Dr. A. Malagardis
The objective of the EU Project on "Health Financing and Management" is to
promote efficient and effective financing and management in the health sector
and create the necessary conditions for implementation of a state system of
social health insurance. It is scheduled for two and a half years, and expected
to be completed in April 2006. The main rationale of a health insurance system
(HIS) is that it is based on individual contributions from people, which will
be accumulated in a special fund which will be used exclusively to finance the
provision of medical services to the population. The advantages of a HIS is its
transparency, adequate identification of the resources required for the
operation of the health care system, collection and use of financial resources
in a more efficient way, improvement of the quality of medical care and the
level of supervision by the state and professional associations over the health
sector as a whole and the spending of financial resources in particular.
The project has the following components: institutional and legal support of
the MoH to ensure favorable conditions for implementation of social medical
insurance; development and implementation of two pilot projects to exemplify
the effectiveness and efficiency of EU best practices in social health
insurance; organization of trainings for current and future administrators
(managers) of health care institutions; and formation of positive public
perception of the reform through wide-raging information campaign in the media.
During its implementation, the project will make use of the positive experience
in reforming medical care and health insurance systems that exists in European
countries, particularly Germany, Czech Republic, Poland, and Estonia, where
similar technical assistance projects in reforming their health care systems
have been implemented with success. The project team is set-up by experts from
Finland, Greece, Germany, Poland, Estonia and Romania, etc. and its Steering
Committee has members coming from various Ukrainian ministries, Oblast and
Rayon authorities, international organizations, such as WHO and the World Bank
as well as from health care institutions in the pilot sites.
The project achievements during 2004 can be summarized as follows: The project
WG has submitted to the Committee on Social Policy and Labour Issues of
Verhovna Rada detailed comments on the Draft Law on MHI; the List of affordable
health care services ("minimum package") has been reviewed in detail with the
aim to support the development of a unified methodological approach of costing
of health care services.
Based on the assessment of IT procurement needs for the pilot work at Oblast
and Rayon level and the tasks to be carried out at MoH the tendering process
has been completed and the installation of HW & SW to support the introduction
of a modern financial and management system in the provision of health care
services is under way. The drafting of a Strategic Plan to cover the future IT
system the main elements of such a plan have been put forward for discussion
and analysis by the WG on IT issues.
The approved set of documents by the pilot authorities in Kharkiv and Zhetomyr
includes among others the establishment of the Rayon Health Care Department
(RHCD), which will act as purchaser of health care services, the Contract for
the provision of services, the Statute of the Central Rayon Hospital which
provides that the CRH will be operating under the legal status of a communal
non-profit enterprise, and the transfer of property and funds from the
ambulatory facilities at village level to the Rayon level in order to be
managed by the RHCD.
The training activities were carried out according to the training methodology,
the training plan and the approved Train the Trainers (TTT) Curriculum. All
seminars and workshops as well as one TTT course (Health Sector Development)
had a two days duration and took place in the premises of the Kiev Medical
Academy of Post-Graduate Education (KMAPO) in line with the signed co-operation
agreement. This educational center has also provided for the licensing of all
TTT courses that have been incorporated in its teaching program. An evaluation
of all training events based on the analysis of the evaluation forms filled in
by aprox. 200 participants has shown positive results as health care
administrators and medical staff have received through the project up-dated and
in-depth knowledge on the areas of health sector development, financing and
The approved communication strategy that is directed towards representatives of
the government and other state authorities, the healthcare workers, the mass
media and the general public is the basis for all PR activities carried out so
far by the project. The results of the survey on expectations of population
from the health reform were taken into account to develop the first two-months
information campaign. Several press-conferences, TV and Radio broadcasting of
interviews of MoH officials and international experts, 10 articles in
magazines, the publication in 5.000 copies of the brochure on "The Regulatory
framework for introduction of Mandatory Health Insurance in Ukraine, meetings
of the national press club as well as of the press clubs in Kharkiv and
Zhetomyr are among the main activities of the project in this area. The project
website is updated on monthly basis (www.healthfin.kiev.ua) and the press
monitoring activity is continous.
The main activities of the project in 2005 & 2006 include further legal support
for the implementation of mandatory social health insurance in Ukraine as well
as the development of certain organizational and operational aspects of the
future HIF. Aiming at a unified methodological approach on costing of medical
services - and its implementation on pilot level - and determining the services
that are to be provided by primary, secondary and tertiary care - and their
introduction on pilot level - will undoubtedly result to finalize the "minimum
package" that a future health insurance system shall cover.
The measures taken so far include the creation of RHCD, the revision of the
hospitals legal status to become communal non-profit making enterprises, the
introduction of contracts between RHCD and these enterprises based on a minimum
package of services, performance criteria, management decisions based on cost
accounting, and a comprehensive registration of all patients. The above
measures are pre-requisites for the full implementation of a compulsory health
insurance system. The ultimate aim is to force health authorities to purchase
affordable services and leave the providers the freedom to adapt their
capacities and utilise their resources freely to meet their contractual
requirements. This will encourage the shift of resources away from the
maintenance of excess capacities towards the actual treatment of patients.
The project will support both the health authorities and the providers in the
pilot sites to meet their "new" obligations through continuous advice and
improvement of their negotiating and monitoring skills. The negotiated
agreements will initially be based on historical costs. However, the purchaser
will be able to calculate the costs which should ideally be associated with
executing the agreed services based upon evidence based medicine and will
consistently apply pressure on the providers to reduce their prices towards
Finally, both the purchaser and the provider will be equipped with IT systems
to be able to carry out their functions effectively by recording and reporting
of all required information and monitoring the utilisation of their resources
in relation to the extent to which they have fulfilled their contractual
obligations. They must furthermore have an overview of their expenses and be
able to identify, design and monitor the effects of cost-saving initiatives.
Pilot staff will be trained in using the new hardware and software to be
purchased under the project.
The aim of the training activities is to create a hard core of staff that are
familiar with the current developments in management and financing of health
care services and through the 7 remaining TTT courses be in a position to
undertake trainer's function in the case of "roll-out" of best practice. Staff
of the pilot sites, in particular hospital administrative staff, RHCD and
Oblast Health care authorities staff will increase their practical skills and
knowledge in health financing and management during 5 two-days courses.
On-going two days workshops will deal with specific issues related to the legal
and public communication tasks. The evaluation results of all training
activities shall at the end be incorporated into the strategic plan for a
national policy health personnel development.
A second information campaign with more emphasis in promoting the pilot tasks
will be organized and carried out while the monthly update of the project
website and the publication of articles will continue. It will be of high
importance that the approved "minimum package" is communicated to the public so
that they are aware of what they can expect and what their rights are.
Therefore, the progress made in defining and costing the list of affordable
medical services shall be communicated to the pilot authorities on Rayon and
Oblast level as well as to the members of VR.
The project objectives are fully in line with the key priorities of the
Ukrainian Government, in particular the introduction of mandatory health
insurance with the provision of a guaranteed package of medical services, the
establishment of quality indicators at the health care facilities level.
We look forward to receiving your feedback to all 6 issues of the newspaper
that are due to be published in 2005/2006 and have you also as active
contributers to the preparation of all related material.