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Since its introduction in 2018, Ukraine's healthcare reform has significantly transformed the system by prioritizing the principles of autonomy, efficiency, and patient-centered funding. The core of this reform, the "money follows the patient" approach, allowed hospitals to manage resources independently, invest in their development, and adapt to local healthcare needs. However, recent governmental proposals to reintroduce centralized control threaten to reverse these advancements and risk plunging the healthcare system back into the inefficiencies of the past.

Achievements of the Reform

One of the reform's most significant successes is the autonomy granted to healthcare institutions. Hospitals gained the ability to manage finances, open accounts in commercial banks, and allocate resources based on patient demand. This autonomy encouraged innovation, enabling institutions to invest in modern medical equipment, train personnel, and expand services.
Another critical achievement is financial stability. By maintaining independent reserves, hospitals weathered crises such as payment delays or emergencies. For example, the war underscored the importance of these reserves, ensuring continued operations despite external disruptions.
Patient satisfaction also improved as funding followed their choices. Hospitals competed for contracts with the National Health Service of Ukraine (NHSU), fostering better service delivery and greater accountability.

Risks of Recentralization

The proposal to transfer hospital funds to state treasury accounts threatens to reintroduce systemic inefficiencies. Payments for salaries, equipment, and supplies could face delays, directly impacting the quality of care. Centralized control removes incentives for hospitals to innovate or tailor services to their communities.
Corruption risks are another concern. Allocating funds and equipment centrally could lead to politically motivated decisions, prioritizing bureaucratic interests over patient needs. Additionally, the economic impact of removing funds from private banks to treasury accounts could harm the banking sector and reduce its contribution to the broader economy.
The potential consequences extend beyond inefficiency. Hospitals would lose the ability to plan for the future, while local governments, currently active in managing healthcare facilities, might disengage. This lack of local involvement would disproportionately affect rural and under-resourced communities, where healthcare access is already limited.

Challenges Highlighted by the Reform

Despite its successes, the reform revealed structural weaknesses in the healthcare system. Many rural hospitals lack sufficient patient flows, qualified staff, and modern equipment, rendering them unsustainable. These facilities require strategic reorganization to align with national standards and community needs.
Another pressing issue is the status of hospitals relocated from conflict zones. Many of these institutions operate at minimal capacity, accumulating unused funds without fulfilling their intended roles. These challenges necessitate careful audits and reintegration into local healthcare networks.
The war has further exacerbated these issues, placing additional strain on facilities in frontline and rural areas. Addressing these challenges requires targeted investments and efficient resource allocation, rather than a return to centralized management.

Recommendations for Sustainable Progress

To maintain and build on the reform’s achievements, the government must avoid recentralization and instead focus on fostering collaboration between local and national authorities. Hospitals should retain autonomy, with reforms addressing inefficiencies through audits and targeted policies rather than blanket control measures.
Reorganizing underperforming facilities into specialized centers—such as rehabilitation hubs or resilience centers—could enhance their utility. Similarly, better integration of relocated hospitals into local networks would optimize resource use and service delivery.
By preserving the core principles of autonomy and patient-centered funding while addressing existing challenges, Ukraine can continue building a healthcare system that serves its people effectively and equitably, even in times of crisis.

This comprehensive approach safeguards the progress made since 2018 while ensuring the healthcare system remains resilient and adaptable to future needs.