The aim: To determine the financial and economic condition before and after the implementation of the hospital district in the Kalush Central District Hospital and to show the medical and social justi!cation of the changes in the institution’s !nances. Materials and methods: The object of this study was the activity of the Kalush Central District Hospital, which is a multidisciplinary medical and preventive health care facility, in which medical assistance is provided to patients in surgical, neurosurgical, traumatological, cardiological, gastroenterological, endocrinological, urological departments, in the department of miniinvasive surgery. In order to see how the implementation of hospital districts a"ected the financial condition of medical institutions, the financial statements of the institution for 2017-2018 were used to study the financial condition of the organization. During this period medical assistance was provided to more than 92,000 patients. Results: The reform of the health care system in 2017 took place in accordance with the developed concept of the development of medicine, which is based on the creation of hospital districts. On average, the hospital district covers about 60 kilometers of territory. Such a distance allows us to deploy a powerful network of various hospitals that are able to provide almost the entire range of medical services, starting from diagnostics and ending with urgent treatment. The hospital district is headed by an institution that coordinates the work of all institutions and recommends building such organizational and financial structures that allow the medical institution to develop and create a quality medical product. Kalush Central District Hospital coped with the reforms of medicine, the implementation of hospital districts became a signi!cant event that changed not only the organization of the provision of medical services, but also changes in the financial and economic condition of medical institutions. In general, the financial condition of the enterprise shows that the hospital is autonomic, it is financed from its own sources of !nancing. Conclussions: The financial condition of the enterprise shows that the Kalush Central District Hospital is autonomous, that is, to a greater extent, it isfi!nanced from its own sources of !nancing. However, liquidity indicators are negative, which require more e"ective management of cash #ows so that the organization can timely repay salary arrears and pay mandatory payments for the use of material resources and energy. At the same time, a large number of patients are coming to the hospital because the income level has increased, which is de!nitely a positive factor. However, when planning activities for the following periods, it is necessary to take into account the need to update material and technical support, as well as to find sources of increasing sta" wages.
The article examines the state of development of hospital districts. According to the results of the research, the urgency of solving the issue of improving the regulatory framework governing the activities of hospital districts was determined. Today, health care is the most pressing issue at the global level and affects the whole society, and the issue of ensuring the right to health care for everyone is enshrined at different levels: internationally, it is declared in the WHO statute; also reflected in the regulatory framework of regional organizations, the constitution of the European Union, enshrined in the national constitutions of all countries. Ukraine is currently in the active stage of reforming the health system and its acute issue in the context of decentralization reform is the formation and operation of hospital districts, the logic of which is based on the territorial availability of quality health care. Given the social significance of hospital districts, the topic of problems of their activities and the development of solutions for their leveling is in demand. Ukraine today has one of the most inefficient hospital systems in the world, the problems of which are the lack of a hospital planning system and the practice of cooperation between local communities and the authorities that represent them. Therefore, an important part of medical reform in terms of reforming and streamlining the network of health care facilities was the approval of the Procedure for the establishment of hospital districts. The study examined the foreign experience of organizing hospital districts, in particular the district of Roth (Bavaria, Germany). A study of the definition of "hospital districts" and identified its main characteristics: the association of health care facilities; providing secondary medical care; clear definition of territory and consumers of services. The mechanism of functioning of the hospital district is considered, its tasks are defined. The principles of work of the main governing body of the hospital district - the hospital council, which is an advisory body and includes representatives of state bodies, local governments, enterprises, institutions and organizations. The purpose and powers of the hospital council are determined. Hospital districts that should operate in the regions of the country are considered. Conclusion. We revealed the main problems in the activity of hospital districts: inconsistency and lack of sufficient regulatory framework on the issue of the process of creating hospital districts; lack of methodological recommendations in the formation of hospital districts on the list of functions of a multidisciplinary hospital and the types of its departments that should operate within it; lack of attention to the assessment of regional features during the formation of hospital districts; unresolved personnel problem; unresolved issues of public access to medical services. We also suggested the ways to solve them
The aim: Theoretical substantiation and determination of the main characteristics of the interaction links of medical institutions within one hospital district in the conditions of aggravation of the epidemiological situation in Ukraine on the analysis basis of the legislative base and elaboration of literary sources. Materials and methods: In the work is used a range of methods: content analysis, bibliosemantic, systematic approach, analysis of products of activity. Conclusions: The authors propose a doctrinal definition of the term “hospital district”. The key problems of the domestic healthcare sector in the context of a pandemic have also been identified. The author points out that in order to successfully reform the health care system and the effective interaction of hospitals in one hospital district, it is necessary to pay attention to funding sources and proper legal regulation, as without the latter any initiatives will have no legal force and will be ignored. health care may be ineffective.
The relevance of the study is due to the problems of medical care of the population of Ukraine caused by the 2019 pandemic and the war of 2022, which requires prompt, timely and high-quality management of the health care system. The purpose of the study was to evaluate the indicators of the financial condition of the Kolomyia Regional Medical Center after the introduction of the hospital district. To achieve the goal, the following tasks were performed in the course of the study: the peculiarities of the formation of hospital districts and the reorganization of the health care system at the local level were shown, the financial condition of the Kolomyia Regional Medical Center was investigated, and the changes before and after the introduction of the hospital district in the main indicators were shown. Materials and methods. In the course of the study, methods of economic analysis were used, in particular, the method of horizontal and vertical analysis, R-indicators. The method of observation and strengths, weaknesses, opportunities, and threats analysis were also used. Results and discussion. The results of the study showed that the Kolomyia Regional Medical Center is characterized by an unstable financial condition with worsening indicators after the introduction of the hospital district. Improvement of the material and technical base and increase in staff wages are positive factors of the impact of the reforms. The practical significance of the study is due to the definition of the problems of implementing the reform in the health care system and the possibility of adjusting the strategy of development of medical institutions of territorial communities. Conclusion. The introduction of hospital districts became one of the elements of the medical reform, which allows optimizing state and local financial resources in order to use them effectively without threats or risks to the population. Such a reform was carried out in 2017, as a result of which a medical cluster was created in the Kolomyia United Territorial Community. Such a cluster made it possible to optimize the work of medical institutions. According to the results of the analysis of the financial condition of the Kolomyia Regional Medical Center before and after the introduction of the hospital district, it can be concluded that, taking into account the unchanged budget costs for financing the Kolomyia Hospital, its financial condition has changed significantly. In particular, indicators of financial condition, liquidity, turnover and profitability have deteriorated. At the same time, due to the use of ineffective means of optimization, in particular, the reduction of personnel, there was an increase in wages, as well as the release of additional funds for equipment and technical support of the medical institution. Of course, the formation of a hospital district did not solve the problems of medicine, and to some extent even aggravated them, since in general, medical institutions faced issues of staff reduction and reduced funding. However, at the same time, newly created medical clusters are opening up new forms of financing that allow them to provide services on a competitive basis and gain financial autonomy and even independence
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