Web-economic-crisis-health-systems-and-health-web

508 Economic crisis, health systems and health in Europe: country experience
• Government expenditure on all key functions of the health care system
(except management functions) increased in nominal terms and in dollar
equivalent (2010 compared with 2009): overall expenditure went up by
16–18%; government expenditure by 19–21%. There was 28% growth
in capital expenditure, mainly for government investment.
• Compared with 2010, the number of hospitals was reduced by 9%
in 2011 and 14.3% in 2012 (by closing low-capacity facilities, which
perform mainly social functions) and the number of beds by 3.4% and
6.2%, respectively.
• At the regional level, rural district hospitals and primary care outpatient
clinics were reorganized. In some of the pilot regions, local authorities
decided to convert outpatient units of these hospitals into territorial
social services centres (2010–2012).
• The government adopted a programme of economic reforms for 2010–
2014, Prosperous Society, Competitive Economy, Effective State, which
envisaged a reform of health care system in Ukraine (2010). In 2011, a pilot
project was launched. The reforms intend to change the budgetary model
of the health system in order to eventually transition Ukraine's health
system to an SHI model. Part of the Programme aimed to redefine the
structure of health service delivery towards a primary health care-focused
model, restructuring the hospital care system (organizing hospital regions
containing an acute care hospital, chronic care hospital, nursing hospital
and hospice), and formation of a unified state emergency medical service.
It was planned to extend the programme to the whole of Ukraine in 2014.
Priority setting or protocols to change access to treatments, coordination
of care and patterns of use
• The Ministry of Health introduced monitoring of adherence to protocols
(2009); non-adherence was not penalized and the policy, therefore, had
no effect on clinical practice.
• The 2010–2014 anti-crisis programme prioritized modernization of
primary and emergency health care and differentiation of secondary
health care facilities depending on the intensity of treatment and care.
Legislation was adopted to determine the scope of competence of primary
health care providers and to provide guidelines on organization of medical
service and referral of patients to secondary (specialized) and tertiary
(highly specialized) health care facilities (2011); these were piloted.
Waiting times
• No response reported.