Health care transformations concern everybody. Their purpose is to provide all Ukrainians with equal access to high-quality medical services and rebuild the health care system to make it patient-centered.
Total expenditure on Ukrainian health care, of patients and the Government combined, matches the average of many European countries. However, medical services have been free on paper only for many years. Most Ukrainians give a "thank you" for treatment such as a payment pocketed by the doctor or a "charitable donation" (which is in effect mandatory).
Besides, money available in the system is used ineffectively. Even though Ukrainians contribute about UAH 3 bn in annual taxes for health care, 640 thousand Ukrainian families face bankruptcy because of a disease as they have to pay for costly treatment out of their own pockets.
The Government has assumed clear obligations to fund medical services. Budget funds are already being distributed by medical services needed by patients on equal conditions for all people. The government-guaranteed package of health care services will be based on health care priorities in Ukraine within public funding limits.
The government-guaranteed package of health care services (the medical guarantees program) will include a rather wide range of out- and in-patient care and medications. The cost of such services will be borne in full by the National Health Service of Ukraine.
The law adopted by the Verkhovna Rada of Ukraine lists health care services to be fully paid by the Government. The specific list will be formed every year based on people's needs for medical services, health care priorities of public policy and funds allocated in the National Budget.
Emergency, primary, out-patient, hospital, and palliative care will be funded by the Government within the medical guarantees program. What patients will have to pay for with their own funds is services such as non-emergency dental care, consulting a doctor without a referral, aesthetic medicine etc.
The National Health Service of Ukraine was created on March 30, 2018 in record time as a central government agency carrying out the main principle of the medical reform, "money follows the patient", and paying the price of health care services that have been actually provided. This payment mechanism started working in Ukraine this year, gradually replacing the ineffective Soviet model of payment for available beds.
The National Health Service of Ukraine contracted (as of October 2018) with as many as 623 community-owned and private health care institutions and self-employed therapists that provide primary health care. It is for the first time that Ukrainians will be free to choose their therapist in a health care institution regardless of the form of ownership, and NHSU pays for the guaranteed package of primary health care services on an equal footing to all partner institutions of the Service. NHSU has paid UAH 1.6 bn worth of services of these institutions at the uniform rate.
In early October, NHSU opened its contact center that can be reached at 16-77. Frequently asked questions will be answered round the clock by a machine. By calling during business hours, you can ask the operator. Any requests that need additional time will be logged and referred to respective NHSU units for resolution. As they are resolved, operators will call you back and provide full information about resolution of the request. Landline and mobile calls are free of charge.
The Government moves away from maintaining a network of health care institutions providing services for free (we know this mechanism worked, but only poorly) to strategic purchases of services from this network.
The Government will stop allocating funds based on a cost estimate to maintain a certain health care institution, whether owned by state or community. Instead, health care institutions should turn into autonomous business entities that will get compensation based on their performance, i.e. for medical services actually provided to patients.
By early 2019, all primary health care institutions should change over to the new funding framework by contracting with NHSU. Starting from 2020, institutions of all health care levels will move to funding by NHSU.
The introduction of the new model of health care financing needs the nature of the relationship between the health care institution (a service provider) and NHSU as the spending unit (the service customer) to be overhauled.
The contract-based model should replace the administrative command system. This means they will be governed by public health care contracts with clearly defined parameters of the funding of expected performance.
Under these contracts, the National Health Service of Ukraine will be acting for patients (taxpayers) as a third paying party, while the health care provider (institution or privately practicing individual) will be service providers.
All primary health care institutions should become autonomous by the end of 2018 to start getting funding from the National Health Service the next year. This is one of the local government's objectives. Computers should also be purchased for therapists because they need this equipment to work effectively.
Obsolete paper-based reporting will pass into oblivion. All medical records will become electronic. This will lift some burden off the doctors, enable them to provide better-quality and faster health care to patients, and rule out loss of patients' medical data. This will also enable collection of data about the need for district-specific services, more accurate price-setting and quality control of health care. New electronic instruments are to be launched as early as in 2019 — medical e-history, e-referral, e-prescription for Affordable Medicines etc.
