J.6_Priorities_from_the_Ukrainian_MOH.pdf

Health System Reform long-term priorities 2018-2023

(as defined by the Ministry of Health of Ukraine)

BACKGROUND

Health Financing Reform and the creation of a Public Health System in Ukraine were proposed in 2015, approved by the Government of Ukraine on 30 November 2016, and implementation of these reforms began in 2017. One of the bills to support the reforms was adopted by Parliament in April 2017 (the bill on Hospital Autonomy #2309 a-d).

Full-scale implementation of the health financing reform will start after adoption of two key bills by the Parliament in autumn 2017 (#6327 and #6604). The bills will provide for the establishment of a single-payer financing system including:

- Clearly defined benefits package (health services, pharmaceuticals and medical devices) and universal coverage for all patients;

- New financial mechanisms based on payment for medical services: ‘money follows the patient’ principle;

- Effective resource pooling and purchaser-provider split;

- Establishment of a single national purchaser of medical services – the National

Health Service of Ukraine;

- Creating a portable and efficient e-Health environment.

In parallel, the MoH has launched a series of other important reform initiatives, in particular:

- Pharmaceutical reimbursement program (the ‘Affordable medicines’), started in

April 2017;

- Introducing internationally recognized clinical guidelines into medical practice;

- Health facilities autonomy (implementation phase based on the respective law adopted by the Parliament);

- Formation of hospital districts (planning and reorganization of the hospital network);

- Initiatives to reform medical education, the emergency medical system and mental health system;

Starting in 2017, the implementation of key health reforms will require several years of consequent changes and intensive capacity building. Several specific priorities related to heath financing reforms are listed below.

KEY PRIORITIES IN HEALTH SYSTEM FINANCING REFORM IN LONG TERM

• Establishment of the National Health Service of Ukraine: legal and operational support and capacity building for the regional branches; human, IT and analytical capacity building;

• Primary health care: implementation of new financial mechanisms (service purchasing based on capitation payment system); strengthening of service delivery side, including intensive human capacity building, empowering medical personnel with modern evidence-based practices, increasing the capacity of local community governments to manage their health infrastructure; promotion campaigns for population (to increase trust in family doctors and promote priority screening programs);

• State guaranteed benefit package: development of the regulatory framework and procedures for development and changing the SGBP; elaboration of health services standards;

• e-Health: development of the central component for the eHealth system including registries, dictionaries, standards and other solutions; building the capacity of the eHealth SOE (the state agency operating the e-Health system);

• Autonomy of health facilities: support to the health care providers in the process of transition to autonomous entities; capacity building for health facilities management;

• Specialist and inpatient care: network planning and strengthening within hospital districts; implementation of new financial mechanisms for specialist and inpatient care

(fee for service, DRGs, pay for performance): preparation of regulatory base; financial analysis; pilot and wide scale implementation; human capacities building.

• Health workforce development: reforming health education (new educational standards; improvement of independent examination of health students; professional development of health universities faculty); reforming post-graduate training

(internship, residency) in terms of contents and procedures (introduction of a system for automatic assignment of students to their internship positions); new quality control mechanisms at internship and residency levels should be introduced; introduction of licensing for health professionals; upgrade of the system of continuing education for health professionals (new regulations; quality control mechanisms); training managers and technical professionals to lead the implementation of a new health financing model (professional education in management, economics, finance for managers of health facilities, MOH agencies and think tanks).

Other important initiatives to emerge in the MoH priority list:

• Wide-scale incorporation of international clinical guidelines into clinical practice;

• Building a modern emergency care system, including development of operational processes and clinical guidelines; doctors and paramedic personnel training;

strengthening the emergency departments and dispatching system etc.;

• Strengthening of human capacity, leadership, and organizational structures at the MoH and regional health authorities;

• Analytics and monitoring: building analytical and policy making capacity and the MoH, launching modern statistical service, reform monitoring etc.

• Building capacity through improvements in medical education

• Implementing the proposed Mental Health Strategy

The MoH believes that the essential condition for the success of the above mentioned projects is close routine cooperation with all partners in both preparation and implementation of the projects. We will commit our time and effort to establish this cooperation.