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ЭКОНОМИЧЕСКИЕ НАУКИ
Лштаба Людмила Biu'iopiiiiia
Асистент кафедри сощально! медицини ,ООЗ з медичною статистикою, ДВНЗ "ТЕРНОШЛЬСЬКИИ ДЕРЖАВНИЙ МЕДИЧНИЙ УН1ВЕРСИТЕТ 1МЕН1 1.Я.ГОРБАЧЕВСЬКОГО МОЗ УКРАШИ"
Lishtaba Liudmyla Viktorivna
Assistant Professor, Department of Social Medicine, Organization and Economics of Healthcare, and Medical Statistics, SIHE "I.Y.HORBACHEVSKY TERNOPIL STATE MEDICAL UNIVERSITY OF THE
MINISTRY OF PUBLIC HEALTH OF UKRAINE"
ОРГАНВАЦП I ПРОВЕДЕННЯ НАВЧАЛЬНИХ ПРОГРАМ З МЕНЕДЖМЕНТУ В ОХОРОН1
ЗДОРОВ'Я: ЗАРУБ1ЖНИЙ ДОСВ1Д ORGANIZATION AND IMPLEMENTATION OF TRAINING PROGRAMS IN HEALTHCARE MANAGEMENT: INTERNATIONAL EXPERIENCE
Анотащя
Розглянуто сучасш свiтовi практики в сферi оргашзаци i проведения освiтнiх програм з менеджменту в галузi охорони здоров'я. Навчальш програми провiдних медичних шкiл i шкiл бiзнесу США i £вропи аиалiзуються за такими факторами: хто е слухачами таких програм, чого на них вчать, яш формата i технологи навчання використовуються? Автор також ставить питання про необхвдшсть застосу-вання сучасних свiтових пiдходiв до створення i наповнення таких програм для виршення завдань ре-форми вггчизняно! охорони здоров'я.
Ключовi слова: охорона здоров'я; компетенции менеджмент; освiта; програма.
Abstract
The article discusses modern world practices in organizing and implementation of educational programs in healthcare management. Training programs of the leading medical and business schools in Europe and the US are analyzed according to the following factors: Who is the audience of such programs, what do they teach, what learning formats and techniques are used? The author also raises the question of the need for modern global approaches to the creation and forming the content of such programs to meet the challenges of the Ukrainian healthcare reform.
Keywords: healthcare; competence; management; education; program.
Problem statement. Ukrainian healthcare reform cannot be considered highly efficient. Significant investments in the construction of new hospitals and clinics, repairs of the existing ones, purchase of new medical equipment and new ambulances does not give the desired effect. Perhaps that is why the "human factor" - the need to improve the training of health sector workers - is discussed more and more. However, what we primarily mean is qualified medical personnel: doctors, nurses.
The word "manager" (or "management"), as discussed in the hospital halls and rooms, often bears an expressed negative connotation, not least because of a series of managerial failures of administrative staff of the health sector. It is believed that a hospital, department or clinic must be managed primarily by an experienced medical professional, and that managerial skills will be acquired on their own. However, they are not. Modern health sector is a very complex industry, a system consisting of many related organizations and institutions, and the ability to manage individual elements of the system requires great management skills and competencies.
Understanding of the importance of forming managerial competencies in the executives of health facilities is progressing gradually albeit slowly. The best proof of this is the growing demand for educational programs in healthcare management. It should be noted, however, that Ukrainian educational institutions are yet gaining experience as to how to organize healthcare
management programs, whom to train and how. No small roles in educational institution's ability to effectively implement such programs are played by factors such as the availability of a strong resource base, high-quality faculty, and international relations.
Setting objectives
To date, a pressing issue of the reforms carried out in the health sector is management training in the health system and introduction of professional managers that will form the basis of the national system of management training for the healthcare system that meets international standards. That is why the international experience of organization and implementation of healthcare management programs is urgent now.
The purpose of the research is theoretical and methodological study of international experience and management of programs in healthcare.
Research objectives are to analyze health management programs in countries with developed health system; to explore the types of degree and short-term programs implemented; to describe the specific contents of the programs in terms of subjects and courses, as well as the most common forms and methods of training.
Course of research
Health management or healthcare management designates the process of organizing and coordinating the performance of a healthcare facility. A health manager supervises the business and administrative aspects of a healthcare institution, and is responsible for the overall internal healthcare system, including clinical
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and non-clinical staff, partner organizations, insurance companies, government bodies, etc.
