Reforming Healthcare: Challenges in Public Administration and System Overhaul

The global practice of providing healthcare services places the paradigm of humanitarian and sustainable development as a prerequisite for economic growth and social progress. Influential international organizations, including the World Bank, the European Bank for Reconstruction and Development, the United Nations, and the World Health Organization, are currently addressing the issues of forming mechanisms for public healthcare system management and their effectiveness[1]. Every country aspires to organize a resilient, efficient, and advanced national healthcare service delivery and financing system.

The issue of public management in the healthcare system is explored by researchers in various scientific fields, including pharmacy, healthcare, sociology, and administrative law. Some contemporary scholars dedicate their work to studying the functioning of public management mechanisms within the healthcare system and the practical projects related to their implementation. For instance, Pupion examines the concept of “new public management” (NPM)[2]. This concept has emerged as a result of digitalization and changing perspectives on management functions in the public healthcare sector.

Funk and Karlsson break down the essence of public management into specific vectors, encompassing objectives, means, and communication among participants in the medical service provision process[3]. At the same time, scholars emphasize that the primary duty of the healthcare sector is to act in the patient's best interest. Meanwhile, the service consumer retains complete autonomy in decision-making and responsibility for the consequences of their choices.

The issue of public management in the medical field is multifaceted, incorporating legal, technological, social, and economic aspects. Ravikumar and Kitana associate the content of public management with the peculiarities of the concept, its significance, its functions in the medical communication system, and its prospects for implementation in the context of a market economy[4].

Certain aspects of public management in healthcare have been thoroughly studied in the works of contemporary scholars such as Abdurahmanov, Chen, Walker and Sawhney[5]^, [6]. At the same time, some questions regarding the analysis of the successful functioning of modern healthcare institutions and effective management utilizing digitalization to enhance the efficiency and accessibility of medical services remain insufficiently explored and require further scientific investigation.

Therefore, despite the scientific value of the published research, numerous questions in the studied field still need to be solved.

The achievements of healthcare reform should be highlighted, namely: 

• An increase in the share of private practice through autonomy and commercialization; 
• The streamlining of patient logistics between sectors of the healthcare industry;
• The optimization of funding. 

It is necessary to strengthen the resource potential and encourage increased efficiency in its implementation from a socioeconomic perspective to maintain a positive trend in healthcare. Achieving this goal requires adequate public management in the healthcare sector.

The research aims to analyze contemporary models of public management in healthcare and the dynamics of priorities and approaches in the management of the medical sector.

Literature Review

Scientists formed the scientific and methodological framework for the study. Their studies focus on the following aspects: 

• State influence on the development of specific segments and forms of ownership in the healthcare sector. 
• Optimization of the quality of medical services;
• Analysis of practical aspects of implementing a public administration system in medicine;
• Protection of patients’ rights; 
• Possibilities of adapting the tools of modern digital transformation in the industry.

Numerous publications in specialized scientific periodicals on the topics studied in this research. Some elements of public administration mechanisms in the healthcare sector are considered in the study by Parkhi and Lucifora [7]^, [8].

Among the scientific papers, it is worth highlighting the works by Klenk and Reiter[9]. They fundamentally substantiate the principles of effective implementation of public administration in the medical field. At the same time, Cazorla[10] emphasizes the need to guarantee the medical rights of citizens in the process of transforming the healthcare sector following modern standards of sustainable development. Mériade and Rochette[11] outline the main conceptual foundations of public administration in medicine. In addition, Sun, Medaglia, Singha, Arha and Kar substantiate the need to introduce digitalization and electronic document management in the industry[12]^, [13].

Given the significant scientific and practical achievements of scholars, it is worth noting the need to develop scientific findings on the research topic to ensure the sustainability of positive dynamics and a preventive response to new challenges and threats in the healthcare sector.

Materials and Methods

In the course of the study, the authors used a range of general scientific cognitive methods, including methods of abstract logical and comparative analysis, abstraction, induction, and deduction, as well as methods of specification and formalization. The theoretical and methodological framework of the research was built upon a systematic approach, taking into account the priority principles of conducting comprehensive studies. This comprehensive approach allowed for the examination of the object and subject of study as a system with all its interconnections.

The comparative method was applied to determine the specificity of the development and features of the evolution of public management models in the healthcare sector. Analysis and synthesis methods were utilized to identify the stages and factors of development, as well as the most influential elements of the subject under investigation. The inductive method was used for forecasting development indicators. The deductive method was applied during the development of proposals for optimizing management processes in the field of medicine.

Abstract-logical and dialectical methods of scientific inquiry and the method of scientific abstraction were employed in the research to form theoretical generalizations, refine the conceptual framework, formulate conclusions, and identify key concepts and categories. This method was instrumental in shaping the concept of a holistic management system in the healthcare sector.

The formalization method was utilized during the derivation of priority vectors for optimizing the public management system in the medical services sector based on sustainable development principles. It was also employed in documenting the research results aimed at active, practical implementation in the management field. Specifically, the formalization process included the principles, components, functions, tasks, and priorities of public administration in the medical field.

