On 5 April 2017, the Cabinet of Ministers of Ukraine approved a package of draft laws on the health care reform which would allow changing the system of financing so that it would be capable to provide high-quality health-care services.
"In fact, on the basis of this resolution, the health care system will be absolutely different in terms of quality in a few years. We need 226 votes for that. Indeed, then, years of hard work will follow, but we, jointly with the health care community, will be able to do this work. In this case, we are self-confident that we will be able to implement it. Therefore, now, we only need to consolidate the support", Prime Minister of Ukraine Volodymyr Groysman emphasised during the meeting at which that resolution was considered and called the Parliament to support the health care system reform.
"This package of draft laws is the package which will allow us transferring from theoretical to the practical level in the health care reform, making certain practical steps still this year, gradually implementing the health care reform in 2018-2019, and obtaining a modern system of financing the health care in Ukraine in three years", Deputy Minister of Health Pavlo Kovtoniuk noted presenting the package of draft laws.
In accordance with the instructions of the Prime Minister, within three days of the date on which the package of draft laws is approved as supervised by Vice-Prime Minister Pavlo Rozenko, Minister of the Cabinet of Ministers Oleksandr Sayenko, and acting Minister of Health Uliana Suprun, a working group will be established comprising Members of the Parliament to finalise the draft laws at the most qualitative level and support their adoption by the Verkhovna Rada (Parliament) of Ukraine.
The Head of the Government also thanked the team of the Ministry of Health for the development of "very complex but needed resolutions" regarding the health care reform.
"Each slide showed to us today concerns the person in every aspect and describes the process of how the person will apply and which services it will receive. We are introducing new treatment protocols in accordance with which the entire civilization is treated, we are changing the system of financing; the remuneration system for physicians will be also changed, we will be forming the facilities and resources in a different way", Volodymyr Groysman noted.
The Prime Minister believes that there are enough funds within the health care system and, when their application is changed correctly and investments are made in modernisation and maintenance of the system, a "great result" will be achieved without fail.
"We will be able to change the system of financing and we will have quite different quality of the funds used. We need to invest in the person - that is the principal change of this system", the Head of the Government assured.
In addition, the remuneration system for health care professionals should be changed, as the Prime Minister noted: "A physician should properly receive his/ her wage in view of the quality of services rendered rather than look into the patients' pocket".
The adoption of the draft law at the current parliamentary session (May of 2017), alongside with the amendments to the applicable State Budget, will enable to:
- start the financing from the second half of 2017;
- introduce into the budget for 2018 a new principle of financing in-patient clinics;
- calculate a guaranteed package of health-care services so that to begin the 2019 budget year with an entire guaranteed package of health-care services at all levels.
Should the Verkhovna Rada (Parliament) of Ukraine fail to adopt the submitted draft laws, the reform will be postponed for an indefinite period of time because of the start of pre-election campaigns of 2019-2020 in the country.
The package submitted to the Verkhovna Rada (Parliament) contains four draft laws:
- "On Government Financial Guarantees Regarding the Provision of Health-Care Services and Medicinal Products",
- "On Amendments to the Budget Code of Ukraine Regarding Primary Care Expenditures",
- Amendments to the Fundamental Principles of Legislation of Ukraine on Health Care (amendments to Articles 3, 8, and 35),
- "On Additional Government Financial Guarantees Regarding the Provision of Health-Care Services and Medicinal Products to Persons Safeguarding the Independence, Sovereignty, and Territorial Integrity of Ukraine in the Antiterrorist Operation and Ensuring the Maintaining of the Operation".
The Draft Law "On Government Financial Guarantees Regarding the Provision of Health-Care Services and Medicinal Products"
The objective of the draft law is to establish a new mechanism of financing health-care services and medicinal products on account of the budgetary funds through the system of state joint medical care insurance.
