The prospects of development of the state and private partnership under conditions of the healthcare reform

Problem setting. The status of the state and private partnership in Ukraine and the prospects of its development under conditions of the healthcare reform were examined. The cooperation of the state and private sector becomes increasingly important in a social sense, however the existing practice does not demonstrate the efficiency of the fulfillment of the assigned tasks. The conducted analysis allowed to determine the risks and problems of the implementation of the state and private partnership in the sphere of healthcare under current conditions in Ukraine. It was substantiated that the fulfillment of the concept of the state and private partnership in the healthcare system of Ukraine is one of the key issues of the state policy.

Recent research and publications analysis.  The involvement of a private partner in the field of healthcare is highly common in many countries of the world. The effectiveness of such cooperation is confirmed  and described in a number of various studies. At the same time, authors’ publications fail to mention the aspects of involving the private sector in the activities of municipal and state healthcare facilities, including under conditions of healthcare reform in Ukraine.

Highlighting previously unsettled parts of the general problem. At the modern stage of reforming of the healthcare system which is an integral part of socioeconomic transformations in Ukraine, the problem of the state regulation of investment support for the development of healthcare sector is becoming ever more important. The main goal of the reform is to build such a model of the healthcare system which would ensure equal and fair access of all members of society to necessary medical services, their high quality and cost-effectiveness while maintaining socially expected volume of state guarantees.

The purpose of this article is to reveal the prospects of the state and private partnership under conditions of implementation of the healthcare reform.

Paper main body. Ministry of Economic Development and Trade of Ukraine continues to play a key role in the institutional support of the state and private partnership in Ukraine. According to the regulatory document (Decree on the Ministry) it is entrusted with various functions related to the implementation of the state policy in this sector, and namely: monitoring the efficiency of the central, regional and municipal authorities in the field of the state and private partnership; verification of the fulfilment of the signed contracts on the state and private partnership; preparation and provision of information on the results of the state and private partnership to the public;  monitoring and evaluation of various types of risks (and namely, general risk) of state partners within the framework of the contracts on the state and private partnership; accounting of contracts on the state and private partnership; organizing and conducting training in order to form and implement the contracts on the state and private partnership; monitoring of compliance with the requirements of current laws on the state and private partnership with respect to existing and new contracts.

As of today, the development of the concept of the state and private partnership in the field of healthcare of Ukraine, unfortunately, is not a matter of priority of the state policy and modern budgeting system creates high financial risks for  the state and private partnership which are related to short-term (yearly) budget cycles of planning and their annual approval procedures which are sometimes unnecessarily prolonged.

Joint activities, distribution of products etc. may be forms of implementation of the projects of the state and private partnership and they may be financed from the funds of the state and local budgets, financial resources of the private partner, loaned funds and other sources which are not prohibited by laws.

In this case, the legislation foresees the provision of support to projects of the state and private partnership through state guarantees, provision of funds from state and local budgets and other sources within the framework of the state-wide and local programmes. 

There are also preconditions for organizing high-tech centres for treating various types of diseases while using financial instruments of investors and staff capacity of the state healthcare facilities.

However, presently there are certain doubts on the side of potential private partners regarding the possibility of implementation of long-term mutually beneficial cooperation. It resulted in the absence of transparency and clarity in the normative and legal regulation of the state and private partnership in Ukraine.

Therefore, state and private partnership must ensure:

1. The use of the mechanism for planning and funding projects of the state and private partnership because it contributes significantly to the interest of private domestic and foreign investors in participating in the state and private partnership.
2. Normative and legal regulation of implementation of projects of the state and private partnership.
3. Successful introduction of infrastructure projects of the state and private partnership into the activities of healthcare facilities.
4. Construction of high-tech centres for treatment of various types of diseases.
5. Increasing the accessibility of health services for the population and supporting the development of the private sector.

Conclusions of the research and prospects for further studies. The majority of projects were implemented in order to reduce the expenses incurred by state and municipal healthcare facilities and neither to increase the quality of provision of health services nor to optimize the expenditure for upgrading material and technical equipment. As a result, the efficiency of such state and private cooperation is one-sided and, as a rule, it has a positive impact solely on the private partner or a short-term result for a healthcare facility where such cooperation is implemented.

In this case, the primary task laid as part of implementation of the state policy within the framework of healthcare reform, and namely improving the quality and accessibility of health services for the population of Ukraine, remains uncompleted on the side of the state and municipal healthcare facilities.

However, there is a positive experience of involvement of private business in the process of introduction of infrastructure projects of the state and private partnership into the activities of healthcare facilities; confirmation of the relevance of the development for practical introduction of infrastructural projects of the state and private partners into the activities of facilities of the system of emergency medical care of Ukraine.

Introduction of the mentioned infrastructural forms of the state and private partnership into the activities of emergency medical care facilities in Ukraine may be an effective instrument for reducing the share of the non-market sector in the field of healthcare while simultaneously increasing the efficiency of the state management.

The involvement of the private sector helps to resolve several issues at once:

1. Involvement of personnel oriented towards the provision of services which will contribute significantly to the competitive ability of the state and municipal facilities.
2. Management which reacts quickly to changes on the market of health services which is somewhat restricted under conditions of budgetary legislation on the side of the state and municipal healthcare facilities and is sufficiently important for constantly adapting the needs of the population to the modern global requirements.
3. Raising funds from partners for upgrading material and technical equipment, on the one hand, may significantly reduce financial losses with the involvement of the most up-to-date technologies or give the facilities an opportunity to receive modern services and equipment with the use of the funds of private partners.
4. Reducing financial burden of expenses on local authorities and the state budget of Ukraine in general while keeping a healthcare facility in a satisfactory condition and corresponding level of provision of health services.
5. Improvement of socioeconomic standard of living on account of an increase in accessibility of healthcare to the population of Ukraine in accordance with global requirements.
6. All of this will finally result in a change of the situation in the healthcare sector, will help to build trust in the domestic medicine and increase the health of the nation in the overall perspective.

Further research prospects in this direction should include the study of successful foreign experience for strengthening the state and private partnership and determining the feasibility of implementation of the best foreign practices under current conditions in Ukraine on account of development, adaptation and introduction of changes into the legal framework.