President P. Poroshenko has signed draft laws marking the launch of Health Reform in Ukraine

At the initial healthcare reform implementation stage, the changes will only touch upon the level of primary care in line with the integration of the existing primary care model in Ukraine with European-style family medicine.

Patients commonly receive primary care from professionals such as primary care physicians (general practitioners or family physicians), therapeutists and pediatricians. Primary care physicians are doctors who serve as the first contact for a person with an undiagnosed health concern and provide continuing care of varied medical conditions. This means that primary care physicians, being well aware of the patient’s healthcare records, provide long-term management of chronic conditions, counsel and educate patients on safe health choices and behaviors. In developed countries, primary care professionals treat up to 80% of patients without hospitalization (on an outpatient basis) – they apply modern knowledge, use basic equipment, conduct the most common analysis and prescribe medications.

Ukrainians are now able to freely choose family physicians and pediatricians for their children by signing the New Patient Declaration (a contract with the doctor) that has a stipulated scope of services guaranteed and fully covered by the state. If a patient is not satisfied with a doctor’s performance, there is always the option for terminating the signed contract and finding another family physician. Primary care professionals also issue notes, medical certificates, sick notes and statements of good health for presenting at kindergartens, schools, or to be enrolled in swimming pools, etc.

Primary care is not dependent on one's permanent address anymore, which means that a patient will be able to choose an outpatient clinic and an individual physician regardless of their official place of registration. Our goal is to ensure that each and every Ukrainian family has a dedicated family physician (A Doctor for Every Family!). Patients can now contact a primary care physician for a consultation, an initial examination or basic diagnosis and treatment of common illnesses and medical conditions. Therefore, the chosen family doctors manage and coordinate the patient’s health care needs, including treatment options and referrals to specialists. All this means that patients should have confidence in their doctors, while primary care specialists should be motivated, above all – financially, to provide the highest quality services.

On December 28, President of Ukraine signed draft laws Nos. 6327 and 7117 providing for the full-scale reform launch and first actual improvement in the Ukrainian health system starting next year. The Law ‘On State Financial Guarantees for the Provision of Healthcare Services’ shall enter into force one month from the date of its publication and come into effect on January 1, 2018. The Law ‘On Improvement of Accessibility and Quality of Healthcare Services in Rural Areas’ shall enter into force on the day following the date of its publication.

These laws are aimed at improving state healthcare financing model, offering guarantees of quality health care to all citizens and providing additional opportunities for the development of medical infrastructure in rural areas.

This provided the Government and the Ministry of Health (MoH) of Ukraine with the legal grounds for adopting a comprehensive package of regulations to ensure that healthcare facilities and local authorities across the country start preparations for implementing the first stage of the reform.

In practice, public social health insurance system will become effective in Ukraine in 2018. All healthcare services, medicinal products, medical tests and examinations covered by public health insurance program will be provided 100% free of charge. All citizens shall have free access to the list of these services.

What does this mean for patients?

All citizens shall have the right to choose a general physician and healthcare facility, regardless of their place of residence or registration. All patients shall receive health care and attention in any of the medical facilities contracted by the National Health Service of Ukraine, as the state pays money to a particular medical institution exactly for these services. And most importantly, all patients shall finally receive guarantees that the provided healthcare services are paid in full by the state.

What does this mean for healthcare professionals?

Doctors shall enjoy fair work conditions and gain more top-management’s attention, because the number of patients and their satisfaction with the services provided, and, consequently, the income of the medical institution will reflect the doctor’s work and performance. Healthcare professionals shall finally receive financial guarantees and decent income, which will depend directly on their experience, professionalism and commitment.

What does this mean for healthcare facilities?

The state shall pay the same amounts to all medical institutions for the same quality healthcare services provided to patients. Tariffs shall include all costs related to healthcare services provided: the work of medical personnel, supply costs, medicines, depreciation of equipment and administrative expenses.

The detailed Healthcare Reform Implementation Plan for 2018 will be presented at the special meeting of the Cabinet of Ministers of Ukraine by the end of December, 2017. As noted earlier, next year the changes shall only be introduced in the primary healthcare, and in 2020, the new financial system will also be implemented in the outpatient and inpatient care sector.

Therefore, there are several essential objectives united under one slogan – show profit. This means that all Ukrainian citizens shall have equal access to quality health care, while all healthcare professionals shall demonstrate high level of professionalism to enjoy fair work conditions and get decent income. As a result, this shall improve life expectancy and the quality of life of all citizens of Ukraine.

It would be unreasonable to expect changes to be visible tomorrow. Reform is a systematic process and we must all – the Government, local authorities, medical institutions, healthcare professionals and patients – be committed to enjoying small victories at each reform implementation stage.

And today, the MoH team celebrates its first win on a long path towards complex structural changes. But the hardest work is still ahead. However, this year we have managed to make an important step in outlining groundwork for action. Now is the right time for the Ministry of Health of Ukraine, together with all citizens, to properly address and manage the Health Reform implementation challenges.