Школа управління в охороні здоров'я

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The cost of treatment and rehabilitation of servicemen with amputation after mine-blast injury
(2025) Shevchenko, Maryna; Yurochko, Tetiana; Maistruk, Pavlo; Skrypnikova, Olena; Oberniak, Artem
Purpose: to study the "portrait" of servicemen with amputations as a result of mine-blast injuries and to calculate the costs of their treatment and rehabilitation in a specialised institution providing highly qualified inpatient care Materials and methods. The study was conducted among servicemen who underwent treatment and rehabilitation at the Feofiniya Clinical Hospital of the State Management of Affairs of Ukraine from September 2022 to June 2024 (46 people in total). The following methods were used to conduct the study: cost-of-illness method, economic analysis. The costs of prosthetics due to amputations were not analysed in the calculations. Results. 46 patients (servicemen) who sustained mine-blast wounds while performing combat missions were included in the study. The patients' ages ranged from 21 to 58 years (mean age – 36.7 years). On average, there were 1.2 amputations per patient. The average length of stay for treatment and rehabilitation was 144 days (median 120 days). Overall, it was estimated that the largest share of costs was for inpatient treatment (45%), laboratory and instrumental tests (9.1%), and medicines (28.6%). The cost per patient was UAH 628 thousand. Conclusions. According to the calculations, the total cost of treatment and rehabilitation of servicemen with amputations (excluding prosthetics) in the study sample was more than UAH 28.9 million (in 2024 prices).
Enhancing Colonoscopy Quality: Evaluating Adherence to Performance Measures in Ukraine
(2025) Hornik, Ivan; Nikiforchin, Andrei; Antoniv, Marta; Huivaniuk, Inesa; Malovanna, Anna; Dzhemiliev, Ali; Savulionyte, Goda; Polishchuk, Serhii; Janelidze, David; Shabat, Galyna; Kopetskyi, Viacheslav; Prystaia, Anastasiia; Murthy, Shilpa; Melnitchouk, Nelya
Purpose. Colonoscopy is a proven screening method for reducing mortality from colorectal cancer (CRC), the most frequently diagnosed cancer in Ukraine. To enhance colonoscopy quality, international societies have defined key performance measures (PMs). We aimed to evaluate adherence to these PMs among Ukrainian endoscopists and explore factors affecting screening colonoscopy quality. METHODS We conducted a cross-sectional study using a web-based survey among members of Ukraine’s endoscopy society EndoAcademy (Kyiv, Ukraine) (October-November 2023). The questionnaire assessed colonoscopy practices and adherence to globally recognized PMs, categorized as six calculated (requiring ongoing numerical data tracking) and six noncalculated (performed/not performed practices). Results. Of 540 invited endoscopists, 122 (22.6%) responded. The median number of adhered to quality PMs was 6 (IQR, 5-8), with noncalculated being reported more frequently: medians 4 (IQR, 4-5) versus 2 (IQR, 1-3), P < .01. Among noncalculated PMs, most common were postpolypectomy surveillance recommendations (98.4%, n 5 120) and retrieval of removed polyps (96.7%, n 5 118). For calculated PMs, cecal intubation (61.5%, n 5 75) and adenoma detection (59.8%, n 5 73) rates were most frequently reported. In multivariable analysis, adherence to each additional quality PM increased the odds of optimal polyp treatment (odds ratio [OR], 1.32 [95% CI, 1.03 to 1.70]), with photo/ video recording (OR, 7.57 [95% CI, 1.66 to 34.49]) and adequate procedure time allocation (OR, 3.86 [95% CI, 1.18 to 12.61]) showing the strongest associations. Conclusion. To our knowledge, this first national study of colonoscopy PMs in Ukraine highlights key documentation gaps and variation in polyp management. As the country implements a population-based CRC screening program, structured quality assurance, audit-and-feedback systems, and education grounded in international PMs will be critical to improving outcomes.
Just informal patient payments are not enough, 'personal connections' and knowledge of the 'rules' are also required: a logistic regression analysis of informal practices in health care in Ukraine
(2025) Levenets, Olena; Stepurko, Tetiana; Polese, Abel; Pavlova, Milena; Groot, Wim
In Ukraine, patients and their family members face numerous barriers to health care services. In response, they use coping strategies, that are manifold and complex activities aimed at overcoming these barriers, the financial burden of the treatment, and the poor quality of health care services. These activities include formal and informal practices. Based on representative survey data from 2015 (N = 2,022), we identify patterns in the use of coping strategies, specific coping strategies used to secure good quality consultation and treatment, and analyse opinions and actions towards coping practices. We further analyse the factors associated with the last experience of coping and look at patterns of connection building. We find that the chances of using both money and connection as a coping strategy are higher for people with incomplete higher and highest levels of education. The size of this effect increases with the level of education. Older people, people with better health, and people with a higher opinion of the state use informal practices less, while women are more active in developing connections. The closer the relationship is with a medical doctor, the higher is the chance that such connection will be used in case of health service consumption.
