TRANSFORMATION TRAJECTORIES AND EFFECTIVENESS OF HEALTHCARE ORGANIZATION IN UKRAINE (1991-2025): AN ANALYTICAL STUDY OF HEALTHCARE NETWORK CAPACITY

Abstract

Introduction. The effectiveness of the healthcare system is determined by the ability of the network of institutions and management to ensure the availability and quality of services with limited resources and in crisis conditions. Ukraine entered 2020 with a long-term optimization of the hospital bed capacity and primary health care reform; a full-scale war has increased the challenges to the infrastructure, personnel and financing of the industry. Aim. To analyze the state and effectiveness of the healthcare network of Ukraine by 2025 (beds, bed days, visits, hospitalizations, coverage by patient declarations, staffing) and to justify management decisions for its improvement. Materials and methods. Retrospective descriptive analysis of official statistical data 1991-2024; aggregated data of the electronic healthcare system / National Health Service on signed declarations as of 01.01.2025; a scanned consolidated document on medical personnel numbers. Relative indicators (per 10 thousand population), dynamic series, shares and percentage changes were calculated; comparison with pre-war periods and managerial interpretation were made. Results. The hospital bed capacity decreased by more than half from 1990 to 2021, while the average length of stay remains higher than the European average, which indicates potential for improving efficiency. The war caused damage and forced relocation of institutions, uneven load between regions, the need for rehabilitation and mental health services. During the study, we identified managerial priorities: completion of network optimization of hospital districts; repurposing of underutilized hospitals into rehabilitation and palliative units; integration of international humanitarian law and telemedicine norms at the primary health care level; staff retention programs (wages, continuous training, support to prevent professional burnout); transparent financing mechanisms and digital quality control. Conclusions. The medical network of Ukraine demonstrates resilience and adaptability, but requires targeted management: network planning based on population needs, strengthening primary health care with the expansion of MHP and rehabilitation services, staff incentives and specialized training, controlled quality management and transparent financing mechanisms. The implementation of these steps will increase the efficiency of resource use, reduce unjustified hospitalizations and ensure continuity of medical care in post-war recovery.