Autonomisation: how will healthcare institutions be funded in 2018?
Last week the President signed the law, enabling the launch of the healthcare reform, and the Government adopted the key documents, allowing to start comprehensive changes. The main task for the first half of 2018 is to reorganise primary healthcare institutions from budget establishments into communal non-commercial enterprises, i.e. autonomise them.
Why should healthcare institutions be autonomous?
Autonomisation is an obligatory prerequisite, since only healthcare institutions in the status of communal non-commercial enterprises will be able to conclude contracts with the National Health Service of Ukraine and receive direct funding for the services provided from the state budget.
Communal non-commercial enterprises are non-profit ones, that is, the purpose of their activities is not profit gaining but provision of healthcare services to the population.
As non-profit enterprises, institutions will not be taxpayers and will be able to independently dispose of the funds received, including to set salary amounts for healthcare and other employees.
How will the transition from subvention to direct payments be carried out?
The first quarter of 2018 is the time for local authorities and primary healthcare providers to prepare for the introduction of a new financing model and new standards for service delivery.
Members of the Verkhovna Rada decided to leave two funding systems – the healthcare subvention and direct payments under the agreements with the NHSU – during the transition period (2018-2019). Therefore, prior to the direct payments from the state budget under the agreements with the NHSU, primary healthcare institutions (including autonomous ones) will be funded by the healthcare subvention as before.
The institutions that will not be autonomised and will not coclude agreements with the National Health Service of Ukraine will be funded with the healthcare subvention till the end of 2018. Accordingly, the salaries of doctors will be tied to the tariff scale.
Healthcare institutions will be able to join the reform only by groups – by the whole rayon, town or amalgamated hromada at once. This is due to the fact that the subvention is paid to the budget, and accordingly can be cancelled completely for this particular budget, and not for a separate institution.
Therefore, to join the reform, all healthcare institutions funded from the rayon, town or AH budget should be autonomous, connected to the electronic healthcare system and comply with the Equipment Table for the provision of primary healthcare services.
Private primary healthcare practices (doctors who are private entrepreneurs and private institutions) can conclude a contract and start their work with the NHSU at any time since the launch of the Service.
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