Historical stages of rural medicine evolutionin Ukraine: from soviet modernization to transformations of the early 21st century (1953–2014)
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Abstract
The aim of the article is to provide a comprehensive study of the historical evolution of rural medicine in
Ukraine from 1953 to 2014. It involves identifying and scientifically substantiating the key stages in the transformation of the medical network, as well as assessing the impact of state policy on the quality of healthcare for rural populations.
The scientific novelty. The study identifies and substantiates the key stages in the transformation of rural medicine in
Ukraine between 1953 and 2014. It is proven that the “optimization” of the medical network during the period of independence was not an autonomous phenomenon but a direct consequence of the exhaustion of the resource potential of the centralized model of the 1970s–1980s. A pattern has been identified wherein the reduction of rural social infrastructure led to the deepening of the demographic crisis and the outflow of labor potential from the agricultural sector. Furthermore, a discrepancy has been established between the regulatory framework of the industry and the actual level of public access to medical care.
Conclusions. As a result of the research, a historical periodization has been developed, allowing for the identification
of three key stages in the transformation of rural medicine. The first stage (1950s–1960s) was marked by the development of the sector, which ensured basic territorial access to medical care for rural residents. The second stage (1970s–1980s) was characterized by a transition to intensive centralization around district hospitals, which led to a technological decline in the primary care level and a functional gap in service quality between the center and the periphery. The third stage (1990s–2014) is characterized by institutional degradation and a transition to a model of forced patient self-reliance. A key factor of this period was the administrative “optimization” of the early 21st century, which, by ignoring geographical specifics and the state of infrastructure, led to the creation of areas with limited access to medical services. It is substantiated that territorial remoteness became a decisive barrier to the realization of the constitutional rights of rural residents; this factor de facto entrenched social inequality between urban and rural areas and created prerequisites for the deepening of the demographic crisis in Ukraine.
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