title: Patient and provider perspectives on quality and health system effectiveness in a transition economy: evidence from Ukraine.
abstract: Facing a severe population health crisis due to noncommunicable diseases, Ukraine and other former Soviet republics and Eastern European countries have a pressing need for more effective health systems. Policies to enhance health system effectiveness should consider the perspectives of different stakeholder groups, including providers as well as patients. In addition, policies that directly target the quality of clinical care should be based on objective performance measures. In 2009 and 2010 we conducted a coordinated series of household and facility-level surveys to capture the perspectives of Ukrainian household members, outpatient clinic patients, and physicians regarding the country's health system overall, as well as the quality, access, and affordability of health care. We objectively measured the quality of care for heart failure and chronic obstructive pulmonary disease using CPV(®) vignettes. There was broad agreement among household respondents (79%) and physicians (95%) that Ukraine's health system should be reformed. CPV(®) results indicate that the quality of care for common noncommunicable diseases is poor in all regions of the country and in hospitals as well as polyclinics. However, perspectives about the quality of care differ, with household respondents seeing quality as a serious concern, clinic patients having more positive perceptions, and physicians not viewing quality as a reform priority. All stakeholder groups viewed affordability as a problem. These findings have several implications for policies to enhance health system effectiveness. The shared desire for health system reform among all stakeholder groups provides a basis for action in Ukraine. Improving quality, strengthening primary care, and enhancing affordability should be major goals of new health policies. Policies to improve quality directly, such as pay-for-performance, would be mutually reinforcing with purchasing reforms such as transparent payment mechanisms. Such policies would align the incentives of physicians with the desires of the population they serve.
authors.affiliation: College of Public Health and Human Sciences, 401 Waldo Hall, Oregon State University, Corvallis, OR 97331, USA. Electronic address: jeff.luck@oregonstate.edu.
authors.forename: J
authors.initials: J
authors.lastname: Luck
authors.affiliation: QURE Healthcare, 1000 Fourth Street, Suite 300, San Rafael, CA 94901, USA; Global Health Sciences, University of California, San Francisco, 50 Beale Street, San Francisco, CA 94105, USA.
authors.forename: J W
authors.initials: JW
authors.lastname: Peabody
authors.affiliation: QURE Healthcare, 1000 Fourth Street, Suite 300, San Rafael, CA 94901, USA; Global Health Sciences, University of California, San Francisco, 50 Beale Street, San Francisco, CA 94105, USA.
authors.forename: L M
authors.initials: LM
authors.lastname: DeMaria
authors.affiliation: College of Public Health and Human Sciences, 401 Waldo Hall, Oregon State University, Corvallis, OR 97331, USA.
authors.forename: C S
authors.initials: CS
authors.lastname: Alvarado
authors.affiliation: Room 410, 50 Mirambo Street, P. O. Box 2054, Dar Es Salaam, Tanzania.
authors.forename: R
authors.initials: R
authors.lastname: Menon
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D001294:Attitude to Health; D003695:Delivery of Health Care / Q000191:economics* / Q000458:organization & administration*; D004467:Economics; D005260:Female; D018166:Health Care Reform; D006282:Health Personnel / Q000523:psychology*; D006291:Health Policy; D006292:Health Priorities; D006297:Health Services Accessibility / Q000191:economics*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D011787:Quality of Health Care; D014455:Ukraine
keywords: Eastern Europe; Health care delivery; Health policy; Health system effectiveness; Noncommunicable disease; Primary care; Quality of care; Ukraine