UKRAINE | Summary

OVERVIEW | HISTORY | HEALTH & HEALTH SYSTEM | HEALTH INDICATORS & DEMOGRAPHICS

GDP: 153.8 Billion USD1
Health Expenditure (% of GDP): 7.72%8
 

Populace2

• Population: 5.1 Million
• Housing: 66.3% Urban, 33.7% Rural

After World War I the USSR faced immense epidemics and other health problems with much of the healthcare infrastructure destroyed. In 1918, the People’s Commissioner of Health, Semashko, introduced Soviet health care. This concept declared state responsibility for health care, universal health coverage, high quality care and prevention of disease. The health system in Ukraine was under strict control of the central government in Moscow. Planning of resources and personnel, among other healthcare decisions, was highly centralized with little autonomy for regional and local governments. During World War II, Ukraine suffered detrimental consequences with many health facilities destroyed again and many health professionals were killed or deported. The period after the war focused on rebuilding the health care system and addressing the concurrent epidemics. There was a rapid expansion of this health system which provided universal access to health services and improved population health significantly. By the early 1970s, the life expectancy increased to 70 years. The 1970s and 1980s had increased specialized care facilities, consulting rooms in polyclinics, and conversion of general medicine units to specialized care.⁵

Ukraine gained its independence from the USSR in 1991 and experienced a harmful process of economic restructuring and social instability. There was a dire need for healthcare but the country had limited resources available. Ukraine maintained the fundamental health system under the USSR with a few changes made later on. It was still determined to provide universal health coverage to its citizens without soviet support. Due to lack of resources, the government had to set limits to health benefits which created discontent among citizens. In 2002, the Constitutional Court examined whether charging patients for services was unconstitutional and determined that care delivered by state-funded facilities should be available to all citizens regardless of volume or length of stay without charges before, during, or after treatment. The Ukranian government has put forth many efforts for health reform but has yet to implement an effective system to combat its inefficiencies and that aligns with the constitutional rights of citizens.⁵

HEALTH & HEALTH SYSTEM

The health system in Ukraine has kept the fundamentals of the Semashko model from the USSR. There have been a few changes but major healthcare reform has not been achieved since the country’s independence. Under the constitution, Ukrainian citizens are guaranteed a package of health services provided with no charge at the point of delivery as a right. This right also applies to foreign citizens, refugees, and stateless persons permanently residing in Ukraine. The major alteration of the health system is the decentralization of financial and managerial powers from national government to regional and local authorities. Under the Soviet Union, there was a highly centralized model of decision making in the health system. Healthcare facilities are functionally subordinate under the Ministry of health but now answer to regional and local governments for other matters. The Ministry of Health develops and approves state quality standards and clinical protocols. They also organize and implement the mandatory accreditation of facilities and licensure of entities and individuals participating in healthcare delivery. The major official sources for healthcare financing in Ukraine is revenue from national and local taxes. There are also revenues from property and enterprises, administrative fees and charges, financial sanctions, and other charges that contribute to the healthcare budget.⁵ 

Ukraine has a commitment to provide universal coverage for its citizens but does not have the financial backing to ensure it. The country faced an economic downturn in the 1990s but kept the model of healthcare resulting in many discrepancies within the system, especially financing. The government is challenged with balancing the services it covers and the constitutional rights of patients to receive healthcare services. In addition to alternating payment decisions, there is little government regulation of payments for healthcare services. Healthcare facilities have the autonomy to decide how much to charge for services and there is no official method to determine medical costs. There is also no official copayment system for patients to know how much they will be charged. These loose policies have led to a lack of transparency in the health system and inconsistencies in receiving care. It has contributed to an increase in informal payments where, for example, one can adjust how much they pay for inpatient care if they bring medicines, dressings and other disposables with them on admission.⁵ 

There are two more types of systems in which Ukraine citizens can receive care: the private sector and parallel health systems. The role of voluntary health insurance through the private system has been growing but accounts for approximately 0.9% of total health expenditures. The private sector is mostly financed through direct payments from the population. Only about 3% of the population was covered under VHI in 2013. Most of the expenditures are out-of-pocket payments for private care and for the high cost of pharmaceuticals. Employers may obtain voluntary health insurance for their employees to promote their health. People who have existing health problems also purchase this insurance to reduce their costs, to get a higher level of comfort, and to avoid waiting lists for care. The parallel health systems are managed by many different ministries and government bodies that provide care for their workers. Some of the major parallel systems are in the Ministry of Education and Science, State administration, and Ministry of Labor and Social Policy. They are governed independently through their respective ministries. These systems are funded from the national budget where about 42% of health expenditure from the national budget is spent on them.⁵ 

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Health Indicators2

Ethnicities6

Age Structure7