Key skills in healthcare administration include a natural inclination toward leadership, interpersonal skills, analytical abilities and an entrepreneurial mindset. Universities and medical or business colleges offer degrees in healthcare management, at both undergraduate and postgraduate level. Academic programs can be found under different titles such as health management and policy, healthcare management and insurance health service management, health administration, health management systems (HMS) or international health management. Regardless of specific curricula, the main focus of such programs is to provide solid business and administrative knowledge in healthcare contexts. To attain a management position, healthcare professionals typically acquire an accredited degree such as Master of Public Health (MPH), Master of Business Administration (MBA), Master of Health Administration (MHA) or Master of Public Administration (MPA).
Currently, the best world-class universities are offering the following types of degree programs in the health sector.
- MBA (Master in Business Administration) programs - programs for managers who wish to make a career in business and, therefore, need to obtain special managerial knowledge and skills. MBA degree appeared in the US in the late 19th century, when the industry began to use scientific approach to management [1, p.34]. Orientation of training on healthcare industry is generally reflected in the program title: MBA in Health Management, Health Sector MBA. Most of these programs enroll professionals who work or want to work in companies and organizations that are independent business units in healthcare. Examples of these are all companies of the pharmaceutical industry, pharmacy chains, companies specializing in clinical trials of drugs or laboratory studies, private or public hospitals and clinics. Health Sector MBA programs are generally implemented within business schools along with other MBA programs that specialize in specific functional areas of management or have general character. Having a portfolio of various MBA programs, business schools can integrate students of different programs on separate courses, thereby overcoming the problem of small numbers characteristic of Health MBA groups.
- MPH (Master in Public Health) programs. This program was established in 1970 and accredited by the Commission on Accreditation of Healthcare Management Education - CAHME - in 1974. The duration, intensity and audience of these programs are very close to those of MBA programs. The difference lies in that their graduates are more focused on work related to the administration of the health system, so these programs focus on courses related to state or public regulation of the health sector of a country or a region. It should be noted that, as the healthcare industry becomes more complex and the elements of its system become strongly interlinked, the distinction between Healthcare MBA and MPH programs gradually fades away. This is illustrated by the fact that both programs often ad-
dress the same audience, e.g. biotechnology and pharmaceutical company managers [7]. But we can hardly expect a complete "fusion" of these programs in the future. The specificity of MPH is revealed in a number of specializations (epidemiology, international public health, biostatistics, bioinformatics, environment and public health, etc.), and healthcare management is only one of them, requiring interdisciplinary training in all of these areas. Another aspect is that MPH programs are traditionally implemented by individual schools of public health and are organizationally separate from business schools. This leads to the formation of a specific contingent of students very different in its motivation from MBA students.
- MHA (Master of Health Administration) programs. This very common degree allows its owner to successfully move up the administrative ladder in healthcare. In fact, this program is meant for "health officials." The programs typically have a specialization (or, as is often said, concentration), such as gerontology, medical informatics etc. Recently, these programs have been facing competition from the MSc programs in the US market.
- MSc (Master of Science) in Public Health programs. Such programs are usually distinguished by the absence of requirements of work experience. Another difference is specialization narrower than that of MBA and MPH. For instance, Yale University offers Master programs in health in two major specializations: Bio-statistics, and Epidemiology of Chronic Diseases. But there are exceptions: London School of Economics and Political Science offers a two-year MA program in Economics, Politics and Management in Healthcare. The program is designed for managers of existing health facilities, insurance funds, international agencies, pharmaceutical and consulting companies. Accordingly, it is implemented in a module format, allowing students to get on the job training, making it very similar to the part-time MBA programs.
The Commission on Accreditation of Healthcare Management Education is recognized as an independent world leader for determining quality in healthcare management education. Universities, programs, practitioners, and international peers will seek the consultation of CAHME professionals to assess the quality of healthcare management education.
CAHME is respected for its collaborative, efficient, and reliable contribution to the more effective delivery of healthcare management education around the world.
CAHME's Mission:
To serve the public interest by advancing the quality of healthcare management education by:
- Setting measurable criteria for excellent healthcare management education
- Supporting, assisting and advising programs which seek to meet or exceed the criteria and continuously improve
- Accrediting graduate programs that meet or exceed the criteria
- Making this information easily available to interested constituencies.
