Results of costing for provider payments in primary health care in Ukraine: technical report

Overview

Between 2021 and 2023 Ukraine conducted a comprehensive costing analysis for provider payments in primary health care (PHC). The methodology employed considered Ukraine’s unique context and the existing PHC financing system. It used retrospective cost data from 2021, adopting a bottom-up approach to capture all PHC provider expenses and taking into account both payer and provider perspectives. Data collection underwent a pilot phase and was expanded to include 100 selected PHC providers, revealing significant cost variations across provider types and regions. Rural and communal providers incurred higher costs and often sought additional funding sources, while individual entrepreneurs optimized labour costs through staff management. The findings informed assumptions and scenarios for provider payment rate estimation, with a goal of incentivizing efficiency while maintaining quality of care. The estimated capitation rate, adjusted for inflation, stood at 878.42 hryvnia in 2023, while the actual rate was 786.65 hryvnia. This highlights the insufficiency of the existing rate to cover provider expenses. The rate estimate is subject to change based on policy priorities and budget constraints. Further refinements will be made through scenario analyses involving input from local stakeholders to enhance provider payment rate estimation.