JUSTIFICATION OF CONCEPTUAL APPROACHES TO THE IMPLEMENTATION OF MANDATORY STATE HEALTH INSURANCE IN UKRAINE

Анотація

Introduction. The poor health of the Ukrainian population has worsened due to the war. However, financial barriers to medical care for citizens – particularly out-of-pocket expenses – remain the highest in Europe. Aim. To investigate the problems of financial support for the healthcare sector and to substantiate conceptual approaches to the implementation of mandatory state health insurance in Ukraine. Materials and methods. State and sectoral statistical data; regulatory legal acts; draft laws of Ukraine on health insurance; scientific literary sources (23 items). Methods: analytical; synthesis; comparison; generalization; conceptual modelling. Results. The allocated funding for the medical guarantee program amounted to UAH 157.3 billion in 2022, or 2.9% of gross domestic product (GDP) instead of the 5.0% provided for by law, UAH 142.7 billion (2.3%) in 2023, UAH 158.8 billion (2.1%) in 2024, and UAH 175.5 billion (2.1%) planned for 2025. International experience shows that most countries in the world use a mixed form of financing the healthcare sector to increase the population’s financial access to medical care. In Ukraine, a number of draft laws on mandatory state health insurance turned out to be flawed and were not adopted by the Verkhovna Rada. A conceptual approach to introducing mandatory state health insurance in Ukraine is proposed, through the adoption of a Law on Mandatory State Health Insurance. The proposed model defines the sources of funding for medical services: insurance payments of employers, state budget allocations, and funds from other sources not prohibited by law. Insurance funds will be directed to cover medical services in insured cases: for working persons – at the expense of employers’ insurance contributions; for the disabled population of retirement age and for persons with disabilities – at the expense of the Pension Fund of Ukraine; and for children, pregnant women, and marginalised groups of the population – at the expense of the Fund of Compulsory State Social Insurance of Ukraine in case of unemployment, without the use of citizens’ taxes for compulsory state medical insurance. Conclusions. Reducing financial barriers to medical care for the population consists in introducing compulsory state medical insurance with a significantly new approach to the sources of formation of insurance funds.

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