UDC 336.5:[338.46:61]:614.2; JEL H35, H72, I13 Dub, A. R. (2018). Transformatsiya mekhanizmu finansuvannya okhorony zdorovya: vyklyky dlya obyednanykh terytorial'nykh hromad [Transforming of the health financing mechanism: challenges for the united territorial communities]. Rehional'na ekonomika - Regional Economy, 87 (1), 76-84. Retrieved from http://re.gov.ua/doi/re2018.01.076.php. [in Ukrainian]. Sources: 8
Authors
Resume
Improving the quality of health care delivery is the goal of medical reform. However, the transformation of the financing mechanism of health care should become the breakthrough in its accomplishment. Particularly, the issues of medical reform financing are of utmost importance for the communities formed in the process of decentralization of power, since in 2018 the changes will affect the primary level of provision of medical services. The purpose of the article is to identify potential problems and risks of public health financing transformation at the level of the united territorial communities. The process of transforming the health financing mechanism in 2016-2017 is examined. The adequacy of funds allocated from the state budget to ensure the functioning of medical institutions providing primary health care in the united territorial communities in Lviv region is analyzed. The possible financial and social risks of introducing a new approach to financing primary health care in 2018 are critically assessed. The budget financing of health care through the use of medical subvention is imperfect and needs reform. An analysis of the use of medical subventions to finance the provision of primary health care at the united territorial communities’ level in 2016 showed that funds allocated from the state budget remained unused in some communities, while others lacked them. The main reasons were: the imperfection of the formula for distributing the medical subvention and the distrust of the population to the medical staff in the primary health care institutions in rural areas due to their low professional level. Changes in the financing mechanism of health care in 2017 did not correct the situation. In 2018, healthcare financing based on the principle of “money going for a patient” will be launched at the level of primary care provision. Despite this, there is a threat of emergence of a number of risks, both financial (the sufficiency of funds to finance medical services and investment expenditures for the development of a network of medical institutions, etc.), as well as of social nature (quality and timeliness of provision of medical services, provision of medical institutions in rural areas, etc.). The need to reform the financing mechanism of the health care sector is beyond doubt. But, besides this, it is accompanied by a significant amount of both financial and social risks that may have an impact on the effectiveness and efficiency of the reform, especially in rural areas. Therefore, related issues will require in the near future a detailed study and development of measures to eliminate them.
Keywords:
budget, medical subvention, health care, united territorial community, medical reform
References
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In this article the rating of the budget provision of Ukrainian regions has been evaluated basing on the calculation of Euclidean distances and grouping of indicators by budget status and balance, intergovernmental cooperation, budget stability and debt load. Using of the cluster analysis allows us to classify regions by integral indicator of budgetary provision into crisis, low, medium and high level. The analysis shows uneven budget distribution and confirms the need and timeliness of fiscal decentralization. The attention is on the first results of the reform of fiscal decentralization. It is shown that with the new changes to the Tax and Budget Codes financial stability of local budgets was strengthened, resulting in the growth of budget support demonstrated by almost all regions of Ukraine. It is proved that a high proportion of social spending in the minimum capital is not able to ensure economic growth in the region. The implementation of budgetary policy should be based on unleashing the potential of the regions, considering the fundamental principles of fiscal decentralization, especially in the empowerment of local governments to accumulation and effective use of development resources. The existence of certain patterns of implementation and budgetary policy of Ukrainian regions, caused by the influence of factors of exogenous and endogenous nature, has been highlighted.
The article presents the study of the fiscal decentralization process in Ukraine at the level of local governance defined by this reform as basic – the level of newly formed UTC in terms of the first results, risks and challenges that occur in modern conditions. The features of administrative and territorial reform in Ukraine in the past and at present are researched. The position of communities’ forming in the reform of administrative and territorial structure of Ukraine is investigated. Amendments to the Budget Code of Ukraine and the Tax Code of Ukraine in the context of the administrative-territorial reform and the reform of fiscal decentralization are analyzed. The necessity of understanding the role and place of local communities in the development of local government is argued. The place and role of cities of oblast significance in the process of implementing the reform of the administrative-territorial system are determined. The notions of «urban agglomeration» are analyzed in the context of existing administrative territorial system. A conclusion is made that, despite lack of changes in the effective legal framework toward improvement of the administrative territorial system and absence of any proper agglomeration act, territorial communities must seek horizontal cooperation for the sake of their economic development and competitiveness. The measures to improve the territorial financial ability to implement the responsibilities granted to local government in the context of changes of administrative-territorial structure are proposed. The ways of strengthening the financial autonomy of municipalities are grounded. The necessity of achieving financial viability in order to accomplish the basic functions conferred on local authorities by the state is grounded. It is shown that the legislative innovations are not able to ensure decentralization. It is concluded that the community development at the local level is possible only when the correct public and local government policies are formed, basing on the fiscal capacity of communities.
united territorial community (UTC), city of oblast significance, agglomeration, financial capacity, administrative and financial decentralization
The article outlines the theoretical principles of reforming of the health care system in Ukraine in the conditions of decentralization, explores the peculiarities and directions of implementation of health care reforms, identifies the problems of organization of the system of medical care in Ukraine and the possible ways of improving the medical care of the population in the context of decentralization reform. The essence of the notion of a hospital district as a functional association of health facilities located on the relevant territory, which provides provision of secondary (specialized) medical care to the population of this territory, is considered and outlined. The criteria of the formation of hospital districts are defined, the features of establishing boundaries and the composition of the district as well as the technical process of its creation are highlighted. The essence and principles of the functioning of the Hospital Council, its main tasks and functions are determined. The sources of funding the activities approved in the Hospital District Development Plan for the next five years are determined. The development of the plan for the development of the hospital district in order to determine the actual loading of medical infrastructure objects and the distribution of relevant functions is emphasized, among which, in particular, the directing of flows to the medical institution with the corresponding level of technical and personnel support. In order to avoid numerous questions about the decentralization reform in the field of health care of the population in Ukraine, it is also necessary to conduct a large-scale information campaign among the regions in terms of clarifying the areas of responsibility of the central and regional authorities in relation to the principles of the functioning of the established hospital districts, as well as to reduce the political and social tension.
decentralization, reform of health care system, medical infrastructure, hospital district
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