Reforming primary healthcare: July 1st marks a new step forward in the healthcare transformation in Ukraine

Patients and primary care physicians now have a clearly defined list of services guaranteed and covered by the state. “By mid-July, the National Health Service of Ukraine (NHSU) will pay 149 communal and 12 private PHC providers under the new healthcare financing model based on the “money follows the patient” principle,” confirmed leaders of the Ministry of Health of Ukraine and Head of the NHSU at a joint press briefing, held on July 2, 2018.

NHSU will pay the first 161 contracted PHC providers 

Starting July 1, the NHSU begins paying contracted primary care providers for the services rendered to patients, which marks the implementation of the key healthcare transformation principle – “money follows the patient” – in practice. By mid-July, 161 health facilities – 149 communal and 12 private PHC providers – will receive the first payments from the NHSU – an age-adjusted capitation per declaration at the established rates for a defined package of services. Over 1000 outpatient clinics in 20 oblasts and in the city of Kyiv serving more than 8 million people have joined the healthcare transformation process.

“Now, the National Health Service of Ukraine becomes a financial guarantor of the real implementation of the “money follows the patient” principle. Every patient should benefit from having a clearly defined list of free-of-charge PHC services covered by the state through the NHSU. From now on, Ukraine, just as the whole civilized world, has a patient-oriented healthcare. We are shifting away from a decayed Soviet system. Now, the state serves the individual, not vice versa. The NHSU is one of the key agents of these changes, a financial insurer of the development of a new, transparent and honest patient-doctor relationship,” noted Oleh Petrenko, Head of the NHSU.

Uniform rates – uniform service standards

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" (available in Ukrainian), which specifies a list of PHC services to be provided free of charge to patients under the state financial guarantees program, came into effect on July 1, 2018.  

For the first time ever, Ukrainians have the uniform rates and standards of PHC services, which are covered by the state through general taxation. It does not matter anymore whether a doctor works at a communal outpatient clinic, a private hospital, or runs own medical practice as a physician-private entrepreneur.

During the transition period up to the end of 2018, all healthcare facilities that have not signed an agreement with the NHSU, as well as those providing specialized and highly specialized care, continue receiving financing in the form of government subvention.

All primary care facilities have to switch to independent management and sign agreements with NHSU by the end of 2018. In addition, the pilot projects on introducing uniform rates for medical services in specialized care will be launched in several oblasts of Ukraine in 2019. In 2020, all healthcare facilities and institutions will switch to operating under a new financing model.

“Our joint efforts contributed to changing the approach to patient care. Every day I receive messages of thanks from Ukrainians – doctors call patients and invite them to sign a declaration. For example, I received a message from a family with children and two adults over 80 years of age from Zaporizhzia. Liudmyla Yezhova, a PHC physician, invited them to sign a declaration with a family doctor. Now, this family has a doctor who provides care to all family members – from children to the elderly. This is a huge benefit that is now available to every Ukrainian. And this is just the beginning. We will gradually transform the Ukrainian healthcare to the point when in 2020 all medical services covered by the state will be included in a clearly defined and transparent list”, underlined Dr. Ulana Suprun, acting Minister of Health of Ukraine.

Chief physicians are responsible for salaries of PHC doctors

All autonomized health facilities are now free to formulate own pay policies and structures. Doctor’s salary shall be agreed upon before the contract is signed by the chief physician and the employee.

Local authorities are the fullfledged agents of the healthcare transformation in Ukraine

Local authorities play an important role in introducing changes in the Ukrainian healthcare system. The unified territorial community is the owner of all communal facilities and is, therefore, responsible for the provision of all necessary equipment and the autonomization of health facilities. These are the key prerequisites for signing an agreement between a healthcare provider and the NHSU. The NHSU guarantees payment for medical services based on market rates, and the local authorities develop the infrastructure to ensure accessibility of medical services to patients. The task of local authorities is to ensure that all healthcare facilities are reorganized and switch to independent management as non-profit enterprises owned by local government by the end of 2018. This must be done anyway, but they should be aware that a special simplified reorganization procedure is in effect only by the end of the year,” noted Pavlo Kovtoniuk, Deputy Minister of Health.

Over 10.8 million Ukrainians – i.e. every fourth citizen – have chosen their doctors in the the first three months since the launch of the national campaign – "A Doctor for Every Family". This is an excellent example that demonstrates that both doctors and patients want and support the ongoing transformation of the healthcare system. In addition, more than 22 000 doctors have registered in the eHealth system – 14 000 family doctors and 4 000 pediatricians.