New packages and more money: what has been changed in the medical reform in 2021

As of April 2021, more than 2,500 health care providers signed an agreement with NHSU, among them, there were 455 sole proprietor-doctors and 185 private medical institutions. That is, a quarter of all medical institutions that participate in the NHSU program came from the market.

What about health care financing?

Compared to 2020, the funding for medical services was increased. If the last year UAH 70.4 billion was included in the state budget for a medical guarantees program, more than UAH 120 billion was included in 2021. Even adjusted for inflation, this is 62% higher than the last year’s expenditures. So the health care funding is growing. Almost UAH 21 billion was released for primary care, nearly UAH 14 billion was released for emergency medical care and about UAH 10 billion was released for helping the patients with COVID-19 out of that amount. The rest will be released for medical care packages that have been entered into a contract by medical facilities of secondary and tertiary healthcare levels. 

And even this amount has already changed. Thus, the Government decided to redistribute UAH 6.5 billion from the finance of the medical guarantees program to purchase COVID-19 vaccines on April 14. However, Minister Maksym Stepanov assures that this money will be returned to the program of medical guarantees. But they can do it with the help of changes in the budget, so the parliament will have to vote for it. 

How many packages of medical services are available for medical institutions?

Today there are 35 packages of medical services instead of 31 packages like it was last year. Since this year, the National Health Service of Ukraine has introduced two new service packages, and the rest have been singled out and detailed for added convenience of patients. 

The new service packages include COVID-19 vaccination and support of patients with primary tuberculosis. However, to take a patient with tuberculosis, the primary care physician must have the appropriate qualifications, and the decision itself shall be unconstrained. 

Patients with haematological and oncohematological diseases (previously it was one package – blood disease and hematopoietic tissue disease), prenatal care under outpatient treatment, dental care package (except for orthodontic procedures and prosthetics) were separated into new treatment packages. Mobile psychiatric service will also be available free of charge at home.

What tariffs have been increased?

NHSU increased payment for childbirth. If the payment for uncomplicated birth was UAH 8.1 thousand last year, then it is more than UAH 10 thousand from April 1. If there is a complicated neonatal case during the delivery of a child weighing up to 1500 g, the tariff is raised from UAH 98.5 thousand to UAH 113.7 thousand. 

The tariff for tuberculosis treatment was increased from UAH 21,000 to UAH 40,000.

The tariff for cancer treatment payment has increased from 18 to 54 thousand UAH for adults and from 30 to 162 thousand UAH for children. This amount does not include specific drugs for treatment: they are purchased separately, centrally controlled and transferred to the hospitals, as before. 

Funding for providing medical care in the case of cardiovascular disease has also been changed. Thus, until April 1, 2021, the NHSU paid at a single rate – UAH 19.3 thousand for stroke care. And from April 1, such care may amount up to UAH 97.8 thousand, depending on the complexity of the case. 

Will everyone be able to use the services?

To use the free services, the patient must sign a declaration with the family doctor and receive a referral from him. You can get these services only in an institution with a contract with the National Health Service of Ukraine. 

Without a referral from a primary care physician, one can only go to a gynecologist, psychiatrist, narcologist, dentist, phthisiologist, pediatrician or specialist who follows the patient for a long time because of chronic disease. 

The National Health Service of Ukraine does not cover expenses on other specialised doctors without a referral. You will have to pay officially for such services out of your pocket, and if there is no payment system for services in a hospital, the patient may simply not be accepted.

Thus, the state kills two birds with one stone: it receives a normal accounting of diseases in the country to know what problems to pay attention to, and it discourages Ukrainians from self-medication – because they have the opportunity to be treated effectively and free of charge.

What are the extra charges for doctors and hospitals?

It is planned to pay the hospitals an additional 5% (and from July 1 – 10%) of the standard rate for each treated case. The extra charge will reach 15% from October 1. Andrii Vilenskyi, the head of the NHSU, commented to Liga.net that hospitals received less money during the quarantine because there were fewer treated cases for which the hospital had received money – because of a ban, for example, on planned operations. Therefore, such an extra charge should be fair compensation for the forced downtime.

To stimulate the purchase of professional equipment for oncology treatment, an adjusting factor 1.2 was set for these services. Therefore, the tariff for radiological treatment will be increased by 20% if the hospital has emerging technology, for example, a linear accelerator, cyber or gamma knife.