WHO Calls on Ukraine to Pass Much-Delayed Healthcare Reform

What You Need To Know:

✅ Ukraine’s Ministry of Health has developed regulatory documents to implement a National Health Service as the country’s single national purchasing agency, to purchase healthcare services and establish contracts between the agency and healthcare providers;

✅ “Such agencies exist in almost every country and the reason why most countries established such agencies is because this purchasing function is very complex,“-Melitta Jakab, Senior Health Economist at the World Health Organization (WHO);

✅ Ukraine is also implementing a ‘patients before money’ approach, where the patient is at the center of the program, increasing primary healthcare spending in Ukraine by approximately 50 UAH ($2 USD) per person, for a total of 200 hryvnias ($8 USD);

✅ “Not doing anything is not an option anymore… We call on the Parliament to pass this very important health financing reform and we ourselves are ready to support its implementation”- Melitta Jakab.

Hromadske spoke to Melitta Jakab,Senior Health Economist, WHO on April 4th, 2017 in Kyiv.

Ukraine’s Ministry of Health has developed regulatory documents to implement a National Health Service as the country’s single national purchasing agency, inline with Ukraine’s multiple healthcare reforms. The National Health Service would function as an autonomous executive agency, subordinate to the Cabinet of Ministers, and would purchase healthcare services and establish contracts between the agency and healthcare providers.

Senior Health Economist at the World Health Organization (WHO), Melitta Jakab, last year presented the concept of healthcare reform in Ukraine. It emphasized the need to change the model of service delivery. In April, Jakab came to Kyiv with the unified mission of the WHO and the European Union to evaluate the steps taken by the Ministry of Health of Ukraine in this area.

According to Melitta Jakab, Senior Health Economist at the World Health Organization (WHO), creating such an agency is crucial in building a modern healthcare system: “Such agencies exist in almost every country and the reason why most countries established such agencies is because this purchasing function is very complex,” she explains. “It’s very difficult to provide good quality healthcare service without the purchasing agency.”

Ukraine is also implementing a ‘patients before money’ approach . While not an easy task, Jakab says that this reform will directly benefit the patient “who is in the center of this program.” Currently, primary healthcare spending in Ukraine amounts to approximately 150 Hryvnias ($6 USD) per patient. The reform would increase this figure by about 50 Hryvnias ($2 USD), which is not a lot when you notice the amount of money misspent by the current Ukrainian health system. “We can spend the money we have much better for the benefit of the people and this new system is going to do that,“ adds Jakab.

The new system also aims to fight corruption in this sector, where money is extorted not only from patients, but from the state budget with the help of undercover schemes. Companies with conflicting interests have long supplied state institutions with overpriced materials, and made medical bosses and politicians richer.

The senior economist acknowledges the work of Ukraine’s Ministry of Health, but says the entire country needs to come together and make these reforms happen. “Not doing anything is not an option anymore… We call on the Parliament to pass this very important health financing reform and we ourselves are ready to support its implementation.”

Photo credit: The Ministry of Healthcare of Ukraine

How do you evaluate the reform, which the Ministry of Health of Ukraine is implementing?

The Ministry of Health team has developed a lot of further conceptual documents, legislation, decrees, regulatory documents to implement the National Health Service, primary healthcare reform, reform in public health and medicines. We see how the discussions are happening in Ukraine and there are some interesting moments. One of them is that there is so much discussion— real live discussion— and involvement of different expert groups and NGOs.

Ukraine has some problems with communication between the Ministry of Health, the Parliament and the relevant committees. Do you see this as a risk to reform?

It’s really important for the Ministry of Health to work together with the Government, with the different branches of government in civil society and also with Parliament. We think that this is a particular moment, a special opportunity in Ukraine when the whole country needs to come together including the Parliament and make these health reforms happen. Because not doing anything is not an option anymore.

We know there have been various efforts, mostly at the local level, but I believe that a national transformation did not take place until now. We call on the Parliament to pass this very important health financing reform and we ourselves are ready to support its implementation.

The Ministry of Health plans to set up a national agency that will control the provision of medical services. How will this work and who will control it?

This agency will be called the National Health Service, and the main function of this agency is to purchase healthcare services to make contracts between this agency and healthcare providers—hospitals, primary healthcare providers.

Such agencies exist in almost every country and the reason why most countries established such agencies is because this purchasing function is very complex. It requires some specialized skills. Such an agency is really a building block of a modern health system; it’s very difficult to provide good quality healthcare service without the purchasing agency.

The National Health Service will function as a so-called executive agency. So it will be autonomous in its operational modality and implementation but it is very strongly subordinated to the Cabinet of Ministers. The Ministry of Health will be the one creating the policies and the agency will be implementing it together with the Ministry of Health.

Ukraine is implementing the approach of ‘patients before money’. The Ministry of Health calculates that is can allocate $8 USD per patient. Is this considered a large sum of money?

Today, if you look at primary healthcare spending, it comes out to be about 150 Hryvnias per person. So compared to this, this is quite a significant increase to move to even 200 Hryvnias ($8 USD) per person.

The second aspect is that these calculations are not yet final. The Ministry of Health is refining these calculations, so this number could be a different number when we come to the final. But it’s clearly going to be an increase compared to what primary healthcare is receiving today.

The third aspect to consider is that today, Ukraine is in a very difficult economic situation.

And one final point, there is a lot of money spent in the Ukrainian health system, not well—not well spent. It’s spent on interventions or medicines that are not improving the health of the people; it’s spent for the maintenance of infrastructures that don’t produce much benefit for the people. So we can spend the money we have much better for the benefit of the people and this new system is going to do that.

Photo credit: The Ministry of Healthcare of Ukraine

The system began operation at the beginning of April. How effective is it as an instrument in fighting corruption in healthcare?

I will be honest with you. This is not and easy program to implement. But I think with good communication efforts and with good people, it’s absolutely possible because it is the patient who is in the center of this program. The patient decides which doctor he or she goes to, that doctor prescribes a medicine, the patient decides then which pharmacy they want to go to, where they have good experience to get this medicine. And then there is a direct reimbursement to the pharmacy for this medicine. So it’s all about the patient, the choice of the patient, the patient chooses the doctor, the patient chooses the pharmacy. And the money actually just goes to this pharmacy in an indirect route and the patient doesn’t need to worry about it. This is the system of medicine-benefit practice in most European countries.