Wschodnioeuropejskie Czasopismo Naukowe (East European Scientific Journal) #12(16), 2016 ssaLl Number of students of 84 CAHME accredited programs in 74 universities of the Americas is shown in Table 1.
Table 1
Total Enrollment
2010 2011 2012 2013 2014
Count Percent of Total Count Percent of Total Count Percent of Total Count Percent of Total Count Percent of Total
Full Time Students 3431 63% 3703 62% 3867 69% 3631 67% 4344 71%
Part Time Students 1981 37% 2242 38% 1709 31% 1818 34% 1800 29%
Total Enrollment 5412 5945 5576 5449 6144
Source: compiled by author based on the data [8]
Universities composed of various faculties and schools often offer double degree programs: by including additional courses in their schedule, students have the opportunity to master a concurrent program and to get not one but two diplomas as a result of the training. Program are offered in partnership or by two different schools (faculties) within one university (so-called concurrent programs), or two different universities. Most popular are the MBA/MPH-type programs, usually offered by joint efforts of business schools and schools of social sciences, such as the University of California, Berkeley. A common combination is Doctor of Medicine and Master of Public Health - MD/MPH, for instance, in a joint program of Stanford University Medical School and School of Public Health of the University of California, Berkeley.
Degree programs of different types are represented differently in different countries. European countries, especially France and Germany, tend to offer MS or MSc (Master of Science) programs. In the United States, Canada and the UK, MBA programs are more common. Interestingly, there is a correlation between the number of programs implemented in a country and the country's position in the ranking of national health systems compiled by the WHO (World Health Organization). Certainly, there is no exact correlation between these parameters, as the size of a country and its focus on exporting business education are important as well. However, it should be noted that France, Germany, and the UK certainly are the Europe's leaders both in the number of programs and the level of healthcare systems.
The development of schools of public health in Europe is greatly influenced by two organizations: the Association of Schools of Public Health in the European Region (ASPHER), dealing mainly with education, and the European Public Health Association (EUPHA), which supports research in the field of public health, health promotion, and epidemiology [5]. Association of Schools of Public Health in the European Region (ASPHER) is the main independent organization in Europe founded with the purpose of strengthening the role of healthcare by training healthcare professionals for both practice and research. Founded in 1966, the Association has 70 members. Those are members of
the European Union, Council of Europe, listed on the ASPHER website [9]
In the European countries, postgraduate training of managers in the health sector is done in schools of public health at universities or at departments of communal medicine at medical schools (UK, Belgium, Netherlands), or in public schools of healthcare (France, Sweden, etc.). Postgraduate public health training in schools of public health at universities has a form of specialization; public schools focus on training for special functions. Public schools founded by the government usually do not conduct scientific research. Their programs include administrative management and service administration, public health legislation, health statistics, planning, etc. University schools were founded for the purpose of scientific research in the theory and methods of public health.
Let us focus on some trends of the development of degree programs in healthcare management.
First, so-called concurrent programs are becoming widespread where two schools (or departments) of one university offer joint programs with students being awarded two degrees (two diplomas). Meanwhile, students enroll and study in one program, but must take a set of courses from another program in order to qualify for the concurrent degree. This has solved several problems: programs become more attractive to students and increase their value on the labor market; both schools do not incur additional costs, since the concurrent students get "embedded" into the main pool of students. Lastly, the two schools can focus on teaching their core subjects - for instance, business schools are responsible for management courses while public health schools offer courses on the health sector.
Secondly, a new type of double degree programs emerges where the above idea is implemented via alliances of schools from different universities. In this case, in addition to the two degrees from different programs, students receive an added benefit of becoming graduates of two universities and gaining access to the various services supported by alumni associations, which increases their chances of successful employment and career growth.
Thirdly, the European Master programs, usually more specialized compared to North American
y
MBA/MPH programs, are becoming increasingly popular. These programs target young people who will enter the labor market after graduation, and are more focused on the future than MBA/MPH programs. Not surprisingly, information technology in healthcare/medicine, biotechnology, and international health are among the most popular majors in Master programs.