The guaranteed range of health-care services and medicines, the cost of which is covered by the insurance, shall be set out at the level of a law in a government guaranteed package. Within the framework of that package, the government will guarantee the coverage of the cost of urgent, palliative, primary care in full, and, in part, the cost of paid services at the secondary and tertiary care levels. In order to forecast the amount of health care expenses, the Cabinet of Ministers will annually approve a concrete list of services and medicinal products comprising the guaranteed package.
The functions of the insurer and the sole contractor for the centralised procurement of health-care services, control over the compliance with the terms and conditions of agreements on the health care of population shall be exercised by a new central body of executive power having a special status - the National Health Service of Ukraine.
The draft law determines such notions as the "state joint medical care insurance", "insured persons", "National Health Service of Ukraine", "reimbursement", "insurer", "insured event", "tariffs", and others. In addition, the document determines the subjects and objects of the state joint medical care insurance, rights and obligations of the insured persons, it governs contractual relations between the National Health Service and health care institutions of all forms of ownership, individual entrepreneurs having a license to practice medicine privately.
The section "Basic Principles of Payment for Health-Care Services and Medicinal Products" determines the principles for setting tariffs - blanket rates, capitation rates, cured event rates, etc. The Law will become effective in one month of the date on which it is officially published, whereas the Government has, within one month period, to adopt a regulation on the National Health Service, approve regulations arising out of the Law, etc. It is provided that, until 31 December 2017, the Law will be applicable only to the primary care level, the financing of health-care services and medicines as specified in the list, whereas the system will become fully operative in 2019.
The Draft Law "On Amendments to the Budget Code of Ukraine Regarding Primary Care Expenditures"
The objective of the draft law is to bring the provisions determining the division of expenditures made by the budgets in line with the new model of primary care and the system of public health care.
The proposed amendments will allow expanding the range of expenditures which may be financed on account of the state budget by the inclusion in it of a new programme on financing services of the primary care by a competent central executive authority, government programmes on public health care and measures to overcome threats and outcomes of emergency situations which may have negative impact on the health of population (epidemics, outbreaks of infectious diseases, etc.).
Those amendments lay the foundations for the formation of a regional network of health care institutions and the formation of a healthy life-style. The creation of a possibility for local authorities to make expenditures for the formation of local programmes and development of health care institutions owned by them is an important amendment proposed, even though the current expenses for the implementation of such measures are made from the State Budget of Ukraine. In addition, local budgets will get an opportunity to engage municipal health care institutions for the implementation of local public health programmes on account of the local budget even though such institutions receive funds from the state budget for the primary care services within the framework of the guaranteed package.
Amendments to the Fundamental Principles of Legislation of Ukraine on Health Care (amendments to Articles 3, 8, and 35)
The adoption of amendments will create conditions for the implementation of a new model of financing health-care services at the primary care level and will offer an opportunity to the communities to establish their own network of primary care facilities. That will expand the range of primary care subjects, including the primary medical care providers of all forms of ownership.
The Draft Law "On Additional Government Financial Guarantees Regarding the Provision of Health-Care Services and Medicinal Products to Persons Safeguarding the Independence, Sovereignty, and Territorial Integrity of Ukraine in the Antiterrorist Operation and Ensuring the Maintaining of the Operation".
The draft law suffered as a result of direct participation on account of the funds of the state joint medical care insurance of health-care services and medicinal products as listed in a detailed attachment and required for the treatment of wounds, blast injuries or permanent injuries obtained by participants of the antiterrorist operation, as well as for the persons who became disabled due to a wound, blast injury or permanent injury suffered as a result of direct participation in, or staying in the areas of, the antiterrorist operation when it was maintained. The draft law is submitted in a package with the major draft law "On Government Financial Guarantees Regarding the Provision of Health-Care Services and Medicinal Products" governing the concept of a guaranteed health care package, detailed list, tariff, powers of the National Health Service of Ukraine, etc. Consequently, the draft law will become effective only after the law on government financial guarantees regarding the provision of health-care services is adopted and becomes effective.
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