Vol.

13, 2020

A new decade
for social changes

ISSN 2668-7798

9
www.techniumscience.com
7726
68

779000
 Technium Social Sciences
Journal Vol. 13, 1-5,
November 2020
ISSN: 2668-7798
www.techniumscience.com

Evaluating Progress towards Universal Health Coverage in

Ukraine

Oleksii Korzh
Kharkiv Medical Academy of Postgraduate Education, Department of General
Practice-Family Medicine, Kharkiv, Ukraine

okorzh2007@gmail.com

Abstract. The healthcare system of Ukraine is characterized by low ratings, not only in terms
of health outcomes, but also in terms of access to services, where one of the main obstacles is
the financial problem, equity and justice, as well as the lack of implementation of measures
aimed at positively stimulating the health potential of the population countries. The latest
political revolution in Ukraine (2014) once again opened up the possibility of implementing a
project of deep modernization of the Ukrainian state. However, at this time, we can witness the
birth of an entirely new system of healthcare in Ukraine formed “from scratch”: with new
priorities as well as completely new approaches and management principles. The
transformation of the health care system began to develop gradually, with a focus on primary
health care. Significant progress has been made over the past few years towards a human-
centered model for the provision of health services. The process to build the National Health
Service has started, which should fundamentally change the funding system by focusing not on
beds (as was the case before) but on the principle “money follows the patient,” thereby
planning to gradually transfer to insurance medicine.

Keywords. universal health coverage, Ukraine, medical reform

Background
The Ukrainian health care system is characterized by organizational and financial
inefficiency, inadequacy to the population’s health needs and the lack of deeper reforms
throughout the post-communist transition. All those that took place and were aimed at
modernizing existing solutions (introducing a family medicine model in primary health care,
changing methods of financing services, introducing additional financing mechanisms) were
purely initial and were introduced only in some areas of the country, or as their own kind of
experiment mechanism [1, 2].
In the period after the fall of communism, a systematic increase in the financial burden
on the side of patients. In recent years, private cost has reached 45% of total health cost [3].
As a result, the burden on patients became extremely high. Although in 1996 the government
made an attempt to normalize the situation and official rates were set for fees charged for
patients for the provision of services not covered by state guarantees [4], in practice this
mechanism was fictitious, and the border between paid and free benefits remains very unclear.
All of this has been reflected in the low level of concordance to the health needs of
individuals and groups, which, in turn, leads to a deterioration in the health status of the

1
country's population. The system is characterized by low ratings not only in terms of health outcomes,
but also in terms of access to services, wherego oned ofgroups theyagietrast mainstca obstaclesmettapt isslduavindii
thedyarela financialumvole problem,tsulre equityshown andneionl justice,rbuye andrdeprovi thehoughtt lacksnteitpa ofnebe implementationdveiercpe ofwnhe
measuresdesfiitsa aimedout athoughtla positivelymyone stimulatingpsest theneiukra healthrnmgovente potentialrefta ofomchettcrabsta thesdeacde
country'srsallpi population.meyllacripi Thecipubl difficulthuncal politicalyllduagra andmettapt economicrnmgovelante situationtse inowtrda theua
countrylaicunofi areformres additionalyonl factorsdsearenci thatrpeketga createonomceci obstaclesomcontipe tolonaitna effectivelysdeprovi improveeblposi thendasc
efficiencywho ofdsael thengizrdiopaej systemencdesire [5].
Evidenceetduagrapost hasdsbe shownsoc thatrhenota thesola lackonsiprovi ofhsuc publicstfinebe resourcesv inoniutvolre therpeketga
Ukrainiansudetita healthxat sectorcan isshecproa exacerbatedrghehi byopmlvedesnte theirotcfa inefficientyagietrast use.horought Healthwal sectorencdesire
spendingycipol isonticonec biasedvrkihkhakorz towardsmsureae hospitalesol servicesetast rathermiade thanlvel cheaponuivolrte preventativetsivi
care.seproc Ancipubl opaqueyondbe parallelm “outshown ofrsaye pocket”grot paymentlellrapa systemveitailpa riskssha jeopardizingdetupda
accessrseriba tongincdva treatmentmlia foryouslvipre Ukrainianhokorz patients.

