of November 30, 2016 No. 1013-r
About approval of the Concept of reform of financing of health care system
1. Approve the Concept of reform of financing of health care system which is attached.
2. To the Ministry of Health together with interested central and local executive bodies to develop and to submit in accordance with the established procedure to the Cabinet of Ministers of Ukraine the draft of the actions plan on implementation of the Concept approved by this order in a month.
Prime Minister of Ukraine
Approved by the order of the Cabinet of Ministers of Ukraine of November 30, 2016 No. 1013-r
Most of Ukrainians live in fear to face domestic health care system. Despite payment by citizens from own pocket of nearly a half of funds for health care in addition to nation-wide taxes they are forced to receive the services provided based on obsolete infrastructure without quality assurances and respect for the rights and advantage of patients. Such organization of system not only violates constitutional right of the person on available and high-quality medical care, reduces the level of health and life expectancy of Ukrainians, but also interferes with economic development and social unity of society.
Dysfunctionality of the operating system is caused by specifics of its organization and financing. For today in Ukraine the command and administrative model of health care inherited from the USSR still is effective. Healthcare institutions are budgetary institutions and are in property of the state or territorial communities. Profit and loss budgets of these healthcare institutions affirm the same authorities in which property they are therefore authorities receive incentive to act for the benefit of the relevant organizations, but not for the benefit of the specific patient. Financing of the specified organizations is performed according to the tough itemized estimate on the basis of obsolete infrastructure standard rates. It deprives of heads of healthcare institutions of managerial flexibility and does not promote motivation to improvement of result.
The international experience, recommendations of the World Health Organization (further - WHO), and also researches of specifics of the model of health care system of Ukraine used today demonstrate that the only way to provide high-quality medical protection without financial stress for citizens is transition to financing of medicine by the insurance principle. This approach allows to spread risks of disease and expenses on treatment between large number of insured persons, in advance collecting feasible fees from big pool of people and allocating the raised funds for payments for insured event in case of disease or other disorder of health.
For introduction in Ukraine the model of the national solidary medical insurance which considers the best modern practices and experience of transformation of health care systems in the world, in particular in Central and Eastern Europe is offered.
The means of the Government budget of Ukraine received from nation-wide taxes remain the main source of financing of updated health care system. Payments for treatment of the certain person are not tied to the size of its individual fees.
Budgetary funds for financing of medicine are distributed via the new, modern mechanism of strategic purchase of medical services. There is transition from financing of itemized estimates of healthcare institutions - the budgetary institutions calculated according to their existing infrastructure (quantity of beds, personnel, etc.), for payment result (that is actually treated cases or the attributed population) to institutions which turn into autonomous suppliers of these services, and also to drugstores as to suppliers of the medicines appointed by doctors. Thus, the principle "will be entered money goes for the patient", but not on infrastructure of healthcare institutions and other service providers.
The state guaranteed packet of medical care becomes subject of purchase - it is transparent certain amount of primary, secondary (specialized), tertiary (highly specialized), emergency medical care and medicines which right will be had in case of need by one and all citizens of Ukraine. The cost of these services will become covered by insurance fully or partially. In case of partial covering patients will perform official copayment for services and/or medicines. Approaches to establishment of the amount of such copayment will be accurately certain and single for all country.
At initial and medium-term stage of reform by the general customer of medical services of the state guaranteed packet of medical care there are acting main managers of budgetary funds which relevant organs of the government and local government bodies are. However final task of reform is ensuring purchases of such services through the single national customer.
Transition to new purchasing system of medical services is followed by creation and continuous improvement of modern platform for collection and exchange of medical and financial information in electronic form. Such electronic system will allow to realize the principle "money goes for the patient", and also to analyze situation with the state of health of the population quickly to develop the optimum plan of purchase of medical services and most effectively to spend means. This system will also open opportunity for creation of "single medical space" - coordination and integration between levels of medical care, and also for implementation of new quality management system of services.
The offered upgrade of the existing system of financing of medical industry is radical therefore the changes provided by it shall be performed gradually. Introduction of new model is supposed to be performed in three stages which complete realization is expected by 2020. Gradualness is especially important for ensuring proper social protection and retraining of health care providers in the conditions of its radical reorganization, and also for development of information systems, effective consolidation of resources for investments into development of perspective healthcare institutions in neogenic hospital districts, fixing of new functions of communities and local self-government in system of medical insurance, ensuring effective social communication and explanation of essence, mechanisms and the expected results of reform to general population.
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