PRIMARY MEDICINE FUNDING: REALITIES AND PROBLEMS OF IMPLEMENTATION OF THE BRITISH EXPERIENCE IN UKRAINE

Abstract

Introduction. In Reforming Ukraine’s health care system involves distinguishing between primary, secondary and tertiary levels of health care, as well as determining the list of services to be provided at each of these levels. Ukraine will have to adapt its chosen model of health care financing to national priorities and ensure the availability of health care. Copying any foreign model without taking into account domestic peculiarities and economic justification will inevitably be accompanied by significant risks and will not lead to the expected results. Taking into account the outlined aspects, the issue of implementation of the British experience of financing primary health care in Ukraine is topical. The purpose of the article is to monitor current trends, identify and analyze problems related to the implementation of the British experience in the system of financing primary health care in Ukraine. Results. The study showed that in the process of reforming Ukraine’s health care financing system, primary health care will undoubtedly be a priority for public funding. The process of implementation of the British model of financing PMD, as expected, has created certain difficulties and problems that require systematic scientific analysis and neutralization of the risks of negative impact on social development. It must be acknowledged that the difficulties in implementing PMD reform are a normal world practice, and budgetary constraints on the financing of the primary care system of Ukraine are an incentive for the NHS to target and rationally allocate budget funds. Conclusions. The cornerstone of the “money follows the patient” reform principle has not been implemented at the primary care level. A problematic aspect of the PHC reform is that in 2018–2020 the NSSU did not perform the function of an organization engaged in strategic procurement of quality primary health care services for the benefit of Ukrainian citizens, but acted exclusively as an organization concluding contracts with medical institutions. We consider debatable the expediency of applying the capitation rate, which clearly does not encourage the family doctor to provide the maximum possible amount of medical care to the patient, but creates a “transfer of responsibility” to narrow specialists. In our opinion, in the logistics of PMD reform, the principle of “money follows the patient” should be replaced by the basic financial model of “money follows services”, which demonstrates the fundamental aspects of the new reform paradigm for public procurement of medical services.