Throughout the years, healthcare system remained one of the least reformed in Ukraine. Quality of healthcare was going down and the system was mired in corruption and unofficial payments. Ukrainians often complain about costs of healthcare services and medicines. As a result, the necessity of healthcare reform was clear, but there was no agreement on the best path forward.
In 2014, the Strategic Advisory Group under the support of the Soros’s Foundation prepared the Strategy of Healthcare Reform for 2015-2020. The Strategy was not officially approved by the Government, but it was considered by the Ministry of Health while drafting legislation on healthcare reform. After long debates, the laws launching the healthcare reform were approved in 2017, with first changes starting in 2018.
The approved legislation changes healthcare delivery and the financing principles. The health facilities will receive greater autonomy after they change their legal status from budget entities to municipal non-commercial companies. The timing of this change will depend on decisions of local authorities. Heads of health facilities will have higher independence in the allocation of funding as well as in setting personnel policies.
According to the reform, the structure of the healthcare delivery will change with more care provided at the primary level. The primary level doctor will be responsible for the preventive measures as well as early diagnostics, which is expected to ensure better health of the population. The reform will launch at the primary level of the healthcare system in 2018, while the changes at the secondary level are to be started in 2019.
The essential element of the healthcare reform relates to the financing of healthcare. The Government will move from financing the health infrastructure to financing the healthcare provided. The allocation of financing will be also changed. Currently, the health facilities are financed by the local authorities but most of the funds come from centrally distributed medical subvention. However, going forward, the National Health Service of Ukraine (NHSU) will contract with health facilities for healthcare delivery and will be paying for the services provided. The Cabinet of Ministers approved the decision to establish the NHSU in December 2017 and announced a search for the NHSU chief at the beginning of February 2018.
Since April 2018, individuals will receive a right to select own primary level doctor (either family doctor or therapist/pediatrician). The doctors of primary care will receive financing based on a number of persons in their care, which is expected to raise the level of their remuneration and increase the quality of care provided. The primary health facilities are to receive financing from the NHSU starting in the second half of the year. According to the Ministry of Health, per capita payment in the second half of the year will be set at UAH 370 (payment per year). It is yet to become clear which costs are to be covered by the tariff. According to the Ministry, the local budgets will be responsible for utility payments as well as the purchase of required equipment.
The financing of the secondary and tertiary level of health facilities are to be changed later. The financing is to be defined based on the diagnostic related groups (DRG). Currently, the Ministry of Healthcare is collecting information from pilot health facilities at the secondary level, which would include data on the actually provided health care as current data is not always accurate. This would allow to define DRG and set the tariffs for care provided.
The shift towards a new approach of financing healthcare requires also the introduction of an electronic system of healthcare data, eHealth. It was launched in 2017 and will be further developed over the next several years. Currently, it focuses on the primary healthcare. The primary level doctors will have to register their patients within a system. In the future, the eHealth will contain all health information on each individual, which is expected to increase the quality of treatment prescribed to the patient. The system will also increase the transparency of financing health facilities as it would register the patient visits to doctors.
Since 2020, the Verkhovna Rada will set a state-funded guaranteed minimum healthcare package as a part of the budget process. It would certainly cover primary healthcare (including several necessary tests, vaccination) and emergency care. The care at the secondary level will be covered by the budget financing only if a patient was directed to the respective medical specialists by his/her primary level doctor. The guaranteed minimum package will not only include costs of the healthcare delivered but also cover the costs of prescribed medicines. Since 2017, the Government has already launched the program “Accessible Medicines”, which reimburses (in full or in part) costs for the essential medicines in case of such diseases as cardiovascular diseases, bronchial asthma, and type II diabetes.
The plans for the healthcare reform are very inspiring. However, there are many risks to the reform implementation. The actual implementation of the reform depends largely on the will and support of the reform by local authorities and heads of health facilities. In particular, the decision on the autonomization of health facilities depends on them. The local authorities should also be fiscally responsible and allocate more financing for healthcare. Another risk relates to the possible delays in the creation of the NHSU, which would become a major player in the reformed healthcare system in Ukraine. Besides, the clear anti-corruption procedures must be included in the system as the NHSU will be a key spending unit in the healthcare system.
Source: Monthly Economic Monitor Ukraine, No.2 (208), February 2018, Institute for Economic Research and Policy Consulting