CC BY
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ARCHITECTURE
UDC 725.51
Bulakh Irina Valerievna
PhD of Architecture,
Associate Professor Department of Design of the Architectural Environment, Kiev National University of Construction and Architecture ORCID: 0000-0002-3264-2505; ResearcherID:V-4802-2018; Spin-Kod: 9274-0113
DOI: 10.24411/2520-6990-2019-10060 URBAN PLANNING PECULIARITIES OF THE FORMATION OF HOSPITAL DISTRICTS OF
UKRAINE
Continuing the research on the dynamics of development and the patterns of the formation of the city-planning system of Ukrainian health facilities [1-23], it is necessary to consider separately the issues of city-planning organization and the formation of hospital districts. Traditionally, all medical institutions of Ukraine, depending on the territorial service of the population, were divided into rayon, city, oblast and rural areas. In the process of conducting the national medical reform of decentralization in the field of health care organization, begun in 2016, the location and definition of quantitative indicators of health facilities is carried out according to another territorial principle, namely, it is distributed to territorial hospital districts. The current legislative documents regulating the procedure for the establishment, organization and functioning of territorial hospital districts of Ukraine are "Model Regulations on the Hospital District" [24]. The Regulation defines the general organizational and procedural principles of the activity of the hospitals in order to provide secondary (specialized) and emergency medical care to the population. Hospital district - functional association of health facilities located on the territory, providing secondary (specialized) medical care to the population of such territory [25]. The purpose of the establishment of hospital districts is to facilitate the organization and functioning of a network of health facilities for intensive, planned, rehabilitation and palliative care in a manner that will ensure the quality and timeliness of providing secondary and emergency medical care to the population, and the effective use of budgetary funds.
The decision on the establishment, structure and boundaries of the hospital district is made by the Hospital Board, which includes representatives of cities of oblast significance, districts, united territorial communities, delegated by local councils. The number of representatives of each territorial unit is calculated according to the formula developed by the Ministry of Health and depends on the number of administrative-territorial units entering the hospital district, the number of vests in the district and in each separate administrative-territorial unit. The project of the hospital district of the network of health facilities, prepared by the Hospital Council, is under approval by the Ministry of Health and the Cabinet of Ministers of Ukraine. The main task of the hospital board is to formulate a plan for the development of the hospital district. It consists of 3-5 years, should include an analysis of the current situation, plans for the development of health care institutions, reorganization measures, including re-profiling, health care facilities, assessment of the financing of the
activities outlined in the Plan, as well as mechanisms for monitoring and Reporting by health care institutions on the progress of service improvements.
The establishment of hospital districts is based on: an adequate workload for health facilities, which contributes to ensuring the level of safety and quality of medical care; observance of the standards of time availability of necessary medical care; current demographic indicators, morbidity structure, trends of population migration, as well as their forecast; stable clinical paths of patients to health care establishments providing secondary medical care; the institutional capacity to make managerial decisions aimed at improving the efficiency of the use of health care resources, including decisions on the re-engineering of existing health facilities or their further specialization [25].
The hospital district consists of at least one multi-disciplinary intensive care hospital of the first and/or second level and other health care facilities. Multidis-ciplinary intensive care hospital of the first level - a health care facility providing secondary (specialized) medical care and emergency medical care to the population in the event of pathological conditions threatening life and victims of emergencies. A multidimensional intensive care hospital of the first level should provide medical assistance of at least 120 thousand people [25]. Multidisciplinary intensive care hospital of the second level - a healthcare facility providing secondary (specialized) medical care in a round-the-clock hospital, day care or outpatient setting for people in acute illness or with chronic diseases requiring intensive care and treatment, from obligatory presence of emergency departments (emergency) medical aid. The multidimensional intensive care hospital of the second level should provide medical care of not less than 200 thousand people [25].
By comparing the difference between the official definition of the multi-profile hospitals of intensive care of the first and second levels provided in the legislative documents, there is doubt about the need for such a complication and distribution - in any modern hospital there is a round-the-clock hospital, and the issue of organization of day care and outpatient treatment conditions is rational optimizing the activities of the hospital. Thus, only one definition of the multidisciplinary intensive care hospital is proposed - a health facility providing secondary medical care in a round-the-clock hospital, day care or outpatient setting for people in acute illness or with chronic diseases requiring intensive care and care, with the obligatory presence of
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emergency departments (emergency) medical aid. The recommended design volume of the multidisciplinary intensive care hospital for medical assistance is assumed to be not less than 200 thousand people, but may decrease or increase depending on the type of locality (urban or rural), etc. regional peculiarities.
