Platform-based Mechanisms of Public Governance in Medical Rehabilitation: Conceptual Foundations and Institutional Prerequisites

Abstract

This article provides a theoretical justification for the conceptual foundations and institutional prerequisites of platform mechanisms in public governance of medical rehabilitation in Ukraine. The research urgency stems from a critical gap between the rehabilitation needs of over 400,000 individuals and the capacity of a system comprising 1,247 contracted providers with a budget of 6 billion hryvnias to deliver coordinated care. The core problem lies in the absence of mechanisms capable of integrating autonomous providers of various ownership forms without their administrative subordination to a single governing body. This challenge reflects a deeper theoretical tension in public health governance, where classical hierarchical models prove inadequate when the system simultaneously encompasses state institutions under different ministries, private clinics with distinct business models, volunteer initiatives with grant-based funding, and international programmes with their own reporting procedures.
The research methodology employs comparative policy analysis across six countries (Germany, France, Estonia, Israel, the United Kingdom, and the United States) combined with institutional analysis of the Ukrainian healthcare system. The theoretical framework draws upon the World Bank’s Digital-in-Health concept of healthcare system digital maturity and the OECD’s Government as a Platform theory of platform governance. The empirical base comprises normative documents and analytical reports from international organisations, official regulatory reporting, and peer-reviewed publications presenting clinical research findings on digital rehabilitation solutions.
International experience with platform solutions has been systematically analysed: the German DiGA model established a market for digital therapeutics with state reimbursement
(€234 million in 2024); the French PECAN extended this mechanism to telemonitoring; the Israeli Sheba Beyond implemented a virtual hospital concept; and the Estonian X-Road ensured cross-sectoral interoperability. The architectural principles of successful platforms have been identified: openness of standards, modularity, patient engagement as co-creators, and interoperability between medical and social sectors.
The institutional capacity of the Ukrainian system has been analysed, identifying three coordination mechanisms: semantic (ICF as a unified rehabilitation language), financial (differentiated NHSU tariffs), and technological (eHealth API). It has been established that the effectiveness of platform coordination is determined by the synergy of these mechanisms rather than their individual functioning. The study identified structural barriers: a cross-sectoral gap between medical and social systems, administrative burden on clinicians, digital inequality, and infrastructure vulnerability to wartime conditions. The Ukrainian experience demonstrates the possibility of rapid platform infrastructure development under emergency pressure, though its sustainability depends upon the capacity to transform ad hoc solutions into systematic mechanisms with an appropriate balance between implementation speed and integration quality.
Practical recommendations have been formulated: development of a national reimbursement programme for digital rehabilitation solutions modelled on DiGA, automation of data exchange between eHealth and Ministry of Social Policy databases, implementation of tools to reduce administrative burden, and strengthening the energy autonomy of digital infrastructure.