Next steps in primary care transformation in Ukraine

June 14, 2018 – Kyiv, Ukraine – At the forum in Kyiv, leaders of primary care facilities, which have already signed agreements with the National Health Service of Ukraine (NHSU), and representatives of the Ministry of Health of Ukraine, the NHSU and the USAID HIV Reform in Action Project, which provides methodological and information support to healthcare facilities, discussed the next steps in primary care transformation in Ukraine.

As of June 5, 2018, the National Health Service of Ukraine signed contracts with 149 primary care facilities nationwide. In total, 21 oblast of Ukraine has already joined the transformation process. In addition, nine private PHC providers plan to sign contracts with the NHSU in the near future. In fact, this means that the key principle of the new healthcare financing model – "money follows the patient" – will work in practice in cities, towns and villages across Ukraine. The NHSU will pay contracted primary care providers an age-adjusted capitation per declaration at a rate which is significantly higher than in traditional funding model.

At the meantime, starting July 1, all primary care facilities should provide services in full compliance with the new Procedure for provision of primary care services – the document that regulates the work of primary care doctors (general practitioners, pediatricians and family doctors), presents a well-defined package of primary care services, and forms a new culture of doctor-patient relationship. Order of the Ministry of Health of Ukraine No. 504 dated March 19, 2018 "On Approval of the Procedure for Provision of Primary Care Services" defines a clear set of primary care services (the guaranteed benefit package) that will be covered by the state and paid by the NHSU.

General practitioners, pediatricians and family doctors will be responsible for monitoring patients’ health and advising on healthy lifestyle, identifying health risks in a timely manner and preventing diseases (including vaccination), diagnosing and treating common diseases, injuries, poisoning, pathological, and physiological conditions. Primary care doctors will also continuously treat patients with chronic diseases and conditions. If necessary, primary care physicians will refer patients to specialists of secondary or tertiary care (i.e. for specialized or highly specialized medical care) and issue health certificates or notes.

"We have come very close to sharing the moment, for which we have all diligently worked since the health reform launch two years ago. The moment when we start using new rules at primary care level – new rules for generating doctor's income and providing 100% covered by the state services to patients. In addition, we now have new requirements for medical services and equipment, which are set out in the agreements between the PHC facilities and the NHSU. Family doctors should change the patients’ attitude towards healthcare. We are also developing an electronic healthcare system, connection to which is one of the key prerequisites for joining the reform, and which should soon become a very useful tool", noted Pavlo Kovtoniuk, Deputy Minister of Health of Ukraine.

On May 25, 2018 the NHSU published on its official website the first announcement of the start of signing agreements between the Service and primary care providers. Therefore, the healthcare facilities that have signed agreements with the NHSU prior to June 5, 2018, will switch to new payment mechanism starting July 2018. The next wave allows primary care providers start operating under the new financing model in October 2018 by signing an agreement with the NHSU no later than August 15, 2018.The key prerequisites for signing the agreement with the NHSU include the healthcare facility’s independent management as non-profit enterprise owned by local government, its connection to eHealth, being appropriately equipped and having patients signing declarations with the chosen doctors.

It is worth noting that the new payment mechanism under the agreement with the National Health Service of Ukraine can only be implemented after all primary care facilities in the city, district or territorial community (share one budget) sign the agreement with the NHSU. This is due to the peculiarities of the budget process in Ukraine. Therefore, there are three waves for switching to a new financing model in 2018 - in July, October and late December. Private PHC providers and rural health posts can sign agreements with the NHSU at any time.

"The transformation of healthcare in Ukraine starts at primary care level. People will soon see the benefits of the new model. PHC providers of any type of ownership can sign agreements with the NHSU and provide services included in a state guaranteed benefit package. We already have a few applications from private PHC providers from different cities. The medical practices with family doctors who provide services to 1800 contracted patients under an agreement with the NHSU will receive financing worth about one million UAH, regardless of how often patients visit their doctors. This model encourages doctors to provide quality services to patients who signed declarations with them. Local authorities, doctors and patients should delay no longer to join the reform. The key drivers for implementing such fundamental changes include a new level of doctor's income and a new level of quality of the services rendered to patients. Both patients and primary care physicians will benefit from a whole new way of thinking and new relationships", explained Oleh Petrenko, Head of the National Health Service of Ukraine.

The USAID HIV Reform in Action Project experts provided strong methodological support for the introduction of a new financing model and the implementation of health reform at primary care level, in particular to local teams – heads of PHC facilities, local authorities, and doctors. The latest tools and guidelines developed for facilitation of the PHC facility management are available on the website and accessible to everyone. Moreover, the methodological support team provided feedback and answers to common questions at each program implementation stage.

"The United States proudly supports the ongoing efforts of the Ukrainian government and the Ministry of Health aimed at reforming and modernizing the healthcare system. We are confident that the implementation of patient-oriented reforms will result in an improvement of the quality of services and elimination of corrupt practices. The US government will continue providing financial and technical support to the healthcare transformation in Ukraine, to aid the development of a system that will improve the lives of the Ukrainian people", commented Marie L. Jovanovic, the U.S. Ambassador to Ukraine.