The procedure for determining the composition, boundaries and area of service of the hospital district includes the following provisions:
- the composition, boundaries and area of care of the hospital district should be defined in such a way that residents living within its borders have access to secondary medical care within their hospital district;
- the center of the hospital district is defined by the settlement, as a rule, a city with a population of more than 40 thousand people, which houses a multidisciplinary intensive care hospital of the second level.
The center of the hospital district may be a locality that is geographically the closest to the center of the district and where the multidisciplinary intensive care hospital operates. Taking into account the number and density of the population, the largest, large and large cities of Ukraine have the opportunity to organize a hospital district within the city.
An example of the formation of a hospital district within a city can serve as the capital of Ukraine. According to the order of the Cabinet of Ministers of Ukraine No. 202-p "On approval of the composition of the hospital district of Kyiv", the composition of the hospital district of Kyiv, which includes all health care institutions for the provision of secondary (specialized) medical care and approved in the territory of ten districts, was approved. Kyiv [26]. To ensure the functioning of the Kiev hospital district it is necessary: to distribute existing health care institutions by categories of intensive, planned, rehabilitation and palliative care; to analyze and optimize the capacity of the bed fund, the intensity of hospitals, the territorial placement of hospitals; to eliminate excess specialization of hospitals intended for the secondary level of medical care, their maximum re-profiling in the multi-profile hospital of intensive care.
According to the legislative documents, the area of care for the hospital district is determined by the timeliness of arrival in multi-disciplinary intensive care hospitals, which should not exceed 60 minutes and should be equivalent to the radius of the service area 60 km, provided that there are hard-coated roads. The service area may be smaller in the absence of communication paths or relief features that significantly impede communications (rivers without bridges, mountains, etc.) [25]. The above-mentioned provisions also raise doubts - on the one hand, the current world trends, considered in the first section of the study, indicate an increase in the radii of hospital services (up to 90-120 km), which is associated with a growing level of general provision of the population with its own motor transport, an extensive system of public types of transport. On the other hand, taking into account the Ukrainian realities of the development of transport infrastructure, in particular the state of intercity and city roads, the radius of service of the hospital population in a certain territory should take into account the actual
condition of roads and you travel on them.
It should be noted that the process of formation of territorial hospital districts in Ukraine is quite long. As of February 2017, 105 state hospital districts in 24 regions of Ukraine were formed and approved by the Cabinet of Ministers of Ukraine. In the Kyiv region, with a population of 1.734 million people, it is planned to form four hospital districts with centers in Bila Tserkva, Boyarka, Vyshgorod and Brovary. A separate status is for Slavutych, because its territorial remoteness does not allow to connect the settlement to any of the specified hospital districts. In the Vinnytsia region, with a population of 1.593 million people, it is planned to create three hospital districts. In the Dnipropetrovsk region (3.236 million people), it is about creation of five districts, which will include 15 intensive care hospitals, two intensive care intensive care hospitals, 42 planned hospitals, three hospitals for rehabilitation, four hospitals, and 51 specialized centers.
