DOI: https://doi.org/10.62204/2336-498X-2023-4-4

A NEW LOOK AT PPP IN HEALTH PROTECTION:

PERSPECTIVES OF INTERACTION BETWEEN THE STATE

AND HOSPITALS OF UKRAINE

 
Victoria Khmurova,
Doctor of Economics, Associate Professor,
State University of Trade and Economics, Ukraine,
v.khmurova@knute.edu.ua; ORCID: 0000-0002-6398-6351
Nataliya Deeva,
Doctor of Economics, Pprofessor,
  State University of Trade and Economics, Ukraine,
n.dyeyeva@knute.edu.ua; ORCID: 0000-0002-2278-549X
Yana Volkova,
postgraduate student,
State University of Trade and Economics, Ukraine,
y.volkova@knute.edu.ua; ORCID: 0000-0001-6531-7728

Annotation. In the context of modern challenges facing the healthcare system of Ukraine, in particular the limitation of financial resources, and the need to modernize the infrastructure and improve the quality of medical services, public-private partnership (PPP) emerges as a strategic tool that offers new opportunities for solving these problems. The relevance of this study lies in the in-depth analysis of the potential of PPPs in the field of health care in Ukraine, with an emphasis on the identification of key success factors, challenges, and barriers that accompany the implementation of such projects. Given the growing need for investment to improve health infrastructure and services, as well as the need to introduce innovative approaches to healthcare delivery, PPP research is becoming increasingly important. It makes it possible to identify mechanisms through which effective interaction between public authorities and the private sector is possible, which, in turn, contributes to the achievement of strategic goals in the field of health care. This study is aimed at revealing the possibilities of PPPs to improve the availability and quality of medical services, analyzes international experience, and outlines recommendations for the adaptation of best practices in the context of the Ukrainian healthcare system. The results of the study are intended to contribute to the development of effective policies and strategies for the implementation of PPPs, which will become the basis for the sustainable development of health care in Ukraine, improving the quality of medical care and providing the population with affordable and high-quality medical services.

Keywords: health care, PPP, Ukraine, medical institutions, investments, modernization of infrastructure, quality of medical services, innovative approaches, strategic planning.

Introduction. In the modern conditions of the development of society, especially in the context of global challenges facing the healthcare system, the search for effective ways of providing the population with quality medical services is becoming particularly relevant. Ukraine, like many other countries, faced the need to adapt its healthcare system to the changing needs of society and the challenges of the times. This requires not only significant financial investments in the development of medical infrastructure but also an innovative approach to the management of medical institutions and the provision of medical services.

The relevance of public-private partnership (PPP) research in the field of health care in Ukraine stems from the potential of this tool to solve several existing problems. PPP can contribute to increasing the efficiency of medical care, modernization of medical infrastructure, introduction of the latest technologies and treatment methods, and attraction of private investments and innovations in the field of health care. Such cooperation between the state and the private sector opens up new opportunities for the development of the medical industry, ensuring a higher level of medical care and the availability of medical services for wider segments of the population.

However, despite the significant potential, the implementation of PPP in Ukraine is accompanied by several challenges. This concerns both legal and regulatory aspects of cooperation between the state and private investors, as well as risk distribution, control over the quality of medical services, and protection of patients’ rights. Therefore, research aimed at analyzing existing experience, studying international practices, and developing recommendations for optimizing PPP models in health care becomes important. It aims not only to determine effective mechanisms of interaction between the state and the private sector but also to ensure a high level of accessibility and quality of medical services for the population, thus contributing to the sustainable development of healthcare in Ukraine.

This study aims not only to highlight the potential advantages and challenges of DPP in health care but also to propose specific directions for improving existing practices and developing effective strategies for implementing DPP in the medical field of Ukraine. Considering the growing interest in PPP models in the world, the analysis of the Ukrainian experience and the adaptation of best international practices can contribute to the solution of current healthcare problems, opening new perspectives for its development.

Literature review. In the introduction and abstract, we emphasized the importance of public-private partnership (PPP) in the field of health care in Ukraine, emphasizing the potential and challenges that arise during the implementation of such projects. The literature review expands this topic, based on the analysis of the works of scientists who investigate various aspects of PPP in the context of health care.