Short-term programs are an international practice, including all programs of study that do not end in a formal degree (diploma). It is obvious that such programs are always shorter in time and their listeners are interested in obtaining immediate knowledge and skills to be used in their management practices the very next day rather than in career advancement or increasing their value in the labor market. Naturally, such programs are less structured than the degree ones, so they are extremely difficult to classify and compare. Typically, they are primarily divided into open-enrollment and customized. People come to open programs on their own initiative and on the initiative of companies and organizations which employ them. The second category is more common if only because this kind of training is very expensive and often is paid by companies. The curriculum of these programs is fixed and does not change based on the needs of the current group. Customized programs are usually developed for particular corporate client's needs. Although students of both types of programs are business people, the processes of the organization and implementation of such programs are so different that separate departments, quite independent from their "mother" business schools and universities, are often created to implement customized programs.
Among the open non-degree healthcare management programs, the following programs are most common. Management program for pharmaceutical and biotechnology companies. A classic example of this type is the Wharton/Windhover Program for Pharmaceutical and Biotech Executives of the Wharton School of Business, University of Pennsylvania. It is designed for five days and costs USD 8,950. It includes the following themes: development of new drugs, marketing and pricing in pharmaceutics, financial instruments for assessing agreements and companies, alliances and acquisitions in the industry - trends and strategies. A similar set of courses is offered by the HSM program of the Fuqua School of Business, Duke University. Generally speaking, topics related to management of new drug development, acquiring rights to new developments through mergers and acquisitions contracts, pricing, are vital for the pharmaceutical industry, as evidenced by deep research [2, p.5] and various educational programs. And this is not surprising: the full cycle of development, testing and registration of a new drug takes 10 to 15 years, and the average cost of development is several billion US dollars.
Because public health is one of the industries where technological, informational and organizational innovations are a norm rather than an exception, it had to affect the number of training programs whose subject of study is innovation. The program Challenges in the
European Healthcare Market. Winning through Innovation offered at IESE Business School, University of Navarra (Barcelona, Spain) can be used as an example. It's a three-day program with every day dedicated to a specific topic: day one - overview of future changes in healthcare, day two - tools for innovation in a challenging industry, day three - putting innovations to life [IESE Business School].
In general it can be said that the number of non-degree programs specializing in certain areas is small compared to programs for certain functional areas of management (such as strategy, finance, marketing) or certain managerial competencies (leadership, negotiations, teams). The share of programs in healthcare management is even smaller. Most of the leading business schools consider it necessary to have at least one such program in its portfolio, but it's safe to say that the current emphasis in business education for healthcare is on the degree and corporate programs. However, many business schools note an increasing number of representatives of the health sector among students of short-term open-enrollment in non-sector-specific management programs.
Programs that offer on the job training (such programs include all part-time degree programs as well as short-term non-degree programs) are focused on health sector and medical staff that have realized the need to acquire knowledge and skills in the field of management. This occurs most often when a doctor first takes an administrative position and realizes that he now spends considerable time solving administrative, nonmedical problems. J. Porter's article on the importance of business education for doctors opens as follows: "When Christopher Burton took over as head of the Emergency Department at the San Francisco Hospital, he first had to deal with a balance sheet, profit and loss statement, and the dissolving staff, and all of this without any business education background" [3, p.1018]. It is a common opinion of all certified US doctors enrolled in such programs that the distinguishing feature of the recent years is this health workers' awareness of the fact that medical facilities are not much different from businesses, and therefore everything that is taught to business managers will also be very useful for themselves.
Conclusions and further research
Drawing conclusions and summarizing the experience of leading universities and business schools in the organization and implementation of healthcare management programs, we are able to notice the following current features and trends of this bloc of educational programs.
Firstly, the health sector is understood in a broad sense to include not only medical facilities and governmental and public institutions, but also pharmaceutical companies, firms engaged in scientific research and clinical trials, corporations that manufacture medical equipment, consultants, Internet companies, etc. The consequence of this approach is a diversified audience of the programs, demand for special programs and courses on pharmaceutics and biotechnology, change of emphasis in teaching from functional management disciplines to courses that reflect industry specifics
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(health economics, information technology in healthcare).
Secondly, application of an integrated approach to healthcare management requires knowledge of industry specifics as well as modern management methods and techniques, and results in the formation of alliances of business schools and medical schools of universities, double degree programs that award both the Master of Business Administration (MBA) and Master of Public Health (MPH) degrees. In the domain of short-term and corporate programs, integrated approach is manifested both in creating courses and programs that are a product of different schools, and in the use of non-traditional methods and forms of education. The distinctive features of the teaching staff of such programs are multiple degrees and diplomas in both medicine and public health management, dual membership of professors in different schools within the university (double appointment) as well as broad involvement of practitioners.
