What is covered by the Program of Medical Guarantees, and how is it purchased?

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Purchasing the Program of Medical Guarantees

WHAT IS COVERED BY THE PROGRAM OF MEDICAL GUARANTEES, AND HOW IS IT PURCHASED?

In 2020, the Program of Medical Guarantees (PMG) was expanded from covering only primary health care (PHC) services to all types of care, including hospital and specialized outpatient care. As discussed in chapter 2, the PMG is the benefit package that is guaranteed to be paid by public funds. In April 2020, in line with the original reform timeline, the scope of the PMG was expanded from PHC to cover the entire health care continuum, including PHC, specialized, and emergency care.

The National Health Service of Ukraine (NHSU) purchases PMG services through distinct service packages, developed on an annual basis, depending on the budget and health policy priorities. In 2020, all health care services in the PMG were initially organized into 27 packages of services. These were adjusted to include three additional packages for COVID-19-related health services plus a temporary package for hospitals that treated COVID-19 patients in the initial stages of the pandemic but were not designated as COVID-19 hospitals. Later in the year, a transformation package was added to support hospitals in adjusting to new contracting and provider payment methods. Service packages in PMG2020, which was effective from April 2020 to March 2021, can be in general categorized into seven broad areas, as presented in figure 3.1. In late 2020, the PMG was organized into a primary care package, an emergency care package, 8 outpatient care packages, 12 hospital and complex care packages covering inpatient and outpatient care, 3 rehabilitation care packages, 2 palliative care packages, and 3 COVID-19 care packages (see figure 3.1). This approach was largely maintained in PMG-2021 covering May–December 2021, which was extended to 36 packages, mostly by unbundling some of the broader packages. It introduced separate packages for dental care and pregnancy management (previously part of the general outpatient care), a separate package for outpatient peritoneal hemodialysis (previously part of the general hemodialysis package), and a separate package for treatment of hematological diseases (previously part of general outpatient and inpatient care). PMG-2021 also included two entirely new outpatient care packages—support to tuberculosis (TB) patients at the primary care