title: Ukraine: health system review.
abstract: This analysis of the Ukrainian health system reviews recent developments in organization and governance, health financing, health care provision, health reforms and health system performance. Since the country gained independence from the Soviet Union in 1991, successive governments have sought to overcome funding shortfalls and modernize the health care system to meet the needs of the population's health. However, no fundamental reform of the system has yet been implemented and consequently it has preserved the main features characteristic of the Semashko model; there is a particularly high proportion of total health expenditure paid out of pocket (42.3 % in 2012), and incentives within the system do not focus on quality or outcomes. The most recent health reform programme began in 2010 and sought to strengthen primary and emergency care, rationalize hospitals and change the model of health care financing from one based on inputs to one based on outputs. Fundamental issues that hampered reform efforts in the past re-emerged, but conflict and political instability have proved the greatest barriers to reform implementation and the programme was abandoned in 2014. More recently, the focus has been on more pressing humanitarian concerns arising from the conflict in the east of Ukraine. It is hoped that greater political, social and economic stability in the future will provide a better environment for the introduction of deep reforms to address shortcomings in the Ukrainian health system.
authors.affiliation: Department of Social Medicine and Health Care Management of Dnipropetrovsk Medical Academy.
authors.forename: Valery
authors.initials: V
authors.lastname: Lekhan
authors.affiliation: Committee on Health of the Verkhovna Rada (Parliament) of Ukraine.
authors.forename: Volodymyr
authors.initials: V
authors.lastname: Rudiy
authors.affiliation: Department of Health Economics and Medical Insurance at the Ukrainian Institute for Strategic Studies (UISS) under the Ministry of Health.
authors.forename: Maryna
authors.initials: M
authors.lastname: Shevchenko
authors.affiliation: WHO Representative and Head of the WHO Country Office in Ukraine.
authors.forename: Dorit
authors.initials: D
authors.lastname: Nitzan Kaluski
authors.affiliation: European Observatory on Health Systems and Policies.
authors.forename: Erica
authors.initials: E
authors.lastname: Richardson
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D003695:Delivery of Health Care / Q000458:organization & administration*; D005260:Female; D005382:Financing, Personal; D018166:Health Care Reform / Q000458:organization & administration; D005102:Health Expenditures; D006291:Health Policy; D006295:Health Resources; D006304:Health Status; D061889:Healthcare Financing; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D009313:National Health Programs / Q000458:organization & administration; D014455:Ukraine; D055815:Young Adult