Introduction
The full-scale war, combined with the continued reform of Ukraine’s healthcare system, has radically changed the conditions in which both civilian and agency-run medical institutions operate. Problems that once appeared local or limited to a particular agency are increasingly systemic. Staff shortages, uneven infrastructure and equipment, duplicated functions, growing demand for rehabilitation and mental healthcare, complex pathways for wounded service members and veterans, and the need to keep hospitals operational amid wartime threats all require a fundamental rethink of how medical care is organized.
Recent experience shows that the system cannot develop simply by increasing funding for individual facilities or restoring pre-war infrastructure in its previous form. Ukraine needs a model that uses existing resources more efficiently, avoids unjustified duplication, concentrates high-technology capabilities, and provides patients with a continuous pathway across different levels and systems of care.
1. Systemic Challenges for Civilian and Agency-Run Healthcare
Staff shortages have become one of the most acute challenges. Some medical professionals have been mobilized, while others have relocated, changed jobs, or left Ukraine. Demand remains greatest for specialists who are critical in wartime: anesthesiologists, surgeons, rehabilitation physicians, psychiatrists, physical and occupational therapists, and nursing staff. In agency-run healthcare, the problem is compounded by different institutions competing for the same limited pool of doctors and, especially, nurses.
Another problem is the fragmentation of medical infrastructure. Municipal facilities operate alongside the medical systems of the Ministry of Internal Affairs, the Ministry of Defence, the State Border Guard Service, the State Emergency Service, institutions of the National Academy of Medical Sciences, and other organizations such as Ukroboronprom. Each has its own governance mechanisms, staffing policies, assets, and procurement processes. Without sufficient coordination, this leads to duplicated functions and does not always ensure the optimal use of expensive equipment.
In practice, institutions may each seek to build their own diagnostic or laboratory capacity and purchase CT and MRI scanners, angiography systems, or other complex equipment even when comparable resources already exist nearby and could be shared. This approach increases capital and operating costs without necessarily making care more accessible or improving its quality.
The war has added another dimension to these problems: the physical vulnerability of hospitals. Medical infrastructure must remain operational during attacks, power outages, mass-casualty events, and logistics disruptions. Shelters, backup power, independent water supplies, oxygen, communications, medicine stocks, and evacuation routes are therefore not only security considerations; they are also essential to quality management and continuity of care.
2. How Wartime Has Changed Medical Needs
The most visible change has been the sharp increase in demand for rehabilitation. Patients with amputations, blast injuries, traumatic brain and spinal injuries, and polytrauma need long-term, continuous support. Rehabilitation cannot be treated as a separate stage that begins only after medical treatment ends. It should start as early as possible and be linked to prosthetics, psychological support, social adaptation, and a person’s return to active life.
Mental health has become equally important. Psychological and psychiatric care for service members, veterans, security-sector personnel, and their families should be integrated into the overall treatment pathway. A system that treats physical trauma separately from the psychological consequences of war does not reflect patients’ actual needs.
The pathway from injury to a person’s return to civilian life requires particular attention. A patient may begin treatment in the military system, continue it in an agency-run or civilian facility, and then move on to rehabilitation, prosthetics, psychiatric care, and primary care. Different institutional affiliations and funding sources create a risk of breaks along this pathway. The central task, therefore, is not merely to make individual services available, but to organize them as one coherent sequence of care.
3. Why Simply Preserving or Reducing the Network Will Not Solve the Problem
Discussion about the future hospital network often focuses on which facilities should remain, which should be consolidated, and which should be reduced. That approach is insufficient during war and post-war recovery. The essential question is different: what function should each institution perform, and how should its potential be used within the wider system?
The starting point should therefore be functional specialization. Before management decisions are made, institutions should be assessed in terms of workforce capacity, actual scope of work, utilization, available equipment, clinical outcomes, financial efficiency, geographic location, logistics, and development potential. On this basis, individual facilities can specialize in advanced diagnostics, surgery, rehabilitation, mental health, education, or other areas in which they have genuine strengths.
This approach makes it possible to move from a model in which every hospital is expected to provide everything to one based on shared resources. The economic benefit would come less from reducing the number of facilities than from limiting duplication, improving equipment utilization, concentrating specialists, and clearly dividing functions.
