Medicine in Ukraine has been in a state of chronic crisis for many years. Systemic problems—from dilapidated infrastructure and outdated equipment to catastrophic staffing shortages—remain unresolved, and with the onset of full-scale war, the pressure on the health care system has only increased. This crisis is especially acute in remote and frontline regions, where hospitals are stretched to capacity and residents have limited access to even basic medical services. In parallel with this, the migration of medical workers abroad continues: low salaries, fatigue, lack of social guarantees — all this forces specialists to leave the country in search of better conditions. Against the background of these challenges, the adoption of Law No. 6013, which was adopted by the Verkhovna Rada in January 2025, is of particular importance. As of March, it is gradually starting to act as a game-changing tool in the healthcare system.
What the law provides
The law provides for changes in the field of financing, regulation of labor relations of medical personnel, implementation of motivational mechanisms for work in rural areas and strengthening of the role of communities in the formation of the network of medical services. Its implementation is not only an attempt to respond to today’s challenges, but also a step towards creating a more sustainable, accessible and efficient medical system. In the context of the current burden on medicine, this law becomes key to its survival.
Adopted by the Verkhovna Rada Law No. 6013 actually became a sentence for the system of free medicine in Ukraine. It envisages that communal medical and social institutions can now be transformed into private economic companies. That is, hospitals, psychoneurological dispensaries, geriatric boarding houses and other social institutions cease to be state or communal structures, and instead receive the status of enterprises operating according to the laws of the market. This law not only changed the form of ownership of medical and social institutions, but actually the approach to them. Now medicine and social assistance cease to be a right and turn into a commodity.
That is, the adoption of this law marked a new era in Ukrainian medicine — an era of commerce, where financial indicators come first, not the lives and health of patients. From now on, communal hospitals and social institutions cease to be public property and turn into business associations. In fact, this means that the principle of “medicine for all” gives way to a strict market logic: pay or stay without help. This decision officially establishes what Ukrainians have felt in practice for a long time. Free medicine is gradually disappearing, and it becomes impossible to get quality treatment without significant financial costs. If earlier patients paid for tests, medicines and “charitable contributions”, now the very fact of the hospital’s existence as a social institution is being called into question. The law launched a process, the consequences of which will be felt already in the coming years. However, the main question is not how quickly the system will change, but who will pay the highest price for these changes. And it seems that this price will be measured not only in money.
On the one hand, the reform opens opportunities to attract investments, improve conditions in hospitals, and raise the salaries of medical personnel. But on the other hand, a commercial approach in the field, where the key should not be profit, but helping people, can have catastrophic consequences. From now on, the heads of these institutions can attract private investors, sell property and set tariffs for services. Government funding, which was already insufficient, will gradually disappear, which means that the cost of treatment and care for patients and their families will increase. If earlier these institutions worked as part of the social system, now they are forced to earn their own living. And that puts those who can’t pay at risk.
A law that targeted the most vulnerable
The most serious risks of the reform will be felt by those who need help the most: people with mental illnesses, the seriously ill, the elderly, and people with disabilities. For example, psychiatric clinics provide care for patients with severe mental disorders, many of whom require ongoing care and treatment. These facilities are not profitable because most of their patients cannot afford to pay for treatment and their families are often unable to provide the necessary care. In the case of privatization, dispensaries will be forced to either reduce services or raise prices. This will lead to mass closures, staff cuts and an increase in the number of people with mental health problems who will be left without help.
In many countries, such reforms led to catastrophic consequences: patients were discharged en masse without the possibility of receiving alternative treatment, which increased the rate of homelessness, crime and suicide. Ukraine risks repeating the same scenario.
Do not forget about geriatric boarding houses – houses for elderly people who do not have relatives or need constant care. Most of the residents of such institutions live at the expense of state funding. After the transformation of these institutions into commercial organizations, the cost of staying in them will increase many times, and many pensioners simply will not be able to afford it. The alternative for them is to end up on the street or become a burden to relatives who do not have the resources to care for them. It should be noted that Western countries, which have switched to a private model of geriatric care, are already facing a crisis: there is a catastrophic shortage of places in homes for the elderly, and conditions in low-cost facilities are becoming terrible due to staff savings. Now Ukraine risks being in the same situation.
However, people with severe chronic diseases are especially vulnerable, including cancer patients, patients with strokes, paralysis, diabetes and other conditions that require long-term treatment and constant care. They often depend on state support, because treatment is expensive and not everyone can afford it. If such establishments start working on commercial principles, then you will have to pay for each procedure, each day of stay, each service. The state can partially compensate costs for certain categories of the population. But these funds are unlikely to be enough.
