How much can we learn from each other? Polish and Hungarian good practices in financing ophthalmology care as a proposal for implementation in Ukraine.

OBJECTIVES: The article aims to compare payment schemes for cataract, glaucoma, vitrectomy, cornea transplantations, DME, and AMD across Hungary, Poland, and Ukraine, and to identify implementable practices in Ukraine within the context of ongoing healthcare reforms. METHODS: Researchers used mixed-method research-with legal documents and data analysis on utilisation of ophthalmology services between 2010 and 2019 and in-depth semi structured interviews with fifteen health experts from Hungary, Poland, and Ukraine. Interviewees, five from each country, were representatives from healthcare providers and payers with at least 10 years' experience in ophthalmology care and knowledge about financing schemes in each country of residence. RESULTS: We identified significant differences in healthcare delivery and financing of ophthalmology services between Hungary and Poland, despite both countries rely on Diagnosis-Related Group (DRG) based systems for hospital care. Good practices for financing specific eye treatments like cataract, glaucoma, age-related macular degeneration (AMD), diabetic macular edema (DME), cornea transplantations, and vitrectomy are identified. The financing scheme, including financial products and incentives, can influence the volume of treatments. Access to ophthalmic care is a key concern, with differences in treatment schemes between Hungary (ambulatory care) and Poland (hospital care), leading to higher costs and the need for centralization of complex procedures like cornea transplantations. CONCLUSIONS: The article highlights the importance of incentivizing quality improvements and removing financial barriers in Poland, while Hungary should focus on continuous monitoring of treatment methods and flexibility in reimbursement. For Ukraine, the research findings are significant due to ongoing healthcare reform, and the country seeks optimal practices while considering the experiences of other countries.

Using a chatbot as a digital tool at the primary health care level.

OBJECTIVE: Aim: To analyze the feasibility of utilizing a digital tool such as a chatbot at the primary health care level as part of a health program. PATIENTS AND METHODS: Materials and Methods: With the involvement of a general practitioner and the use of a digital tool, a chatbot, a three-month health program was conducted for employees of an IT company. The chatbot was used to collect information, monitor the health status of participants and provide personalized health recommendations. To evaluate the program's effectiveness survey was conducted to compare participants answers before and after using standardized evaluation scales. A questionnaire based on the Evaluation and Management Services Guide was created to collect medical information on the health status of participants before and after the program. RESULTS: Results: After the program, the average total score of participants' health complaints and symptoms decreased (from 27.1 to 16.1, p=0.019). The average severity of the chief complaint on a scale of 0 to 10 decreased from 5.08 to 2.27, or by 55.3% (p=0.00676). The frequency of individual complaints such as eye pain, decreased concentration, increased fatigue and irritability also dropped. CONCLUSION: Conclusions: The chatbot enabled the primary care physician to respond promptly to participants' health complaints. The results demonstrated the potential of chatbots as innovative and accessible digital tools at the primary health care level for providing recommendations, monitoring health, and contacting a primary care physician in a timely manner.

SOCIO-PSYCHOLOGICAL READINESS FOR MANAGEMENT OF FUTURE HEALTH CARE MANAGERS.

OBJECTIVE: The aim: To determine the content, components and levels of formation of social and psychological readiness of future managers of the health care system for management activities. PATIENTS AND METHODS: Materials and methods: The research was conducted among students of master's programs that prepare future managers for the health care system of Ukraine. The basic motivators of their social and psychological activity as a person, the formation of metacognitive strategies, the diagnosis of communicative and characterological features of personality and signs of leadership are determined. RESULTS: Results: These studies indicate the readiness of students for future activities. 80% of respondents were diagnosed with a high level of such potential, 20% - medium. The results indicate that the respondents have a significant potential of communicative and characterological abilities that can affect their further professional activity: intellectual (4,11±0,66) and volitional (4,17±0,33) traits, attitude to themselves (4,02 ± 0,36), focus on achieving goals (4,22 ± 0,42). The evaluation of the above characteristics was made on a 5-point scale. Future managers have formed a metacognitive "profile", identified high levels of metacognitive abilities (47,6 ± 4,182 points). CONCLUSION: Conclusions: It is established that the respondents have a high and appropriate moderate level of formation of the main components of readiness for managerial activity and have the appropriate managerial potential.

EATING BEHAVIOUR OF INTERNATIONAL STUDENTS IN UKRAINE.

