FUNCTIONAL EFFICIENCY OF HEALTHCARE FACILITY INTEGRATION IN UKRAINE: RISKS OF FORMAL INTEGRATION UNDER COMMUNAL NON-PROFIT ENTERPRISE CENTRALIZATION
DOI:
https://doi.org/10.11603/1681-2786.2026.2.16414Keywords:
healthcare integration; formal integration; primary healthcare; communal non-profit enterprises; financial imbalance; health system management; pseudo-integration.Abstract
Objective: To conduct a comprehensive assessment of the consequences of integrating polyclinics into large territorial medical associations (TMAs) in Ukraine, focusing on financial imbalances, management transformations, and the risks of formal integration without a real increase in functional system efficiency. Materials and methods: Systems analysis, comparative and financial-economic analysis, case analysis, and conceptual modelling were used. Secondary analysis of analytical materials from WHO, OECD, World Bank, WHO/ Europe, and national sources (NHSU) was applied. Results: The formal consolidation of healthcare facilities within communal non-profit enterprises (CNEs) / TMAs was found not to ensure functional integration. Financial resource redistribution from primary healthcare (PHC) to hospital care was identified (from 62% to 46% of budget), administrative cost growth (from 9% to 19%), and physician turnover doubling (from 8% to 18%). The concept of 'formal integration' and an integral effective-ness index are proposed. In Ukrainian TMAs, the index value of 0.3-0.5 indicates a predominantly formal nature of mergers. Conclusions: Centralised formal integration is a transitional institutional form. Key conditions for successful integration include: KPI-based management, financial transparency, independent audit, development of digital inte- gration, and preservation of primary care functional autonomy.
References
World Health Organization. Framework on integrated, people-centred health services. Geneva : WHO, 2016. 48 p.
World Health Organization Regional Office for Europe. Primary health care financing in Ukraine: a situation analysis and policy considerations. Copenhagen : WHO/Europe, 2023. 48 p.
OECD. Health at a Glance 2023: OECD Indicators. Paris : OECD Publishing, 2023. DOI: https://doi.org/10.1787/7a7afb35-en DOI: https://doi.org/10.1787/7a7afb35-en
OECD. Realising the Potential of Primary Health Care. Paris : OECD Publishing, 2020. 180 p. DOI: https://doi.org/10.1787/a92adee4-en DOI: https://doi.org/10.1787/a92adee4-en
WHO/Europe, World Bank. Health Financing in Ukraine: Reform, Resilience and Recovery. Washington DC : World Bank Group, 2024. URL: https://documents.worldbank.org
Valentijn P. P., Schepman S. M., Opheij W., Bruijnzeels M. A. Understanding integrated care: a comprehensive conceptual framework based on the integrative functions of primary care. International Journal of Integrated Care. 2013. Vol. 13. P. e010. DOI: https://doi.org/10.5334/ijic.823 DOI: https://doi.org/10.5334/ijic.886
Rechel B., McKee M., Richardson E., Roberts B. Health systems in Eastern Europe: post-transition reforms and the impact of the Ukraine conflict. European Journal of Public Health. 2023. Vol. 33(Suppl 2). P. ckad160. DOI: https://doi.org/10.1093/eurpub/ckad160
Dyer T. A., Brocklehurst P., Glenny A. M. Integration of health services: a systematic review of formal mergers. BMJ Open. 2023. Vol. 13(4). P. e067819. DOI: https://doi.org/10.1136/bmjopen-2022-067819 DOI: https://doi.org/10.1136/bmjopen-2022-067819
Valentijn P. P., Ruwaard D., Vrijhoef H. J. M. et al. Collaboration processes and perceived effectiveness of integrated care projects in primary care: a longitudinal mixed-methods study. BMC Health Services Research. 2015. Vol. 15. P. 463. DOI: https://doi.org/10.1186/s12913-015-1127-5 DOI: https://doi.org/10.1186/s12913-015-1125-4
Goodwin N. Understanding integrated care: a complex process, not a structural change. International Journal of Integrated Care. 2016. Vol. 16(4). P. 6. DOI: https://doi.org/10.5334/ijic.2533 DOI: https://doi.org/10.5334/ijic.2530
Kasekamp K., Habicht T., Demeshko O., Hawkins L. Primary health care financing in Ukraine: a situation analysis and policy considerations. Copenhagen : WHO Regional Office for Europe, 2023.
Кравченко М. В., Дудіна О. О. Стан і тенденції первинної медичної допомоги в Україні в умовах медичної реформи. Вісник соціальної гігієни та організації охорони здоров'я України. 2024. № 1. С. 4–12. DOI: https://doi.org/10.11603/1681-2786.2024.1.14405
Грицко Р. Ю., Фуртак І. І., Грицко О. М., Колядич М. М., Пеканець С. Р. Напрями удосконалення управління ресурсами системи охорони здоров'я України. Problems of Science and Practice. 2022. № 1(5). С. 45–52.
Грицко Р. Ю. Інституційні та правові засади формування інтегрованого інвестиційного клімату в Україні. Наукові праці МАУП. 2025. № 79. С. 55–62. DOI: https://doi.org/10.32689/2523-4536/79-6 DOI: https://doi.org/10.32689/2523-4536/79-6
Грицко Р., Грицко О., Пеканець С. Трансформація медичної допомоги через інноваційні технології: роль цифрових технологій у реабілітації пацієнтів. Grail of Science. 2025. № 53. С. 840–845. DOI: https://doi.org/10.36074/grail-of-science.20.06.2025.111
Національна служба здоров'я України. Звіт про діяльність НСЗУ за 2023 рік. Київ, 2024. URL: https://nhsu.gov.ua
Національна служба здоров'я України. Дані Програми медичних гарантій. Київ, 2023. URL: https://nhsu.gov.ua
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