The impact of health insurance models on reducing DALYS from cardiovascular diseases and neoplasms: A panel study across 51 OECD member and candidate countries

In Ukraine, there is a steady increase in the mortality rate of the population, which is due to the low quality of medical provision. The main advantages and the efficiency factor of the health care system in the Western European countries are analyzed; the key factors regulating medical provision in Ukraine are systematized; the effectiveness of modern health care reform in Ukraine is evaluated; practical recommendations to improve the administrative and legal regulation of the system are developed. The analysis showed that the effectiveness of health care reform in Ukraine is currently about 30%, and the high mortality rate of the population in Ukraine is primarily due to the low quality of medical care and inadequate investment in the industry. The main health problems in Ukraine are failure to comply with legislation on the amount of funding and remuneration in the public health system, high levels of corruption and lack of control over the competence of doctors, inaccessibility of medical products for consumers due to the pharmaceutical market monopolization.

The most significant problems in financing the public health system in Ukraine are the permanent deficit of public spending on medicine and the shallow development of the voluntary health insurance market. The aim of study is the search of optimal interactions between stakeholders in the system of relations “state – insurance companies – households” in the context of voluntary health insurance. The study hypothesizes that households can become more active participants in health insurance only if their average monthly income reaches a certain threshold level. It is calculated based on the results of simulation games using the Brown-Robinson iterative method. According to the simulation results, this threshold level is only 7% higher than the actual value of the average monthly income of Ukrainian households during the analysis. At the same time, under this condition, the state in Ukraine will be able to transfer part of the financial burden of compensating healthcare costs to insurance companies. According to the calculations made with the help of the game theory toolkit, with the maximization of insurance payments to the population under health insurance contracts, the burden on public health financing in Ukraine could be reduced by 67.7%. The paper was conducted on the data of the ten most potent insurance companies of Ukraine as of 2021 (it is they who accumulate the lion’s share of household insurance premiums), that is, before the start of a full-scale war between the Russian Federation and Ukraine. The obtained results can be used both by insurance companies during the management of insurance premiums and payments and at the level of state management of costs in the field of public health.

Acknowledgment
This study was undertaken as a part of the research projects granted by the Ministry of Education and Science of Ukraine: “Socio-economic recovery after COVID-19: modeling the implications for macroeconomic stability, national security and local community resilience” (registration number 0122U000778); “The impact of COVID-19 on the transformation of the system of medical and social security of population: economic, financial-budgetary, institutional-political determinants” (0122U000781).

In the conditions of insufficient budgetary financing of the health care system and low quality of medical care in the state medical establishments of Ukraine, the importance of extra-budgetary sources of financing becomes increasingly relevant. One such source is voluntary health insurance. The aim of the paper is to compare the state and structure of medical financing in developed countries and in Ukraine, to study the global experience in the functioning of the voluntary health insurance market, and to calculate the potential capacity of the voluntary health insurance sector in Ukraine. For mathematical calculations, 20 absolute indicators of the state of the voluntary health insurance sector, as well as macroeconomic indicators, were used. The annual values of absolute indicators for the period 2010–2019 were used in forming the array of input data. Based on the experience of foreign countries, the paper substantiates the development of the voluntary health insurance in Ukraine as an extra-budgetary source of health care funding. The capacity of the voluntary health insurance sector was defined by the authors as the maximum possible amount of insurance premiums that insurers can receive in the process of selling voluntary health insurance products. The calculations made it possible to conclude that the voluntary health insurance market in Ukraine has the potential for development, as evidenced by the predominance of the potential capacity of the voluntary health insurance segment over its real indicator.