Ukraine

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Eastern Europe and Central Asia

8%CHE/GDP

46.3%OOP/CHE

10.1%GGHE-D/GGE

200BGDP (USD)

43.5MPopulation

Ukraine is the second largest country in Europe. Ukraine declared independence in 1991 and is classified as having a lower middle-income economy.

Largely unchanged health system model

Ukraine maintained most of the fundamental features of the Soviet era Semashko health system model and did not undertake any major health system reforms^[1]. Ukrainian citizens are guaranteed the right to a package of health services provided at no charge at the point of delivery. This right also applies to foreign citizens, refugees, and stateless persons^[1]. Key features include central budgetary financing, a hierarchical organizational structure, and dominance of the public sector^[2]. For many years, the country lacked the financial backing to ensure the universal coverage its constitution promised. The government set limits to health benefits in the past, which created discontent among citizens^[1].

Ukraine’s health financing is mostly based on general taxation (national and local taxes), whereby expenditures are split between national and regional budgets. Primary care funding was about 10 percent of total health care financing^[2]. Ukraine has always spent more on health than an average CIS country, starting at 6.35% of GDP in 2005 and reaching 7.62% in 2020^[3] Current health expenditure per person was at the CIS average, increasing from Int$ 443 in 2005 to Int$ 945 in 2020^[3]. The share of out-of-pocket expenditure at 38% was lower than the CIS average of 49% for the years since 2005 but increased and reached 51% in 2018–2019.

Reform attempts and challenges

As Ukraine emerged from the post-Soviet era, its health system was one of the weakest among eastern European countries, characterized by organizational and financial inefficiency and unmet health needs^[2]. In 2014 the Ministry of Health of Ukraine began drafting the National Strategy on Health Reform to improve quality and access and to mitigate financial risks for the population. In 2016, the Cabinet of Ministries of Ukraine approved the Concept of Reforming Health Care Financing^[2]. In 2017 the Ukrainian parliament passed a law on health care financing and two related bills. The law was intended to introduce an insurance system financed by the government, allow provider choice, and launch a nationwide e-system for health information. The bills were to provide access for people in remote areas and to amend Ukraine’s financial code^[2].

The health care system faces many challenges because of political instability and conflict that constitute the largest barriers to improving people’s health and sustaining the health system.

References

[1] Columbia University Mailman School of Public Health. Ukraine: summary. Accessed 25 April 2023.

[2] Romaniuk, P., Semigina, T. Ukrainian health care system and its chances for successful transition from Soviet legacies. Global Health 14, 116 (2018).

[3] Global Health Expenditure Database. Geneva: World Health Organization. Accessed 26 April,2023.

[4] World Health Organization. Accessing health care in Ukraine after 8 months of war: The health system remains resilient, but key health services and medicine are increasingly unaffordable. 2022. Accessed 27 April 2023.