Getting healthcare, in practice

Ukraine reformed its health financing substantially, moving from funding institutions to purchasing services. Described that way it is abstract, so here is what it looks like from a patient's side.

The declaration

A person signs a declaration with a specific family doctor, chosen by them, at any facility public or private that has a contract. The money follows the patient: the doctor's practice is paid per declared patient.

That single change created something that had not existed: a doctor with a reason to want patients to choose them.

The guaranteed package

A defined list of services the state pays for in full, published, covering primary care, emergency care, defined diagnostics, childbirth, cancer treatment and a growing list of other conditions.

Publication matters more than the content: a patient who can read what is free knows when they are being asked for something improperly.

What a patient actually experiences

Primary care through the family doctor, who is the entry point and the referrer. Specialist care with a referral, at a contracted facility. Emergency care without either.

Medicines are the main out-of-pocket cost, with a reimbursement programme covering a defined list for certain chronic conditions.

Where it still falls short

Rural access, where the family doctor may cover a wide area. Waiting times for some specialties. And informal payments, which the reform was designed to remove and has reduced rather than eliminated.

The wartime note

The system continued paying providers throughout, including for patients who had moved, because the money follows the person rather than the building. That design choice turned out to matter enormously.

As someone who uses this system, what I can say is that the declaration and the guaranteed package clarified not where care is obtained but who pays for it — and even that is a large difference. Where it still falls short is rural: the design can be right and it does not work where there is no doctor. As a foreigner, this is the public service I have seen improve most over the years.