CONCEPTUAL APPROACHES TO BUILDING A COMPETITIVE METROPOLITAN AREA AND ITS HEALTH CARE SYSTEM

Abstract

Based on the generalization of France’s successful experience in metropolitan development, conceptual approaches to building a competitive metropolitan space in Ukraine and the health care system in three areas of attraction based on mutually agreed organizational, managerial and legal relations between metropolitan communities are substantiated. The metropolises of Ukraine include the cities of Kyiv, Dnipro, Odesa, Kharkiv, Lviv, and after the deoccupation - the city of Donetsk. A key problem in Ukraine is the lack of discussion of the institutional framework for the creation of metropolises according to EU standards for their integration into the European space on the basis of Ukraine's national interests. Such approaches should correspond to the fourth stage of reforming the administrative-territorial system at the regional level. This should apply to the formation of 13 metropolises in 25 regions on the basis of candidate cities - Zaporizhia, Vinnytsia, Kryvyi Rih, Sumy, Khmelnytsky, Uzhhorod, Cherkasy, Zhytomyr, Chernivtsi, Mykolaiv, Poltava, Chernihiv and Mariupol. It should be noted that the viability of metropolises is calculated by experts from the administrative, economic and social components. The strategy of the metropolitan health care system should include harmonization of prospects for the development of communities, districts and regions in the creation of an optimal system of primary health care, coordination of medical institutions in the hospital district and in the provision of tertiary care. It should be borne in mind that the metropolis forms 3 zones of influence: the first - within a radius of 15 km, the second up to 60 km, the third – up to 300 km. Each community provides primary care and is part of a hospital district that specializes in providing secondary care. In the third zone, the metropolis provides tertiary care with coverage of neighboring areas using the above approaches. The dynamics of morbidity of the population of the metropolis of Lviv and its metropolitan region has been studied. Promising actions of the Cabinet of Ministers of Ukraine and the National Academy of Sciences of Ukraine include preparation and holding of scientific-expert discussion of the draft law of Ukraine "On the formation of metropolises" with preliminary professional discussion and public involvement.