Valery Lekhan

The aim: To evaluate the long-term dynamics of health losses caused by ambulatory care sensitive conditions (ACSCs) to justify the priorities of public policy regarding this group of diseases. Materials and methods: The data used were obtained from the Institute of Health Metrics and Evaluation, the European database “Health for All”, for 1990-2019. The study was conducted using bibliosemantic, historical and epidemiological study methods. Results: Disability-adjusted life years (DALYs) due to ACSC over 30 years in Ukraine averaged 5145.4 years per 100,000 population (95% CI 4731.1 -5559.7), which is approximately 14% of DALYs of all reasons without a clear trend of change - compound annual growth rate (CARG) of 0.14%. These five causes –angina pectoris, chronic obstructive pulmonary diseases (COPD), lower respiratory infections, diabetes, and tuberculosis – account for 90% of the disease burden associated with ACSCs. There was an increasing trend in DALYs (CARG varied for different...

The aim: To assess the long-term dynamics of health spending in Ukraine from the standpoint of readiness to make progress in the universal health coverage (UHC) Materials and methods: Data from the Global Health Expenditure Database, European Health for All database, World Bank Open Data, collected during 2000-2019 were used. The research was conducted using bibliosemantic, historical methods and benchmarking. Results: All indicators of health spending in Ukraine showed some growth: total and government health spending of % Gross Domestic Product (GDP) by 34% (95% CI 13-55) and 28% (95% CI 8-48), total and government health spending per capita in US $ by 7.1 and 6.5 times and in Purchasing power parity (PPP) – by 4 and 3.8 times. Growth was interrupted during the global (2008) and national (2017-2019) financial crises. Out-of-pocket spending in Ukraine grew and amounted to 51.1% in 2019, which is by 2.1 times more than in the European region – 24.0% (15.5; 36.6). In 2019 Ukraine ran...

Most healthcare systems use the Appropriateness Evaluation Protocol (AEP) to analyze the adequacy of inpatient care. As a result of the study, for the first time, according to the Delphi Collective Expert Assessment procedure, Ukrainian indications for inpatient care in hospital and its duration, consisting of four groups of criteria, were developed: severity of the disease, intensity of medical services, medical care / life support services and others; among the latter, the leading place is occupied by the hospitalization indications, defined in national unified clinical protocols. The inpatient care duration is determined on the basis of an individual assessment of the patient's condition dynamics, taking into account indications for hospitalization. The analysis showed high values of validity and reliability of the developed criteria for justification and inpatient care duration, which permits to recommend the Ukrainian version of the protocol hospitalization justification (AEP-UA) for use. Key words: Ukrainian version of the hospitalization feasibility assessment protocol (AEPUA), criteria for hospitalization and its duration

The aim: Identifying the components of availability of Primary Health Care (PHC) and integration between PHC and secondary Health care (SHC) which need strengthening to reduce the rate of Ambulatory Care Sensitive Hospitalizations (ACSH) in Ukraine. Materials and methods: The study was conducted in two stages: the focus of interviewing experts on the list of components of the availability of PHC and its integration with SHC; survey of our questionnaire is based on the results of the first stage of the study. The responses of 93 respondents - 20 experts and 73 general practitioners/family doctors - were analyzed using descriptive and analytical statistics. Results: There were identified 14 components of PHC availability and 8 integration components of PHC with SHC, their quantitative value (in points) of impact on ACSH. The informativeness of components is confirmed by the agreement of opinions of experts on their list (concordance coefficient W = 0.75 -0.87; p <0.01) and the reli...

Objectives: This article reviews the applicability of a customized version of the Appropriateness Evaluation Protocol (AEP) to evaluate the magnitude of inappropriate hospitalizations in two regions of Ukraine. Data and methods: The original AEP was modified to develop a customized tool, which included criteria for the appropriateness of hospitalization and duration of inpatient stay. The customization of the tool followed the Delphi procedure. We randomly selected 381 medical records to test the feasibility and reliability of the method and 800 medical records to evaluate the scope of inappropriate hospitalizations. We used descriptive and analytical statistics, ROC analysis, and Cohen's kappa to check the consistency between the findings of primary reviewers and experts. Result: We observed high levels of agreement in conclusions of primary reviewers (reference standard) and experts during testing of the reliability and validity of the method. The external validity check showe...

OBJECTIVE The aim: Identifying the components of availability of Primary Health Care (PHC) and integration between PHC and secondary Health care (SHC) which need strengthening to reduce the rate of Ambulatory Care Sensitive Hospitalizations (ACSH) in Ukraine. PATIENTS AND METHODS Materials and methods: The study was conducted in two stages: the focus of interviewing experts on the list of components of the availability of PHC and its integration with SHC; survey of our questionnaire is based on the results of the first stage of the study. The responses of 93 respondents - 20 experts and 73 general practitioners/family doctors - were analyzed using descriptive and analytical statistics. RESULTS Results: There were identified 14 components of PHC availability and 8 integration components of PHC with SHC, their quantitative value (in points) of impact on ACSH. The informativeness of components is confirmed by the agreement of opinions of experts on their list (concordance coefficient W...