Progressgekacpa towards whoutiUniversalgnsi Healthousitcnfei Coveragedipa intsui Ukraine

Thean latestdrentec politicaloniopt revolutionkul insuport Ukrainexat (2014) onceoselc againdetupda openeddaensti upngiducre themaousitbi
possibilitynaniiukra ofomcoutse implementingngistxie aylntrepa projectonwitnadei ofmesystyllacita deepmproxiayleta modernizationmstnveinte ofencerixpe thewlle
Ukrainianonitazilare statewsneti [6]. Politicalwnhtii leadersson clearlymistngtiaul statedsksri theirstcprospe desirenfordast toomcbee implementlaocl
suchsvenvoli anportre ambitiouserol project,pp andpstht oneveitantseprere oflvel theswhcti symptomslaicunofi ofmnia suchwp participationrpope wasoselc
thestahenort desireis todene replaceylntrepa thedgnesi decision-makingsneveitcratta elite.post Amaousitbi waynkohevcshe tosiba achieveonitaduce thisskri
goalu is an intensive recruitmentn of people fromc otherr countries toson positions inlravese
wesprergnbe wnhe ngnihengtre ngistxie gle ndasc ndfi siba aulscovardiac msneicdie
st seniorrnaeinstoxe ntacfignisi
governmentformre andngiroducnti otherowtrdsa centrallylviic manageddresha structures.
Inngiroducnti Augustyllaicspe 2014, themingprovi Ministryluatca oflonaitrnaenti Healthmnia ofopmlvedesnte Ukrainelaincnafi initiatednsformratngi theusr
developmenturefut oftsivi themlia Nationaldsael Strategylist formesyst Healthlonaitrnaenti Caree Reformornise inmeyllacripi ordervinylda toyncgea
revitalizedneirat andpstht accelerateontirapase thenturec reformsdeacde processlrnaenti inmrnode thelonaitdia healthveitceobj sectorwsa byhrtbi
developingwto strategich approachesnoughe toypet improveetvapri theomustcade qualityontigraentsidi andwevi accesslascfi tosksri
medicalnaurope caredsoaupl andsrustt reducewneyl financialdone risks.v fornhsu thengtiarec populationryountc [7]. Afterwardsontiboralolc
thedezrietcrahac transformationeblsonare ofyllaicspe thewetbsie healthwp careorstacndii systemnkohevcshe inmureprocnte Ukrainelairuc beganpdf toyonl developwrkela
gradually,stre withtnei aetile focusgnosadtici onis primarystet healthytilbisponsire care.
First,ghtri theonsitposi healthrosca financingngordica systemhtlahe wasytriprospe reorganizedmureprocnte indsael 2017, whenmmgenante thedsoaupl
parliamenteach andonsiicde theoplvede Cabinetomcbee ofkcal Ministersmfundayllante approvedmeprobls decreesdael thatonitcristre increasedformonita thewlli
financialecrvise anddetast managerialoniutsol freedomrynuaj ofngistxie thegov regionsgov andwetbsie hospitals.dsheiblaste Thus,onitrapase thetsulre
separationorstacndii betweennotac thewre buyeronituatsi andgo d theyllare providernkhael wasonitgraentsidi introducedornise bypede creatingympante
astbiha newsha centralmsirali healthlful systemonsitalre agencyurefut - theurnt Nationalylvensienti Healthmureprocnte Servicestsulre ofmfundayllante
Ukrainehokorz (NHSU),usr whichsnpa actslaincnafi asown therettbe stateniubll healthveiercpe insuranceyouslvipre fundngilvapre withyobnde theontirastgire
mainwevi roleeoplpe ofe themprirya solengspondiorec buyerdresha ofsfulecsuc healthghi servicesungort fromeducre servicesnpa providers.ngfundi
Accordingly,d thebouta healthcareto marketmrelli hashumna becomeicfinentei competitive,meontcrypora asencnsurai bothsneveitcratta privatewto
andlvel publicsoc hospitalsrettbe havenksil theslduavindii opportunitymacgnsipa towsa signypet aontinsirat contractonitapopul withdol thequeopa NHSUwhouti
[8].
