A Year after Ukrainian Parliament passed Health reform law: What has changed

A year ago, the Verkhovna Rada of Ukraine passed (240 votes in favor) the first health reform law launching the long-awaited process of change in the national healthcare system, and introducing the state guaranteed benefit package. Great progress has been made since the key law was passed.

Here is a look at the four biggest health reform achievements during this year.

On October 19, 2017, the Ukrainian Parliament voted on – and approved – Law of Ukraine On State Financial Guarantees of Public Health Care, document No. 2168-VIII, therefore giving the "green light" to the launch of healthcare financing reform. In December, President Petro Poroshenko signed the law.

In January 2018, the Ministry of Health of Ukraine began a fundamental transformation of the national healthcare system. Considering that family doctors, general practitioners and pediatricians are typically the first point-of-contact for patients, the implementation of a new primary care financing mechanism was one of the first systemic changes introduced.

National Health Service of Ukraine

The National Health Service of Ukraine (NHSU) was established in record time – on March 30, 2018.  The NHSU is a central executive body that implements the key health reform principle – "money follows the patient", i.e. the NHSU pays PHC providers for the actual medical services they deliver to patients. In 2018, this payment model has finally started working in Ukraine, gradually replacing the outdated and ineffective Soviet input-based financing model.

The NHSU has already contracted 623 PHC providers nationwide, including public facilities, private clinics, and physicians entrepreneurs. For the first time ever, Ukrainians can freely choose a doctor in any health facility they want, regardless of its form of ownership. The NHSU has the same standard agreements for both private and public PHC providers, and therefore pays for the primary care services included in the state guaranteed benefit package to all contracted providers based on the unified tariffs. In the first four months, the NHSU paid the contracted PHC providers a total of UAH 1.6 billion.

Free choice of PHC physician

The nationwide campaign for the free choice of PHC providers (family doctors, general practitioners, and pediatricians) started in April 2018. For the first time ever, Ukrainians could freely choose a doctor, irrespective of their registered place of residence. Over the past seven months, about 20 million Ukrainians have signed a declaration with doctors of their choice. This means that almost every second Ukrainian has already chosen the doctor s/he trusts. Patients can change a doctor at any time by signing a declaration with another one.

The signing of declarations with the chosen PHC physicians, and the NHSU capitation payments to the contracted PHC providers would not have been possible without the introduction of the national eHealth system. This was also the first step towards electronic document management in Ukrainian health facilities.

Higher salaries of doctors and medical staff

All PHC providers that have signed an agreement with the NHSU now have administrative and financial independence, and can, therefore, manage their budgets independently. These health facilities are no longer limited by unified pay scales or staffing tables. As a result, doctors-in-chief can review their salary policies. Some physicians have already received salaries three times higher than they used to receive under the previous financing model (for instance, some physicals reported a pay raise from UAH 5,000 to UAH 15,000).

Health reform 2019

What changes to expect in 2019?

Starting January 2019, all public PHC providers nationwide will switch to operating under the agreements with the NHSU.

In 2018, eHealth is mainly used for signing a declaration with a PHC physician and for signing an agreement with the NHSU. In 2019, family doctors, general practitioners, and pediatricians will switch to electronic document management, including e-medical records, e-prescribing, e-referrals, e-sick leaves and other medical certificates. By the end of 2019, most processes will be paperless.

The next stage of the healthcare reform will start in the second half of 2019, with the launch of the Free Medical Diagnostics Program. With a referral from a PHC physician, patients will be able to undergo free of charge up to 80% of all medical diagnostic tests and procedures, including x-rays, ultrasounds, mammography, echocardiography, and other medical analysis and diagnostic procedures at any NHSU-contracted health facility of their choice. In this way, the health facilities providing specialized outpatient services will join the reform.

One of the key objectives for Ukraine’s Health Ministry and the National Health Service is the development of a state program of healthcare guarantees for 2020, which will be approved along with the state budget for 2020. It will cover all levels of healthcare, which means that in 2020 the NHSU will start paying for the primary care, specialized outpatient and hospital care services provided to patients under the "money follows the patient" model.