Ukrainian medicine has been chronically underfunded for years. Funding for certain packages under the Medical Guarantees Program does not cover their actual cost, UNN writes.
Recently, Oleksandr Slobozhan, Executive Director of the Association of Ukrainian Cities, stated that insufficient funding for certain packages under the Medical Guarantees Program, particularly in the surgical field, reaches 30%.
According to calculations by experts from the Association of Ukrainian Cities, the "Surgical Interventions" package is underfunded by 30.5%. Thus, the average funding tariff per case is about UAH 9,500, whereas the average actual cost is UAH 12,400. A similar situation exists with the "Inpatient Therapeutic Care" package: the average funding tariff per case is about UAH 7,200, whereas the average actual cost is UAH 8,900, meaning a difference of UAH 1,700, or about 23.6% in underfunding.
Former Health Minister Oleh Musii is even more categorical. As he explained in a comment to UNN, in his opinion, the average underfunding rate reaches 50%. And it all starts at the primary-care level, becoming most noticeable in the cost of treating complex cases.
Dmytro Lubinets, the Parliament Commissioner for Human Rights, has also drawn attention to insufficient funding. Using the example of treating complex cases involving wounded people, he explained the calculation principles of the National Health Service of Ukraine and why hospitals are effectively trapped.
"The most acute problem lies in the financial ‘scissors’ created by the NHSU. Current state tariffs are detached from reality: UAH 1,200 is allocated for a contrast-enhanced CT scan, while the actual cost of the procedure exceeds this amount by approximately 2.5 times. In other words, the hospital operates at a loss on every procedure. The situation is even more critical with the long-term treatment of severely wounded patients, which can last for months. The NHSU covers this complex process as a single case, with a symbolic additional payment of 10% for prolonged hospitalization," Lubinets explained.
The main factors leading to an increase in the actual cost of medical services:
- rising medication costs;
- the duration and complexity of treatment:
- the presence of comorbidities in the patient;
- energy supply costs;
- labor costs.
In addition to energy supply, hospitals often have to address a whole range of other issues: reliable water supply or heating, additional teams, and so on.
How the NHSU calculates tariffs and why a deficit arises
Natalia Husak, Head of the National Health Service of Ukraine, has emphasized that tariffs should not be based on the cost of medical services. For example, the NHSU purchases surgical services for Ukrainians in multidisciplinary hospitals under an "average weighted tariff."
"That is, there are tariffs within diagnosis-related groups that cover expenses above cost, and there are those that under-cover costs, but the average weighting makes it possible to cover the treatment of all patients who seek care at a medical institution," Natalia Husak said.
In other words, the NHSU does not pay hospitals for every hryvnia spent and does not reimburse the actual cost of a specific operation or the treatment of a specific patient. Inpatient care operates under a different model: a treatment case is assigned to a particular diagnosis-related group (DRG), for which a corresponding complexity coefficient is established.
In simplified terms, the calculation works as follows: the base rate is multiplied by the coefficient of the DRG to which the treatment case is assigned, and the adjustment coefficients provided for under the Medical Guarantees Program are also applied. The hospital receives a certain amount for a treated case, rather than reimbursement for specific expenses: the cost of medications, doctors’ work, diagnostic examinations, the length of the patient’s stay in the hospital, energy costs, and so on.
The result is something like an average weighted indicator. Under this system, less expensive and more expensive cases are supposed to balance each other out. For one patient, the NHSU may pay an amount exceeding the actual cost of their treatment, while for another it may pay less. Overall, however, the payments should cover both cases.
The problem arises when this balance is disrupted by a large number of complex cases. If the actual cost of a significant proportion of cases systematically exceeds the amount received by the medical facility, the hospital is forced to cover the difference from other sources. This is particularly noticeable in complex surgeries, lengthy inpatient treatment, and cases requiring expensive medicines, a large number of examinations, or the involvement of a significant number of medical staff. It is especially acute in hospitals that treat large numbers of wounded military personnel and civilians with blast and mine-related injuries and burns, and that are often forced to perform resuscitation measures or diagnostic tests and support patients’ vital functions with mechanical ventilation.
Thus, the dispute surrounding the PMG tariffs essentially comes down to two different approaches. The NHSU proceeds from the premise that funding should be assessed across the aggregate of cases and their weighted-average cost. Hospitals and local self-government bodies, by contrast, draw attention to situations in which payment for specific types of care does not correspond to actual expenses, and the deficit has to be covered by the medical facility itself or its owner.
This is precisely where the so-called "tariff scissors" arise: the cost of treatment increases along with the prices of medicines, salaries, energy, and other hospital expenses, while the state tariff does not always compensate for this increase.