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Reverse decoupling: Ukrainian case of healthcare financing system reform

Veronika Vakulenko (Nord University Business School, Bodø, Norway)
Anatoli Bourmistrov (Nord University Business School, Bodø, Norway)
Giuseppe Grossi (Nord University Business School, Bodø, Norway)

International Journal of Public Sector Management

ISSN: 0951-3558

Article publication date: 23 April 2020

Issue publication date: 22 June 2020




The purpose of this paper is to explore inter-organizational interactions that might result in prolonged decoupling between central governments' ideas and local governments' practices during the reform of an institutional field (i.e. healthcare).


The paper is based on a qualitative study of the centrally directed reform of the healthcare financing system in Ukraine and focusses on practices and reform ideas from 1991 to 2016.


The findings show that, for more than 25 years, local governments, as providers of healthcare services, faced two major problems associated with drawbacks of the healthcare financial system: line-item budgeting and fragmentation of healthcare funds. Over 25 years, central government's attempts to reform the healthcare financing system did not comprehensively or systematically address the stated problems. The reformers' ideas seemed to focus on creating reform agendas and issuing new laws, instead of paying attention to challenges in local practices.

Practical implications

This article has two main points that are relevant for practitioners. First, it calls for greater involvement from local actors during all stages of public sector reforms, in order to ensure the relevance of developed reform strategies. Second, it points to potential challenges that central governments may face when conducting healthcare financing system reforms in transitional economies.


The paper's contribution is twofold: it outlines reasons for problematic implementation of healthcare financing system reform in Ukraine and explains them through a “reverse decoupling” concept.



We would like to thank to anonymous reviewers, whose comments helped us to improve the manuscript. We also would like to thank Massimo Sargiacomo for his valuable insights and suggestions from other participants to the earlier draft of the paper presented during the international workshop “Modernization, Westernization, and Democratization of Public Financial Management” in Kyiv, Ukraine, 2018.


Vakulenko, V., Bourmistrov, A. and Grossi, G. (2020), "Reverse decoupling: Ukrainian case of healthcare financing system reform", International Journal of Public Sector Management, Vol. 33 No. 5, pp. 519-534.



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