Publications Health-care reform in Ukraine: myths and realities

On November 30, 2016, the Cabinet of Ministers of Ukraine approved the Concept of Health Care Financing Reform.

The adoption of this document marks the beginning of a new era in Ukrainian medicine.

On 10 May 2017, the Cabinet of Ministers of Ukraine approved and sent to the Verkhovna Rada of Ukraine for adoption a draft law on State financial guarantees for the provision of medical services and medicines.

Almost immediately rumours emerged that medicine in Ukraine would become expensive and less accessible to ordinary citizens.

The Ministry of Health stated the opposite - Ukrainian medicine after the reform will reach a completely new European level in the quality of the medical services provided, and the poor will have full access to the health system.

Given the controversy on this issue, we will try to understand what medical reform is and try to answer the question of how the reform will affect the quality of the health services provided, their cost and the cost of medicines.

The cornerstone of medical reform is the gradual shift to insurance-based financing of medicine. In other words, the funds will not flow to the hospitals according to the standards of the Ministry of Health and the quantitative indicators of the hospital infrastructure and its personnel, but to the payment of a certain package of medical services. Such an approach would allow for the distribution of disease risks and treatment costs among a large number of insured persons.

The main source of funding for the new health-care system will continue to be the State budget of Ukraine, which is derived from State taxes. At the same time, payments for the treatment of an individual will not be tied to the amount of his or her individual contributions.

It is important to note that the payment of individual medical services will be partly covered by the State budget of Ukraine and partly by patients who will be able to pay for medical services directly at the hospital.

The new health system will give preference to primary and outpatient care. In-patient (in-patient) medical care will be kept to the minimum possible.

The funds transferred to health-care institutions will be used to pay for specific, available health-care services and will be distributed in accordance with the decisions of the head of the hospital. That is, the financial flow will be more flexible and it will be possible to use the surplus money to develop the functionality of hospitals. In this way, health facility managers will have more management tools and possibly incentives to use money rationally and efficiently.

With regard to medicines, it is planned to approve a list of medicines, at the purchase of which the State will partially compensate the purchasers.

The implementation of the Concept will take place in three phases: the preparatory phase (2017), the implementation phase (2018 - 2019) and the integration phase (2020).

It should be noted, however, that the draft Act on State financial guarantees for the provision of medical services and medicines already states that the State will fully compensate citizens for the cost of only those medical services, which are directly listed in the State guaranteed package (emergency, primary, palliative care). The partially paid services will be consultations of Laura, endocrinologist, neurologist, surgeon, orthopedic (traumatologist). In-patient treatment (in-patient treatment) will also be partially paid for by patients. The rates and prices are not yet officially approved.

The cost of medicines will be reimbursed only in exceptional cases according to a detailed medical prescription.

In addition to the above, patients may have to provide the doctor with reliable information and a certain package of documents on the disease in order to properly cover the insurance case and to pay funds for treatment from the state budget.

Thus, medical reform in Ukraine was aimed at the gradual development of medicine and health care, but, given the poverty of the population and the corruption of hospital management, the new system could have negative consequences. Insurance medicine does not guarantee that money will be spent efficiently, so close monitoring by law enforcement agencies of the distribution of funds and the pricing of medical services is necessary. 

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