The healthcare system transformation is everybody’s business. Its goal is to provide Ukrainians with equal access to quality medical services and make the results of the reform patient-oriented.
Upon completion of the reform, the healthcare system should be: efficient, accessible and focused on the needs of the people of Ukraine. The living standards and quality of life of people are expected to improve after healthcare services have become more accessible, qualitative and safe as a result of more productive medical personnel, which will have better social security due to enhanced and streamlined social support.
Healthcare system transformation
The Secondary (Specialised) Healthcare Guarantee Programme was launched on 01 April, 2020. The healthcare facilities which offer secondary (specialised) care are now operating under agreements with the National Health Insurance Fund.
As of September 2020, the National Health Insurance Fund had contracts with 3,095 healthcare providers who have been paid UAH 51.6 billion for rendering services to patients under the Healthcare Guarantee Programme. Including: UAH 13.3 billion paid to primary care facilities; UAH 29.7 billion - to secondary (specialised) care facilities; UAH 3.7 billion - to emergency care facilities. UAH 4.9 billion has been paid to medical facilities treating patients with known or suspected COVID-19 diagnosis.
The number of declarations signed by Ukrainians with their GPs has increased by 1.5 million from January to September 2020 — 30 million 610 thousand Ukrainians have already signed declarations with primary care physicians.
1,682 primary care providers have signed contracts with the Fund, including 1,102 municipal healthcare facilities, 206 private centres, and 374 self-employed doctors. As of 01 October 2020, there were 216 more primary care providers who signed a contract with the National Health Insurance Fund compared with the same period last year. 75% of them are private or self-employed doctors.
The number of primary care physicians has also increased since the beginning of the year by more than 800 persons.
Primary care currently plays an important role in fighting the pandemic. Physician workload has increased significantly as they mainly work with patients with suspected COVID-19 diagnosis. 1,051 mobile teams have been established in nearly 600 primary care facilities.
More than 290,000 patients received specialised priority services in the period from April to August 2020. This year’s Healthcare Guarantee Programme defines 5 top priority medical services:
acute stroke treatment;
myocardial infarction treatment;
care during pregnancy;
complex neonatal care;
imaging studies for early detection of cancer.
To date, healthcare institutions have received UAH 2.7 billion for the provision of priority services to patients.
The Healthcare Guarantee Programme also includes the Affordable Medicines Reimbursement Programme allowing patients to get prescription drugs for their cardiovascular conditions, type II diabetes and bronchial asthma free of charge or with a small co-payment. Patients can currently get 264 prescription drugs under this programme, including 85 free of charge. Patients can get medications in more than 8.5 thousand partner pharmacies across the country. 2.4 million patients participate in the Affordable Medicines Reimbursement Programme. UAH 686.6 million has been paid to the National Health Insurance Fund of Ukraine since the beginning of the year.
Raising healthcare worker pay
Healthcare worker pay has been increased since 01 September 2020, including +70% (UAH 3,561) of salary for doctors, +50% (UAH 2,362) for nurses, and +25% (UAH 1,181) for nursing assistants.
Promoting digital transformation in healthcare
24/7 availability and stability of eHealth has been ensured, SDLC Committee has been established for the proper management and development of the system functionality, and eHealth components roadmap has been created.
Healthcare provider administrative burden has been decreased (more than 25,000 primary care physicians, more than 113,000 medical specialists and more than 157,000 nurses). Electronic medical certification of births has been launched.
Healthcare personnel, education and research
Compensation of labour costs and salary paid by internship centres to first-year interns has been addressed.
Measures have been taken to pay the salaries to 3,510 first-year interns trained in 1,090 internship centres.
Mental health and tuberculosis services
Mental health and tuberculosis services in Ukraine were on the brink of closure due to significant funding shortages.
In June 2020, the Ministry of Health developed regulations to review medical service tariffs, support and prevent closure of healthcare facilities and dismissal of medical professionals. Healthcare facilities have been funded at least at the level of 2019 since 01 July.
Speaking about public anti-tuberculosis treatment, medical service packages will be priced at their cost and included in the 2021 Healthcare Guarantee Programme in 2020.
As to mental health care, the Ministry of Health is cooperating with experts to finalise and submit the draft plan of mental health care development in Ukraine to the Government for approval.
Why change anything?
Ukrainians live 9-year shorter lives than people in the EU — the average life expectancy at birth in Ukraine is 72 years as opposed to 81 years in the EU member states.
About 50% of patients after a stroke have primary disability, about 12% of deaths from stroke happen to people of working age.
Ukraine ranks first in Europe in terms of catastrophic health expenditure prevalence causing impoverishment of vulnerable households.
The share of pharmaceuticals and other medical supplies is 99% of a patient’s total expenditure for medications.
37.6% of hospital admissions in Ukraine are done without proper indications.
Ukraine is among the worst world’s performers in terms of child immunisation: e. g. polio vaccination coverage in 2018 was only 69%.
What does the reform include?
Healthcare funding reform, implementing new financial vehicles at the specialised and tertiary (outpatient and inpatient) care levels.
Public insurance against excessive expenditure.
Proper safeguarding healthcare service package which should be accessible for all people regardless of their gender, residence, level of wealth and other socio-demographic factors.
Improving logistic support, maintaining information and personnel resources of healthcare facilities at each healthcare level in line with international standards.
Using technological innovations in daily medical practice and ensuring access to cutting-edge treatments.
Goals and Objectives
The reform is currently being implemented in the following priority areas:
affordable and quality medications.
In each of these areas, steps are being taken to: ensure healthcare funding, increase medical personnel compensations, set efficient quality control of healthcare, develop and update the national industry standards and treatment protocols, perform state assessment of medical techniques, create the competitive environment for healthcare facilities, promote voluntary health insurance, encourage public-private healthcare partnership, attract private capital, apply preferential tax policies in relation to income tax, empower the healthcare institutions network, develop telehealth and eHealth, promote cutting-edge medical technologies, the transplantation system and emergency care, provide treatment to patients with tuberculosis, mental illnesses or orphan diseases, launch and implement the National Cancer Strategy, define the basic principles and processes of public health in Ukraine with regard to the risks and challenges of the spread of COVID-19 caused by coronavirus SARS-CoV-2 in the world and in Ukraine, update the drug control laws for the transparency of the pharmaceutical market, develop medical education and research.