Rehabilitation Assistance for Adults and Children: What Services Are Provided for Free

VoxCheck, with the support of the USAID Health Reform Support project, continues to explain to patients how the state Medical Guarantees Program works. We outline the free medical services included in the rehabilitation packages for both inpatient and outpatient settings, where these services can be accessed, and what patients can do if their rights are violated.

What is rehabilitation and how does it work

Rehabilitation is a set of measures aimed at restoring health, functionality, and the ability to work, which have been impaired by diseases, injuries, or other factors. This process includes physical, psychological, and social support for the patient. Examples of rehabilitation services include:

• Speech training to improve communication skills after a traumatic brain injury.
• Physical exercises for stroke patients.
• Teaching safe physical exercises to people with heart conditions.
• Preparing a patient with an amputation to use a prosthesis.
• Reducing swelling and restoring movement after burn surgery.
• Prescribing medication to reduce spasticity in a child with cerebral palsy.
• Psychological therapy for individuals experiencing emotional stress.
• Social skills training for people with schizophrenia, etc.

Quality rehabilitation assistance cannot be provided by a single specialist, which is why Ukrainian legislation mandates the formation of a multidisciplinary rehabilitation team. This team includes physical and rehabilitation medicine doctors who lead the team and are responsible for organizing its work and implementing the individual rehabilitation plan, as well as physical therapists, occupational therapists who help restore social and everyday skills, speech and language therapists, prosthetists-orthotists, psychologists, psychotherapists, nurses, and assistants.

“The full-scale invasion forced us to look at rehabilitation services from a new perspective. War injuries require new approaches — comprehensive ones involving a multidisciplinary team of specialists, individualized programs, and evidence-based methods. In 2022, the National Health Service of Ukraine (NHSU), along with experts, began working on improving the rehabilitation packages for adults and children. In 2023, we started purchasing inpatient and outpatient rehabilitation separately. In the Medical Guarantees Program, this service has become comprehensive and a priority. Accordingly, tariffs have changed: instead of a global budget, payment is made for specific services provided. In 2024, the total funding for rehabilitation assistance increased to 5.54 billion UAH. Restoring our people is one of the most important tasks of today,” says NHSU Head Natalia Husak.

How to get rehabilitation services for free: patient’s route

Under the Medical Guarantees Program, free inpatient rehabilitation assistance is available at 316 medical facilities contracted with the National Health Service, and outpatient rehabilitation is available at 473 facilities.

According to the Ministry of Health of Ukraine, to receive inpatient services, a referral is required exclusively from the treating doctor. The specialization of the specialist who issues the referral depends on the patient’s disease or injury. Patients may also be transferred for rehabilitation from one medical facility or clinical unit to another. At the same time, a family doctor can refer a patient for outpatient rehabilitation.

After receiving an electronic referral, patients can independently choose a medical facility for rehabilitation. The addresses and contacts of the nearest facilities contracted with the NHSU can be found by calling the contact center at 16-77 or using the dashboard: “Contracts for Medical Services Under the Medical Guarantees Program”.

Rehabilitation services covered by the NHSU

Services included in the inpatient rehabilitation package:

• Examination by a physical and rehabilitation medicine doctor, other rehabilitation specialists, and consultations with other specialists as needed.
• Development of an individual rehabilitation plan.
• Monitoring of the clinical condition and adjustments to the rehabilitation plan as needed.
• Necessary laboratory and instrumental examinations.
• Provision of rehabilitation assistance in several areas simultaneously.
• 24-hour nursing care.
• Psychological assistance.
• Timely pain management at all stages of rehabilitation.
• Medicines from the National List of Essential Medicines, medical devices, and consumables according to health sector standards.
• Nutrition.

Services included in the outpatient rehabilitation package:

• Examination by a physical and rehabilitation medicine doctor, other rehabilitation specialists, and consultations with other doctors.
• Diagnosis and development of an individual rehabilitation plan.
• Monitoring of the clinical condition and adjustments to the rehabilitation plan as needed.
• Rehabilitation assistance (neurological, orthopedic, psychological, cardiorespiratory, comprehensive rehabilitation, etc.).
• Selection, adjustment, and training in the use of assistive rehabilitation devices.
• Psychological assistance.
• Training for patients, family members, or caregivers on care specifics.
• Issuance of certificates, preparation of medical opinions on temporary disability, and referrals to medical and social expert commissions and/or medical advisory commissions, among others.

The full list of services under the package can be found on the NHSU website in the “Medical Guarantees Program Requirements 2024” section, points 23 and 24.

What to do if your rights are violated when receiving medical assistance

If a patient is denied rehabilitation services provided under the Medical Guarantees Program, if services are not provided in full, or if payment is demanded, they should file a complaint with the medical facility’s chief physician. If the issue cannot be resolved this way, they should contact the local health department. If that does not help, they should submit a complaint to the NHSU.

Since the beginning of 2024, there have been 33 complaints about rehabilitation service packages. The highest number of complaints (7) was recorded in the Dnipropetrovsk region. Complaints were also recorded in the Lviv, Vinnytsia, Odesa, Zhytomyr, Sumy, Ternopil, Kharkiv, Khmelnytskyi, and Cherkasy regions, as well as in Kyiv.

For example, in February 2024, a patient filed a complaint against the Mykulyntsi Regional Physiotherapy Rehabilitation Hospital for demanding payment for services. As a result of the complaint, the money was refunded to the patient. The medical facility informed VoxCheck that the patient’s treatment plan included peloid therapy (the use of therapeutic mud), which is not included in the standard list of rehabilitation services covered by the NHSU. After clarification, the patient declined additional procedures, and the money was refunded.

Complaints to the NHSU can be submitted in several ways:

• Submit a complaint through the online form on the NHSU website in the “For Citizens” section: https://cutt.ly/hewPO7gU
• By calling the free contact center number 16-77. The hotline operator will record the complaint and assist with submitting the request.
• Send an official letter to the email: [email protected].
• Send a letter to the NHSU postal address: Stepan Bandera Avenue, 19, Kyiv, 04073.
• Write a request during a personal reception of citizens.

The complaint should include the patient’s full name, date of birth, and contact details, as much detail about the event as possible: date, the amount spent or demanded, copies of receipts, if available, as well as the full name and position of the doctor who demanded payment or refused to provide the service.

Rehabilitation is a complex process that requires an individualized approach. Meanwhile, corruption undermines the accessibility of these services, which are increasingly needed during the war. Complaints are one of the tools to combat corruption in the healthcare sector. They help increase transparency and accountability in the medical system and ensure that patients receive the necessary assistance on a legal basis.