Analysis of the opinions of health care managers at different levels on the reorganization of the primary and secondary health care links

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Analysis of the opinions of health care managers at different levels on the reorganization of the primary and secondary health care links

Yasynska Elvira

Candidate of Medical Sciences,

Associate Professor of the Department of Social Medicine and Public Health

Bukovinian State Medical University

Summary

The article analyzes the opinions of health care managers of all levels regarding the transformation of primary and secondary health care. The questionnaire proposed by the author made it possible to study the individual assessment of the state of health of the population provided by each respondent before and after the implementation of health care reform. Based on the results of the research, conclusions were drawn regarding respondents' awareness of the main aspects of health care reform (assessment of the quality of medical services and patient care, standardization of medical care, licensing and accreditation of medical facilities, autonomy and financing of medical facilities, regulation of drug prices).

Key words: primary medical care, respondents, standardization of medical care, personnel potential, reform.

The quality of medical care, especially at the pre-hospital stage, depends on the reorganization of ambulatory polyclinic care and its staffing potential. When transitioning to market relations, there is a change in economic relations, which similarly requires changes in the organization of the health care system, thereby starting its reformation, which primarily involves reforming primary health care [3]. Almost 80% of patients receive a significant amount of medical and preventive care, which includes analysis of risk factors for the occurrence of diseases, preservation and strengthening of health. It is the level of organization of the work of the primary link that largely determines such key points as the quality, availability and timeliness of medical care, the development of the preventive direction,

Recently, there has been a deterioration in the health of the population of Ukraine, which is associated with the consequences of COVID-19 and Russia's armed aggression against the Ukrainian people. At the same time, during this period, in general, there were no significant changes and improvement in the quality of medical services and public service. System problems remained unsolved [1]. There is no doubt that preventive measures play a crucial role in the fight against morbidity and mortality among the population. Therefore, it is extremely important to transfer a significant emphasis of health care to the pre-hospital stage, which involves effective training and retraining of medical personnel on new bases, the use of effective methods and forms of work with patients and their families. It is with the general practitioner that the patient's contact with the health care system as a whole begins.

The new medical reform transformed the emphasis from specialized medical care to primary health care based on family medicine. When developing an organizational system of primary health care, the following indicators should be taken into account: the number of the population served; fulltime staff; list of types of medical care, regulatory documentation, performance indicators; phasing of the organization of primary health care according to the principle of general medical practice; financing mechanisms; sexual coefficients of the norm according to the number of the population [5].

All these factors require the continuation of the initiated health care reform in accordance with international standards, which will make it possible to provide the population with the full scope of medical care at the pre-hospital stage. Since the end of 2014, with the adoption of the National Strategy for Reforming the Health Care System in Ukraine for the period 2015--2020 [6], a number of resolutions and orders have been created to improve the quality of providing medical services to the population. It should be noted that the improvement and effectiveness of health care reform also depend on the state of training of medical managers at different levels of management.

Basic material. In the study of the following methods were used: questionnaires, systematic analysis and approach (for the analysis of problems in the organization of health care at the primary and secondary levels, analytical (analysis of the received information), statistical. Our research was carried out in several stages:

1. Development of a special questionnaire for health care managers.

2. Interviewing respondents to obtain the necessary information.

3. Processing and analysis of received information.

4. Formation of conclusions and practical recommendations.

The questionnaire consisted of 24 questions, which were divided into thematic blocks. All questions related to the analysis of reforming primary and secondary links of health care.

Respondents were divided into several groups:

-- managers of primary care (medical directors of general practice clinics and city hospitals -- 24%;

-- secondary (heads of departments of city polyclinics and general practice clinics -- 38%, heads of private medical offices -- 15%;

-- of the tertiary level of medical care provision (heads of information and analytical centers of regional and city hospitals -- 23%). To obtain more detailed information, health care managers were divided according to their experience in health care: beginners with up to 5 years of experience in health care (14%); from 5 to 15 years (45%); from 15 to 20 years (20%) and more than 20 years (21%).

In addition, in the course of our research, an analysis of the qualification categories of medical managers fromhealth care organizations: 15% of respondents have a higher category; the first -- 8%, the second -- 3%; 18% of medical managers do not have a healthcare qualification category.

The questionnaire included an individual assessment of the state of health of the population by each respondent before and after the implementation of health care reform.

Goal: to analyze the results of the questionnaire and draw conclusions about the opinions of health care managers of all levels regarding the reform of the primary and secondary links of health care.