OBJECTIVE: The aim: Investigate the eating behaviour of international students in Ukraine. PATIENTS AND METHODS: Materials and methods: A cross-sectional quantitative research approach was taken in conducting this study. 193 international students (98 males, 95 females) filled the questionnaire assessing their diet for the past 7 days, perceived changes made to their diet since their arrival to Ukraine, knowledge of healthy dietary habits, and perceived barriers to maintaining a healthy diet. At the time of this study, the students were between the ages of 18 and 36 years, of 11 nationalities, and enrolled at both undergraduate and postgraduate levels in 12 Ukrainian tertiary institutions. RESULTS: Results: Assessment of the students' diet quality reveals that 75.1% of the students consume fruits at least 2 times/day and 73.1% consume vegetables at least 3 times/day. More students consume poultry daily and fish at least twice a week than beef and pork daily. More than half of the students consume starchy foods, mostly rice daily. Only 7.3% of the students consume up to 1 alcoholic beverage daily. Gender significantly affects the consumption of alcohol, dairy products, low fat milk and milk products, and marginally affects beef and dark chocolate. 95 % of the student have made changes to their diet since coming to Ukraine. CONCLUSION: Conclusions: The dietary behaviour of international students in Ukraine is characterized by: high consumption of fruits and vegetables, high intake of lean meats and fish, higher consumption of unsaturated fats and oils than saturated ones, and low consumption of soft and alcoholic drinks.

Factors of working environment influencing occupational stress among primary health care doctors in Ukraine.

OBJECTIVE: Introduction: Stress is considered to be a very common pathology among primary care doctors, since practically any professional activity requires significant emotional, mental and practical efforts. The aim has determined the factors associated with occupational stress and compare the difference of behavior patterns which is used to reduce stress among primary care doctors in Ukraine. PATIENTS AND METHODS: Materials and methods: The authors used medical-statistical methods as well as analyzed questionnaires of the sociological survey conducted among general practitioners and family doctors of the primary care level from various regions of Ukraine. RESULTS: Results: Occupational stress is a common symptom among primary care physicians of different ages and genders in Ukraine. For primary care doctors the most common symptoms related to occupational stress were found to be burnout (n=93), poor night's sleep (n=84) and tiredness (n=84). Female doctors experience more often symptoms such as frequent headaches tiredness, burnout, whilst for male doctors feelings of irritation and anxiety are more common indicators of occupational stress. Work experience also has a strong association with experiencing stress related to "unrealistic expectations from their patients with complex medical and social problems" (s.df=.082). Young doctors with work experience of less than 5 years and those who have worked for more than 20 years in the industry similarly find it stressful to deal with such "complex patients". CONCLUSION: Conclusions: Primary care doctors in Ukraine, from many different demographic backgrounds, experience high levels of occupational stress; this is a common health condition, which can have devastating personal and professional consequences.

Ukraine: health system review.

This analysis of the Ukrainian health system reviews recent developments in organization and governance, health financing, health care provision, health reforms and health system performance. Since the country gained independence from the Soviet Union in 1991, successive governments have sought to overcome funding shortfalls and modernize the health care system to meet the needs of the population's health. However, no fundamental reform of the system has yet been implemented and consequently it has preserved the main features characteristic of the Semashko model; there is a particularly high proportion of total health expenditure paid out of pocket (42.3 % in 2012), and incentives within the system do not focus on quality or outcomes. The most recent health reform programme began in 2010 and sought to strengthen primary and emergency care, rationalize hospitals and change the model of health care financing from one based on inputs to one based on outputs. Fundamental issues that hampered reform efforts in the past re-emerged, but conflict and political instability have proved the greatest barriers to reform implementation and the programme was abandoned in 2014. More recently, the focus has been on more pressing humanitarian concerns arising from the conflict in the east of Ukraine. It is hoped that greater political, social and economic stability in the future will provide a better environment for the introduction of deep reforms to address shortcomings in the Ukrainian health system.

Ukraine: health system review

This analysis of the Ukrainian health system reviews recent developmentsin organization and governance, health financing, health care provision,health reforms and health system performance. Since the country gainedindependence from the Soviet Union in 1991, successive governments havesought to overcome funding shortfalls and modernize the health care systemto meet the needs of the population’s health. However, no fundamental reformof the system has yet been implemented and consequently it has preserved themain features characteristic of the Semashko model; there is a particularly highproportion of total health expenditure paid out of pocket (42.3% in 2012), andincentives within the system do not focus on quality or outcomes.The most recent health reform programme began in 2010 and sought tostrengthen primary and emergency care, rationalize hospitals and changethe model of health care financing from one based on inputs to one basedon outputs. Fundamental issues that hampered reform efforts in the pastre-emerged, but conflict and political instability have proved the greatestbarriers to reform implementation and the programme was abandoned in 2014.More recently, the focus has been on more pressing humanitarian concernsarising from the conflict in the east of Ukraine. It is hoped that greater political,social and economic stability in the future will provide a better environmentfor the introduction of deep reforms to address shortcomings in the Ukrainian health system.