Вплив конкуренції на ефективність системи охорони здоров'я України ; Influence of the competition on the efficiency of the healthcare system in Ukraine

Abstract

Зазначено, що запровадження конкуренції позитивно оцінюється як потенційний механізм підвищення ефективності та продуктивності й покращення здоров'я населення. Той факт, що конкуренція може розглядатися як "проблема", так і як "рішення", є ознакою вирішальної ролі контексту в розумінні потенціалу ринкових сил для вдосконалення системи охорони здоров'я. ; Problem setting. Providing broad access to health services, while improving the service quality and cost optimization, is a topical issue for healthcare systems around the world. One of the alternative options for solving this problem, which affects all these components, is the creation of a competitive environment and the development of competition in this area.Recent research and publications analysis. Among health managers, there is no single approach to the issue of how acceptable the competition is in the healthcare sector. Consequently, the concept of "competition" may have different content depending on the expected result that will affect the implementation of public health policy, especially at the local level. But the key issue is whether health systems based on the competition can be more successful and how competition can differ from conventional medical practice.Highlighting previously unsettled parts of the general problems. One of the strongest arguments in favour of competition is that it can help to create powerful incentives to encourage service providers to innovation, to deliver better quality medical services at a lower cost. At the same time, experts warn that for highly specialized services competition should be limited enough or be used very carefully in order to ensure quality and avoid over-supply of services.Paper main body. Traditional healthcare competition involves one or more elements (such as price, quality, convenience, and availability of the service). At the stage of creating conditions for the development of a competitive environment, state policy managers need to take into account the fact that price competition is the main type of competition that is understandable to the consumers (patients) in the healthcare system.Competition usually eliminates inefficiency, which in many cases leads to high costs allocation associated with the treatment and diagnosis process and will be reflected on patients because of the high price of medical services and the costs for the treatment. Scientists argue that medical care/services of the best quality can cost less in general because of putting more accurate diagnoses, fewer complications and errors, less invasive treatment, faster recovery, fewer risks and complications in the course of the disease. However, opponents of the competition development in the medical sector also defend their arguments against the feasibility of creating such an environment, noting that the provision of competition in the healthcare system is a conceptually imperfect and unproductive process.There is another important issue in this discussion to clarify, i.e. by means of which mechanism may the competition become beneficial in the context of improving health indicators. This concerns both the level of competition and the level of regulation (from the central to the local authorities), which would bring the best results.Conclusions of the research and prospects for further studies. Most health facilities in Ukraine are still local monopolies at present and real competition among them is just impossible, which can be explained by a number of objective and subjective factors. Trying to influence the minimization of those factors that make it impossible to develop "healthy" competition, the government drafted a new legislation, which provides for a new approach to financing health facilities as well as healthcare workers. This legislation was also passed by Verkhovna Rada.The reform of the healthcare system will affect not only the financing but also the overall structure of the market of health services. The ability to attract more patients through state-guaranteed payments is likely to encourage foreign and local investors to enter the market and manage competition, which consequently may result in increasing the overall quality and variety of services.The position on the appropriateness of competition in the healthcare system is also a political and cultural problem related to the values inherent in different countries. In general, the introduction of competition is positively evaluated as a potential mechanism for increasing efficiency and productivity as well as improving the health of the population. The fact that competition can be seen both as a "problem" and as a "solution" is a sign of the decisive role of the context in understanding the potential of the market for improving the healthcare system as such.