  1. Kachula, L. Lysiak, Liliya Barannyk, I. I. Masyuk, T. Tereshchenko, and Tetyana Salnikova (2023) in their study emphasize the role of PPP in providing the population with high-quality medical services and maintaining financial stability. Their work emphasizes the importance of integrating the efforts of the state and the private sector to achieve sustainable development in the field of health care.
  2. Borshch, Yevhen I. Maslennikov, V. Truba, and Lyudmila M. Tokarchuk (2019) examine the scientific debate on PPP issues, providing an overview of the current state and prospects for partnership development in the healthcare sector. Their analysis reveals key success factors and major challenges faced by PPP participants.

Yu. Gumenna, Ihor Martsovenko, P. Srovnalikova (2021) investigate in detail the peculiarities of PPP implementation as a key form of investment of financial resources in the field of medical services in Ukraine. Their work makes an important contribution to understanding the mechanisms of effective cooperation between the state and private investors.

  1. Shevchuk, V. Zuy, Ihor Kompaniets, V. Martynovskyi, and Yuriy Matat (2021) discuss aspects of legal regulation of PPPs in the field of health care, highlighting the importance of creating a clear and effective legal framework to ensure the successful implementation of PPP projects.
  2. Ovcharova, M. Grabovska (2022), T. Popova, N. Gavkalova (2021), A.A. Nurkaeva, I. Vaslavska (2022), K. Pavlyuk, O. Kaminska (2018), Yevdokia Sergeyivna Kuznetsova, Azizakhon Zhalalidinovna Abdalieva (2023), and A. Ivanyuk (2020) complement this analysis, studying both global experience and specifics of the Ukrainian context in PPP implementation. Their research covers a wide range of issues, from the development of PPP elements and the formation of an effective environment for its implementation to the analysis of specific cases of successful interaction between the state and private organizations.

These authors made a significant contribution to the understanding of the role and potential of PPPs in health care, pointing to the need for an integrated approach to the planning and implementation of such projects. Their research emphasizes the importance of adapting the international experience to Ukrainian conditions, as well as the need to take into account the specific challenges and opportunities that arise in the process of PPP development in the Ukrainian healthcare sector.

The main goal of the study is a comprehensive analysis of public-private partnerships (PPPs) in the field of health care in Ukraine to identify the potential, challenges, and opportunities for improving the health care system through effective interaction between state structures and the private sector. The study is designed to determine the strategic directions and mechanisms of PPP optimization, which will contribute to improving the quality and availability of medical services in Ukraine.

Analysis of existing theoretical approaches to the definition of PPP in the field of health care: Review of scientific literature to synthesize the main theoretical concepts of PPP, which were developed by Ukrainian and foreign researchers, to establish the conceptual basis of the study.

Study of international experience of PPP implementation in the field of health care: Analysis of successful international PPP practices and models, to identify key success factors that can be adapted and implemented in Ukraine.

Assessment of the current state and specifics of PPP implementation in the field of health care in Ukraine: A detailed analysis of existing PPP projects in Ukraine, including an assessment of their effectiveness, challenges, and barriers to implementation.

Identification of the main challenges and barriers to the implementation of PPPs in the field of health care: Identification of legal, economic, organizational, and other obstacles that slow down or limit the effective implementation of PPPs in health care.

Development of recommendations for optimizing the interaction between the state and the private sector within the framework of PPPs: Formulation of proposals and strategic steps to overcome identified barriers and challenges, as well as to increase the effectiveness of PPPs in the healthcare sector.

Forecasting the development potential of PPP in the health care of Ukraine: Determination of opportunities and prospects for the development of PPP as a tool for the modernization of healthcare, increasing the availability and quality of medical services for the Ukrainian population.

These tasks form the basis of the research and are aimed at achieving a defined goal, which will allow a deeper understanding of the potential of PPPs in health care in Ukraine and the development of effective recommendations for their implementation.

Methodology. The methodology includes methods of economics and managerial science as well as scientific publications of the world and Ukrainian scientists in economics and management. There are specific tools in economics today to conduct research in the institutional providing of entrepreneurship. However, there is a need to identify of the main directions to improve institutional conditions to provide activation of entrepreneurship in terms of after-war renovation. In this research, the authors used the dialectical method, method of analysis and synthesis, historical method, statistical method, formal-logical method, and scientific abstraction method.

