Private provision of health services in Ukraine: A qualitative exploration of current policy challenges, and considerations for reform

IF 3.6 3区医学 Q1 HEALTH CARE SCIENCES & SERVICES

Health Policy Pub Date : 2025-05-14 DOI:10.1016/j.healthpol.2025.105349

Mark Hellowell , Olga Demeshko , Radmyla Hrevtsova , Tomas Roubal , Kateryna Fishchuk , Solomiya Kasyanchuk , Jarno Habicht

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Abstract

Background

The role of private healthcare providers (PHPs) in Ukraine has increased, despite the ongoing war. As the Government of Ukraine (GoU) continues health reforms, governance mechanisms for PHPs need further examination.

Objective

This study assesses the policy responses to the growth of PHPs in Ukraine, focusing on four key state functions: information generation, regulation, purchasing, and policy-making.

Methods

A qualitative approach was used, including interviews and document analysis, to explore the effectiveness of governance frameworks in managing the private healthcare sector.

Results

Regulations for PHPs are comprehensive but outdated and require stronger enforcement. The National Health Service of Ukraine (NHSU) has extensive purchasing agreements with PHPs but lacks policies to address equity and efficiency concerns. Many PHPs are not enrolled in the national health information system, limiting the GoU’s ability to make evidence-based policy decisions. Strengthening the requirement for PHPs to enrol in the e-health system is needed, along with improved licensing and contractual specifications. Additionally, policy-making processes are vulnerable to influence by PHPs’ commercial interests, highlighting the need for greater transparency and broader stakeholder engagement.

Conclusions

Enhancing regulatory enforcement, expanding e-health system participation, and improving policy processes are essential for the GoU to address challenges posed by private sector growth. Strengthening these governance mechanisms will support Ukraine’s goals of equity, financial protection, and high-quality care, enhancing resilience to the multiple impacts of the war.

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乌克兰私人提供保健服务：对当前政策挑战和改革考虑的定性探讨

背景尽管战争仍在持续，但乌克兰私营医疗保健提供者（PHPs）的作用有所增加。随着乌克兰政府继续进行卫生改革，需要进一步审查初级保健医院的治理机制。本研究评估了乌克兰PHPs增长的政策反应，重点关注四个关键的国家职能：信息生成、监管、采购和决策。方法采用定性方法，包括访谈和文献分析，探讨治理框架在管理私营医疗保健部门方面的有效性。结果：对PHPs的监管是全面的，但过时了，需要更强有力的执行。乌克兰国家卫生服务体系（NHSU）与初级保健服务机构签订了广泛的采购协议，但缺乏解决公平和效率问题的政策。许多初级保健医生没有在国家卫生信息系统中登记，这限制了初级保健医生做出基于证据的政策决定的能力。需要加强对PHPs注册电子卫生系统的要求，同时改进许可和合同规范。此外，决策过程容易受到PHPs商业利益的影响，这突出表明需要提高透明度和更广泛的利益相关者参与。结论：加强监管执法、扩大电子卫生系统参与和改进政策流程对于政府应对私营部门增长带来的挑战至关重要。加强这些治理机制将有助于乌克兰实现公平、财政保护和高质量医疗服务的目标，增强应对战争多重影响的韧性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Health Policy 医学-卫生保健

CiteScore

6.40

自引率

6.10%

发文量

157

审稿时长

3-8 weeks

期刊介绍： Health Policy is intended to be a vehicle for the exploration and discussion of health policy and health system issues and is aimed in particular at enhancing communication between health policy and system researchers, legislators, decision-makers and professionals concerned with developing, implementing, and analysing health policy, health systems and health care reforms, primarily in high-income countries outside the U.S.A.