Since the beginning of the year, the media have been actively discussing the closure of oncology, pediatric, and maternity hospitals in various regions of Ukraine. The closure and merger of hospitals is a cause for concern among medical staff and patients. In some places, local authorities decide to pay extra to patients to keep the unit open, while in others, institutions are liquidated or merged with other hospitals. People are afraid that the nearest hospital they have been going to for years will cease to exist. Let’s look at how optimizing the network of healthcare facilities will impact patients and the quality of healthcare services.
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A bloated network
The Ukrainian healthcare network was built long ago to meet the needs of 50 million Ukrainians. Now there is no such need — since independence and especially during the war, the population has shrunk significantly and continues to decline every day. Over the past 10 years, the birth rate has also fallen significantly: from almost 514,000 births in 2013 to 174,252 in 2023, according to the EHS.
The number of people receiving medical care has decreased significantly, which means that Ukraine no longer requires such numerous medical institutions, especially with a limited budget during the war. In addition, given the decline in the birth rate and the increasing share of middle-aged and elderly people, we do not need so many maternity or children’s hospitals.
So the state’s logic is quite clear: stop maintaining empty buildings and instead divide medical institutions into those that provide general, specialized, and highly specialized care. This is the way to improve the quality of healthcare services on a limited budget.
An excessive number of hospitals are often located in large cities of Ukraine (city, regional, departmental institutions, etc.). Most of them provide the same services. Therefore, some of these institutions really need to be closed, in particular those that provide too few services and are not profitable to maintain.
Medical institutions are now being optimized as part of the infrastructure phase of the healthcare reform. In each region, the Ministry of Health has already identified a capable network of institutions so that people can receive highly specialized care in their region. Patients do not need to be afraid of such changes, because a hospital near their homes that does not have qualified staff and modern equipment will not solve their health problems.
Ukraine’s healthcare network is one of the largest in Europe, yet the state spends the least on it. According to the World Bank, in neighboring Romania, almost 12% of the state budget goes to the healthcare system every year, while in Ukraine it is 8%. The EU average is over 15%. The number of medical facilities is not about quality. With this number of healthcare facilities, about 30,000 Ukrainians of working age die or become disabled due to stroke every year (with proper patient routing, this number would be significantly reduced).
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Optimization logic
In Ukraine, it is commonly believed that a good hospital is characterized by an intensive care unit. But do all medical facilities need intensive care? The answer is definitely no. Because a properly built medical system is primarily about a person’s own capabilities and primary care. The work of the primary healthcare system, which should cover 80% of patient requests, can be considered a definite success of the healthcare reform. Patients should pay attention to changes in their condition, but not self-medicate or self-prescribe MRI or CT scans. It is the family doctor who is the patient’s guide in the healthcare system. However, there are still problems with patients’ access to primary care in remote and frontline areas, and insufficient capacity of primary care.
At present, the same services are duplicated in hospitals of different levels and are often provided with poor quality. For example, low-specialized interventions are provided both in general medical facilities and in specialized hospitals of the fourth level. This is also the situation with complex cases: hospitals do not want to refer patients to higher-level medical facilities, and spend time on treatment without the necessary capabilities. The state is working to ensure that high-tech intensive treatment is available in designated multidisciplinary institutions, not in every hospital. The situation is similar with stroke treatment and rehabilitation services — they will be implemented on the basis of designated cluster or super cluster hospitals. Identification of a capable network and division of all hospitals into three levels will allow to separate and clearly define the boundaries of medical services provided in a particular hospital.
Redistribution of funding
When the network is optimized, there will be no need to maintain insolvent hospitals. The freed-up funds will be used to provide hospitals with modern equipment, increase salaries of doctors, and procure more necessary medicines. Patients should not be afraid of such changes, because it is about improving the quality of medical services. This will increase competition among doctors and will help to replace the medical staff with progressive and competitive specialists.
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