Ministry of Health of Ukraine approved Procedure for the provision of primary care services

The Concept of Healthcare Financing Reform in Ukraine, adopted by the Cabinet of Ministers of Ukraine, suggests implementing the government-guaranteed healthcare benefit package first. It will be subject to contractual relations between the government (the single national purchaser of health services) and healthcare facilities of all types.

Secondly, the Concept provides for the introduction of new methods of performance-based payment to providers, which means paying for the services in compliance with the "money follows the patient" principle. 

Therefore, most primary care services are now covered by the National Health Service of Ukraine at the expense of health insurance funds and provided free-of-charge, just like with emergency care. The government pays for the guaranteed benefit package of healthcare services for individuals, and healthcare providers compete for these funds. Services beyond the guaranteed package can be paid or co-paid for by patients directly or by other health insurance types.

• What to do if your doctor asks for money?

Call the National Health Service hotline or contact the nearest NHSU regional office. Any illegal requests for payment for the services covered under the guaranteed package and paid by the NHSU constitute a legitimate reason to terminate a contract with a family physician and for this doctor -- a risk of being prohibited to practice medicine within the NHSU system.

• Will I get necessary care if I do not contract with a family doctor?

Of course, emergency care is provided to all patients under any circumstances. But if a patient seeks secondary care (needs to visit a specialist) and has no referral from a primary care doctor, this visit will not be covered by the guaranteed package, which means that such patients will have to pay for the services provided out of own pockets.

The Ministry of Health of Ukraine has approved Procedure for provision of primary care services – the document that regulates the work of primary care doctors (general practitioners, pediatricians and family doctors), presents a well-defined package of primary care services, and forms a new culture of doctor-patient relationship. Starting July 1, 2018, all primary care facilities should provide services in full compliance with this document.

Services that will be provided by primary care doctors

Order of the Ministry of Health of Ukraine No. 504 dated March 19, 2018 "On Approval of the Procedure for Provision of Primary Care Services" (hereinafter referred to as the Procedure) defines a clear set of primary care services (the guaranteed benefit package) that will be covered by the state and paid by the National Health Service of Ukraine (NHSU).

General practitioners, pediatricians and family doctors will be responsible for monitoring patients’ health and advising on healthy lifestyle, identifying health risks in a timely manner and preventing diseases (including vaccination), diagnosing and treating common diseases, injuries, poisoning, pathological, and physiological conditions. Primary care doctors will also continuously treat patients with chronic diseases and conditions.

If necessary, primary care doctors will refer patients to specialists of secondary or tertiary care (i.e. for specialized or highly specialized medical care) and issue health certificates or notes.

Primary care physicians can also provide emergency care for an acute physical or mental disorder if a patient does not need an emergency, specialized or highly specialized care.

The competence of primary care physician includes certain palliative care services, uncomplicated pregnancy and pediatric care.

Recommended number of patients one doctor can manage

Pursuant to the Procedure, the recommended number of patients for a family doctor equals 1 800 people, for a general practitioner – 2 000 people, and for a pediatrician – 900 children.

The number of patients one primary care doctor manages may differ on a case-to-case basis depending on the socio-demographic, infrastructure and other peculiarities of the settlement or territory. For example, when a family doctor works in a village with the population of 2 000 inhabitants, then this doctor should treat all these people. No one will be deprived of medical care.

Home visits

Yes, primary care doctors will do home visits, but it is now at the doctor's discretion (not patient’s or registrar’s anymore) whether a home visit is deemed necessary.

Primary care doctor will visit a patient at home when this patient is confined due to illness or disability, or urgent treatment can be given more quickly by visiting. Doctors will always encourage patients to come to the primary care facility when a home visit is not medically necessary, because this is where the best care can be provided. Moreover, in the time it takes to see one person at home, a doctor can see 2-4 patients at the hospital.

Patients can call and ask for the doctor's home visit or make an appointment, leaving personal contact information. The doctor will then call the patient back and discuss his/her health concerns and symptoms, and based on this conversation decide whether a home visit is necessary and, if so, agree on specific time.

What to do when the chosen doctor is currently unavailable

When the chosen primary care physician is not available (for example, is currently on vacation or sick leave), patients should contact a back-up physician. Patients should be notified about t any changes in advance: one week in advance when doctor’s absence is planned (for example, a vacation or business trip) and on the first day in other cases (for example, when the doctor gets sick). It is the responsibility of administration of the hospital to inform patients about any changes in a timely manner, to provide information about a back-up doctor, and to ensure access to medical care.

If a patient needs help and is currently in a different city, s/he shall contact the nearest primary care provider.

Patient-oriented service requirements for primary care providers

Primary care providers should notify patients about any changes in the address or working hours. If a patient has already scheduled an appointment, primary care provider should inform this patient personally about any changes (for example, make a call). It is equally important to inform patients when primary care facility ceases to function or is closed for some reason.

How to make an appointment and primary care provision on weekends/holidays

Patients can now schedule an appointment with a doctor personally at the reception, by telephone, by e-mail or any other means available. Patients should be informed about any changes of the phone number, e-mail address etc.

Most primary care facilities will not work full time on weekends and holidays. But the Procedure stipulates that all primary care providers may independently or jointly create special on-call rooms for providing primary care to patients outside of the regular working hours.

Technical Equipment List

In order to provide high-quality services, all primary care facilities must comply with the Technical Equipment List. The updated Exemplary list of material and technical equipment for both public and private primary care providers (Order of the Ministry of Health of Ukraine No. 148 dated January 26, 2018 "On Approval of the Exemplary List of Material and Technical Equipment for Public and Private Primary Care Providers") is now much shorter than before, and meets actual needs of the primary care sector. The necessary technical equipment will allow fulfilling the Procedure for provision of primary care services.