Regional patterns in the development of the palliative care provider network in Ukraine during the transformation of the healthcare system (2020–2026)

Abstract

Introduction. Analysis of regional patterns in the development of the palliative care contracting network is important for assessing the performance of the Medical Guarantees Program during the ongoing transformation of the Ukrainian healthcare system. Objective: to analyse regional patterns in the development of the network of palliative care providers in Ukraine during 2020–2026 using data from the National Health Service of Ukraine, to determine the dynamics of mobile and inpatient palliative care, and to assess the overall contracting activity of healthcare providers as a characteristic of the functioning of the Medical Guarantees Program. Materials and methods: a retrospective analysis of open administrative data from the National Health Service of Ukraine was conducted for contracts under Package No. 23, “Inpatient Palliative Care for Adults and Children”, and Package No. 24, “Mobile Palliative Care for Adults and Children”, in Kharkiv, Dnipropetrovsk, Lviv, Ternopil, and Vinnytsia regions for 2020, 2022, 2023, 2024, and 2026. To characterise overall contracting activity within the Medical Guarantees Program, a contracting activity coefficient was calculated as the ratio of the number of contracts to the number of healthcare providers. Descriptive statistical methods were applied. Results: compared with 2020, the scale of contracting under the Medical Guarantees Program increased in all regions included in the study. The highest values of the contracting activity coefficient were generally observed in 2022–2023, followed by a decline in 2024–2026. Contracting under the palliative care packages was characterised by more pronounced growth in the mobile segment: from 2022 onwards, the number of contracts under Package No. 24 exceeded the number of contracts under Package No. 23 in all five regions. Private-sector participation remained limited and was more evident in mobile palliative care. Regional differences were identified in both the scale and pace of development of the contracting network. Conclusions: during 2020–2026, contracting under the palliative care packages expanded in the studied regions, with the most pronounced increase observed in the mobile segment. The identified regional differences indicate heterogeneous development of the contracting network. Contracting activity indicators describe patterns of contracting but do not reflect the accessibility, volume, or quality of palliative care.