In April 2017 the Government started the Affordable Medicines program. Patients with cardiovascular diseases, Type II diabetes, or bronchial asthma, are entitled to medications free of charge or at a fraction of the price. To join the program, they need to request a prescription from their doctor and get the medications at the drugstore.
Optimizing medication purchasing is an important component of health care transformation. So far, corruption practices have been minimized. The next step is to create a modern national purchasing system. On September 26, 2018, the Government adopted the Concept of Reform of Purchasing of Medicines and Medical Devices, Auxiliaries, and Other Medical Products.
The Concept involves creating an effective mechanism of providing medicines where the patient receives high-quality treatment in the most convenient manner. The most optimal method of delivery to the patient is chosen for every drug and medical device listed for centralized purchasing — through reimbursement programs, inclusion in the price of the health care service, or purchasing by the Central Purchasing Agency.
Since 2015, public procurement of medicines and medical devices has been carried out through specialized international organizations such as the UN Development Program, UNISEF, and Crown Agents (a British procurement agency).
Change in medical education is an integral part of transformation of the health care system in general. Systemic and consistent change will make Ukraine's medical education more competitive, push it to an absolutely new level and, as a result, improve the quality of health care services. In its Medical Education Development Strategy, the Ministry of Health of Ukraine proposes a comprehensive approach to introducing qualitative changes in medical education for the first time since Ukraine's independence.
This reform aims to build a high-quality system of higher medical education in Ukraine to raise health care professionals with a qualification that meets international standards.
Among the local government's powers, Article 32 of the Law of Ukraine On Local Government lists managing health care institutions, organizing their material and financial support, arranging for medical services and meals at community-owned rehabilitation institutions, providing affordable and free medical services within its respective area and powers granted, and developing all types of medical services, inter alia, the network of health care institutions, and facilitating training and continuing learning for professionals.
Local governments face a number of obstacles to an effective exercise of these powers. Significant funds allocated from local budgets towards medicine are forcedly directed for co-payment of the cost of basic medical services rather than for development of community-owned health care institutions and their personnel.
The new financing model of the health care system keeps the local governments' powers in this sector and creates opportunities for their exercise in full. Based on the new model, the national level will fund the medical guarantees program, while local budgets will fund the operation of the system and the implementation of local programs.
This stage lays legal and institutional foundations for the new health care system, introduction of the new funding model of primary health care, and the incipient arrangement of a network of institutions providing hospital care by creating hospital districts.
In 2017, MoH in partnership with non-governmental and international organizations held consultations in all regions of Ukraine on the implementation of the reform. On October 19, 2017, the Verkhovna Rada of Ukraine gave a start to the reform by adopting the Law of Ukraine On Government Financial Guarantees of Public Medical Services and amended the National Budget, and on November 14 adopted the Law of Ukraine On Improving Affordability and Quality of Medical Services in Rural Areas.
The national campaign for the selection of family doctors, therapists, and pediatricians started in April 2018. Ukrainians were for the first time given a free choice of their doctors not bound to their registered residential address. In seven months, more than 20 mln Ukrainians signed declarations choosing their doctors. This means that almost every second Ukrainian citizen already has a doctor that he or she trusts and can consult with any health problem or find out how to lead a healthy lifestyle and avoid disease. One can change the doctor at any time by signing the declaration with another doctor.
In 2018, health care institutions can only sign doctor choice declarations and contract with NHSU in the health care electronic system. In 2019, family doctors, therapists, and pediatricians will change over to electronic document management that includes electronic medical history, Affordable Medicines prescriptions, referrals to medical specialists, and medical certificates. Family doctors should abandon paperwork by the end of 2019.
The next stage following the primary component reform is starting in H2 2019 — the Free Diagnosis program. It covers 80% of the patient's needs for diagnosis by the family doctor, therapist, or pediatrician, most needed free examinations and tests, services of medical specialists. When referred by their family doctor, therapist, or pediatrician, patients will be able to have examinations done such as X-ray, ultrasound, mammography, echocardiography, and others for free by any health care institution that has contracted with NHSU. Therefore, clinics, which are institutions specializing in in-patient care, will be transitioning to the new funding model.
Another great mission facing the Ministry of Health and NHSU is designing a government program of medical guarantees for 2020. It will include all levels of medical services that NHSU will be paying for in 2020 by the "money follows the patient" principle.
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