Navigating cancer care in Ukraine: patient’s coping strategies to ensure access and quality
(2025) Levenets, Olena; Chernysh, Tetiana; Pavlova, Milena; Groot, Wim
Purpose This study investigates how socio-economic and healthcare factors shape the coping strategies of patients diagnosed with cancer in Ukraine, including the decision to forego treatment. The focus is on how these variables influence patients’ strategies to gain access to services, ensure better treatment quality, and decrease treatment costs. Methods Data were collected in 2021 through structured interviews in three oncological dispensaries and an online questionnaire among patients diagnosed with cancer in Ukraine (632 patients in total). Sequential logistic regression analyses were applied to identify patterns in selecting specific coping strategies. Results The results show that socio-economic characteristics, the perception of service quality, financial resources, and the availability of support influence the choice of coping strategies. Older patients and women are more likely to use informal payments than connections. Patients, who perceive service quality as (very) bad and those finding it hard to afford treatment, are more likely to deploy coping strategies. Higher education and urban residency also impact the coping strategy applied. Conclusion The study highlights significant disparities in the choice of coping strategy regarding cancer treatment in Ukraine. Coping strategies, including informal payments and connections, are crucial for accessing and ensuring better treatment. These findings underscore the need for evidence-informed policies to support the most vulnerable cancer care patients in Ukraine.
The perception of outpatient care quality by healthcare users in Ukraine
(2024) Anufriyeva, Valentyna ; Pavlova, Milena ; Stepurko, Tetiana; Groot, Wim
Background: Ukraine has been improving the quality of health care by reforming the health care system. Evidence on healthcare users’ perceptions of quality is important for future system changes. This paper aims to analyze the aspects of quality that outpatient care users find most important. Methods: Data from a longitudinal household survey ‘Health Index. Ukraine’ in 2016–2019 were used. The survey had a sample size of over 10,000 participants per wave. Data were analyzed using descriptive statistics as well as binary regression analysis. Results: Our results showed the importance of quality attributes as ‘effectiveness of treatment’ and ‘qualification of medical personnel’ as well as changes in the perception of quality attributes connected with payment policies and general management of the facility (like working hours, setting and hygiene ensuring by medical personnel). Conclusions: Our study provides new insights into the importance of healthcare quality attributes for outpatient healthcare users in Ukraine, showing the need to develop in future a national policy on quality and a national quality strategy for health care that incorporates quality aspects important to patients to make the healthcare system more responsive to the needs and expectations of healthcare users.
Perceptions of healthcare quality indicators by anesthesiologists in intensive care departments in Ukraine
(2026) Barsa, Maksym; Anufriyeva, Valentyna
Background. During the last decade more and more countries plan to reach universal healthcare coverage by 2030. Financial healthcare reform in Ukraine started in 2016, focusing on effective financing and providing access to qualitative medical services to the population. Primary healthcare started to change in 2018 followed by secondary and tertiary care in 2020. In 2022–2023 great challenges emerged because of the full-scale war. The aim of this research is to describe the perception of healthcare quality indicators among anesthesiologists in intensive care units in Ukraine, that might be used to improve the quality assessment system in Ukraine as well as in other countries that have similar healthcare systems or undergo similar processes of changing their specialized care. Methods. Data were collected in November 2024 - January 2025 applying the survey as the main data collection method. The normality of the distribution of respondents’ age and work experience was assessed by the Kolmogorov-Smirnov test followed by the Mann-Whitney U test. Responses to the open-ended questions were initially categorized according to the established framework and subsequently analyzed using descriptive statistics and binary logistic regression analysis. Results. In total, 114 filled in questionnaires were received and included in the analysis. Doctors-anesthesiologists tend to perceive quality as a process quality. Among the most important clinical quality indicators for anesthesiologists there are "prevention of thromboembolism" (99.1%), "prevention of ulcer formation"(98.3%), "control of ventilator-associated pneumonia" (98.3%). Non-clinical indicators included "nurse-to-patient ratio" (100%), "availability of a mechanical ventilation weaning protocol" (100%) and "compliance to clinical guidelines" (96.5%). A statistically significant relationship (p˂0.05) between the indicator "Satisfaction of the patient’s relatives with the patient’s stay in the intensive care unit" and the independent variable "owner" was found. Conclusions. Our research provides new insights into perception of healthcare quality and importance of quality indicators for its assessment among the medical doctors of specialized care. In comparison with the general practitioners focusing on the process quality, the focus of doctors-anesthesiologists lies in the outcome quality. But little consensus about healthcare quality remains to be an issue, as does the necessity to develop and promote a national quality policy and a national quality strategy.
Three years into Russia's full-scale invasion, Ukraine offers a model of health system resilience
(2025) Murphy, Adrianna; Kovtonyuk, Pavlo
The 24 February 2025 marks the third anniversary of Russia’s full scale invasion of Ukraine. This grim milestone coincides with a radical shift in American policy towards Ukraine and the rest of Europe that challenges the country’s sovereignty and capacity to recover. It is an appropriate time to reflect on the impact the invasion has had on Ukrainians and the resilience they have demonstrated in their response.

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