Abstract
The article studies the evolution of reforming the health care system of Ukraine and the transformation of the national market of medical services in the period of independence and further socio-economic changes. Particular attention is paid to the transition from the centralized Semashko model to a modern system based on the principles of state financial guarantees, contracting of medical services and strengthening the role of public procurement. The main stages of reforming the healthcare system, which include the initial post-Soviet period, the stage of fragmentary changes, pilot reform projects, the institutional design of the new model, and the current stage of systematic implementation of the medical guarantee program, are summarized. The paper analyzes the scientific approaches of domestic and foreign researchers on the regulation of health care systems, financial mechanisms, competition in the market of medical services and the impact of state policy on the quality and accessibility of medical care. It has been established that despite significant progress in the regulatory and legal support of the reform, the effectiveness of its practical implementation remains limited due to insufficient funding, uneven access to medical services, institutional weakness of the system and the complexity of tariff regulation. The influence of external factors, in particular the COVID-19 pandemic and armed aggression, which significantly transformed the conditions for the functioning of the health care system and actualized the need to increase its resilience, is considered separately. The need for further improvement of the mechanisms of public administration and development of the market of medical services on the basis of efficiency, accessibility and transparency has been substantiated.
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