PROBLEMS AND OBSTACLES OF IMPLEMENTING PUBLIC-PRIVATE PARTNERSHIP IN THE HEALTH SECTOR OF UKRAINE IN THE INSTITUTIONAL, ECONOMIC AND SOCIO-POLITICAL DIMENSIONS

Abstract

Introduction. In the context of the transformation of the national economy and limited budget resources, the search for effective models of financing and management of the medical sector is becoming a strategic priority. Public-private partnership is an effective tool for attracting investments and innovative technologies, but its implementation in Ukraine faces a number of complex barriers. There is an urgent need to systematize the obstacles that prevent the full functioning of this model, through the prism of the institutional environment, economic factors and socio-political context.

Purpose. The purpose of this work is to identify and systematically analyze key economic, institutional, and socio-political obstacles to the implementation of public-private partnership projects in the healthcare sector of Ukraine under the new legislation and to develop recommendations for overcoming them.

Materials and methods. The materials of the study are: 1) the current regulatory framework of Ukraine, which regulates the issues of PPP and reforming the healthcare system; 2) scientific works of specialists in the field of public administration, economics and medicine on the experience of implementing joint investment projects.

The following scientific methods were used in the research process: theoretical generalization and comparative analysis (to identify the specifics of PPP in the medical field); systemic approach and structural-functional analysis (to differentiate obstacles along three dimensions); logical generalization (to formulate proposals for improving state policy).

Results. The scientific article analyzes the regulatory framework, with an emphasis on changes in the Law of Ukraine "On Public-Private Partnership".

Three groups of key obstacles are identified and systematized: economic - the lack of an investment component in the tariffs of the National Health Service of Ukraine, high currency risks and the impossibility of implementing the "pay for accessibility" model due to the one-year budget planning cycle; institutional - the lack of administrative capacity of communities in preparing complex infrastructure projects and corruption risks at the tender stage; socio-political - resistance of the medical community due to fear of optimization and privatization of hospitals.

Particular attention is paid to a comparative analysis of international experience: the fiscal risks of the model in Turkey and the problems of short-term contracting in Poland are considered.

Based on the results of the study, recommendations are developed regarding the need to amend the Budget Code to guarantee long-term commitments, create a specialized PPP support unit, and introduce blended financing instruments with the participation of international donors.

Discussion. In further scientific research, it is proposed to focus on developing a specific procedure for integrating the “accessibility payment” mechanism into medium-term budget planning, as well as on the methodology for calculating the investment surcharge to the tariffs of the Medical Guarantee Program. A separate study requires the creation of typical algorithms for assessing the capacity of territorial communities to manage PPP projects. This will allow improving the regulatory and organizational support for the modernization of medical infrastructure, ensuring a balance of interests between the state, private investors, and patients.