In the process of policy- and decision-making in health care, local self-government bodies (hereinafter LSG) often need so-called verified data, which can be used as indisputable arguments.
Theoretically, each municipality can collect the array of data it needs on its own, involving the health care facilities (hereinafter HCF) that provide medical services to the residents of this municipality. However, in practice, requests like that only increase the burden on the medical staff of the HCF, are often issued with delays, contain a large percentage of incorrect data and, most importantly, do not show a bigger picture of the current and historical situation in other HCFs regarding management approaches, resource allocation, volume and areas of providing medical services. At the same time, taking into account the infrastructural stage of the reform of the health care system, the creation of capable hospital and primary medical care networks and changes in the terms of contracting by the National Health Service of Ukraine (hereinafter the NHSU) that come into effect in 2024, verified data arrays openly available 24/7 on the NHSU website are the best tool to help LSG shape a policy for adapting to new conditions.
This article highlights possible approaches to the analysis of data from the NHSU website, directly links the pages that display them, as well analyses operational activities of HCFs using anonymised cases, which will certainly be useful to municipalities, regardless of whether they own health care facilities.
Today, data arrays on the NHSU website are presented as 22 dashboards and 25 regional analytical reports, which include every municipal health care facility that was contracted by the NHSU in 2021 and 2022. So, let us consider possible options for analysing information from the NHSU website using the following cases:
“Statistics of submitted declarations on the choice of primary care physician”
https://edata.e-health.gov.ua/e-data/dashboard/declar-stats
Section III (“Detailing Submitted Declarations. Table”) provides information on the number of declarants by age groups, names of doctors and HCFs. It immediately becomes clear which medical service provider has declarants in the municipality’s towns and villages to substantiate the request to organise on-site (scheduled) appointments of doctors to the declarants in remote localities of the municipality.
Section VI expands the capabilities of analysing the demographic data of the municipality by providing information about the declarants by year of birth and gender rather than by age groups, which, together with the demographic register of the municipality, creates the framework for policy-making and clearly indicates the potential directions of public health (hereinafter PH) programmes regarding the organisation of provision of pre-medical care, additional equipment of remote outpatient clinics and first aid stations.
For instance, in a municipality with a population of 14,000 and an extensive network of settlements, primary medical care is provided by two municipal HCFs and two physicians that work as individual entrepreneurs. The information presented on the NHSU website makes it clear that the majority of the children’s population in the age group of 0-6 years is declared with a private practice; the elderly population in the age group of 75+ is with municipal HCFs; and the other groups are equally distributed among all providers. A total of 11 doctors provide services to the population of the municipality. Residents of settlements are assigned to doctors without taking into account the radius of accessibility, causing constant complaints about the lack of on-site appointments.
The analysis of this information helped LSG to enter into a constructive dialogue with the providers of medical services, council deputies and starostas on the organisation of on-site visits of doctors to the settlements of the municipality according to the agreed schedule, provided that 10% of the medical list of all declarants is reached. For settlements with more than 40% of the population aged 75+, additional equipment is to be purchased, including telemedical equipment, and the CPR skills of medical staff are to be updated.
Analysis of coverage by pharmacies participating in the Medicines reimbursement programme (Affordable Medicines Programme) of the primary medical care network
https://edata.e-health.gov.ua/e-data/dashboard/pharmacy-pmd-coverage
The Section “Table of Distances from the Place of First Aid Provision to the Nearest Pharmacies and Pharmacy Points” clearly shows how far the residents of the municipality have to travel in order to get the medicines according to the prescription in the 5 nearest pharmacies and allows you to compare this situation with a similar situation in neighbouring municipalities and learn about pharmaceutical market providers operating in your region or in similar areas in other regions.
In addition, the Section “Map of the Classification of Places of First Aid Provision by the Number of Declarations and Distance to the Nearest Pharmacy/Pharmacy Point” presents information in a convenient format for potential negotiations regarding the organisation of access to pharmacies/pharmacy points among neighbouring municipalities. The existing pharmaceutical legislation provides numerous options for the organisation of accessibility for obtaining prescribed pharmaceutical drugs. For example, by establishing a municipal pharmaceutical enterprise through inter-municipal cooperation within the region, which, while being solely a social project, will undoubtedly bring medical care to a qualitatively new level. That is, the data presented in this Section provide sufficient grounds for local self-government to initiate a public dialogue and become an evidence base for decision-making at the municipal level.
Payments to medical care providers under the Medical Guarantee Programme
https://edata.e-health.gov.ua/e-data/dashboard/pmg-pay
The Section “Analysis of the NHSU Payments Using a Structured Tree” provides visual information on the payments made to HCFs both individually and in any combination among contracted facilities for different periods, enabling quick comparisons of the revenues of HCFs that have approximately the same population to service or are servicing a single accessibility area.
At the same time, “Distribution of Payments by Groups of Services” presents payments as a diagram of the distribution of income by different groups of services. This kind of analysis facilitates monitoring contracts for the packages that have a greater impact on financial stability and, by comparing them with expenditures for the same areas, determining which areas require special attention when developing policies and allocating resources.
A more in-depth analysis of the operational activities of each individual HCF or a certain group of HCFs within one region can be found in the next Section:
“Analytical Information on the Progress of Implementation of the Medical Guarantee Programme by Region”
https://edata.e-health.gov.ua/e-data/zvity-pmg-za-regionamy.
This Section presents detailed information about medical care providers within one area.
Section 1.2 contains information on the amounts of health insurance contracts under the Medical Guarantee Programme. In view of the infrastructural stage of the health care reform, the analysis of Package No. 49 for 2022 (“Ensuring the Preservation of Human Resources for Providing Medical Care”) is of particular note, especially regarding facilities where the share of revenues under this Package is above 10%. The information given in Box 1.7 regarding other revenues, including from budgets of different levels, from paid services and charitable assistance, along with all categories of expenses, provide a completely clear picture of approaches to the management of this HCF. For example, some facilities purchased no PPE or disinfectants in a given year. At the same time, comparing expenses for medicines and medical goods helps to understand whether the residents of the municipality receive treatment with medicines from the national list of medicines free of charge. According to the NHSU regulations, expenses for medicines and medical goods should be at least 15% in the structure of expenditures of the provider contracted by the NHSU.
The importance of the information in Box 1.13 on the wage funds for various categories of personnel of health care facilities can hardly be overestimated, especially taking into account the analysis of the previous boxes. For instance, if you compare several centres for primary medical and sanitary aid or hospitals that fall under the criteria of a general hospital status within one region or even one cluster, you will get wildly different ratios of wage funds for different categories of personnel and the number of personnel and can find out how much the wage fund corresponds to the indicator in the structure of packages of the Medical Guarantee Programme (85%). Even a quick analysis of this Box and Box 1.3 with a selection of hospitals located within the same cluster reveals possible ways of strategic unification or concentration of efforts in a certain direction while adapting to the new hospital statuses.
Therefore, regular analysis of verified data arrays is an indisputable argument for creating policies for the development of the health care system, for the distribution of resources, the identification of partners and the role of the municipality in ensuring the accessibility of medical and pharmaceutical services to the residents of the municipality. Exploring all the possibilities of NHSU dashboards for LSG is a far-sighted time investment that will help the municipality to be more adaptable in both the medium and long term.