The full-scale invasion continues to inflict painful and devastating blows on the life of every Ukrainian, the plight of the Ukrainian health care system, which was far from exemplary even before the war began, has not passed by.
According to a WHO study, 136 doctors died as a result of 1,773 attacks on Ukraine’s healthcare system.
As of 2023, the following losses were recorded:
- 414 hospitals were destroyed;
- damaged children’s hospitals – 57;
- maternity homes were damaged – 40;
- damaged emergency vehicles – 79;
- 148 medical workers died;
- 106 workers were injured.
As of 2024:
- 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 providing primary medical care to residents of frontline areas;
15% of attacks destroyed emergency medical centers.
Experts estimated the damage to health care from the attacks in the amount of 3.12 billion dollars.
Kherson, Kharkiv, Donetsk and Mykolaiv regions suffered the greatest destruction from the relentless attacks of the aggressor. According to the Ministry of Health, Donetsk region suffered losses of 768 million dollars, Kharkiv region – 618 million dollars, Chernihiv region – 259 million dollars, Luhansk region – 188 million dollars.
According to the Minister of Health of Ukraine Viktor Lyashko, the war affected the lives and health of Ukrainians both directly and figuratively. Being under constant stress leads to exacerbation of chronic diseases, and can also cause the emergence of new diseases. At the same time, the impossibility to undergo a comprehensive examination, to turn to doctors for consultation and the unavailability of medicines are the reasons for the deterioration of the mental and physical health of the population.
For expert assessments, the state will need $1 billion to restore the medical infrastructure to the state it was in by February 24, 2022. Since the hostilities are not abating even now, there are also problems in the energy sector, which causes the need to purchase generators for the uninterrupted functioning of medical facilities in wartime conditions, which means additional costs. Experts of the World Health Organization point out that the probable investments of damaged medical institutions should also be taken into account, and therefore, with this approach, the amount may increase to 26 billion dollars.
Despite all the troubles, the health care system of Ukraine is trying to cope with the challenges of wartime. 96% of medical facilities located on the territory controlled by Ukraine continue to perform their functions. However, the situation becomes more complicated depending on the geography of hostilities. So, about 70% of institutions are significantly damaged in the territory of Kherson region, and in Donetsk region the situation is even worse – there are fewer and fewer institutions that are able to perform their activities at the proper level. A very difficult situation is also observed in the eastern and southern regions of Ukraine.
What does the state do to support the health care system
According to according to the Ministry of Health, the following changes have been achieved over the past two years:
- the list of available drugs has been expanded by 30 items;
- the supply of medical facilities increased by 5 times;
- the possibility to prescribe medicine by e-prescription;
- the procedure for opening pharmacies in rural areas is simplified;
- an electronic queue at the VLK was introduced;
- the number of VLKs increased at the expense of civilian-type medical institutions;
- outbound MSEK was introduced;
- financing of evidence-based rehabilitation practices was carried out;
- the qualification level of specialists on the basis of 6 centers of excellence has been increased;
- expanded the base of neonatal screening;
- funding for organ transplantation was provided by the National Health Service of Ukraine. Thus, compared to 2022, when 223 transplants were performed, 340 stem cell transplants were performed in 2023.
According to Prime Minister Denys Shmyhal, the government plans to contribute UAH 239 billion to the state budget, which will be allocated specifically for health care. Compared to 2023, when only UAH 217.4 billion was allocated, this amount exceeded last year’s amount by UAH 31 billion. In the current year, the state has planned the following measures:
- digitization of the healthcare system. The patient’s electronic office will be launched, which will greatly facilitate the procedure of concluding a declaration with the family doctor;
- expansion of the list of medicines and medical products, the purchase of which will be carried out through the electronic catalog;
- arrangement of shelters and safe conditions in medical institutions. The state plans to allocate UAH 1 billion for this;
- launching a pilot project of free dentures for veterans.
“We make medicine more accessible and high-quality, regardless of where a person lives.” – noted Denys Shmyhal.
Availability of medical services during wartime
Despite the serious financing of health care in Ukraine, the availability of medical services remains a big question. As reported by the WHO, most respondents complained about the difficult transport accessibility to the medical facility, the high cost of services and the time spent on performing these services. As a result of the war, more and more people find themselves on the verge of poverty (60%). This factor cannot fail to affect the low availability of medicines for such a vulnerable segment of the population as people living in temporarily occupied territories, in active combat zones and internally displaced persons. According to the survey, this is 22% of the population.
Among the drugs that were in short supply, the respondents named:
- from high blood pressure and heart diseases – 49%;
- painkillers – 41%.
