Changes in the conduct of economic activity by state and communal institutions of healthcare as an element of medical reform in Ukraine
Authors: Selivanova Iryna , Mamaiev Illia 
Published: January 2022

Problem setting. Prior to the medical reform in Ukraine in 2017, the situation in the field of health care was extremely negative. One of the reasons for this was the extremely inefficient organization of financing and management of the health care system – the command-and-control model of health care inherited from the USSR. This management model is characterized by the fact that most health care facilities are budget institutions. They were funded by central authorities according to outdated sectoral standards, mainly on the basis of statistics on staffing and the number of hospital beds.
However, in the transition to a market economy, this approach proved ineffective because it limited the managerial flexibility and independence of management, did not encourage them to increase the efficiency of health facilities, reduce inefficient costs and introduce innovative organizational practices not provided for in the guidelines.
Analysis of recent researches and publications. S. Lukash, O. Maslak and R. Pobidynskyi have been studied the issues of the state administration of medical institutions’ autonomy. Comparative analysis of approaches to transformations in primary health care systems (in Europe and Ukraine), issues of primary health care system development, analysis of the results of health care reform in the pilot regions was carried out by Lekhan V.M., Kryachkova L.V., Volchek V.V., Borvinko E.V., Slabky G.O., Shevchenko M.V. However, the changes that have taken place in the conduct of economic activity by health care institutions have not been studied.
Target of research. The purpose of the article is to describe the process of autonomy of health care facilities of the state and municipal sectors of the economy, change the principles of their financing and economic activities, identify the main problems associated with these processes.
Article’s main body. The article is devoted to the transformations taking place in the medical system of Ukraine since 2016. The essence of changes in the organization and implementation of economic activity of health care institutions of the state and municipal sectors of the economy is studied. The article discusses the legal issues related to the autonomy of such health care facilities and the resulting change in governance, in particular, the emergence of supervisory boards, new bodies, public involvement in health care management (supervisory and boards of trustees).
One of the main principles of the transformation of the Ukrainian medical system is to expand the economic freedom of health care facilities in the public and municipal sectors of the economy. For its introduction the autonomy of such institutions was carried out, ie their organizational and legal form was changed from a budgetary institution to a non-profit enterprise, and the organization of their financing was changed from budgetary financing to receiving funds under the agreement with the National Health Service of Ukraine. The choice of an enterprise with the status of a non-profit organization was justified by the following factors: 1) it protects health care facilities from the privatization of their property; 2) such enterprises cannot be declared bankrupt; 3) the status of a non-profit organization protects the medical enterprise from the owner, because he can not distribute its income.
Conclusions and prospects for the development. After the autonomy, health care facilities are represented by the following organizational and legal forms. In the public sector of the economy, they can be formed and function as stateowned enterprises or state institutions, in the communal sector of the economy – as municipal non-profit enterprises or communal institutions. Private health care facilities are not limited in their choice of legal form.