It is likely that in the first years after the implementation of the changes, hospitals, dispensaries and boarding houses will still be able to work according to the old rules, but gradually they will be forced to either look for profitable models (raise prices, cut costs, close unprofitable departments) or simply close. This will lead to a massive reduction in access to health and social services, especially in regions where there are simply no alternatives.
Officials need to understand that the loss of affordable treatment in Ukraine is not an abstract threat, but a very real prospect that will affect everyone who will one day face illness, old age or the need for social assistance. And the question is no longer whether medicine will survive after such reforms, but how to survive without it.
Medicine of Ukraine: from independence to war
After 1991, Ukrainian medicine went through several key stages: the collapse of the Soviet system, chronic underfunding, the first reforms, and later the trials of war. From free but scarce medicine in the 1990s to attempts to implement an insurance model and funding reform, the health care system has been changing, but it has not been able to completely rid itself of corruption, bureaucracy and lack of resources. A full-scale war only exacerbated these problems, adding new challenges to them.
As an inheritance from the USSR, Ukraine received an extensive system of hospitals, polyclinics and sanatoriums, which formally remained free. However, already in the first years of independence, it became clear that this model would not be able to exist without adequate funding. Every year, for some reason, the state ignored the needs of medicine and allocated less and less money, doctors worked for meager salaries, and the equipment became obsolete. There was a significant shortage of medicines. Patients had to buy almost everything – from bandages to anesthesia. Unofficial payments have long become traditional in the Ukrainian medical care system. Small settlements, where access to medicine was minimal, suffered especially badly from neglect by the state.
In these conditions, Ukrainian medicine worked not thanks to, but against. Doctors often survived due to part-time jobs, and hospitals – thanks to “help” from patients or local authorities.
The beginning of the 2000s did not bring drastic changes, but economic stabilization allowed at least a partial increase in the financing of medicine. In 2011, a reform was launched to make medicine more effective. The main changes it brought:
- reducing the number of hospitals in favor of creating multidisciplinary hospital districts;
- the introduction of family medicine and the first steps towards an insurance model;
However, the reform did not have time to bring significant results. It was accompanied by the closing of hospitals and dismissal of doctors, which caused strong opposition. Ultimately, after the Revolution of Dignity, the changes were reversed.
In 2017-2019, the new team of the Ministry of Health (MoH) undertook radical changes, starting funding according to the principle “the money follows the patient”. The state no longer maintained hospitals, but paid for specific services. During this period, the National Health Service of Ukraine (NHSHU) was created – a body that concludes contracts with medical institutions. Family doctors are starting to sign electronic declarations with their patients. On the one hand, the system has become more transparent: patients have received an official list of free services, the link to “registration” has disappeared. On the other hand, hospitals were forced to find funding themselves, and many non-profit institutions were threatened with closure.
In the period from 2020 to 2021, the COVID-19 pandemic caused a crisis that Ukrainian medicine could not withstand. The coronavirus exposed the weak points of the reform. Due to low salaries and excessive workload, many doctors left abroad or changed professions, which caused a shortage of personnel. Hospitals suffered acutely from the lack of ventilators, oxygen and even protective suits. At that time, the state unevenly distributed funds, providing assistance to hospitals only under “Covid-packages. And other patients were left without assistance. The pandemic became a litmus test that pointed to the vulnerability and shortcomings of the reformed system.
Starting from 2022, as a result of the full-scale invasion of the Russian Federation, Ukrainian medicine is in extreme conditions. As of 2024, the enemy applied large losses to the health care system of Ukraine:
- destroyed medical institutions – 195;
- damaged medical facilities – 1,523;
- damaged emergency vehicles – 103;
- 258 emergency vehicles were destroyed.
The infrastructure suffered the following damage:
- completely destroyed – 14% of medical facilities;
- partially damaged – 48% of medical facilities;
The largest number of destroyed medical institutions was recorded in the Kharkiv region – 348. In the Kherson region – 204, and in the Donetsk region – 257.
40% of attacks caused complications in the provision of primary medical care to residents of frontline areas, and 15% of attacks destroyed emergency medical care centers. Experts estimated the damage to health care from the attacks in the amount of 3.12 billion dollars.
A significant deficit is also felt in the provision of personnel. Doctors started leaving Ukraine since the beginning of the pandemic. Yes, for calculations experts, during 2020 due to unsatisfactory working conditions, such as the lack of personal protective equipment, a sharp increase in workload, outdated material and technical base, more than 34,000 medical workers were laid off.
For data research According to the Ukrainian Center for Health Protection, as of the end of 2022, there were 6,300 fewer doctors in medical institutions subordinate to the Ministry of Health than at the end of 2021. The number of junior and intermediate medical personnel (nurses, nurses, paramedics, paramedics) decreased by 35,000. Today, the combat zones of Donetsk, Luhansk, Kherson and Mykolaiv regions are the least equipped. The problem is acutely felt throughout the country in rural areas, where doctors have always been in short supply even in peacetime.