- 84% could not get the medicine because of the excessively high price, and 46% – in general, because of their lack in pharmacies.
The Analytical Fund “Believe in Yourself” carried out a study on the needs of vulnerable population groups, and found the following shortcomings in the health care system of Ukraine. Elderly people (600 people), IDPs (601 people) and people with disabilities (413 people) took part in the survey. The majority of respondents noted that they need and apply for psychological support. But, due to the established stereotype in society that this support is needed only by those with serious mental disorders, this need is kept silent.
Access to services is the most difficult for people with disabilities. Problems with the bureaucracy, requiring confirmation of disability in case, lack of an inclusive space – all this became an obstacle to the full receipt of services for 17% of people with disabilities, as well as for 14% of IDPs.
Among the most important social services for the respondents are:
- free medicines – 61% of people with disabilities, 49% of IDPs and 40% of elderly people.
- free rehabilitation courses – 21% of people with disabilities, 7% of IDPs, 8% of elderly people;
- psychological assistance – 3% of people with disabilities, 2% of IDPs, 11% of elderly people.
In turn, the servicemen noted that the provision of medical assistance for them is carried out at an inappropriate level.
Another manifestation of the imperfection of the medical system is the so-called shadow payments – the habit of Ukrainians to “thank” doctors for their work from their own pockets, despite the fact that medicine in the country is free. According to the general director of the “Dobrobut” medical network Vadym Shekman, the annual amount of such “thanks” can reach UAH 150 billion. At such rates, this figure will rapidly approach the one set by the state budget for financing the medical system. Bureaucratic red tape is not the first factor contributing to shadow payments. Thus, according to the USAID Project “Health Care Reform Support”, it was established that 53% of patients made an informal payment for medical services in order to avoid a long paper procedure.
SWOT – analysis of the current state of the health care system of Ukraine
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Health insurance system
Since the main amount of revenue from the State Budget is focused on financing the country’s defense and security sector, it became necessary to create a health insurance system that would cover the cost of expensive medicines and provide access to all medical services without restrictions. Such a move will make it possible to relieve the state budget and make medicine more accessible.
However, all this sounds good only on paper, but in practice the insurance system still remains with many unknowns. For example, it is still not clear who exactly should pay, which medical services will be covered by the insurance and what is its cost. To give examples, insurance against critical illnesses, such as oncology, heart attack or transplantation, is about $300 per year. A broad-spectrum policy will cost about $600. It is obvious that such an amount is quite significant. You can also get insurance from the Ministry of Health, but for an incomplete program. For example, to purchase German-made artificial joints instead of free Indian ones.
Thus, in order to fully use medical services, each citizen will have to pay an average of 12,000 hryvnias per year for insurance. In Ukraine, it is planned to create a health insurance system where the state will finance a certain package of medical services. It will include:
- emergency medical care;
- oncology;
- treatment of infections;
- anti-tuberculosis assistance;
- psychiatric care.
As for planned operations that do not threaten the patient’s life, the provision of more comfortable services or dental prosthetics, this is already the patient’s concern. As we can see, medical insurance in Ukraine still needs a more detailed understanding and full introduction into practice with the health care reform. For now, this system is voluntary.
In 2024, the state allocated UAH 159 billion. for the Program of Medical Guarantees (PMG), this is UAH 16 billion. more than in 2023. According to this program, assistance covers all basic types of medical services: primary, emergency and medical rehabilitation, free assistance for children under 16 and pregnant women. The priority of the Medical Guarantee Program in 2024 will be the restoration of human potential: reforming the blood system, rehabilitation services, mental health. New directions are also foreseen – assisted reproductive technologies and transplantation. Of the total amount, UAH 5.2 billion was allocated for the reimbursement of medicines.
However, not everything turned out as expected. At present, the practice of making charitable contributions for repairs, purchase of medicines and hygiene products, etc. continues in state medical institutions. If we take dental treatment as an example, which is an urgent problem for every citizen, then depending on the needs, you can spend from 4 to 8 thousand hryvnias on average. There is no need to talk about operations at all, they are extremely expensive. The average salary of teachers and staff of state institutions is UAH 7,000, so such an amount is obviously unaffordable for them. And what can we say about pensioners who live on a pension of 2,000 hryvnias, and about students with a scholarship of 1,250 hryvnias. So, we see how incompatible tariffs for standard medical services are with the standard of living of Ukrainians.
According to the Ministry of Health, 24% of respondents cannot purchase medicine due to a difficult financial situation, and 51% do not have access to medical services at all.
Therefore, Ukraine is still on the path of not reforming, but renovating the health care system, although certain positive steps are being taken.
