EASO Ukraine FFM report – healthcare reform and economic accessibility Medical Country of Origin Information Report February 2021 More information on the European Union is available on the Internet (http://europa.eu) ISBN 978-92-9485-862-7 doi: 10.2847/190187 BZ- 04-21-035-EN-N © European Asylum Support Office, 2021 Cover photo EASO, 2020 Reproduction is authorised provided the source is acknowledged. For any use or reproduction of photos or other material that is not under the EASO copyright, permission must be sought directly from the copyright holders. Medical Country of origin information report | Ukraine: FFM Report – healthcare reform and economic accessibility Acknowledgements EASO is the drafter of this report. The following departments and organisations have reviewed the report: • Belgian Desk on Accessibility (BDA); • Country of Origin Information Division, Office for Foreigners, Poland; and • COI Information Desk, Federal Office for Migration and Refugees, Germany. It must be noted that the review carried out by the mentioned departments, experts or organisations contributes to the overall quality of the report, but does not necessarily imply their formal endorsement of the final report, which is the full responsibility of EASO. 3 Medical Country of origin information report | Ukraine: FFM Report – healthcare reform and economic accessibility Contents Acknowledgements ................................................................................................................................. 3 Contents .................................................................................................................................................. 4 Disclaimer................................................................................................................................................ 6 Glossary and Abbreviations .................................................................................................................... 7 Introduction ............................................................................................................................................ 9 Methodology ...................................................................................................................................... 9 Defining the terms of reference ..................................................................................................... 9 Collecting information .................................................................................................................... 9 Sources ............................................................................................................................................... 9 Quality control .................................................................................................................................. 11 Structure and use of the report ........................................................................................................ 11 Map ....................................................................................................................................................... 12 1. Healthcare system and reform ..................................................................................................... 13 1.1. Background to the reform ................................................................................................... 13 1.2. The healthcare reform implementation .............................................................................. 13 1.3. Challenges and critical outcomes of the reform ................................................................. 14 1.3.1. Phase 1: Changes in primary healthcare ............................................................................ 14 1.3.2. Phase 2: Secondary care reform and COVID-19 outbreak ................................................. 16 1.3.3. Changes in health facility infrastructure ............................................................................ 19 1.3.4. Changes to HIV and TB services ......................................................................................... 20 1.3.5. Data collection in healthcare ............................................................................................. 20 1.3.6. Opposition to the reform ................................................................................................... 21 1.3.7. Political changes’ impact on the reform ............................................................................ 22 1.4. Quality practices .................................................................................................................. 23 2. Health insurance ............................................................................................................................... 24 2.1. National Health Service Ukraine (NHSU) ................................................................................... 24 2.2. Public healthcare insurance treatment coverage ..................................................................... 24 2.2.1. Included population groups ............................................................................................... 26 2.2.2. Coverage for oncology treatment ...................................................................................... 26 2.2.3. Coverage for patients with Crohn’s disease and Parkinson disease .................................. 27 2.2.4. Coverage for patients with TB, Hepatitis and HIV .............................................................. 28 2.2.5. Coverage for paediatric patients ........................................................................................ 28 4 Medical Country of origin information report | Ukraine: FFM Report – healthcare reform and economic accessibility 2.3. Affordable Medicines Programme ............................................................................................ 28 2.4. Private sector ............................................................................................................................. 30 2.5. Private insurance ....................................................................................................................... 31 3. Out of pocket (OOP) payments .................................................................................................... 31 4. Pharmaceutical sector .................................................................................................................. 34 4.1. Essential Medicines List (EML) ............................................................................................. 34 4.2. Accessibility of medication .................................................................................................. 35 4.3. Registration and procurement of medication ..................................................................... 36 4.4. Pharmacies .......................................................................................................................... 38 4.5. Not registered medication .................................................................................................. 39 5. Accessibility for specific groups ................................................................................................... 40 5.1. Discrimination and societal groups ..................................................................................... 40 5.2. IDPs and the situation in the non-government-controlled areas ........................................ 40 5.3. Patients with mental health disorders ................................................................................ 41 5.4. HIV patients ......................................................................................................................... 43 5.4.1. Funding for HIV services ............................................................................................. 43 5.4.2. Availability of treatment and medications ................................................................. 44 5.4.3. Access to treatment .................................................................................................... 45 5.4.4. Cost of treatment ........................................................................................................ 46 5.4.5. Consequences of the reform ...................................................................................... 47 5.5. TB patients ........................................................................................................................... 47 5.6. Oncology patients ................................................................................................................ 48 5.6.1. Availability of treatment and medication ................................................................... 49 5.6.2. Access to treatment .................................................................................................... 51 5.6.3. Cost of treatment ........................................................................................................ 52 5.7. Paediatric patients ............................................................................................................... 52 Annex 1: Bibliography ........................................................................................................................... 55 Annex 2: Terms of Reference ...............................................................................................................