The dissertation is devoted to the deepening and improvement of theoretical principles, development of practical and methodological recommendations for public administration in the health care system.
Analytical generalizations revealed shortcomings of the system, including: insufficient funding, which does not meet the criteria of optimal allocation of funds, lack of incentives, low managerial autonomy and lack of competition between providers of tools and services. Lack of motivation of medical staff sometimes leads to poor quality work. Although private health insurance helps people get better health care, it is not clearly regulated and does not play an independent role and does not supplement the lack of funds in the public funding system. In the context of poor quality medical care, key stakeholders have developed new rules for cooperation. For example, patients try to overcome the negligent attitude of doctors and the low quality of medical services through informal payments. At the same time, the medical staff explains the need for informal payment with their low salaries, as well as poor financial, including diagnostic, provision of health care facilities. However, the new system of relations does not ensure justice and equal access of Ukrainians to medical services. In addition, institutionalized informal payments do not guarantee the provision of quality health services, although they create a balance in the system. Although patients and medical staff expect reforms, they do not have a clear vision of what type of system is needed. At the same time, politicians, having put health care reform at the top of the agenda, have failed to develop a concept for health care reform in Ukraine. Our study showed that effectiveness. effectiveness and quality should be the main goals and objects of health care reforms in Ukraine. Restrictions on reforms should be taken into account when developing policy recommendations. The main limitation in Ukraine is the balance in the sector, which is created and maintained through informal payments. Identified shortcomings of the system include insufficient funding, disproportionate distribution of funds, lack of incentives, low managerial autonomy and lack of competition between suppliers. Lack of motivation of medical staff leads to unsatisfactory work.
The paper identifies the main tools for the development of health care and governance in the Ukrainian context by analyzing the complex historical, structural and financial situation that led to the emergence of the current system. We have determined that the system consists of two things. First, it is the historical organization of the health care system developed during the Soviet Union, and second, it is the system of government of Ukraine. What both contexts have in common is a common system of top-down policy formulation and implementation. Therefore, the model is considered one of the worst in Europe with significantly lower life expectancy among men and women than in other countries.
