Ukraine: health system review

ABSTRACT

This analysis of the Ukrainian health system reviews recent developmentsin organization and governance, health financing, health care provision,health reforms and health system performance. Since the country gainedindependence from the Soviet Union in 1991, successive governments havesought to overcome funding shortfalls and modernize the health care systemto meet the needs of the population’s health. However, no fundamental reformof the system has yet been implemented and consequently it has preserved themain features characteristic of the Semashko model; there is a particularly highproportion of total health expenditure paid out of pocket (42.3% in 2012), andincentives within the system do not focus on quality or outcomes.The most recent health reform programme began in 2010 and sought tostrengthen primary and emergency care, rationalize hospitals and changethe model of health care financing from one based on inputs to one basedon outputs. Fundamental issues that hampered reform efforts in the pastre-emerged, but conflict and political instability have proved the greatestbarriers to reform implementation and the programme was abandoned in 2014.More recently, the focus has been on more pressing humanitarian concernsarising from the conflict in the east of Ukraine. It is hoped that greater political,social and economic stability in the future will provide a better environmentfor the introduction of deep reforms to address shortcomings in the Ukrainian health system.