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| Health Financing Reform in Ukraine
envisages an integrated model of service delivery across all types of care, but no formal strategy to this end has been adopted or even developed.
Scope of specialized care covered by the PMG In April 2020, for the first time, Ukraine introduced a benefit package for specialized care. The PMG specified the services to be covered in inpatient and outpatient settings as well as a range of services for prehospital emergency medical care (EMC) treatment and mobile care. Before this, specialized care was financed using an input-based approach, in other words through approving facility budget requests organized by economic line items, such as salaries and utilities. Figure 3.7 details the specialized care services within the PMG, which are divided into 25 service packages, each contracted separately. They include four COVID-19 packages that were added in response to the pandemic and four broad packages covering the rest of care. Sixteen packages are defined as conditions and cover a comprehensive set of services to treat them, such as acute stroke, childbirth, mental health, TB, HIV, and COVID-19. A further nine packages are defined as service inputs, which can be used to treat a variety of conditions, such as colonoscopy, hemodialysis, and radiotherapy, for example. All other services that did not fall into any of these groups were covered by the remaining four broad packages defined by provider setting—inpatient, outpatient, and emergency care—and also paid through the PMG. Specifically, figure 3.7 illustrates the following: • Comprehensive sets of services to treat specific conditions. Of the 25 service packages, 16 were defined based on the treated condition.
FIGURE 3.7
Packages of specialized care in the PMG, 2020
Inpatient (4)
Broad specification by type of provider setting
Specific interventions / specific services
Specific conditions
• Acute stroke • Acute myocardial infarction • Childbirth • Complex neonatal care
Complex care (3)
• Mental health • Tuberculosis • HIV
Rehabilitation (3)
• Infants born prematurely and/or ill during 1–3 years of life • Musculoskeletal disorders • Lesions of the nervous system
Palliative (2)
• Inpatient care • Mobile care
COVID (4)
• Mobile testing brigades • Emergency care • Hospitalization • Transitional financing +16
Outpatient (7)
Complex care (2)
• Mammography • Hysteroscopy • Esophagogastroduodeno scopy • Colonoscopy • Bronchoscopy • Cystoscopy • Hemodialysis • Chemotherapy • Radiotherapy
Outpatient (1)
• All other types of outpatient care
Inpatient (2)
• All other types of surgical inpatient care • All other types of nonsurgical inpatient care
Emergency care (1)
• All types of emergency care
+9
Source: Prepared by World Bank staff using data from the NHSU, accessible at https://contracting.nszu.gov.ua/.
+4 = 29