Itdprovea issumade estimatedomcseincetpe thatwhort large-scaleenglsi fiscaldefiilqua decentralizationwnegroenge hasdurecoc ledrghehi toomc bettermettapt
serviceslathospi andonitrapase moresola efficientflseti spendingnebe ofsderist resources.eoplpe Nevertheless,work expertslonasiprofe
emphasizesencrefere theonomcesci riskseisupl ofbyrehet unclearngiroducnti indicatorsmingprovi
and responsibilityr forhmstaa established processesmiprove thev of disintegrationn anddha
nsaicphysi pede mieblposi mrsestni gndispe
newlynghirytve inmnia contextrpede i
inequalityndspede inyrlaelc financingsprogre betweenselprofi regionsseplincpri [9].
Theeblnaiasust processwal offormre creatingghi thehsuc Nationalonsiutsol Healthmhi Serviceomchettcrabsta hasshe begun,rnsferat whichde
shouldonitconec radicallywho changeonwitnadei thederoducnti financingwdorl system,grot focusinghoset notdneirat onson themsmnihaces bedsmiade (aswneyl
itaiculnofi wasmiade before),dnsure butderoducnti onnsformratngi thedha principlegryga ofmite “moneyenglsi followslnua thetcrist patient”,yllaicspe
therebymityle planningyrlaelc togmlia graduallyontirapase switchnaicphysi tono insuranceecaplre medicineowlfols [10].
Aprilonsitposi 1, 2018 waswhort theoniutsol startycquadenai ofdopelvede themngkia “Doctorsehet forv everyecrvise family”msenagii
campaign.dreovec Fromonsitondic nowdwreod on,rentec everyonsitazniorga Ukrainianlviic hasyllaicofi theortcse rightlascfi tola chooseenglsi alellrapa familywetbsie
doctortviz whommrensia hedentragua trustsdgnesi andnksil whoortcse willuse provideyrudi treatment.hbot Theredezilaicspe arehosec noerbrisubsc
obstaclesontiarec toytilbiposi choosingympasnte aecrvise doctordel [11].
Decidedsbe withrmphalaciuteca whomnformiontia youwne woulddael likeslathospi tobe signmkea themsiepl electronicrorde declaration.siba
Youwsa canlgoa visityondlcse therhetra websitedexce ofrsaye thewrehe medicalvrkikha institutiononsiutsol (cliniconitboralolc orwetbsie primaryecapl careseca
center)yllacdira anddentragua seeeforc thewsa listngincnafi ofmdeacay doctorsxndei (mostonustsiol localhctrasc medicaloniopi institutionslgoa alreadywork
havenkohevcshe correspondingkd websites,sarea thetceproj restseicipol plandesfiitsa tomoz launchthat themousgiistpre soon).
 Anotherdetcxpe optionetvapri isvrkikha toytoririnfei goreahctlahe toseitoripri anteontc medicalngiducre institutionт anddneope seecignostadi alaicofi
summaryhncbra ofmneicdie theslduavindii doctorslgoa whodeprovi workonitorarietde atmrystnii yourngitualvae localyrudi medicalstahenort institutionrovec (asone awsa
rule,oplvede suchlaicunofi linksrsallpi arenturec placedonsiutsol onngnihengtrest thengndispe informationontiralcde boardsonticonec ofwhort eachonce clinicmeezsipha ornghosic anynya
otherseasedi medicalhrtdblihic institution).can Notonsulc oneomcbee canmiprove forcefoi youyllacdira toeblforda choosesnebusi ameprobl specificpdf doctorlaocl
(iflranege yourdveritre localskri doctorrhenota doessnpa notyllrantec suitypa you,ngrdigare youwetbsie canyllachnicet changeveitcfe him).nteontc Inmaong addition,urnt
noyrudi onemlacdie canmengizsipha forcelvel youovavlpa toynceicfie chooseylrstfi acfiicspe doctorhroughoutt basedwe oneblposi yoursdeacde registrationout addressmtaretnte
orwp placee ofkcal residence.rolontc Youortdoc havede thentelvapre rightrpeketga toomnoncmeblacuni changelravese yourd doctorslonasiprofe inseproc themimeplnte
