BY-

ANUKAMPA RAJMEDHI
GROUP-(2A)
SUBGROUP-4
 Health is one of the major values of the people's life. For the country it
is important as stimulates human capital accumulation and
development. In Ukraine the health care system produces rather
poor outcomes contributing to low life expectancy, high rates of
sickness and tuberculoses epidemic. One of the causes of such situation is
improper structure of health sector and inadequate and
insufficient financing. The worsening of people health and
demographic situation create a pressure for systematic changes in the
health sector. Ukraine inherited rather complex structure of the health
sector from the Soviet Union, which was intact during years of Ukrainian
independence, while neighboring countries were conducting health reforms.
The health care is declared to be free of charge, but private payments both
formal and in-formal are common in Ukraine. Such situation has endorsed
segregation of population by the in-come level, place of residence,
contradicting to the universal constitutional guarantee of free health care
provision. At the same time, the possibility of making informal payments
creates equilibrium in the system, though the outcome is not an efficient
one.
 Health situation in Ukraine is not encouraging. According to the estimation of the World Health Or-ganization
healthy life expectancy at birth in Ukraine remains rather low comparing to the members
of the European Union at 62 years for man, and 73 for woman (see Appendix A1). Life expectancy at
birth varies between regions of Ukraine (66.27 years in Odessa region and 71.35 in Kyiv City).
The poor health of Ukrainians might be attributed to several factors, including poverty, ecological
environment, and deficiencies of health care system. Mass poverty (around 30% of households)
contributed to the spread of the HIV/AIDS. The real problem is faced by Ukraine in the form of tuberculosis
epidemics. Over the last decade the number of people with this illness substantially in-
creased from 41.8 persons per 100 thus. of population in 1995 to 84.4 persons in 2005. One of the
explanations of such trend might be a lack of efficient preventive health care measures.
The main causes of death are diseases of the circulatory system followed by injury, and respiratory
diseases. The tobacco and alcohol consumption is rather high in Ukraine, also contributing to low life expectancy.
Maternal mortality, though falling, remains about five times the EU average. Be
sides, Ukrainians have health problems due to Chernobyl nuclear accident. For instance, cancer in-cidence is more
than three times higher than EU average.
While data reveals that health situation in Ukraine is not encouraging, the access to the health care
services is poor. In 2005 around 13% of households reported that they were not able to receive nec-essary health
care services, when needed.
From these households around 77% claimed that the reason for that were high costs of needed consultation of a
doctor, 95% could not buy necessary medical devices, as they also were too expensive. Besides, there are
significant regional differences in
the access to the health care services. In order to improve the situation the government should con-
duct policies aimed at enhancing quality and equity of the health care system.
 1. Introducing the government-guaranteed package of health care services
The Government has assumed clear obligations to fund medical services. Budget
funds are already being distributed by medical services needed by patients on
equal conditions for all people. The government-guaranteed package of health
care services will be based on health care priorities in Ukraine within public
funding limits.

 2. Single national purchaser of health care services

The National Health Service of Ukraine was created on March 30, 2018 in record
time as a central government agency carrying out the main principle of the
medical reform, "money follows the patient", and paying the price of health care
services that have been actually provided. This payment mechanism started
working in Ukraine this year, gradually replacing the ineffective Soviet model of
payment for available beds.

 3. Introducing the "money follows the patient" principle

The Government moves away from maintaining a network of health care
institutions providing services for free (we know this mechanism worked, but only
poorly) to strategic purchases of services from this network.
 4.Making health care providers autonomous
The introduction of the new model of health care financing needs the nature of the relationship between the health care
institution (a service provider) and NHSU as the spending unit (the service customer) to be overhauled.

5. Implementing the e -Health system

 Obsolete paper-based reporting will pass into oblivion. All medical records will become electronic. This will lift some burden
off the doctors, enable them to provide better-quality and faster health care to patients, and rule out loss of patients' medical
data. This will also enable collection of data about the need for district-specific services, more accurate price-setting and
quality control of health care. New electronic instruments are to be launched as early as in 2019 — medical e-history, e-
referral, e-prescription for Affordable Medicines etc.

6. The Affordable Medicines program

 In April 2017 the Government started the Affordable Medicines program. Patients with cardiovascular diseases, Type II
diabetes, or bronchial asthma, are entitled to medications free of charge or at a fraction of the price. To join the program,
they need to request a prescription from their doctor and get the medications at the drugstore.

 7. Transparent and effective purchasing of medications

 Optimizing medication purchasing is an important component of health care transformation. So far, corruption practices have
been minimized. The next step is to create a modern national purchasing system. On September 26, 2018, the Government
adopted the Concept of Reform of Purchasing of Medicines and Medical Devices, Auxiliaries, and Other Medical Products.

8. Reforming medical education

 Change in medical education is an integral part of transformation of the health care system in general. Systemic and
consistent change will make Ukraine's medical education more competitive, push it to an absolutely new level and, as a
result, improve the quality of health care services. In its Medical Education Development Strategy, the Ministry of Health of
Ukraine proposes a comprehensive approach to introducing qualitative changes in medical education for the first time since
Ukraine's independence.

 9. Creating new opportunities for local government to exercise its health care powers
 Among the local government's powers, Article 32 of the Law of Ukraine On Local Government lists managing health care
institutions, organizing their material and financial support, arranging for medical services and meals at community -owned
rehabilitation institutions, providing affordable and free medical services within its respective area and powers granted, an d
developing all types of medical services, inter alia, the network of health care institutions, and facilitating training and
continuing learning for professionals.
The perception of main problems of health care system by patients and
doctors is different. The patients stressed on the following problems:

 1.Impossibility to receive quality state guaranteed health care without

'informal payment';
 2.No guarantee of timely provision of quality health care even in case of
'informal payment';
 3.Insufficient qualification of health personnel;
 4.Careless attitude of health personnel to patient

 According to the health personnel the main problems of health care

system are the following:

 1.Low salary, which does not reflect the social role of health personnel in
the society;
 2.Poor material, technical and diagnostics basis of hospitals;
 3.Low incentives for professional development;
 4.Careless attitude of patients to their health.
<-
ULANA SUPRUN- HEALTH MINSTER
OF UKRAINE
 The major features of Ukrainian health sector could be summarized as
follows:
 • the health care reform is only declared, but nothing specific has been
done;
 • the principle of financing existing HCPs rather than services provided;
 • provision of health care services rather on the hospital than on primary
level;
 • the coverage of priority services through private sector is restricted;
 • there is an inequity of health care generation and allocation patterns;
 • the motivation of health personnel is rather absent and managerial
autonomy is restricted.

The performance and quality should be the major subjects for health
care reforms in Ukraine. While elaborating policy recommendations the
restrictions on reforms should be taken into account. The major
restriction in Ukraine is an existence of equilibrium in the sector, which
is created and supported by informal payments. So, some stakeholders
benefit from the status quo and might oppose reforms.
 The health care sector in Ukraine remains unreformed,
keeping the substantial overcapacities inherited from the
Soviet Union. The health care is declared to be free of
charge, but private payments both formal and informal
are common in Ukraine. Insufficient government financing
created the situation that promoted segregation of
population by the level of income, place of residence, and,
thus, contradicts to the constitutional guarantee of free
health care provision to all. As a result, the current health
care system is delivers poor results and lacks equality.