Five district hospitals plan to be established in the Kharkiv region, namely: the Balakliya district (population 188.9 thousand people), Central district (629 thousand), Lozovsky (265.1 thousand), Kupyansky (189.5 thousand), Kharkiv (1.430 million). Zaporozhye, Berdyansk, Melitopol, Vasilivskyi, and Pologovskii hospitals are planned to be formed in the Zaporozhye region (1.742 million people). In the Ivano-Frankivsk region, with a population of 1.380 million people, the formation of Ivano-Frankivsk (478.8 thousand), Kolomyia (281.1 thousand), Kalush (292.6 thousand), Nadvirna (208.4 thousand) and Kosiv (118.1 thousand) hospital districts. In Kherson oblast (1.057 million people) four districts with centers in Kherson, Nova Kakhovka, Ber-yslav and Genichesk were created. In Khmelnytskyi oblast, it is planned to form three hospital districts: Khmelnytsky (672 thousand), Kamenets-Podilskyi (324 thousand) and Shepetovsky (296 thousand). In Ki-rovograd Oblast it is planned to create three hospital districts: Western (205 thousand), Kropivnitsky (529.7 thousand) and Alexandria (235.9 thousand). In the Luhansk region (2.197 million people), the planned district districts with centers in Severodonetsk, Lisichansk, Rubizhne, Starobilsk, and Bilovodsk are planned. In the Lviv region, with a population of 2.535 million people, the issue is about the formation of ten hospital districts, while the list of districts and the justification of their numbers are being clarified. In Myko-layiv oblast (1.152 million people) there are plans to create four hospital districts: Voznesensky, Mykolayiv, Bashtansky, Pervomaisky. In the Poltava region, it is planned to create four hospital districts to serve 1.429 million people. In Zhytomyr oblast (1.243 million people) it is planned to establish four hospital districts: Zhytomyrsky (548.1 thousand), Korostensky (218.8 thousand), Novograd-Volynskyi (217 thousand) and Berdychivsky (259.1 thousand). ) In the Volyn region (1.042 million people) it is foreseen the creation of Lutsk, Novovolynsk, Kovel, Kamien-Kashir districts. In Chernihiv region, they count on the creation of seven districts to serve 1.036 million people. Three districts will be created in Rivne oblast (1.161 million), six in Sumy (1.106 million), five in Ternopil (1.061 million). There is no information on the list of hospital districts
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in Donetsk, Transcarpathian, Chernivtsi, Cherkassy, Odessa region.
Particular attention should be paid to the issue of urban planning of emergency medical care, as part of the medical care of the population within the hospital district. Emergency medical care is a medical aid provided in case of acute violations of the patient's physical or mental health that threatens his life or the health of others. Emergency medical care is obliged to provide all health care providers and health care institutions regardless of the form of ownership and subordination. The ambulance service serves as the basis for the emergence of emergency medical care, whose competence is the provision of timely and qualified medical assistance to patients in emergency situations at the scene and during transportation of such patients to the relevant health facilities.
Emergency medical care is organized by stations and ambulance stations, their units, which legally must enter the hospital districts. Emergency hospitals (Kyiv, Lviv, Chernivtsi) serve as an emergency mechanism for the organization of emergency medical care in Ukraine. According to the regulations, the "fast" carriage must arrive in cities for 10 minutes in the place of call and 20 minutes in the countryside. The real waiting time for the ambulance brigade in Ukraine is longer. This is due to the unsatisfactory state of roads, the lack of coordination, the large number of non-core calls that the "fast" leaves. Modernization of operational-dispatching services of centers of emergency medical aid and disaster medicine on the basis of GPS-technologies will enable to track the carriage moving on the map and direct the nearest crew to the place of call. Similar changes have already been successfully implemented in Kyiv, Dnipropetrovsk, Kherson, Kharkiv oblasts, as well as in the testing mode - in Vinnytsya (Vinnytsia and Vinnitsa region) and Poltava (Poltava and Poltava regions) oblasts. In order to create the right conditions for the provision of emergency medical care, the ambulance service is provided with appropriate equipment and special transport vehicles for ground, air and, if necessary, water species.
Thus, the analysis of the first steps of the reorganization of the health care sector of Ukraine allowed to identify and systematize the direction of the state policy regarding territorial zoning in order to improve, optimize, decentralize the provision of medical care at all levels and for all segments of the population. The reform of medicine in Ukraine, built on the basis of the current world-wide experience in the health care of the leading powers, has created positive expectations for qualitative and fundamental changes that can revive the domestic health care system, including in the architectural and urban aspects. Undoubtedly, the information analyzed concerning concrete ways of reorganization of the city-planning network of health care institutions is still rather generalized and aggregated, needs to be clarified and corrected. Unfortunately, the state programs have poorly traced the specifics of the reorganization of children's health care institutions. It must be agreed that the reform directions addressed concern the changes in the provision of medical services for adults as well as for the treatment of children. However, in the
future, it is proposed to focus on identifying the location of children's health facilities in the general urban health system, at its separate component levels.
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