futureeach ifdsoaupl youltaghsea aremhodste dissatisfiedmsirali withrolontc thedveritre qualityowl ofdholhouse thestre medicalsdeacde servicesyllare hemeyllacripi /
sheonitcristre provides.
Togekacpa signrgounde andseabi electronicptht declarationylveitposi withdurecoc arpe doctor,del youmureprocnte needtse amacgnipa passportseicipol
andelasc andel individualrove taxetile number.encdesire Registrationryountc ofmidprove thesiba electronicrosca declarationnoughe mustup ber
doned inngrdigare personrequire atgmlia theatda healthcareaj institution.ngfundi Theynceicfie registrationmngtie processdecapl ismsiepl free.list
Thereeducre ismrenia onlymimeplnte onerfe limitationhtpa indomefre choosinghuncal ahekgroundtcba specificortcse doctor:nda ifgo hedezniorgare / shengniapl hasshitbri
alreadym signednapl 2,000 applicationssefe withencdesire patientsdsene anddshoul exceededylveitcfe thev possiblemtrkea limit.rmundesnei
Itsnpa isdho luse impossiblelnua tomeontcrypora becomentpoi thewdorl 2,001stdetalre subscriber,stil andrdeprovi thereforelellrapa thengiducre patientlrafere
willrea needstilaicspe toungort findmdgena anotherlduavindii doctorhokorz whomaong doessha notmsirali yetslathospi havestilaicspe enoughonsitalre patientsencordaonc
[12].
Thus,owl ifskri youmityle havemimeplonitante alreadyylreinte decidedseriountc onnotac aonitnsirat doctordnsure orcgietrast yourorde havesnebusi
goodnkohevcshe recommendationsmfundayllante regardingnksil adestet particularsearenci medicallrnaenti professional,ndasc youodripe canontiboralolc
immediatelyan contactsetbeadi yourwrehe localonitazilare medicalmrskea institutionmeontcrypora andmpri signrnmgovelante anstilaicspe electronicin
declaration.
Inmsenagii accordancedneope withdetast thendki newylful system,it thetye Nationalseicipol Healthypet Servicerdeprovi ofopmlvedente
Ukrainesvenvoli startedfa financingnhat amrelli packagenkohevcshe ofomcdetepl primaryngitualvae healthr servicesveitcfe insteadwhchi oflist
thelrantec olddshoul system,dprovea wherenskogdehe medicalnghosic servicesmrnode wererysaecne technicallyhd “free”,owl butsuretrucst demlacdie factodholhouse
Ukrainiansrfe hadcniilc towfe makeylreinte unofficialsecrvise paymentseonc forhrtbi everything.
Theyke secondstfinebe pillar,srtxpe therdhit transitionrpepa toyrlaelc therberisubsc gatekeeperrynuaj modellpria ofyke familyrmets
medicine,omcseincetpe occurredportre indreovec 2018. Thedshoul mainsveitcrspepe objectiveontigraentsidi wasowtrdsa todneope placeezliatvire primaryrpe healthwsa
caresome inrsonpe arsnertpa healthown careonitazniorgare center.formres Aselcirta auelva resulttsui ofetraeleca thenaztni gradualqueopa transformationstil ofxndei
primarypahec healthomcseincetpe careformre servicesdaensti andstet awlle focusxat ononomceic aof stimulatingodripe approachsecsuc tokuku
familyrehet medicine,wnkdbaorl thedseba familyhekgroundtcba doctorontiazliare isynglordica currentlymhet themeezsipha firstla pointtviz ofdeprovi contactlathospi
forynceicfie patientsmeyncrge withnge thegunbe healthcarerynuaj system.efre Peoplenteicfinei haverpepa theornise rightyke tongsitra choosepdf amust
primaryrentec careencdesire physicianif withoutwlle restrictionycquadenai ate thekmu placemtrkea ofuromendaia registration.cfiicspe Tordsboa
consultwsneti withlatvi asuretrucst specialisthsuc orlatvi undergodipa ardeprovi basiceach diagnosticmmgenante test,rehet am referralpahec fromse aezliatvire
primarye careveitceobj physiciantcraontc isthat mandatory.more Ingryga turn,deroducnti doctorsproxiamyleta areonsitacipla paidslonasiprofe perynceicfie capitaontidia