The specification method was used to measure the effectiveness and feasibility of increasing the role of public management in the implementation of medical reforms and identify optimal conditions and solutions for optimizing the medical management system to mitigate risks.

Results

The term “public management” has gained significant popularity relatively recently. It refers to the synergy of activities of government and local authorities, the private sector, and society in shaping and implementing management decisions of societal importance within the framework of powers and functions defined by the law[14]. Public management primarily involves planning, organizing, and monitoring the delivery of medical services, the implementation of modern information systems and digitization tools, effective personnel management, and performance monitoring.

Compared to the government, public administration in the healthcare sector has several advantages, including depoliticization, the prioritization of consumer interests, systematic quality monitoring and improvement, and a partnership approach where the state and citizens are equal participants[15]. Key elements in this context include a patient-centered approach and digitizing processes in the medical field.

Analyzing the experience of developed countries on this issue, it is worth focusing on the most representative models of public administration. These methods allowed us to draw certain conclusions regarding the advantages, risks, and challenges of each.

For instance, Japan’s healthcare system prioritizes the influence of local authorities. The country prohibits income from medical insurance and limits the payment to medical professionals who provide substandard services. Japan also has an advanced public management system in the healthcare financing sector. Although healthcare services are costly, the state medical insurance system compensates approximately 90 percent of citizens’ expenses[16]. Meanwhile, as seen in the transformation of the healthcare sector in the United States, the prioritization of private medical insurance leads to significant financial disparities in the healthcare system[17]^,[18].

Unlike the United States, Germany is a representative country in terms of the structure of healthcare insurance. In this regard, about 89 percent of the population is covered by public insurance[19]. It is worth noting that all hospitals are non-profit organizations. Among the main advantages of the German healthcare system, we can mention the following ones:

• High quality and accessibility of medical care;
• Innovations in medical equipment. 
• A significant level of qualification of medical personnel[20].

Germany effectively positions public management in the healthcare sector as one of the priority directions in state governance.

The experience of the United Kingdom is illustrative, where one of the most influential healthcare systems on a global scale has been successfully formed. The main principles of public management in the healthcare sector in the United Kingdom include: 

• Accessibility of medical services; 
• Absence of intermediaries in the form of insurance companies; 
• Maximally efficient use of available resources[21], [22].

However, according to the World Health Organization’s ranking, France holds the top position in the field of healthcare. France has successfully implemented principles of providing universal coverage of the population with medical services, prioritizing patient choice and satisfaction, and synergizing mandatory and voluntary insurance systems[23].

In general, public management systems in the healthcare sector in developed countries are marked by a consumer-oriented and solidary-corporate approach to management[24]^, [25]. First and foremost, these principles manifest in the dominance of a private service system and the state guarantee of a minimum medical assistance package (Table 1). The above-mentioned countries' experience is relevant for forming a public management development strategy in the medical field of Ukraine in terms of maximizing adaptive opportunities and piloting regional projects.

For developing countries during economic reforms, general market approaches to the formation of a package of medical services remain a priority[26]. Such approaches allow to support coordination mechanisms of public-private partnerships. They provide medical guarantees for the protection of low-income and vulnerable populations while providing the possibility of variability of medical services for people with medium or high incomes.

Table 1. Principles of public administration in the healthcare sector.

Source: compiled by the authors

Effective implementation of public-private partnerships in the healthcare sector will contribute to improving the quality of healthcare services through competition, increasing the share of the private sector in healthcare, implementing quality standards, and expanding the range of services and their structure by the public (free) and private (paid) sectors[27],[28]. Together, such dynamics will make it possible to ensure high quality and accessibility of medical care to all segments of the population and to significantly optimize and develop the public administration system in the sector (Figure 1).

Figure 1. The algorithm of the public management process in the healthcare sector

Source: compiled by the authors

An essential issue in developing public healthcare management is ensuring the transparency, reliability, and timeliness of informational data[29]^, [30]. The most optimal communication method in the medical field is the electronic healthcare system (e-Health). It will simplify and streamline processes, taking into account the global trend of digitization. E-Health brings together healthcare institutions, administrations, doctors, and patients into a single hub as a key factor in optimizing public management mechanisms in medicine[31]. The e-Health system can significantly expand the capabilities of both patients and healthcare providers and is an influential element in public management in the healthcare sector. The electronic healthcare system provides quick access to clinical and statistical information and the collection and consolidation of clinical data.

It is worth noting that the implementation of e-Health as a central component of transforming public management in the medical sector in various countries has highlighted a series of risks. Drawing from the experience of the United Kingdom, we can identify the main challenges of a communicative medical system based on digitization: 

• The complexity of standardizing and unifying medical documentation in different organizations.
• Resistance from medical personnel to innovations;
• Passive participation of the population in the process. 
• The lack of high-quality software, data security, and personalization[32]^, [33].

