Transformation of Inpatient Healthcare Under Financing Reform, Pandemic, and Martial Law: A Case Study of Hospitals in Zhytomyr Region (2014–2024)

Purpose: to analyze the dynamics of hospital bed capacity, inpatient care volumes, and staffing in Zhytomyr region hospitals during 2014–2024 to assess the impact of healthcare financing reform, COVID-19 pandemic, and martial law on the regional inpatient care system functioning. Materials and methods. A retrospective descriptive-analytical study was conducted using official statistical data from Zhytomyr Regional Medical Statistics Center for 2014–2024. Annual reporting forms No. 20 data were analyzed regarding staff positions, bed capacity, discharged and deceased patients, and average length of stay. Systems analysis, time series analysis, comparative and structural analysis methods were applied. Statistical processing included growth rate calculations, linear and segmented regression. Results. Total staff positions decreased by 22.3% (from 25,071.75 to 19,474), with the greatest reduction among junior medical staff (–32.3%). Bed capacity decreased by 13.8% (from 9,180 to 7,912), but increased by 10.9% in 2023–2024. After a 35.0% drop in 2020, treated patients reached a record 319,644 in 2024, exceeding pre-war 2019 levels by 18.1%. Average length of stay decreased from 10.3 to 7.6 days (–26.2%). Bed turnover increased from 31.8 to 40.4 (+27.0%), reaching maximum values. Physician workload increased from 57.7 to 69.7 patients (+20.8%). Conclusions. The inpatient care transformation in Zhytomyr region demonstrated successful adaptation to multiple crises. Implementation of per-patient payment catalyzed resource utilization efficiency, compensating for pandemic and war impacts while achieving record productivity. Despite reduced resources, the system showed high adaptive capacity, ensuring increased healthcare accessibility. Critical challenges include increased staff workload requiring compensatory mechanisms for long-term sustainability.