For the third year now, the Ukrainian health care system has faced the challenges posed by the great war. Despite this, the implementation of the reform continues, the rapid development of certain fields is taking place, in particular, thanks to foreign investments and in response to new needs. The “Patients of Ukraine” charity foundation analyzed the biggest successes and challenges of the health care system in the first half of 2024.
Among the positive changes, the patients’ community highlights the expansion of the Medical Guarantee Program by 3 new packages in 2024. Thus, free services of assisted reproductive technologies, organ and bone marrow transplantation were added. In total, there are 44 packages of state-guaranteed treatment. This year, medical guarantee program funding increased by UAH 16.1 billion: from UAH 142.7 billion to UAH 158.8 billion.
The field of rehabilitation and prosthetics is actively developing. Currently, the state is working to ensure that the rehabilitation full-time department is based in all multidisciplinary superclaster and claster healthcare facilities. Thus, the patient will be able to receive rehabilitation services starting from the acute period and will have more chances to restore lost body functions. Rehabilitation services are financed by the National Health Service and are free of charge for patients. Currently, 295 HCFs are contracted for the stationary package, 453 HCFs for the ambulatory package. Patients also do not need to save money for prostheses, because they are provided by the state. The state invests up to UAH 856,000 for leg prosthetics, and up to UAH 503,000 for hand prostheses. The state provides military personnel with any prosthetic products worth up to UAH 2 million.
One of the successes highlighted by the CF “Patients of Ukraine” is the adoption of the bill on the introduction of the parallel import mechanism for state procurement of drugs from January 1st, 2025. Currently, the state is forced to purchase drugs for patients with cystic fibrosis, Crohn’s disease, multiple sclerosis and many other diseases 1.5 times, and sometimes 3.5 times more expensive than these drugs cost in Europe. When the mechanisms of parallel import become operational, Ukraine will be able to buy the same medicines in EU countries at lower prices and provide drugs to more patients.
“The patients’ community highlights that it is necessary to introduce a parallel import mechanism for all procurements in order to reduce the prices of medicines in pharmacies. Meanwhile, patients are forced to pay exorbitant amounts of money for a package of pills, when in the EU they could buy 3 such packages. This provokes “gray” transportation from abroad or refusal of treatment. Mechanisms of parallel import for medicines have been operating in Europe for 20 years in general. During this time, it was possible to reduce the prices of medicines by 20%,” says Inna Ivanenko, the executive director of the “Patients of Ukraine” CF.
The government has already removed cannabis from the list of particularly dangerous drugs, so patients will soon have access to treatment.
Another success is the start of the creation of supervisory boards at healthcare facilities. This mechanism involves the active involvement of the public in the control and management of healthcare facilities. Currently, 4 supervisory boards have already been established in Kyiv and Zhytomyr regions.
“This mechanism is about monitoring the observance of patients’ rights, the transparency of the HCFs’ work and the fight against corruption. At the same time, for the heads of healthcare facilities, it is an opportunity to attract the public and specialized professionals who, as members of the supervisory boards, will help in the management of the HCF,” reports Inna Ivanenko.
Furthermore this year, the National Health Service of Ukraine continued the monitoring of healthcare facilities. Currently, the service primarily inspects healthcare facilities that receive the most complaints from patients. This is an important tool for improving the quality of medical services and protecting patients’ rights, the foundation reports. Also this year, the Council of Public Control of the National Health Service was reset, according to the results of the vote, 5 representatives of the patients’ community entered the Council of Public Control. This will allow patients to contribute to the improvement of the Medical Guarantee Program and monitor the transparency of budget expenditures.
Also this year, SOE “Medical Procurement of Ukraine” switched to three-year planning. The foundation says that this will save money on purchases, manage supplies more effectively and minimize the risks of interruption of patient treatment. These are all important steps towards a stable access to treatment.
In 2024, the Verkhovna Rada adopted a decision that finally unblocked the Compassion Medicines Program, which was supposed to start working in 2022. From now on, such medicines will be completely free of charge for patients — without the need to pay personal income tax. The manufacturer’s tax was reduced from 20% to 7%.
Challenges for the work of the health care system for 6 months of 2024:
– The patients’ organization says that the deficit of the state budget for the purchase of medicines amounted to UAH 2.6 billion. This year, UAH 9.4 billion has been pledged, with a need for at least UAH 12 billion. With current funding, it is not possible to expand the list of drugs to meet the needs of patients with rare diseases (Parkinson’s, Duchenne, Crohn’s, etc.). In addition, it is impossible to expand purchases of innovative drugs for patients with some types of oncology, multiple sclerosis, epilepsy, pulmonary hypertension.
– The foundation highlights that patients continue to face the lack of guaranteed medicines in healthcare facilities. Although the majority of vital drugs are delivered on time by the SOE “State Medical Procurement of Ukraine”, some patient communities had problems with delays in the delivery of drugs purchased at state expense. For example, the drugs Ambrisentan for patients with pulmonary hypertension and Dactinomycin for the treatment of pediatric oncology had a 6-month delay in deliveries.
– Since the beginning of 2024, SOE “Medical Procurement of Ukraine” has concluded only one managed access agreement. For comparison, in 2022 contracts were concluded for 11 drugs. Ineffective negotiations on the conclusion of the MAAs have serious consequences: patients do not receive the necessary treatment and are often forced to travel abroad, and the state spends more money due to the need for longer treatment.
– This year, unfortunately, the exemption from value added tax of medicinal products purchased by SOE “Medical Purchases of Ukraine” was not extended. The lack of this benefit significantly reduces the number of medical products and medicines that the state can purchase, the foundation says. Currently, it is impossible to cover 100% of the needs of patients in all necessary medical products with the help of the state budget, but without the value added tax exemption, their provision is reduced. Also, the introduction of the value added tax does not fill the budget, but only diverts funds within it, limiting the volume of drug purchases.
– Since the beginning of the year, 1,800 complaints about extortion of money from healthcare facilities for medical services guaranteed by the state have been received by the National Health Service. According to the patients’ community, the priority direction in the fight against corruption in medical facilities is the introduction of supervisory boards.
