Co-payment policy: considerations for Ukraine (2021)

Ukraine’s constitution states that all citizens are entitled to free health care in public facilities, but low levels of public spending on health and an inefficient provider network have created favourable conditions for informal payments, contributing to high levels of out-of-pocket spending on health. Comprehensive health financing reforms have been under way since 2016, aiming to improve population health outcomes and ensure financial protection from excessive out-of-pocket payments. Alongside this reform process, discussion is ongoing about introducing co-payments for services covered by the Programme of Medical Guarantees. Co-payments may create additional financial barriers to access and increase financial hardship for the people most in need of health services. Any decision-making on their potential role in the health system should therefore involve public consultation and technical discussion reflecting international experience and the current context in Ukraine. This policy brief aims to contribute to these discussions, detailing the ways in which people currently already pay out of pocket for health care, looking at international evidence on co-payments as a policy instrument, and highlighting policy considerations for Ukraine.