The development of the medical industry is complicated by the aging of personnel – almost a quarter of doctors (23.6%) and 11% of middle and junior medical personnel have reached retirement age.
Currently, Ukraine is approaching a model where medicine is partially free, but patients are forced to pay for most services. The war accelerated modernization, but deepened the personnel crisis and widened the gap between the level of medicine in cities and villages.
Ahead is a struggle to preserve at least minimal social guarantees. If the state does not find mechanisms to support hospitals and social institutions, the system risks sliding into a scenario where quality treatment becomes available only to those who can pay for it.
Medicine abroad: how much does health cost and who pays
As the experience of foreign countries shows, there medicine has found a balance between state support, private investments and citizens’ contributions. No country has a completely free system, but neither does it leave its most vulnerable citizens without help. This especially applies to psycho-neurological dispensaries, geriatric boarding houses and institutions for people with serious illnesses – structures that always operate at a loss and require significant budget subsidies.
Psychiatric care is one of the most expensive medical services in the world. This is not just treatment, but long-term care, rehabilitation, socialization, and sometimes lifelong maintenance of patients. Because of this, most psychiatric hospitals and dispensaries in developed countries are financed by the state or charitable foundations. In European and North American countries, psychiatric clinics are divided into public, private and charitable.
State institutions are financed by taxes and receive patients free of charge or for a nominal fee. Private hospitals operate under insurance policies or direct payment. But even in the most commercialized systems (for example, in the USA) there are special state programs for the maintenance of mentally ill people who cannot pay for treatment on their own. The closure or privatization of such institutions always ends the same way: patients end up on the street or in prisons. That is why most countries do not try to make money from psychiatric care, but support it at the expense of state subsidies.
Elderly people are another category that cannot “work off” the costs of their treatment and care. In most developed countries, there are three levels of maintenance for pensioners:
- public homes for the elderly – financed from the budget and intended for those who cannot afford private care. The conditions here may be modest, but they provide a basic level of care;
- private geriatric centers are a more expensive option for those with insurance benefits or family willing to pay for services;
- home care at public expense – in many countries there are programs under which the government partially or fully covers the costs of caregivers who help the elderly at home.
In the EU and Canada, geriatric nursing homes are largely publicly funded, even though they are formally private institutions. Pensioners who cannot afford to pay receive subsidies or the right to stay in such institutions for free.
In the US, the situation is more complicated, because the state-run Medicaid program covers the cost of geriatric care only for the poorest, while the middle class is forced to sell real estate or spend all their savings to pay for a place in a nursing home. This is why most American retirees try to live at home as long as possible, and the health insurance system takes into account long-term care and patient costs.
Cancer patients, people with severe neurological or genetic diseases, paralyzed patients need long-term treatment and rehabilitation. Of course, this is expensive, and in many cases it never pays off. European countries and Canada finance such institutions mainly through taxes and insurance funds. In Germany, for example, hospitals that accept patients with difficult diagnoses receive additional payments from the state, because the care of such patients is much more expensive than conventional treatment. In France and Great Britain, there are special social hospices where the seriously ill can receive medical care for free or for a minimal fee. The state compensates these costs through medical taxes and national insurance funds.
But the USA is an exception: there, the treatment of seriously ill patients mainly falls on the shoulders of private insurance companies. Medicaid only covers basic costs for the poorest, and those who don’t meet the criteria are forced to find the money themselves or rely on charities.
The experience of other countries shows that privatization of medicine is not an absolute evil, but it is not a panacea either. Where the market has completely replaced state support, medicine has become inaccessible to the general population. Conversely, in countries with strong state involvement, even private clinics receive government subsidies to ensure access to services for the poorest.
The main lesson that can be learned from the international experience is that medical and social care for the most vulnerable categories of the population can never be completely commercial. It is either financed by the state or falls on the shoulders of families and charitable organizations, which leads to a social crisis.
As you can see, Ukrainian medicine is at a crossroads today. Formally, it is still free, but reality says otherwise: money is needed for everything – from analyzes to operations. Law No. 6013, which opens the door to the privatization of hospitals and social institutions, only accelerates this process. It seems that the state is gradually removing responsibility for the health of citizens, transferring it to the shoulders of Ukrainians themselves, or rather, their wallets.
This is nothing new, it has happened in many countries that have moved to a market economy. But wherever medicine has been completely taken over by business, mortality among the poor has increased, and the quality of treatment depends not on doctors, but on the size of the bank account. Ukraine still has a chance to avoid this scenario, but if medical institutions become just another type of business, then very soon treatment will cease to be a right and will turn into a privilege.
