Ukraine

In 1991, Ukraine inherited an extensive and highly centralized Semashko health system (a hierarchical, nationally controlled system the staff of which were state employees). There has been considerable decentralization in the system since independence and profound reforms to health financing in recent years, which have continued despite the full-scale Russian invasion in 2022. 

Half of health financing in Ukraine comes from general government revenues, while out-of-pocket payments account for the other half; and nearly one in five households experiences catastrophic health spending. Much of OOP and catastrophic spending is driven by costs associated with inpatient care

 In 2017, the Government created a single national purchasing agency – the National Health Service of Ukraine (NHSU) – to enable better resource allocation and strategic purchasing. It introduced a purchaser-provider split and new methods of paying healthcare providers and allowed the NHSU to contract private providers. At the same time, it established two defined sets of benefits, one for outpatient medicines known as the Affordable Medicines Programme (AMP) and one for health services (initially primary care but later including specialist and emergency services) known as the Programme of Medical Guarantees (PMG). These Programmes have been an important attempt to explicitly link publicly financed health benefits to population health needs and available resources.

 Primary health care in Ukraine is provided by public and private providers, including public communal providers, private institutions, or private practices owned by a doctor (who may work alone or employ additional practitioners) known as fizychna osobapidpryemets (FOPs). Secondary care in larger cities is provided in city hospitals, maternity hospitals and children’s city hospitals, while central rayon hospitals in each administrative district of each region provide care for their respective populations. Tertiary hospital care is provided in regional multiprofile hospitals, monoprofile specialized hospitals, regional children’s hospitals, psychiatric hospitals, and tuberculosis and other monoprofile facilities.