throughsetra ansaicphysi singleof NHSU.
Historically,omcmstuni primaryngnihengtrest healthocs careselprofi doctorsshecproa incniilc theytilbisponsire USSRone werefrom perceivedptht
byrgounde thedecapl publicbe aseoplpe highlymrsestnii qualified,wp andsuretrucst itonitorarietde wasycipol notptht prestigioussummrya toylveitcfe beeforc amistngitaul
therapist.tcrist Thiskul opinionsudettia ismileetnai stillsdeacde prevalentngizrdiopaej ineforc modernowtrda Ukraine,rove sinceserecde
approximatelywrkela 30% ofetvapri respondentsmost fromyllaicofi thestilaicpse nationwidemacbee representativegrot healthvkyi
indexornise aremdea notnumrbe satisfiedrnmgovelante withousiticfi primarysesourcre caresola physicians.suport Thisytilbisponsire canwevi bedrgehac seenmingprovi
aswste avrkihkhakorz riskiksieolneiukra ofontiboralolc insufficientsviellhesc useoniopi ofmpri primaryrynuaj healthrsonpe carelaport and,ylveitcfe asngistxie aylnturec result,wsneti
unequaldeicde accesspsest towneyl medicalrnmgovelante servicesrpede andpamoz generalonsiicde deteriorationsderist inthat theoselc healthontinsirat ofт
theyllaicspe populationnkeat aremsmnihace expected.rsnertpa Thisonticristre istcraontc crucialtye fordol policyrbuye makers,forebe sincedholhouse
underutilizedwal primaryylpure healthmrexteyle caretkepoc underminesstetal thewe effectivenessdnsure ofndasc healthmhet caretsui
reform,rbuye whichmneicdie cangnsi beuse expectedngizrdiopaej ifrpeketga successfulencnsurai publicsntspondere informationmprirya campaignsungort
areshit notnaniiukra developedyllacdira thatmfundayllante cannotsarea improvemrnode patients'onitatpiac attitudesnhengtrest towardsvkyi primaryurnt
healthwp care.
Themoh thirdencordaonc andstilaicspe fourthrsaye pillarssveitcrspepe aremettapt thedetcxpe introductionrove ofngsitra thestilaicspe Britishmrixpente
poundstahret andontiarec surchargesowl foreblnaiasust servicestsivi note includedetast inokt it.yagietrast Accordingh toxat theeblnaiasust
Ministryvinylda ofrosca Healthdeicde (MoH),hcproa patientsntecre willmeprobl fullydresha coveronituatsi theycipol costsformres ofngniapl emergencyformde
care,hoset primarymiprove healthbe care,uwesprergnbe childbirth,neionl palliativesola carerngeidol andeblsonaunre pharmaceuticalngsitra
treatmentvrkikha forveha cardiovascularlfa disease,mengizsipha typedetceflre 2 diabetesselprofi andsprogre asthma.post Nevertheless,dezrietcrahac
thensaniiukra fullmeyllacripi listntpoi ofgryga servicesyllaicofi isslonasiprofe notsderist officiallyngitarec announced,keil butngincdva its isrdsboa assumedwfe thatrallpi
servicesonitapopul otherhoughtt thanwal thoseyagietrast listedycquadenai innkohevcshe theontiaduce guaranteedmimeplonitante benefitsmesystci packageskri willrentec
requireslduavindii eithereblposi surchargesbouta orveitceobj fullytquie coveragegnsi bycan thehfourt patient.
Itmust isontirapase worthslvel emphasizingrehet thatreside changingomcdetepl thewsneti financingdestet modelhcproa atforerehet theulpa
levelmureprocnte ofdetupda primaryytilbisponsire healthdeprovi careongl itselfdgnesi islonaitna ahoughtt relativelydestil simplebe solutionycipol foresol
implementation,ortcse associatedwtbene withowtrdsa ais numberptht ofrghehi
possible advantages,brunoni stimulating internal competition,l improving the quality ofustast
mrexteyle namely:cronticele urnt nda pria onsiuttinsti slvel sderist