The method of logical conclusions made it possible to work out recommendations for using international experience to improve the institutional environment to activate entrepreneurship in the economy of Ukraine.

To achieve the defined goal and solve the set tasks, within the framework of the study “A new look at PPPs in health care: prospects for the interaction of the state and hospitals of Ukraine” a comprehensive methodology will be used, which covers the following aspects:

  1. Theoretical analysis.

Literature review: In-depth analysis of scientific works, monographs, articles in professional journals, and official reports of governmental and international organizations, which allows for the formulation of the theoretical basis of the research. Particular attention is paid to the works of scientists indicated in the list of authors, to integrate current approaches and conclusions into the research.

  1. Comparative analysis.

International experience: Study and comparison of international PPP cases in the field of health care, to identify effective models and practices that can be adapted to Ukrainian conditions.

  1. Empirical research.

Case studies: Detailed analysis of specific cases of PPP implementation in Ukraine, to identify success factors, key challenges, and opportunities for further development.

This methodology will enable a comprehensive approach to the study of PPPs in health care in Ukraine, providing a deep understanding of the topic, identifying the main challenges, and developing effective recommendations for improving policy and practice in this area.

Results and discussion. Taking into account the established goals and objectives,

the study is revealed through the analysis of existing practices, challenges, obstacles, and opportunities of PPPs, as well as through the development of recommendations for their optimization.

A review of scientific literature demonstrates that PPPs in health care are considered a tool for attracting private investment and management practices to improve the efficiency and quality of medical services. In Ukraine, PPP is starting to gain popularity, but there are still significant barriers to its implementation, in particular, imperfect legislation, bureaucracy, and the lack of clear control and monitoring mechanisms.

International experience shows that successful PPP projects in the field of health care are based on a clear division of risks, responsibilities, and duties between the state and private partners. Countries with developed PPP practices, such as the UK and Canada, demonstrate the importance of creating a favorable investment climate and transparent conditions for private investors.

Project “Royal Liverpool University Hospital” in Great Britain. This project involved the construction of a new university hospital complex in Liverpool through a PPP. The goal of the project was to provide the population with high-quality medical services with the help of modern infrastructure. Cooperation between the state and the private sector made it possible to use innovative technologies and approaches in treatment, as well as to increase the efficiency of hospital management.

“Alzira Model” project in Spain. The “Alzira Model” is a pioneering PPP model in the field of health care, which was introduced in the Valencia region. Under this model, the management of the hospital was transferred to a private company, which was given responsibility for providing medical services in a certain area. The peculiarity of the “Alzira Model” is that financing is carried out according to the capitation system, where the fee for services depends on the number of patients served, which contributes to increasing the efficiency and quality of medical care.

Project “Queen Elizabeth Hospital” in Belgium. The “Queen Elizabeth Hospital” project in Belgium is an example of a successful PPP in the field of health care, where the state cooperated with private partners to reconstruct and modernize the hospital. The project involved not only the physical renewal of the infrastructure but also the introduction of advanced technologies in diagnostics and treatment, which allowed to raise the level of medical care. An important condition for success was a clear interaction between all project participants, including the involvement of medical personnel in the process of project planning and implementation.

These projects demonstrate that PPPs can be an effective tool for the development of the healthcare sector, ensuring the modernization of infrastructure, improving the quality of medical services, and introducing innovations. An important aspect of success is the clear definition of goals, the allocation of risks and responsibilities, as well as the involvement of all stakeholders in the process of planning and project management.

Assessing the current state of public-private partnerships (PPPs) in healthcare in Ukraine, several successful initiatives can be highlighted that highlight the significant potential of PPPs to modernize medical infrastructure and improve the quality of medical services. These initiatives cover various aspects of health care, from the construction and reconstruction of hospitals to the introduction of advanced technologies and approaches to health care.

  1. Modernization of the Kyiv City Clinical Hospital.

City: Kyiv, Ukraine

Project: Cooperation between Kyiv city authorities and private investors for the modernization of the Kyiv City Clinical Hospital. The project included the renewal of medical equipment, the reconstruction of hospital departments, and the introduction of the latest technologies in the field of diagnostics and treatment. Special attention was paid to improving the conditions of providing medical services for patients and the working conditions of medical personnel.

