Do you know Ukraine has three times more hospital beds per 100,000 people than the UK? 73 beds per 100,000 people vs. 21.2. Ukraine has the largest number of hospital beds in Europe. Although the number of both healthcare (hereinafter referred to as HC) facilities and hospital beds has significantly decreased since the start of the healthcare reform, there are still a lot of hospitals operating which are not strategically important for the healthcare network. Meanwhile, their financing often burdens municipal budgets, with the poor quality of medical services and limited access to services.
This situation is historically rooted in the Soviet Union, when megalomania and extensive development due to increased quantitative indicators were common. Back then, official statements claiming free medical services to all citizens in full were untrue and merely declarative. In practice, the situation differed: the HC system used funds irrationally, on the principle of preserving rather than developing the system. This led to the fact that the HC system budget was distributed among a huge number of healthcare providers without any corresponding improvement in the quality and accessibility of medical care, or even vice versa, without the possibility to improve them. Meanwhile, the state undertook to maintain the functioning of all HC facilities without considering any performance indicators.
Ukraine is currently in the process of reforming its HC system. Today, the infrastructure phase of the reform is the priority, with planning of capable networks of HC facilities in hospital districts across Ukraine. This planning left some hospitals outside the capable network, as not allocated to any of the defined types of hospitals (general, cluster, supercluster). Typically, this applies mainly to small, underfunded hospitals in need of additional funding to cover the budget deficit. At the same time, they often provide a standard range of services: they have inpatient therapeutic and surgical places, as well as auxiliary diagnostic units. The situation is similar for medical staff, who often either work as external part-time employees at a rate of 0.25 to meet the terms of the Medical Guarantee Programme packages, or work at their main place of employment, while providing a very limited and insignificant number of medical services (for example, 100 anaesthetics per year by an anaesthesiologist or 80 surgeries per year by a surgeon).
But what is the reason such hospitals do not provide adequate access to quality medical services and have a budget deficit? And in general, do they have any future prospects?
First of all, we need to look at the purpose of any institution's existence and the range of services it provides. The purpose of hospitals should be taking care of public health in a broad sense. Therefore, in discussing the expediency of hospitals' existence, both the current demand for medical services from the local population and the range of services provided by these hospitals should be considered. Local self-government bodies, together with the management of HC facilities, should clearly understand the needs for social and medical services in their municipalities, identify the services lacking and how to address them. It is quite obvious that the "traditional" service package previously provided by hospitals requires review and adjustment to meet the current needs of the population, rather than the previous experience of the HC facility.
Next, due to the dispersed resources, lack of expensive medical equipment, and a shortage of sufficient workload for doctors to maintain an adequate professional level, medical care in such hospitals is usually of a poor quality. For example, an obstetrician-gynaecologist who delivers 20-40 births a year, out of the recommended 200, loses their qualification and cannot provide the proper quality of medical services.
On the other hand, due to their excessive workload and large patient flow, large multidisciplinary hospitals often focus on the disease rather than the patient's problems. As an example, a socially vulnerable person is admitted to hospital with a limb gangrene. After amputation of the limb, the patient leaves the hospital in the early postoperative period and returns home with limited capabilities, without adequate income, and no proper care. And this is exactly where the municipality should consider how to take care of such patients. Who is there to help and support them, to draw up the necessary paperwork to receive disability-related payments, to provide recovery and rehabilitation treatment?
Unfortunately, in practice, we often face a situation where the heads of HC facilities and local self-government representatives want to keep the hospital at any cost. Most likely, they are motivated by certain political ambitions, the desire of the hospital management to keep their positions, and the medical staff's fear of the future. However, everyone is well aware of futility for the hospital to exist in this format. As a rule, in such situations, they do everything to prevent the facility from "dying", but meanwhile, the development strategy of the facility remains unreviewed, the areas of activity unchanged, as well as the work priorities not updated. In other words, there are no processes to help the facility not just stay afloat, but also to ensure its stability and sustainability, whereby the hospital would guarantee access to the required services of the proper quality.
In summary, we may state that the priority goal of strategic planning in the HC system should be to create an integrated HC system providing a comprehensive approach to patient problems, with the focus on a person with their problems rather than a medical service as a product. Strategic planning and implementing the model of integrated HC system means your municipality to invest in the most valuable asset - human capital, i.e. what is essential for any municipality to exist and develop.
We will discuss this in the second part of our article.
