• Spending overview
• Policy overview
• Diseases overview

Spending overview

Over the medium term, rising disposable incomes, in combination with the deterioration in health standards that followed the Soviet collapse, as well as the ageing of the population, will support growth in demand for healthcare products and services. Government expenditure on healthcare is also expected to pick up gradually from its current low levels. In the nearer term, however, demand will be negatively affected by the severe financial and economic difficulties faced by Ukraine since late 2008.

The gap between healthcare spending in Ukraine and more prosperous countries in the transition region is therefore expected to persist over the medium term. By the end of the forecast period healthcare expenditure per head in Ukraine will still lag far behind levels in east-central Europe, as well as in Russia. The persistent gap will reflect lower income per head in Ukraine and greater government budget constraints. It will also reflect the slow pace of reforms. In particular, problems of resource misallocation in the medical sector will persist, and the introduction of a mandatory health insurance system will proceed slowly.

Policy overview

There has been no substantial reform of the Ukrainian healthcare system since independence. The system is managed by the state, through the Ministry of Health. A private healthcare sector has emerged since independence; in particular, private clinics have emerged in the main cities, offering services of relatively high quality at Western prices. However, with most of the population unable to afford private treatment, the private sector remains marginal in terms of its share of healthcare provision.

The healthcare funding system is also practically unchanged from Soviet times, and is based on general taxation. However, although in theory the government finances medical services, public funds are limited and patients are unofficially required to pay for them, at least in part. As a result, the provision of free medical care has increasingly been replaced by chargeable care. Some attempts have been made in recent years to reform the funding system by introducing obligatory health insurance. In January 2009 the president gave preliminary approval to a bill on setting up a mandatory health insurance system, but the plans did not get off the ground, owing to political instability and institutional inertia.

More recently, parliament has taken an interest in driving through plans for compulsory health insurance, and in July 2009 a draft law was submitted to parliament. A number of legal barriers, however, would need to be removed to set up such a system, including a constitutional provision guaranteeing free healthcare to Ukrainian citizens. Private insurance companies have also warned that any compulsory health insurance system that is introduced should not be managed by the state, as the state would be likely to prove slow and inefficient in implementing the system.

Diseases overview

Adult mortality in Ukraine exceeds the levels elsewhere in Europe (generally by a factor of between two and four), and an unusually high share (almost one-half) of adult mortality is attributable to infection. The economic decline during the post-Soviet period resulted in spiralling poverty, poor nutrition and substance abuse. Cardiovascular diseases and tuberculosis have become particularly serious problems, and HIV/AIDS has spread at a rapid rate, alongside the growth of intravenous drug use. The situation with infant mortality is a little better, although the rate of infant mortality is still significantly higher than the EU average—as is the mortality rate for children under five years of age.

Ukraine ranked 85th in the UN Development Programme's 2009 Human Development Index, putting it in the category of medium human development. This was behind Russia, at 71st (at the lower end of the high human development category).