Today, there exists a more advanced alternative to e-Health. According to many scientists, m-Health is an evolutionary format of the electronic healthcare system that can guarantee a more convenient and secure form of communication in the medical field[34]. This issue is highly relevant and requires immediate attention, as the digital transformation of the medical sector affects a wide range of communications and the implementation of effective financial and administrative models in the field of healthcare.

At present, it is considered a priority to search for the most efficient public management model in the healthcare and pharmaceutical system. This model will maximize the efficiency and accessibility of medical care, strengthen the public healthcare system's status, and ensure essential medication availability.

Discussion

The vast majority of modern scientists see public management in the healthcare sector as the basis for the development of the medical sphere towards sustainable development.

Bertl et al. argue that one of the most effective means of optimizing the healthcare sector is the active utilization of digitization tools within the public management system[35]. The primary goal of the digital transformation process, as they believe, is to provide high-quality medical services to all population segments. This goal can be achieved through various efficient algorithms. The authors emphasize that several factors influence this process, including time constraints, financial capabilities, and the personnel's intellectual resources level.

Contemporary scholars such as Wang and Li, along with their colleagues, also consider digitization as the most promising direction for the development of the public management system in healthcare[36]. They highlight that currently, only a small number of medical institutions are consumers of technological and managerial innovations. At the same time, smaller entities in the healthcare sector lack such opportunities. Consequently, it can be argued that insufficient access to modern technologies and reluctance to implement them are significant constraints on the potential of healthcare institutions.

Massaro suggests that modern public management, through digital methods, primarily involves practical recommendations that aid service consumers in achieving their goals and tasks[37]. This is done through problem-solving, discovering new possibilities, implementing changes, and coaching. The scholar proposes that accessible consultation services are a necessary preventive element within the healthcare system. 

Chau and Lam, along with their co-authors, emphasize the specific prerequisites for forming an effective public healthcare management system[38]. Among the key factors highlighted are the presence of an appropriate resource base and readiness for dynamic changes, both on the part of patients and medical personnel. Researchers argue that these conditions are a crucial component of the algorithm for implementing public management in medicine, and it’s difficult to disagree with them.

The forecast of the healthcare sector’s development trends suggests that in the future, industry-specific demands will increasingly depend on the competitiveness of the offering for one category of consumers and the accessibility of services for another, less socially protected, category of the population[39].

Based on the aforesaid conclusions of researchers and the results of the current study, it can be argued that public management in the healthcare sector has significantly expanded its scope of functioning. It has become an essential element of the system of providing the population with quality and affordable healthcare services. It’s worth noting that increasing the productivity of the medical field through optimal public management involves a gradual and efficient achievement of goals. These goals include optimizing the approach to healthcare service users, strengthening the status of healthcare entities, building trust among the population, and enhancing the quality and accessibility of healthcare.

Based on all the above, it is possible to predict an increase in the role of public management in the implementation of a successful healthcare system. This will significantly increase its productivity, particularly by introducing innovative solutions and digital optimization opportunities.

Conclusion

The article determines that public management in the healthcare sector occupies one of the key roles in the system of implementing national policy regarding the concept of healthcare accessibility of proper quality for all segments of the population without exception. The authors have established that only the synergy of a professional approach, a strong position and stable principles for implementing the strategic goals of healthcare reform, the priority of effective transformation of the industry because of global digitalization, and proper control by the state and society allows for the complete and timely implementation of an effective system of public administration in the healthcare sector.

As a result of the study, the authors managed to complete the following tasks:

• To analyze the multifactorial nature of the current state of public administration in the healthcare sector.
• To assess its role and place in the system of current management models of sustainable development. 

The research has established that the development of the medical sphere in the direction of increasing the factors of openness and publicity plays a significant role in improving the quality and accessibility of medical services. It strengthens the position of healthcare institutions as active participants in the system of modern social communications and optimizes the process of providing services to all segments of the population without exception.

The article proposes a range of measures that should be applied within the framework of the general trend of digital optimization. The authors highlighted the priority directions of the digitalization strategy of the medical sphere. The paper forms the basis of a mechanism for adapting the existing principles of functioning of the healthcare industry to the requirements of global digitalization. In addition, it substantiates the feasibility of transforming this area.

Based on the research findings, the authors proposed priority vectors for further research on the topic. They also argued the need to organize the availability and systematization of practical information on the research subject.

A practical approach to public administration in the healthcare sector based on the principles of digital transformation will ensure the successful adaptation of healthcare institutions to the requirements of today. It should be based on implementing a development strategy based on the principle of unimpeded access to quality and comprehensive medical care in a convenient format.

It is currently considered a priority to find the most effective model for practically implementing the public administration strategy in medicine using digital tools. This will maximize the efficiency and accessibility of information resources and strengthen the status of a medical institution as a modern healthcare hub. Further research on this topic should be aimed at a detailed identification of the conditions for systemic integration of digitalization tools, considering the current capabilities of the existing electronic and communication base.