Most healthcare systems use the
Appropriateness Evaluation Protocol (AEP) to analyze
the adequacy of inpatient care. As a result of the study,
for the first time, according to the Delphi Collective
Expert Assessment procedure, Ukrainian indications
for inpatient care in hospital and its duration,
consisting of four groups of criteria, were developed: severity of the disease, intensity of medical services,
medical care / life support services and others; among
the latter, the leading place is occupied by the
hospitalization indications, defined in national unified
clinical protocols.
The inpatient care duration is determined on the
basis of an individual assessment of the patient's
condition dynamics, taking into account indications for
hospitalization. The analysis showed high values of
validity and reliability of the developed criteria for
justification and inpatient care duration, which permits
to recommend the Ukrainian version of the protocol
hospitalization justification (AEP-UA) for use.
Key words: Ukrainian version of the
hospitalization feasibility assessment protocol (AEPUA), criteria for hospitalization and its duration

. In the modern world, the use of the
global burden of diseases and the quantitative assessment of the factors leading to the loss of a healthy life provides
fundamental evidence for the development of an adequate public health policy. The purpose of the study is to
substantiate the system of measures on improvement of the health of the population of Ukraine on the basis of an indepth analysis of the global burden of diseases and injuries and associated risks. The study used materials from the
Institute of Health Metrics and Evaluation of the University of Washington, Human Development Network of the World
Bank and the «Disease Burden Unit» of the World Health Organization, collected during 1990-2017 years. The
bibliosemantic, historical, epidemiological, conceptual modeling methods and benchmarking were used in the course of
study. The loss rate of age-standardized disability-adjusted life year (DALY) in Ukraine in the period between 1990-
2017 practically unchanged and in 2017 it was 34 975.04 DALYs per 100 000, which is almost a quarter more than in
the countries of Eastern Europe and twice as much as in the countries of Western Europe. In the structure of Global
diseases burden in Ukraine, 3/4 falls on non-communicable diseases, about 15 % depend on external causes and less
than 1/10 – on infectious and other diseases and conditions. Shares of the disease burden associated with specific risk
factors and diseases related to the relevant factor were identified. The evidence-based system of measures is aimed at
achieving goals to reduce the global burden of disease and the risk factors affecting it, being based on an inter-sectoral
approach and combines population and individual risk strategies. The subjects of the system are parliament, central
and local governments / communities, private campaigns, the media, public health structures and primary health care.

Estimates of potentially preventable hospitalizations in diseases ambulatory care subjected to in
Ukraine. Lekhan V.N., Kriachkova L.V., Doroshenko O.О., Gritsenko L.O. The purpose: this study aims to identify
the most relevant diseases that can be treated outpatient (Ambulatory Care Sensitive Conditions, or ACSCs) and to
define the scope of potentially preventable hospitalizations (PPHs) for such conditions (Ambulatory Care Sensitive
Hospitalizations, or ACSH), for Ukrainian adults (above 18 years old), subject to improvement of primary care
efficiency. The study has been carried out in four phases, using the World Health Organization’s (WHO) guidance on
ACSCs for the European Region, which was adapted to the national context. The data was taken from the official
statistical reporting and analyzed by 104 reviewers. The assessment of the PPHs is conducted based on responses of the
subgroup of reviewers – 6 experts and 61 primary care physicians, which confirmed the levels of competencies. The
most significant rates of potentially preventable hospitalizations (PPHs) are registered for hypertension, pneumonia,
angina, chronic obstructive pulmonary disease (COPD), and diabetes, which coincide with ACSCs that are most
prevalent for Ukrainian adults. The overall rate of PPHs for adult population of Ukraine with ACSCs is 28.2% as
defined by physicians and 32.9% as defined by experts, which may reduce the hospitalization rate for all ACSCs (as
percent of all patients with ACSCs) from 8.2% to 6.1% (according to reviews of physicians) or to 5.7% (according to
experts’ reviews). The study has shown an important scope for better managing of ACSCs in Ukrainian adults. The
results of the study can be used to inform the continued health system transformation, specifically for the development
of interventions to prevent avoidable hospitalizations for ACSCs in Ukraine, which can lead to more efficient use of
resources in the health system and further strengthening of the primary care.

ObjectivesThis article reviews the applicability of a customised version of the Appropriateness Evaluation Protocol (AEP) to evaluate the magnitude of inappropriate hospitalisations in two regions of Ukraine.Data and methodsThe original AEP was modified to develop a customised tool, which included criteria for the appropriateness of hospitalisation and duration of inpatient stay. The customisation of the tool followed the Delphi procedure. We randomly selected 381 medical records to test the feasibility and reliability of the method and 800 medical records to evaluate the scope of inappropriate hospitalisations. We used descriptive and analytical statistics, receiver operating characteristic curve analysis and Cohen's kappa to check the consistency between the findings of primary reviewers and experts.ResultWe observed high levels of agreement in conclusions of primary reviewers (reference standard) and experts during testing of the reliability and validity of the method. The ex...

The HiT profiles are country-based reports that provide a detailed description of a health system and of policy initiatives in progress or under development. HiTs examine different approaches to the organization, financing and delivery of health services and the role of the main actors in health systems; describe the institutional framework, process, content and implementation of health and health care policies; and highlight challenges and areas that require more in-depth analysis. The Ukrainian health system has preserved the fundamental features of the Soviet Semashko system against a background of other changes, which are developed on market economic principles. The transition from centralized financing to its extreme decentralization is the main difference in the health system in comparison with the classic Soviet model. Health facilities are now functionally subordinate to the Ministry of Health, but managerially and financially answerable to the regional and local self-govern...