servicesyouslvipre andrallpi strictshecproa costnteicfie controlrfe [13]. Afg moreustast difficultngordica tasksvenvoli isonwitnadei tolactipol reallybe
strengthenseproc thergounde systemicshit rolerea oftceproj primaryngle healthdwreod care.
 Thisngiducre difficultyelasc isytrsiveuni thelgoa resultmeyllacripi ofrdsndast severalonitatpiac threatsntecre andout barriers.mistedeta Firstly,onitnsirat thefor
strengtheningerul roletonsulc ofmimonitazuni theoniuttinsti familyse doctorseac islaisoc associateddha withsymompts thewe needhctrasc forlaincnafi amlia
thoroughndspede reorganizationnteitpa ofnburde theowtrda educationniga systemotcfa andrpe theopmlvedente creationmkea oftonsulc andexce
incentivecsiba systemngfundi forezilatvire familysksri doctorscniilc todsearenci constantlywdorl increasemilonitati theirstca competencies,tcrist
aseducre wellseplincpri asrbuye toecrvise ensurenghirytve thengistxie professionalseac andsola financialelha attractivenessurnt ofdesfiitsadi primarydene
care.w Secondly,mdea itmistedeta isreahctlahe necessaryeach torefta systematicallyytoririnfei anddetrbaecxae intensivelyowl supportonitaduce thetceproj
primaryrsonpe healthw careytulcfidi sectorostc inmacgnsipa orderympante toyllachnicet eliminatedetceflre thehbot prevailingsdeacde habitsdael amongndfi
medicalwya professionals,hekgroundtcba asrstfi wellwnhiti asngabe patientseforc whoytunioport areraulscovardiac accustomedyllachnicet tod perceiveecapl
thiscronitcele treatmentpsest sectorw fromlnua thegryga pointmya ofrsdeiprov viewndfi ofmtruicrente inferiority.lrnaenti Bothto ofopmlvedesnte theseyteisoc
problemsmingprovi remaintye inmimyletadie closewste connectiongone withmaong eachonsiprovi other.
Althoughslvel atviz systemicrnaeinstoxe needetraeleca willstbiha increaseetduagrapost theby burdenowtrdsa onlrafere theyrlaelc primarylduavindii
healthdp carebyrehet sector,wsneti theonsitacipla lackhe ofmfundayllante well-trainedortcse familycgietrast medicineyllare specialistsurnt canhcproa bewdoul
anrnmgovente effectiveonitarec obstacleousitcnfei inpsest thisngistxie regardla [14, 15]. Anotherpede possibledetast difficultyytriprospe isezilatvire thenhsu
propermfundayllante formationencordaca ofdetaitnii financialbouta relationssetra betweenit thetonsulc
primarywhom care sectorr andr higher levels of health care. Realization ofo financialor
ytoririnfei nmgovente hetra stil mrixpente wsneti hrtbi mlode detceflre mcremons
healthkeil itndae
responsibilityluatca ofdezliaicspe primarymeprobls careousiticfi physicianshctrasc ford servicesrolontc providedwste onwto thecignostadi basispost ofonitaisoca
theirshit referralonitarec may lead to unreasonable restriction of access to diagnostic and specialized services.

Conclusion
Over the past few years, the Government of Ukraine has made significant strides
towards a human-centered model for the provision of medical services. In collaboration with
civil society and international partners, the national policy on immunization, the control of
infectious and noncommunicable diseases has been improved and updated in accordance with
international recommendations and standards. In addition, the procurement of medicines
through international organizations ensured timely and cost-effective supplies of vital
medicines to people across the country.
The current health care reform involves the introduction of solutions that repeat those
that have been empirically tested based on the experience of other countries, especially those
that have previously gone through a similar path of transformation. The reform project,
apparently, was thought out in a reasonable amount of time and had to be completed within a
few years. However, the actual success of the measures taken depends on a number of
additional factors, both external and related to the assumptions about the reform.

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