Digital transformation of Ukraine's health care system: development prospects and economic effectiveness of telemedicine

The article substantiates a systemic approach to the digital transformation of Ukraine's health care system as a process of institutional restructuring that integrates regulatory frameworks, the development of eHealth, the digitalization of managerial and clinical processes, telemedicine, and the establishment of a modern health data governance system. It is demonstrated that, amid the full-scale war, damage to medical infrastructure, territorial inequalities, restricted population mobility, and shortages of human and financial resources, digital technologies acquire not only a service-oriented but also an infrastructural and stabilizing role by ensuring continuity of health care, access to specialized expertise, and more efficient use of resources. Based on a structured analytical examination of 42 international and national regulatory, institutional, and scientific sources, five functional dimensions of the digital transformation of Ukraine's health care system are systematized: regulatory, infrastructural, crisis-related, economic, and data-related. The conceptual understanding of telemedicine is reconsidered as a component of an integrated digital patient pathway rather than as a separate channel of remote communication, implying its interconnection with electronic health records, referrals, prescriptions, information systems, financing mechanisms, and management data. In addition, the main areas of practical application of telemedicine in Ukraine are identified: expanding access to health care, maintaining continuity of care under wartime and territorial constraints, and providing remote expert support for trauma care, vulnerable groups, and distributed professional networks. Accordingly, a minimum analytical framework for assessing the economic efficiency of telemedicine models is proposed, encompassing direct system costs, health care facility costs, patient costs, clinical outcomes, the time horizon, the comparator, and the analytical perspective. It is substantiated that the economic outcomes of telemedicine are determined not by the mere fact that a service is delivered digitally, but by a combination of implementation conditions, including the disease area, regional context, scale, financing model, integration with eHealth, organizational costs, data quality, and actual clinical outcomes achieved. Key systemic constraints on the scaling of telemedicine are also identified.