The second phase of medical reform: how can private institutions join?

The medical reform is based on the Law on State Financial Guarantees of Public Health Services (hereinafter – the Law), whose final and transitional provisions provide for the gradual introduction of the reform on the different levels of medical care.

Since 2018, medical reform has been implemented for the primary level. And on April 1, 2020, reform is to be implemented at other levels.

There is not much time left until April 1, but not all utilities are ready for reform. Due to this, in some regions, the postponement of the date of implementation of the second stage of reform was initiated. The Minister of Health has also stated the need for additional time to prepare for the second stage.

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However, no decisions on postponing the date of the second stage have been made, and therefore – everything should happen according to plan.

Medical Guarantee Program

The state guarantees payment not for all medical services, but only for those provided by the Medical Guarantee Program. In the future, the program will be approved by the Parliament in the law on the state budget. The current law abolishes this rule for 2020 and stipulates that the amount of expenditures is set by the government based on available financial resources.

Considering the experience of some social payments (pensions) in Ukraine, it is possible that a similar norm will not yet be in one law on the state budget.

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National Health Service of Ukraine (NHSU)

The reform is being implemented through the National Health Service, coordinated by the government through the Minister of Health. The NHSU was created by the Cabinet of Ministers on December 27, 2017, to provide state financial guarantees for health care.

NHSU is the body authorized to conclude a health care agreement with institutions.

Requirements for service providers

The law provides for the possibility of entering into an agreement on public health care with the NHSU by a healthcare institution of any form of ownership, and even an individual entrepreneur.

So – private institutions can join the reform and after concluding the contract with the NHSU – receive funds for medical services provided from the state budget.

To be eligible for service providers, you must:

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• be registered as a legal entity or individual entrepreneur;
• have a valid license for medical practice;
• have the necessary material and technical base that complies with industry standards and equipment plates approved by the Ministry of Health;
• ensure accessibility for persons with disabilities and other low-mobility groups;
• meet the criteria for the relevant budget program.

The health care provider must be connected to the Central Database of the Electronic Health Care System. Accordingly, there is a need for computerization.

The connection is made through MIS (medical information systems). The list of MISs connected to the Central Database of the Electronic Health Care System can be found on the website of the Central eHealth Ukraine database administrator.

Contract with the National Health Service

Announcements for the conclusion of contracts (with descriptions of medical services, requirements for specialization and number of specialists, list of equipment) can be found on the website of the NHSU.

The essential terms of such a contract are the scope of services (as well as medicines), the procedure, terms and conditions of payment, the address of provision of services, the rights and obligations of the parties, their liability, the term of the contract and reporting. The Cabinet of Ministers approves the Standard Form of the Contract and the procedure for its conclusion.

Once the contract is concluded, the National Health Service publishes it on its website within 5 days.

Payment for services will be made to the account of the institution based on reports submitted by the institution to the electronic system.