  1. Creation of a diagnostic center in Odessa.

City: Odesa, Ukraine

Project: Launch of a diagnostic center in Odesa with the participation of local authorities and private investors. This PPP project focused on providing access to highquality diagnostic services using advanced technologies, particularly MRI and CT. The center has become a key element in improving diagnosis and treatment planning for residents of Odesa and the region.

  1. Update of the emergency medical care system in Lviv.

City: Lviv, Ukraine

Project: The PPP project, implemented between the Lviv City Council and private partners, was aimed at updating the emergency medical care system. It included the acquisition of new ambulances equipped with the latest technology and the implementation of information systems to optimize emergency response. The project significantly increased the efficiency of emergency medical care in Lviv, shortened the response time to calls, and improved the quality of first aid.

The main challenges facing the implementation of PPPs in Ukraine include legal uncertainty, high risks for private investors, lack of trust between public and private structures, and bureaucratic obstacles. Specific barriers were also identified, in particular, the difficulty in defining KPIs (key performance indicators) for evaluating the effectiveness of projects.

Based on the analysis, several recommendations aimed at overcoming existing challenges and barriers were developed. This includes improving the regulatory framework, developing clear risk-sharing mechanisms, creating specialized agencies to support PPPs in health care, as well as measures to increase project transparency and accountability. It is also recommended to introduce programs to support and stimulate private investments in the field of health care.

The final section is devoted to the assessment of the prospects for PPP development in health care in Ukraine. Given the international experience and existing initiatives in Ukraine, we can expect a growing interest in PPPs as a tool for attracting investments and improving the quality of medical services. An important success factor will be the creation of a favorable investment climate and effective interaction between the state and the private sector.

Conclusions. PPP has significant potential in the field of health care in Ukraine, offering ways to modernize the infrastructure and improve the quality of medical services. However, several legal, economic, and managerial challenges must be addressed to achieve success. It is recommended to further improve the regulatory framework, develop clear criteria for the selection of PPP projects, and ensure mechanisms for monitoring their implementation.

References:

  1. Kachula, L. Lysiak, Lilia Barannyk, I. I. Masyuk, T. Tereshchenko, Tetiana Salnikova (Kachula et al., 2023). PUBLIC-PRIVATE PARTNERSHIP AS A FOUNDATION OF THE FINANCIAL STABILITY OF THE STATE AND HOUSEHOLDS IN THE CONDITIONS OF HEALTH CARE FINANCING

TRANSFORMATION IN UKRAINE – Consensus

  1. Borshch, Yevhen I. Maslennikov, V. Truba, Lyudmila M. Tokarchuk Publicprivate partnership as an investment and innovation tool for medical facilities: a case of Ukrainian healthcare. – Consensus (Borshch et al., 2019).
  2. Humenna, Ihor Martsovenko, P. Health Care Reform In Ukraine: PublicPrivate Partnership Issues – Consensus (Humenna et al., 2021).
  3. O. Shevchuk, V. Zuy, Ihor Kompaniets, V. Martynovskyi, Yuriy Matat Publicprivate partnerships in the healthcare sphere: legal models in Ukraine and foreign countries – Consensus (Shevchuk et al., 2021).
  4. N. Ovcharova, M. Grabovska Implementation of Public-Private Partnership in the Healthcare Management System – Consensus (Ovcharova & Grabowska, 2022).

8 T. Popova, N. Gavkalova PUBLIC-PRIVATE PARTNERSHIP IN THE FIELD OF HEALTH CARE – Consensus (Popova & Gavkalova, 2021).

  1. A. Nurkaeva,        I.          Vaslavska        DEVELOPMENT        OF       HEALTH

INFRASTRUCTURE ON THE BASIS OF USING THE MECHANISM OF PUBLICPRIVATE PARTNERSHIP – Consensus (Nurkaeva & Vaslavskaya, 2022).

  1. Pavlyuk, О. Foreign experience of development of public-private partnerships in the health system – Consensus (Pavliuk & Kaminska, 2018).
  2. Yevdokia Sergeyivna Kuznetsova, Azizakhon Zhalalidinovna Abdalieva PUBLIC PRIVATE PARTNERSHIP IN THE SPHERE OF HEALTH CARE – Consensus – Югра (Kuznetsova & Abdalieva, 2023).
  3. Ivanyuk Influence of public-private partnership mechanisms on health investments in health care – Consensus (Ivanyuk, 2020).