The obtained results showed the following: 90% of the interviewed health care managers (40% -- primary level, 30% -- secondary and 20% -- tertiary level) believe that the health of the Ukrainian population has significantly deteriorated in recent years due to the consequences the incidence of COVID-19 and Russia's war against the Ukrainian people (migration of the population and medical workers, frequent cases of professional burnout among doctors, exacerbation of serious diseases, deterioration of mental health, reduction of incomes of the population and the state budget).

Only 10% of respondents hold the opinion that the state of health of the population has not changed significantly after the medical reform began.

The following questions related to the main aspects of the initiated medical reform:

-- assessment of the quality of medical services and patient care;

-- standardization of medical care;

-- licensing and accreditation of medical institutions;

-- autonomy and financing of medical facilities;

-- price regulation of medicines.

65% of surveyed primary care managers and 45% of secondary care managers consider the following transformations in health care to be positive: the introduction of electronic systems for registering patients with family doctors, a significant increase in the powers of family doctors, a guaranteed package of medical services, payment depending on the level of medical service. 20% of respondents have a negative attitude towards existing electronic patient registration systems and consider them imperfect. 65% of health care managers, including all levels, emphasized that health care financing is still carried out through general taxes and are of the opinion that the introduction of health care cost-sharing between the state and patients based on health insurance. It should be noted that 45% of respondents (18% of primary level managers,

At the time of the interview, 40.3% of managers believe that in order to ensure the organization of quality medical care, it is necessary to resolve the issue of increasing modern medical equipment and financing treatment and prevention facilities in full in accordance with the standards approved by the medical reform.

During the survey, the heads of medical institutions were asked questions about their awarenesswith Resolution No. 174 of February 28, 2023, approved by the Cabinet of Ministers of Ukraine, “Some issues of the organization of a capable network of health care institutions.” To realize this strategic goal, the process of forming a network of capable institutions has been started. Institutions with a quality mark with clear guarantees that the patient will get exactly where there will be specialists of the required profile and the necessary medical equipment to provide all professional assistance. It is to the capable network of hospitals that the resources that will restore the system and ensure its development will be primarily directed,” Viktor Lyashko emphasized. Unfortunately, only 30% of respondents (primary managers with more than 20 years of experience and 10% of secondary managers with more than 15 years of experience) are familiar with this reform. This percentage of managers fully supports this reform, and more informed managers noted that this reform will make it possible to clearly clarify the place and list of providing medical services to patients and which medical institutions need to strengthen the material and technical base, this will allow finding the right approaches to planning personnel and financial resources. where it is necessary to strengthen the material and technical base. An efficient network of health care facilities will make it possible to provide timely, affordable and high-quality medical care to the population that is subordinate to the rel-evant hospital district, which is especially important during martial law [7]. In addition, this approach will allow to increase the effective use of material, technical, labor and financial resources. 70% of managers (45% of primary managers, regardless of length of service, and 25% of the secondary and tertiary management of medical institutions are not familiar with new approaches to forming a modern network of hospital districts and medical institutions. to the definition of hospital districts and the implementation of modern approaches to the forma-tion of a network of medical institutions. reorganization health care link

During the survey, respondents were interested in a block of questions related to the “Affordable Medicines” program. Health officials at all levels noted that the program did not work as planned. For example, according to the prescriptions, pharmacies sold 10 times less antibiotics than was foreseen by the program. According to the program, according to electronic prescriptions, pharmacies sold only psychotropic and narcotic drugs.

Managers paid special attention to the block of issues related to wages. 72% of managers (43 primary and 29% secondary) are familiar with the new Decree of the Cabinet of Ministers of Ukraine on changes in the remuneration of employees of state and communal health care institutions and fully support it.

Conclusions:

1. Approximately 70% of managers of medical institutions are not familiar with a number of legislative and regulatory acts related to health care, which were approved in the last 2 years.

2. 65% of the interviewed managers of primary care and 45% of secondary care noted the following positive transformations in health care: the introduction of electronic systems for registering patients with family doctors, a significant increase in the powers of family doctors, a guaranteed package of medical services, payment depending on the level of medical services.

3. 20% of respondents believe that existing health care reforms are imperfect, but some of the leaders, including all ranks, could not give reasoned explanations on a number of issues.

4. The issues of timely informing the heads of medical institutions about familiarization with legislative and regulatory acts on health care are especially important.

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