CONCEPTUAL ORGANIZATIONAL AND FINANCIAL SUBSTANTIATION OF THE MODEL OF A REGIONAL CENTER FOR RECONSTRUCTIVE ORTHOPEDIC AND TRAUMA CARE FOR LARGE JOINT DISEASES IN UKRAINE

Abstract

Study goal. To develop and scientifically substantiate a conceptual organizational and financial model of a regional center for reconstructive orthopedic and trauma care for large joint diseases in Ukraine, taking into account current financial support mechanisms within the framework of the Medical Guarantees Program (MGP). Materials and methods. The study is organizational and economic, employing methods of structural-functional analysis and counterfactual scenario modeling. The information base comprised the actual financial performance indicators of the specialized large joint replacement department of the Municipal Non-Commercial Enterprise (MNE) “Uzhhorod City Multidisciplinary Clinical Hospital” for 2025: surgical activity volumes, revenues from the National Health Service of Ukraine (NHSU) and paid medical services, and internal cost calculation of the service. The specialized department was considered as a conditional autonomous institution with its own contract with the NHSU. Results. In 2025, the department provided 832 completed large joint replacement services: 488 under the MGP (revenue of UAH 9.269 million under the DRG) and 344 from individuals (UAH 11.825 million). Considering the calculated global budget rate of the NHSU (UAH 4.171 million, CMU Resolution No. 1503), the total calculated revenue of the conditional Center amounted to UAH 25.265 million. The optimal staffing structure of the Center with maximum outsourcing of auxiliary functions comprises 29 full-time positions; private entrepreneurs (PEs) with Unified Social Contribution (USC) accruals – UAH 11.858 million/year. Direct costs for service provision (excluding the cost of endoprostheses) – UAH 13.520 million/year. The total deficit of the model at 832 operations is only UAH 113,000 (0.4% of costs); the break-even point is 999 operations per year. Conclusions. The conceptual organizational and financial model of an autonomous regional center for large joint replacement, built on the principles of mono-specialization and maximum outsourcing, is financially realistic under the current MGP. Operational self-sufficiency is achieved with a minimal increase in service volume (+20%). Long-term financial sustainability requires income diversification, optimization of the case mix structure, and attraction of external investment resources for capital development.