Can people afford to pay for health care? New evidence on financial protection in Ukraine 2023

Overview

This review is part of a series of country-based studies generating new evidence on financial protection – affordable access to health care – in health systems in Europe. It updates an analysis of financial protection in Ukraine published in 2018. Financial protection is central to universal health coverage and a core dimension of health system performance.

The incidence of catastrophic health spending is higher in Ukraine than in many other countries in Europe. It is heavily concentrated in the poorest fifth of the population and among households headed by older people or pensioners. The main drivers of catastrophic spending are medicines in poorer households and inpatient care in richer households.

Unmet need for health care is highest for medicines, dental care and outpatient care, mainly driven by cost and affects poorer households the most. In spite of near universal population coverage and the limited presence of user charges, informal payments and other out-of-pocket payments are widespread in the health system, reflecting gaps in the service dimension of health coverage, low levels of public spending on health (‎persistent underfunding of the Program of Medical Guarantees)‎ and other inefficiencies.

Although the Government has taken steps to strengthen access and financial protection, as demonstrated by recent reforms, and given priority to public spending on health, the health system needs to continue to reduce out-of-pocket payments for medicines and inpatient care.

Options for achieving this include prioritizing public spending on comprehensive primary care, which includes funding for better access to medicines and diagnostic tests; strengthening the prescribing, dispensing, price regulation and availability of medicines; tackling informal payments for inpatient care; improving the ability of the National Health Service of Ukraine to use public resources efficiently; and enabling the Government to implement policies to enhance protection for households with low incomes and others at high risk of catastrophic health spending.