28 May 2023
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Decentralisation of Health Care will Start at the Primary Level, Concept of the Ministry of Health of Ukraine

The Ministry determined that the creation of maximum possibilities for providing high-quality and affordable health care services at the local level without increasing the tax burden on the people at the same time is the key priority in the circumstances of decentralisation. 

The primary medical care level is the basis of the health care system, therefore, it is required to start the practical implementation of the reform at the primary level. That was the point of the press conference of Deputy Minister of Health of Ukraine Pavlo Kovtoniuk.

 "The Ministry of Health faces two practical tasks - to start the real deployment of the insurance-based model of health care financing in 2017 and ensure 100% coverage of citizens by the medical care. Therefore, the Government and the industry-specific ministry have chosen the model requiring minimum amendments to the laws, and that model is recommended by the WHO and international partners", Pavlo Kovtoniuk emphasised. He noted that similar model (taxes-budget-agency) operates in the Great Britain, Scandinavian countries, Italy, Spain, Canada and it proved to be highly efficient.

The advantage of the reform proposed by the Ministry of Health is the fact that it would not require any separate taxes. "The collection of insurance contributions is in place in Ukraine: it is the general taxation system, reminded Mr. Kovtoniuk. - Every citizen pays indirect taxes (VAT, excise duties) purchasing anything in a shop."

As is known, transferring of the health care system to the insurance-based model will start as early as in 2017 and it will continue for three years. The transformation starts with the launch of family medicine according to European model on the basis of existing primary level of the Ukrainian health care system (out-patient clinics and departments, primary health care centres).

"Over the last 25 years, there were developed 21 draft laws on the introduction of insurance medicine. Many of them provided for the establishment of large bureaucratic agencies or the redirection of cash flows from the budget to private purses - fortunately, the Verkhovna Rada did not allow to do so. The aim of our team is to start launching the insurance-based model of health care in practice as early as in 2017, and we have found the method to do it by making minimum amendments to the laws which are comprehensible to everyone.

Ukrainians will be able to freely choose a family physician and paediatrician for their children and sign direct agreements with him or her, which agreements contain the expressly determined scope of services that are guaranteed and paid for by the state. In the event when the patient is not satisfied with the family physician, he or she may change it. Family physicians will issue certificates required by the kindergarten, school or swimming-pool. The place of residence ceases to be binding.

"Our aim is that each family has a physician. The family physician should become the family's agent in the health care system, he or she should steer, monitor the health and ensure the entire initial diagnostics. The family should have confidence in him or her, and for this purpose, the physician should be motivated, first of all, financially", noted Pavlo Kovtoniuk.

The primary health care physicians will be able to choose any organisational form of activity - individual entrepreneurs, out-patient clinics and departments, and primary health care centres. The work will be paid for on a per capita basis depending on the number of agreements entered into by the physician and subject to compliance with the medical treatment protocols and diagnostics.

The licensing procedure for medical practices will be accelerated, the DBNs (State Construction Regulations) and SanPiNs (Sanitary Regulations and Standards) for opening medical practices will be simplified and harmonised with the European laws and regulations. Also, as early as in 2017, the paper-and-pencil reporting will be cancelled for the primary health care physicians.

"The key function of the family physician is to maintain their patients' health. Any other work will be minimised. In the event when the family physician chooses to start private medical practice, the payments will be transferred to his/ her account directly, bypassing any intermediaries. That will allow creating a simple and transparent system comprehensible to all", Mr. Kovtoniuk added.

A transparent insurance agency involved in the document management with the physicians will become the technical operator for transferring funds from the state budget. It is not provided for the imposition of any new taxes or insurance contributions.

"Ukrainians pay taxes anyway. Our task is to ensure that they are used transparently and efficiently. Every Ukrainian citizen, notwithstanding the place of residence and the welfare level should have the access to the family physician, and the communities should not send couriers to Kyiv to implore additional budgets. The logic is very simple: you choose a physician, and we pay to him/her", noted Pavlo Kovtoniuk.

The tactics of the reform implementation will be published on the web-site of the Ministry of Health. Also, a national rating of the reform implementation in regions will be created and detailed methodological materials explaining the role of physicians, patients, and local administrations will be developed.

"Prime Minister Volodymyr Groisman set a clear task for us - the reform should start in 2017 and any events that will happen should not be an unpleasant surprise for anybody. Everyone should understand how and when the system will change and be clearly aware of his or her role and the task in the reform process", emphasised the Deputy Minister.

In 2017, there will be also launched the preparatory work for reforming the hospital component in the health care system, expanding the autonomy of medical institution, their transfer to the universal budget and payment for the result, simplifying access to funding and investments.

"It would be naive to think that the huge health care system in the country of 42 million could be changed by the ministry with a snap of fingers. Our team's key priority in the conditions of decentralisation is to create maximum possibilities at the local level where the changes will be going on, which changes will be seen by Ukrainians. Undoubtedly, we are facing great challenges but we also enjoy large-scale support on the part of all with whom we work - the Parliamentary Committee, international experts, medical professionals, and patient organisations. However, it is important to be aware that the deployment speed of the reform will depend on the quality of work of the local government. The fact that Head of the Government Volodymyr Groisman expressed his readiness to personally control that issue gives cause for optimism", emphasised Mr. Kovtoniuk.

Please see frequently asked questions regarding the insurance-based model at the primary level in the attached materials: model and diagram of insurance medicine.



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