no incentives for any improvement of work; the management does not have the managerial flexibility to optimize the activities of medical institutions and reduce inefficient expenditures.
In the recommendation part of the thesis there is proved the necessity to improving the mechanism of state provision of human resources of health care in the primary sector of the medical and sanitary aid.
The study of the influence of negative factors on the access of rural population to the specialized medical aid in the context of reforming the health care system has made it possible to suggest possible ways of eliminating them. In the context of the implementation of the state policy of decentralization in Ukraine, the necessity of transition from state to state-public form of management of the healthcare sphere has been proved, which is to strengthen the role of United territorial communities, to activate the participation of professional and non-governmental organizations, as well as the transparent system of accountability of the medical sphere management authorities and subjects of medical activity for the public as the main consumer of medical services. State-managerial measures for further stimulation of cross-sectoral and inter-industry partnerships concerning the improvement of determinants of public health of rural population have been identified.
Key words: healthcare, public administration, state-managerial mechanisms, medical aid, rural population, equal access, medical industry financing, primary medical an
