| Abstract [eng] |
The challenges of the COVID-19 pandemic have revealed the most vulnerable links of state systems and inability to respond and adapt to large-scale significant events. Responding to a crisis of this magnitude requires both a robust public health response and a resilient healthcare system. Although many decisions have been made during the coronavirus pandemic that affects the health system and its performance, there is a lack of analysis summarizing how the health system has changed and whether it has become more resilient. This study aimed to find out the impact of the COVID-19 pandemic on the change and resilience of the healthcare system. The study draws on punctuated equilibrium theory and theory of change and contribution analysis to map the mechanisms of health system change that occurred during the COVID-19 pandemic. Based on these theories, two possible paths of change have been established and two hypotheses have been put forward. H1: the COVID-19 pandemic has had the greatest impact on change in those areas of the healthcare system, which have been the focus of the media, society, and politicians the most. H2: the change in the healthcare system that occurred during the COVID-19 pandemic is based on the goals and outcomes set in the pandemic management strategies. By applying the process tracing method, analyzing primary and secondary sources, and using information obtained during semi-structured interviews, it was found out what decisions and changes were implemented during the pandemic and how the COVID-19 pandemic contributed to this. Change in healthcare system is categorized according to the WHO’s key elements of resilience (governance and leadership, information, medical staff, medical facilities, financing and service delivery). The study showed that the pandemic opened a window of opportunity for changes in the healthcare system. During the COVID-19 pandemic in Lithuania, many operational decisions were made that allowed to ensure the needs to control the outbreak of infectious disease. When assessing fundamental changes in the health care system, two main decisions was made: reorganization of public health institutions and decision regarding the reform of the personal healthcare network. However, not all decisions affected the health system's preparedness for future threats. The greatest progress in increasing resilience to future threats has been made in the fields of information and medical products. The analysis of attention mobilization showed that the greatest attention during the pandemic was directed to the problems of service availability, the problems of shortage of doctors and medical personnel. Taking into account the areas where the greatest change occurred, it can be concluded that hypothesis 1 was partially confirmed. The testing of hypothesis 2 showed that the two strategies drawn up for the management of the COVID-19 pandemic were implemented inconsistently, the measures provided for and implemented in them allowed to control of the epidemiological situation at that time but did not have a significant impact on the main changes; hypothesis 2 was partially confirmed. However, the first path of change still had a greater influence on the changes in the healthcare system. This research has contributed to the interpretation of public policy change through the theoretical foundations of public policy analysis and the public policy process. The study made it possible to assess the impact of significant events on the public policy subsystem. Evaluating the change that took place during the pandemic and the factors that influenced the emergence of this change, it can be concluded that the main path of change can be considered the mobilization of attention because both fundamental changes and the adoption of other significant decisions corresponded to the main points of attention. |