4. Agency-Run Healthcare: Preserving Capacity Through Integration
Agency-run healthcare remains an important part of the health system, especially during wartime. Its role is to provide medical support for active personnel, the wounded, veterans, and, in certain cases, their family members. At the same time, limited staffing and financial resources make it inefficient for every system to reproduce a complete set of highly specialized functions in parallel.
This is not about dismantling agency-run healthcare or removing the organizational autonomy required for special missions. That model has demonstrated capacity, effectiveness, rapid response, and manageability through its close connection to the security and defence forces. A more promising approach is functional integration with civilian and academic medicine in areas where it improves quality, accessibility, cost-effectiveness, and continuity of care. Core agency capabilities can be preserved, while high-technology resources, education, rehabilitation, and diagnostics can be shared and developed in line with modern requirements.
5. Lukianivka Medical Campus as a Pilot Model
In this context, the Lukianivka Medical Campus should be understood not as another large hospital project, but as a new model of cooperation. It could serve as an integrated multidisciplinary platform for medicine, rehabilitation, education, and research, combining the strengths of security-sector institutions, agency-run healthcare, Kyiv’s municipal health system, and, where possible, academic institutions.
Potential participants include the Ministry of Internal Affairs, the State Border Guard Service, the State Emergency Service, selected medical institutions in Kyiv, and institutions of the National Academy of Medical Sciences of Ukraine. For Ministry of Defence facilities, the priority should be clinical cooperation, patient routing, and the option to share certain resources without requiring administrative consolidation.
The campus’s practical value lies in its ability to test interagency coordination in a defined location and across a specific set of medical services. It would create the conditions for concentrating advanced diagnostics and developing modern rehabilitation, mental healthcare, high-technology surgery, centralized laboratory and sterilization processes, telemedicine, and other resource-intensive services.
6. Education, Workforce Development, and Innovation
A further advantage of the integrated model is the opportunity to connect clinical practice with workforce training. A strong medical cluster can function simultaneously as an education and simulation center, support continuing professional development and workforce succession, and introduce modern medical technologies.
For security-sector medicine, particularly relevant fields include tactical medicine, trauma care, emergency medicine, infection control, rehabilitation, psychological support, and healthcare management. In this model, training is directly connected to clinical needs, allowing new approaches to move more quickly from professional education into practice.
7. Governance and Financing
Implementing the concept requires a clearly defined governance model. Options include a single legal entity, a consortium, a network of institutions, an interagency cluster, or a coordinating body. The choice should be based not on formal convenience, but on the model’s ability to coordinate resources in practice, ensure transparent accountability, and support joint planning.
The financing system also requires careful design. Potential sources include the state budget, the Medical Guarantees Programme administered through the National Health Service of Ukraine, agency and local budgets, international assistance, and investment projects. The financing model must not create new barriers between patients and the services they need or reproduce existing fragmentation at the payment level. In our view, attracting investment will be the main source of funding during the initial stage.
8. From Crisis Management Experience to Long-Term Transformation
The integrated medical cluster should be seen as a logical conclusion drawn from the experience of the MIA medical system and other agency-run institutions during two major crises: the COVID-19 pandemic and the full-scale war. Both periods demonstrated the system’s ability to mobilize resources in emergencies, but they also exposed the structural limitations of fragmented governance, insufficient coordination, and dependence on the staffing and material reserves of individual institutions.
The future model should therefore be built not only around crisis response, but around a resilient system capable of operating over the long term. It should integrate treatment, diagnostics, rehabilitation, mental health, education, research, resource management, and secure infrastructure.
Conclusions
The main challenge facing Ukrainian healthcare today is not only a shortage of funding or damaged infrastructure. It also lies in the fragmented use of existing resources and inadequate coordination among different systems. Under these conditions, mechanically preserving the pre-war network or formally reducing it will not deliver the necessary result.
A promising way forward is to develop integrated medical clusters in which institutions retain their strengths while working within a shared framework for patient routing, functional specialization, and resource use. The Lukianivka Medical Campus could become a pilot for this approach in Kyiv and a practical testing ground for solutions that could later be applied in other regions of Ukraine.
The guiding principle of this transformation should be neither mechanical consolidation nor the dismantling of agency-run healthcare, but its functional integration with the civilian system wherever that produces better outcomes for patients. Patients, continuity of treatment and rehabilitation, quality of care, and efficient use of resources should be the central criteria for future management decisions.