Foreign experience of state regulation of medical services for the rural population (example of EU countries, Canada, Poland, Lithuania)

Abstract

The article considers the acute and multifaceted problem of ensuring equal access to quality medical services for the rural population, which is a fundamental principle of a modern welfare state. For Ukraine, this problem is of particular relevance due to the protracted demographic crisis, intensive labor migration, chronic underfunding of the industry and unprecedented destruction of medical infrastructure as a result of the full-scale military aggression of the Russian Federation. In this context, ensuring the health of the rural population becomes not only a matter of social justice, but also a critically important factor in national security and the state's ability to recover after the war.

The study is based on a detailed comparative analysis of foreign experience in state regulation of medical services in the countries of the European Union, Canada, Poland and Lithuania. It is determined that, despite differences in financing and administration models, effective rural health systems are based on universal principles of solidarity, universality and accessibility, with a particular emphasis on strengthening primary health care (PHC) as a central link.

Various instruments aimed at overcoming challenges, in particular the shortage of personnel in rural areas, are analyzed. These include strong financial incentives (student loan forgiveness programs, job placement and maintenance bonuses, preferential mortgages in Canada, additional coefficients to capitation rates in Poland and Lithuania) and non-financial mechanisms (professional support, "locum" programs). The role of telemedicine as an innovative tool for expanding geographical access to specialized care is highlighted, as well as the importance of mobile medical teams and the empowerment of other health professionals, in particular nurses with extended powers. Particular attention is paid to the significant progress in the digitalization of healthcare (e-Health), which includes electronic prescriptions, referrals and national patient portals, which significantly simplify logistics and increase the transparency of the system. Based on the generalization of best practices, comprehensive recommendations for Ukraine are formulated. They include further strengthening the institution of the family doctor by improving payment mechanisms taking into account geographical and demographic characteristics; developing a long-term state program "Doctor for the Village"; large-scale and systematic implementation of telemedicine with appropriate infrastructure and regulatory support; creating a national network of mobile medical teams; and expanding the powers and role of nurses/paramedics in rural areas. In conclusion, the article emphasizes that success does not lie in copying one model, but in building one's own adapted system based on universal principles of solidarity, the priority of the primary care, strong state support for human resources, deep integration of technologies and readiness for structural reforms. This is a key roadmap for Ukraine in the post-war period.