Medical reform: co-payment for medical services may be introduced in Ukraine
20 November 16:18
The other day, a regular meeting of the Verkhovna Rada Committee on National Health, Medical Assistance and Medical Insurance was held under the chairmanship of Mykhailo Radutsky, during which MPs, in particular, discussed the introduction of co-payment for medical services, "Komersant Ukrainian" reports.
Radutsky noted that the Medical Guarantee Program is only the minimum guaranteed by the state that it is able to pay for each citizen, based on the real capabilities of the state budget. In practice, some patients who seek medical care receive a list of necessary medicines at the hospital that they have to buy at their own expense, or an offer to pay extra for treatment or other services. At the same time, the state provides hospitals with the necessary medicines and consumables. Therefore, such situations should also be considered by law enforcement agencies, as it is not always a matter of underfunding hospitals. In view of this, it is proposed to bring informal payments out of the “shadow” and transfer them to official services, in particular by introducing co-payments for medical services.
Victoria Wagner, a member of the Committee, noted that the state is not able to finance the provision of all medical services, so it is proposed to provide for co-payment for medical services. This practice is also used by the European Union countries. However, when introducing co-payments, mechanisms should be provided to avoid abuse by hospitals and to control co-payments.
Viktor Lyashko, Minister of Health of Ukraine, noted that the Ministry of Health of Ukraine has repeatedly conducted research on co-payment for medical services, which showed that there are several concepts of co-payment in healthcare facilities. Thus, co-payment should be considered as a fixed amount that a patient will pay when visiting hospitals. It was introduced in those countries where there were fraudulent schemes when one person could seek outpatient care every day, and to counteract this, a fixed price for a visit to a doctor was introduced. Another type of co-payment is coinsurance, which is a certain share of the cost of a medical service in countries where health insurance is introduced. There are also countries that have introduced an annual threshold for a patient’s out-of-pocket expenses for medical services. However, all of these mechanisms in other countries have nothing to do with the so-called balance billing, when there is a certain practice of charging the patient the difference over and above the established tariff set by the state insurer, which is the National Health Service of Ukraine (NHSU).
This issue was already discussed several years ago in the Committee, after which the Ministry of Health presented a roadmap for the implementation of health insurance. One of the steps envisaged under the roadmap was the implementation of co-payment for medical services in Ukraine by paying for them outside the PMG. Based on this, in July 2024, the Government adopted Resolution No. 781 “Some issues of providing medical services to the population for a fee from legal entities and individuals”. This resolution defines both fully paid services, i.e. those services that are not covered by the UHI or are provided without a referral to an institution, and additional improved services, in particular, the possibility of paying extra for increased comfort or service, a higher level ward, choosing a specific doctor, etc.
According to the Ministry of Health, this is one of the mechanisms to counteract informal payments in healthcare facilities. A trilateral Memorandum between the Ministry of Health, the NHSU and the State Audit Service of Ukraine (SAU) has already been signed, which provides the SAU with information on informal payment practices that the agency should pay attention to during inspections.
Lesia Ivanyshchuk, Director of the Department of Humanitarian Budget Expenditures at the Ministry of Finance of Ukraine, emphasized that when introducing a co-payment mechanism, it should be ensured that this mechanism does not harm vulnerable groups of the population and does not affect the availability of medical services in general. After all, co-payments can lead to patients postponing visits to doctors, which can lead to serious consequences for their health.
Natalia Husak, Head of the NHSU, said that the agency monitors the implementation of Resolution 781, and in the first half of 2025, patients paid UAH 2.3 billion as official payments for paid services.
Also in 2025, the NHSU introduced an obligation for healthcare facilities to enter information about these services into the electronic healthcare system in order to track and systematize these payments. Based on this data, the Ministry of Health will detail the PMG. She emphasized that additional tools to control informal payments are needed, and the NHSU is implementing them jointly with the Ministry of Health. However, the NHSU does not currently support the introduction of a co-payment mechanism for medical services in Ukraine.
Dmytro Gurin, a member of the Committee, reminded that Article 49 of the Constitution of Ukraine stipulates that medical care is provided free of charge in state and municipal healthcare institutions. Therefore, given the prohibition on amending the Constitution of Ukraine during martial law, it makes no sense to consider introducing a co-payment mechanism now.
Also, cases of informal payments are mostly found at the secondary level of medical care. Therefore, the only way to counteract these informal payments is to gradually increase the funding of the PMG so that it covers as many medical services as possible.
The participants agreed to continue discussing this issue in different formats. No decision on this issue was voted on.
