The article discusses approaches to optimizing the health care system in the context of reform. In the article identified institutional and organizational constraints to shape the health care system model with the necessary components: quality assurance, financial constraints, and optimization of budgetary resources. In the article developed the approaches to the formation of the health care system at the regional level. To this aim, the factors that influence the efficiency of the organization and functioning of the medical system are identified. Particular attention is paid to the organization of quality medical care in the united territorial communities of the Sumy region. The factorial analysis made it possible to form models of organization of medical institutions in the united territorial communities, taking into account financial and organizational constraints. In the process of research used the conditionally constant and variable factors in the model to adapt effectively to changes in the external environment. Modeling is based on a functional approach (model based on data flow construction). This approach allows you to identify functional problems of the system, to determine the basic requirements of stakeholders, to determine the structure of information flows in the model. In this case, the health care system is considered as a set of processes (related or independent) that achieve this goal. Then the overall management of the system can be represented as the management of a set of these processes in order to obtain the end result (with the specified characteristics). The peculiarity of this approach to modeling is to summarize a large array of input information, to establish direct and feedback between economic, demographic, geographical, social indicators of community development and medical indicators (results) that characterize the level of public health. The introduction of an integral indicator in the calculation model will solve both general institutional tasks, such as temporal dynamics within the created unified territorial community and creating a competitive position in comparison with other unified territorial communities of the region, and making local management decisions based on the influence of individual factors on the functioning of the health care system. The application of the model makes the practical importance in the control of deviation of the actual value of the integral indicator from the normative and planned result.

The aim: To study the results of a medical and sociological research as to the attitude of rural population in amalgamated hromadas (AH), i.e. united territorial communities, of Sumy region to the results of primary care reform. Materials and methods: The form of research – a survey with closed questionnaire. The study was conducted on a specially designed three-tier quota sample, which was calculated allowing for the territorial and socio-demographic indicators. A total of 320 respondents residing in the specified rural communities (hromadas) were surveyed with quota sampling. The theoretical sampling error makes 3%. The questionnaires were processed by the laboratory staff with the help of the “OСA” program. Results: Among the surveyed in Nyzhniosyrovatska AH (amalgamated hromada), 23.5% of the population emphasized that their authorities neglected medical problems, while in Bezdrytska AH this indicator was 6.7%, as evidenced by the difference in the industry financing from own assets (274 thousand less than in Bezdrytska AH). The survey revealed that in the communities where the population knows their family doctors better and trusts them, the satisfaction with the quality of medical care and the attitude to prophylaxis (prevention) is much higher. Conclusions: A significant part of the population demonstrates a low level of awareness of the course of the reforms, their goals and objectives. The specified trends may indicate a lack of communication or distortion of information on the implementation of medical reform. It is an information support that is one of the key instruments for effective introduction of medical reform. At the local level, this function is assigned to a family doctor who becomes a determining factor not only for providing medical services to patients, but also for communication, keeping the population informed and prophylaxis.

Introduction: Primary health care is the most important part of the health system. Family physicians, as representatives of this link, are key figures who are assigned a number of responsibilities for the prevention, diagnosis, and treatment of both adults and children. An indicator of the effectiveness of their work is the level of satisfaction of citizens with the quality of service. To understand the effectiveness of reform implementation, the authors evaluated the activities of the family physician and its influence on the health of citizens living on the entrusted territory. The aim of the study is an empirical analysis of the selection criteria, frequency and reasons for the citizens' visits to a family physician in the amalgamated territorial communities of the Sumy region. Materials and methods: During the research, methods of a systematic approach and comparative analysis were used. The study was conducted in the form of a survey. Calculations and processing of statistical information were carried out using the "OSA" application. Study results and discussion: The paper shows the condition of primary care as a result of the health system reform. The sociological survey on the work of family physicians in the amalgamated territorial communities concerned the criteria for choosing a family physician, the frequency of requests for medical care, and the reasons for requests, in particular for preventive purposes. The analysis showed that the percentage of signing declarations is relatively high. However, a certain formality of this process was observed, since a significant percentage of citizens who signed the declaration have never met their family physician. The result indicates that citizens often do not seek medical care in outpatient clinics on the territory of the amalgamated territorial community, and they rarely visit the physician for preventive purposes. According to respondents, the reason for not seeking prevention is the lack of need. Conclusion: A high percentage of residents of the amalgamated territorial communities signed declarations with family physicians. However, having analyzed the survey data, we can note a rather formal attitude to this procedure, since many residents seek medical services in other medical institutions. It is a consequence of the insufficient effectiveness of the reform of primary health care and insufficient attention on the part of local authorities to provide outpatient clinics with qualified specialists. There is a need to raise awareness about the importance of preventive measures. Keywords family medicine, family physician, preventive work, declaration, communication.

The aim: The aim of the study is to analyze financial indicators and assess the effectiveness of financing secondary medical care enterprises during the transition period in the context of remuneration to doctors. Materials and methods: To perform the analysis, the financial characteristics of 26 medical facilities have been collected and processed by means of involving the bibliosemantic method, data extract and content analysis. Conclusions: Presents a comparative analysis of labour payment expenses to doctors of cardiology, obstetric and gynecological and surgical departments of medical facilities. The predicted labour payment expenses for the number of services provided have been calculated. Besides, the article makes it clear that the allocation of funds according to bed-day loads and the number of medical services rendered is unsustainable and does not correspond to the real load on the actual position.

Вивчали особливості складу мікрофлори товстої кишки у дітей дошкільного віку, хворих на гострі респіраторні вірусні інфекції (ГРВІ) на фоні аденоїдних вегетацій і хронічного аденоїдиту. Під час дослідження встановлено, що в гострому періоді вірусних інфекцій у дітей віком 3–7 років зміни мікрофлори товстої кишки зумовлені зниженням кількісного та якісного складу як анаеробних, так і аеробних представників. Порушення складу анаеробної флори проявлялися у дефіциті біфідо- та лактобактерій порівняно з показниками групи здорових дітей. Разом з тим дітей, хворих на ГРВІ на фоні аденоїдних вегетацій та хронічного аденоїдиту зміни мікробіоценозу товстої кишки були достовірно (Р < 0,001) значнішими, на відміну від даних дітей групи контролю. Також установлено достовірне збільшення умовно-патогенної мікрофлори товстої кишки у хворих на гострі респіраторні вірусні інфекції на фоні аденоїдних вегетацій (Р < 0,01) та у хворих на ГРВІ із супутнім хронічним аденоїдитом (Р < 0,001).