If a package of laws required for the healthcare reform is adopted soon, the whole system will be able to switch to the new working process in three years. This was announced by Pavlo Kovtoniuk, Deputy Minister of Healthcare of Ukraine, during a press briefing at Ukraine Crisis Media Center. “We are ready to start this [at primary link of healthcare system] after mid-year, if this package of laws is adopted. In 2018-2019, hospitals, diagnostic centers and other institutions of secondary and tertiary levels will also switch to agreements with the National Healthcare Service and join the system. So, it will take three years to launch the new healthcare system in full,” he explained.
This package ought to be adopted soon; otherwise the actual start of reforms can be suspended until 2021-2022. “If we fail to do it this year, we will have to come back to this conversation next year, and then try to implement all these things during elections in 2019 and 2020. However, all of us know very well that no one will address the issue of the healthcare reform at that times,” noted Pavlo Kovtoniuk.
What does a key draft law provide for?
The key draft law “On state financial guarantees of provision of medical services and drugs” clearly specifies the state guarantees of medical services and the implementation tools for these financial guarantees. The main purpose of changes is to provide citizens with a package of free services, improve the quality of services and efficiency of funds allocated from the state budget to healthcare.
Firstly, the draft law provides for introducing the real guaranteed package of medical services. The guaranteed package of medical services will be common, i.e the same for all citizens regardless of their wealth. “It will be defined and open: each year people should know what rights they will enjoy next year, paying for this from their taxes,” noted Pavlo Kovtoniuk. Secondly, it introduces personalized payment of funds from the budget: the money must follow the patient for a particular service according to the fixed rate. Thirdly, it provides for a standardization of medical services by recognizing international protocols.
What will be free and what shall we pay for?
The guaranteed package will consist of “red”, “green” and “blue” lists. Patients will pay themselves for the “red” list services, such as non-emergency dental services, visiting a doctor without a referral, medicines that are not protocol-stipulated, aesthetic medicine. The “green list” will include services fully covered by the state: emergency care, primary care services and palliative care. The “blue list” will include non-emergency routine medical services, some of which will be paid for by the state at an established rate, and partially by patients at the rate of co-payments. “These rates will be unified for private and public medical institutions […], pre-defined, known to all citizens and can be paid for at any hospital within the healthcare system completely legally. And they will be much smaller than what we are paying to doctors’ pockets or as so-called charitable contribution,” said Pavlo Kovtoniuk.
Citizens will be able to save on medical services that are not included in the “green list” using private health insurance. According to Pavlo Kovtoniuk, its market is growing, so the price should be significantly lower. Additional targeted assistance programs will be developed for the socially disadvantaged people. The first program is aimed at ATO veterans: it will completely cover the treatment of contusions, wounds and injuries received in a combat zone, and all services for those who gets disability as a result of wounds.
Who will control the process?
The guaranteed package of healthcare services will be operated by the National Healthcare Service of Ukraine, established on the model of similar services in Norway, Italy, the UK and other countries. “This institution pays for medical services under a contract, according to a guaranteed healthcare package. It pays not only to state-owned institutions, but also to any form of property, selected by the citizen: private medical and departmental institutions, if they sign relevant contracts with the National Healthcare Service,” explained the deputy minister. The amount of assistance, coverage rates and co-payment rates for each service will be known in advance; all payments will be non-cash to remove the risks of corruption. “That is, you do not think about money, and the doctor does not think about money, it is the hospital manager’s concern. He concludes a contract with the National Healthcare Service and private insurance companies, or receives money for certain categories of patients under specific programs,” added Mr. Kovtoniuk.
The guaranteed healthcare package, the list of services and the rates will be determined for each following year on September 15 of the previous year, considering priorities (public importance, incidence, mortality from specific diseases) and available budget resources. This process will involve the Ministry of Healthcare, the National Healthcare Service and the Cabinet of Ministers. The first guaranteed package will be calculated on September 15, 2018, when the system is prepared for a full-fledged launch.