Second Phase of Medical Reform Begins in Ukraine

Medical reform in Ukraine is taking place in several phases. The first phase saw the implementation of family doctors and the launch of the eHealth system. The second phase launched on April 1, involving changes to specialized hospitals and the introduction of free services. Hromadske looks at what is going to happen with hospitals, patients and payments for services.

Three Levels of Health Care

Health care has been divided into three levels: primary, secondary and tertiary.

Primary care means family doctors, pediatricians, and non-specialized therapists.

Secondary hospitals provide specialized and more sophisticated services – for example, trauma, poisonings, pathological conditions, pregnancy, and rehabilitation.

Tertiary care in hospitals and out-patient clinics is done with high-tech equipment and highly specialized procedures.

READ MORE: Repairs and Safety Infrastructure – Ukraine’s 2020 Road Strategy

Do You Need to Have a Contract With a Family Doctor to Get Help at a Secondary Hospital?

This is not a prerequisite. But starting April 1 you’ll be able to get specialist medical care for free with a referral from your family doctor. If you consult a specialist on your own, you’ll have to pay.

Patients will be able to choose a medical institution, and their residence registration will not affect receiving services in secondary hospitals.

If you need emergency help, you will also be able to get it without a family doctor contract.

Will All Services Be Free for Patients?

Different hospitals will provide different services form the  medical guarantee program approved by the government on November 27, 2019. The service package of free services was announced on April 1, and includes, among other things:

• First aid
• Emergency help
• Specialized and highly specialized emergency help
• Tuberculosis diagnostics and treatment
• In-patient palliative care
• Psychiatric care

Treatments and services that are seen as life-saving will also be free – for example, childbirth and newborn care, treatment of cardiovascular diseases, stroke, and diagnosing oncological diseases.

Where Will the Hospitals Get Their Money After April 1?

Only the health care institutions that are autonomous, computerized, licensed, and have the necessary equipment – that is, communal non-profit enterprises – can join the second phase of the reform.

Starting April 1, the principle that already applies to family doctors – "money follows the patient" – will be implemented in the hospitals. That is, hospital funding will depend not on the general number of beds, but on the number of patients using the hospital's services, and payment will not depend on the number of patient visits, but on the outcome of treatment.

Services would be paid not by the patients but the National Health Service of Ukraine at set rates. In order to receive money, the hospital must submit to the electronic health system a report on medical services provided and the quantity of medicines and other treatments used in its serrvices.

READ MORE: Ukraine's 2019 in Numbers

What About Doctors' Salaries?

The law provides neither for the closure of hospitals nor for the reduction of the number of specialists. At the same time, institutions providing poor quality services may simply not have clients. Such institutions will be reprofiled to become, for instance, hospices, and qualified doctors will move to hospitals where they are needed.

The Ministry promises that doctors' salaries will increase if they provide effective treatment – the better the services, the more people will turn to them and the more the salaries and funding of the medical institution will increase.

/Text by Oksana Rasulova, translated by Vladyslav Kudryk