The document “Can people afford to pay for health care? New evidence on financial protection in Ukraine” provides an in-depth analysis of financial protection in Ukraine’s healthcare system, focusing on out-of-pocket payments, financial hardship, and healthcare accessibility. Key findings:
- Increasing Financial Hardship:
- The percentage of households with catastrophic out-of-pocket payments rose from 11.5% in 2010 to 14.5% in 2015.
- Impoverishing out-of-pocket payments increased from 7.6% in 2010 to 9.0% in 2015.
- The burden of catastrophic spending is highest among the poorest households.
- Out-of-Pocket Payments & Health Coverage:
- The Ukrainian health system heavily relies on out-of-pocket payments, which constituted 48% of total health expenditure in 2015.
- Public spending on healthcare in Ukraine was significantly lower than in the EU and WHO European Region.
- Medicines and inpatient care are the primary contributors to catastrophic health expenditures.
- Limited Public Health Financing:
- Although Ukrainian citizens are entitled to publicly funded healthcare, in practice, most outpatient and inpatient services require significant out-of-pocket payments.
- Medicines are almost entirely paid for out-of-pocket, with very minimal government coverage.
- Unmet Healthcare Needs:
- The proportion of people reporting unmet medical needs due to cost doubled from 15% in 2010 to 29% in 2015.
- There is a high degree of income inequality in unmet healthcare needs, particularly for inpatient care.
- Role of Informal Payments:
- Informal payments are widespread, including “charitable donations” and direct payments to providers.
- These payments create barriers to access and increase financial hardship, disproportionately affecting lower-income households.
- Policy Implications:
- The government introduced the Affordable Medicines Programme in 2017, which provides essential medicines for chronic diseases at reduced prices.
- Addressing financial protection requires increased public investment in health, improved coverage policies, regulation of medicine prices, and better efficiency in public health spending.
The document highlights the financial burden placed on Ukrainian households due to low public health financing, high out-of-pocket expenditures, and widespread informal payments. Despite recent reforms, financial protection remains weak, particularly for low-income groups. Strengthening public investment in healthcare and enhancing policy transparency are critical steps toward achieving universal health coverage.
