Is there a place for the patient in the Ukrainian health care system? Patient payment policies and investment priorities in health care in Ukraine

The principle of free-of-charge health care services is written in the Ukrainian Constitution. However, the state fails to implement this principle in practice. Our analysis confirms that in spite of the proclaimed free-of-charge health care services, many Ukrainian patients pay for health care services and these payments are considerable. As much as 57% and 73% of patients using out-patient and in-patient services respectively reported having spent money for this. Among those who paid for health care services, the average annual expenditure is 636 UAH for out-patient services and 2,019 UAH for hospital services. Patients who paid formally on average spent 555 UAH for out-patient services per year, while those who paid informally, spent about 337 UAH. This unregulated patient payment system is a threat to the population’s health as it prevents many patients from obtaining the health care that they need. Hence, the current’ free-of-charge’ system does not work properly and cannot sustain the health of the nation any more. There is a need for a thoroughly designed official and transparent payment system as well as structural financial reforms.