The dissertation solved an actual scientific problem of substantiation of the integrated system of organization of perinatal care under conditions of modernization of the health caresystem in Ukraine. Systematization and generalization of existing approaches to improving the quality and effectiveness of reproductive and perinatal health showed that the integration of medical and including perinatal assistance at the present stage is seen as an important and independent branch of government health policy. The level and dynamics of indicator reproductive health indicators (infant, perinatal and maternal mortality) indicate low quality of perinatal services at all stages of their provision and have significant regional differences. The general model of integration of health care in Ukraine is theoretically justified, based on the principles of integration of care, formulated on the basis of the evidence and the results of international research. Proved by the method of projecting the organizational, an integrated system of organization of perinatal care developed and adjusted in the organizational experiment, including regionalization and routing (separation of institutions and units providing perinatal care, with a concentration in these patients according to groups that perinatal obstetric risk); set of mechanisms necessary to ensure coordination and succession of perinatal care (pooling of budgetary funds for health care at the regional level; methods of payment for medical services, taking into account the volume and complexity of medical care, and methods of motivating remuneration system, centralization of medical and logistical resources, a set of measures to maintain a high professional level staff; permanent update of evidence-based perinatal technologies and development through clinical protocols with the organization of their enforcement) of system support (satellite) services. Expert established that the introduction of an integrated system of organization of perinatal care has led to a substantial improvement in the quality of care of both pregnancy, childbirth and postpartum (increased frequency of timely and decreased levels of premature births from 89% to 95,2% and from 11% to 4,4%, respectively, p <0,05; increased frequency of physiological birth from 71,9% to 82,0% p <0,05; reduced the overall incidence of medicalization of childbirth and frequency not shown interventions from 53,9% to 28,2% and from 54,2% and 22,6%, respectively, p <0,05; decreased frequency of complications at birth from 22,7% to 8,7%, p <0,001), and infants (the share of healthy newborns from 46,6% to 90,1%, p <0,001; increased the adequacy of preventive measures to all newborns and adequacy of treatment and preventive measures carried out with respect to children born with various diseases and pathological conditions, from 43,8% to 98,6% and from 17,1% to 64,7%, respectively, p <0,001; the share of newborns discharged healthy from 77,9% to 88,8%, p <0,01). With the help of a sociological study it is revealed that the main participants in the diagnostic and treatment process after the implementation of an integrated system of organization of perinatal care demonstrated a high, albeit expressed in varying degrees, level of satisfaction with medical care (98,9% of the patients, 97,6% of health workers, 88% policy-makers). A significant relationship of overall level of satisfaction with medical staff and heads of agencies with the power of obstetric hospitals (?2 = 34,95; p <0,001 that ?2 = 13,5; p = 0,009, respectively) is established. It is proved that the integration of perinatal care leads to a significant increase in its medical, social and economic efficiency: for the period of implementation of the system in the region decreased: infant mortality from respiratory distress syndrome in 8-fold (from 1,58% to 0,2%), which in 2013 was 1,6 times lower in comparison with Ukraine (0,32%); the frequency of major bleeding and removal due to postpartum haemorrhage of uterus - 1,9 and 1,7 times, respectively; perinatal and infant mortality - by 3,1 and 1,7 times, respectively. The total annual savings makes it possible for the structural optimization is 15,8% of the general fund budget funds allocated for the maintenance of midwifery institutions and departments.
