A Conceptual Approach to Organizational and Infrastructural Modeling of Telemedicine Services Delivery in Ukraine

Abstract

Purpose. The main purpose of the study was to develop a conceptual approach to organizational and infrastructure modeling of telemedicine services in Ukraine.

Methods. The study was based on a comparative analysis of international practices (WHO, NHS, CMS, OECD, OTN) and the application of financial investment assessment methods. DCF, NPV, IRR and break-even point analysis were used. Calculations were carried out over a 10-year horizon with discount rates of 5–15%, different implementation levels (20%, 50%, 80%) and tariff formation scenarios. Additionally, information flows, financial mechanisms and organizational structures were modeled for each of the concepts.

Results. The comparative analysis showed that the centralized model provides high manageability and rapid scaling in crisis conditions, but requires significant initial investments and is characterized by the risk of single-point failure. The decentralized model creates more opportunities for regional adaptation and sustainability, but has higher operational costs and difficulties with interoperability. The most promising model was a hybrid model that combines a centralized core (single registries, data protection) with regional hubs. It demonstrates a positive NPV from the fifth year of implementation and an IRR of over 12% in a scenario of 50% population coverage. Economic analysis showed that telemedicine can reduce direct costs for chronic patients by 10–25%, reduce the level of hospitalizations by 20% and increase labor productivity by reducing transport and time costs. Under the scenario of average coverage of 50% of the population, the integral economic effect is estimated at 1–1.5% of GDP annually.

Scientific novelty. For the first time in the Ukrainian scientific field, a systematic typology of organizational models of telemedicine with an assessment of their economic efficiency based on financial and investment analysis is presented. An instrumentalized hybrid model adapted to the conditions of martial law and post-war recovery is proposed, which takes into account digital, regulatory, infrastructure and personnel limitations.

Conclusions. Telemedicine in Ukraine is an innovative tool that contributes to reducing costs, increasing productivity and social sustainability. The optimal strategic solution is a hybrid model that combines centralized management with regional flexibility and is consistent with the European vector of healthcare digitalization.