Thirdly, the fact that both the health sector in general and, consequently, healthcare management programs are oriented towards technological and organizational innovation and information technologies requires the introduction of advanced research into the programs. Therefore, such programs are developed most successfully by business schools and universities capable of generating new knowledge as a result of cross-functional research in the field, which casts doubt on the effectiveness of traditional organization of research and training centers of business schools based on the functional principle.
References
1. Cameron S. The MBA Handbook: Skills for Mastering Management / S. Cameron. - Financial Times/ Prentice Hall; 5 edition; 2004. - 432 p.
2. Perfilieva O.V. International strategies of continuous education: role and experience of colleges / O.V. Perfilieva // Higher Education Today. - 2008. -No 10. - pp. 4-5, 7, 9.
3. Protopopov A.A. Methodological aspects of professional training of healthcare managers / Protopopov A.A., Yeruhina M.V., Korshever N.H. et al. // Saratov Scientific Medical Journal - 2012. - No 8. - pp. 1017-1022.
4. Reshetnikov V.A. Conceptual approaches to the training of specialists in the field of healthcare management / V.A. Reshetnikov, Skvyrskaia L.Y., Syrtsova L.Y. et al. // Healthcare in the Russian Federation. -2003. - No 6. - pp. 11-12.
5. State of training in public health specialists in Ukraine and in the world: an overview / R.V. Voro-nenko, V.V. Glukhiv, O.S. Kovalenko, V.M. Lekhan, V.M. Rudyi, L.M. Skoropada, I.M. Solonenko. - Kyiv: Sfera, 2003. - 86 p.
6. Formation of competences of healthcare managers in the course of additional professional training / Kycha D.I., Fomina A.V., Maarian A.S., Pachhin I.V., Ivanenko A.V., Lugovoy V.E. // Social Aspects of Population's Health. - 2013. - No 6. - pp.42-48
7. Degree programs (view list): http ://www. hsm.tulane.edu/ programs/programs_in-dex.html
8. https://www.cahme.org - the official website of the Commission on Accreditation of Healthcare Management Education (CAHME)
9. http://www.aspher.org/ - the website of the Association of Schools of Public Health in the European Region (ASPHER)
Фетщенко С. М.
Нацюнальна aKaAeMÎH державного управлшня при Президеш^ Украши, астрант кафедри управлшня нацюнальним господарством та економiчноï полггаки
Fetishchenko Ye. M.
National Academy of Public Administration, Office of the President of Ukraine, postgraduate student of the
Faculty of national economy management and economic policy
ПЛАНОВ1 ВИДАТКИ ДЕРЖАВНОГО БЮДЖЕТУ УКРАШИ: АНАЛ1З СТРУКТУРИ ТА ПРОПОЗИЦП ЩОДО ÏÏ ВДОСКОНАЛЕННЯ THE PLANNED EXPENDITURES OF UKRAINE GOVERNMENT BUDGET: ANALYSIS OF THE STRUCTURE AND PROPOSALS FOR ITS IMPROVING
Анотащя: В статп aнaлiзуються плaновi видатки Державного бюджету Украши на 2012-2016 роки. Розраховуються ïx структурш показники. Визначаються прюритетш напрями бюджетного фшансування та встановлюеться необхвдшсть змшити структуру державних видатшв. Дослщжуються рекомендацп вгг-чизняних науковщв щодо рaцiонaлiзaцiï видатшв Державного бюджету. Пропонуються заходи, орiенто-ваш на забезпечення структурних змш у планових видатках Державного бюджету на майбутш перюди.
Ключовi слова: Державний бюджет Украши, плaновi видатки бюджету, структура планових видатшв бюджету, видатки на сощальний захист та сощальне забезпечення, видатки на загальнодержавш функцп, видатки на оборону, видатки на економiчну дiяльнiсть.
Summary: The article analyzes the planned expenditures of the Ukraine Government budget for 2012-2016. The structural indicators of planned budget expenditures are calculated. The priority directions of budget financing are defined and the necessity to change the structure of public expenditures is established. The recommendations of national scientists to rationalize the expenditures of the Government budget are researched. The measures aimed
