Funding the Program of Medical Guarantees
• Prepare a long-term health financing strategy that can be politically endorsed and includes a vision for the expansion of the PMG and its financing, over a 10-year period, along with complementary visions for associated programs, such as the gradual expansion of the AMP to replace OOP spending on medicines and policies such as stronger rules to prevent overprescribing or health care quality improvement measures.
NOTES 1. As of 2017, this included 24 oblasts and the city of Kyiv, 148 cities (average population 130,000); 464 rayons (districts with an average population of 45,000); and 159 hromadas (communities with an average population of 9,000). 2. The ceilings for the PMG components (such as primary, specialized, or emergency care) are defined in the program passport approved by the Ministry of Health (MoH) with the consent of the Ministry of Finance (MoF); the NHSU/MoH, therefore, have significant within-year flexibility for changing the PMG expenditure composition. 3. Article 4 of the 2017 Law on Financial Guarantees for Health Care Services states population coverage as including “citizens, foreigners, stateless persons permanently residing in the territory of Ukraine, persons designated as refugees or persons in need of additional protection.” 4. Data are from the Ukraine National Health Accounts 2018 and the State Statistics Service of Ukraine, http://www.ukrstat.gov.ua/ 5. Data are from the World Bank World Development Indicators database. 6. Data are from the Ukraine National Health Accounts 2018 and the State Statistics Service of Ukraine. 7. The consolidated budget of Ukraine includes budgets of all government tiers. Namely, it includes the central budget and the subnational budgets. 8. In this report, the definition of “medical goods” corresponds to “Category HC.5 Medical goods” of the System of Health Accounts 2011 (https://www.oecd.org/publications/a-system -of-health-accounts-2011-9789264270985-en.htm), which covers pharmaceuticals (prescribed and over the counter); therapeutic appliances; and other medical goods such as glasses, hearing aids, orthopedic appliances, and medical durables including technical devices. In Ukraine’s economic classification, this category of consumables is coded as 2220 “medicines and dressing supplies,” which, despite the title, is not limited to pharmaceuticals but also includes therapeutic appliances and all kinds of medical goods (any medical equipment not classified as capital investment) (according to the MoF coding guidelines outlined in Section 2.2.2. of the MoF Order No. 333 of March 12, 2012, available at https://zakon.rada.gov.ua/laws/show/z0456-12#n16. 9. The range of OECD countries here is limited to those that have formally reported their levels of total pharmaceutical spending for both 2015 and 2018. 10. Data are sourced from the State Statistics Service of Ukraine. 11. Calculations are based on data collected by the State Statistics Service of Ukraine through the 2009–18 Household Living Condition Survey’s module on self-perceived health status. 12. International comparisons are currently impossible because Ukraine collects the unmet need data by household rather than individual as in OECD countries. 13. Figure 2.4.4 shows the change in the shape of the concentration curves plotted for the two-period year moving average of the overall level of unmet need (measured as the share of households reporting such need). Each curve plots the cumulative percentage of the unmet health care need against the cumulative percentage of households ranked by income deciles. The blue curve depicts income distribution of the unmet need in 2009–10, and the red curve shows the situation as of 2017–18. During this decade, the curve moved closer to the full equality line. Illustrating that the concentration index, which measures the area between the concentration curve and the line of equality, grew from −0.15 to −0.12.
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