On December 10, the President of Ukraine signed the Law of Ukraine “On the State Budget of Ukraine for 2022” № 1928-IX, which the Verkhovna Rada adopted on December 2, 2021. The document will enter into force on January 1, 2022. In the field of health provided UAH 157.3 billion for the implementation of the program of state guarantees of medical care, UAH 4.3 billion – for the budget program “Public Health and measures to combat epidemics”, UAH 2.6 billion – for vaccination of the population from COVID-19. In this publication, we will consider the key items of expenditure on health in 2022.

The budget calculations for 2022 are based on the indicators of the baseline scenario of the macroeconomic forecast, approved by the Cabinet of Ministers of 31.05.2021 № 586 “On approval of the Forecast of economic and social development of Ukraine for 2022-2024”. In 2022, real GDP is expected to grow by 3.8%, while consumer inflation will slow to 6.2% (“December to December of the previous year”). The level of the average monthly salary will increase by 4.4% to UAH 15,258. Factors in wage growth should be the increase of social standards by the Government and the reduction of unemployment (up to 8.5%), which will take place in the context of the revival of economic activity.

Revenues of the State Budget for 2022 are set at UAH 1,323.9 billion (which is 9.7% more than in 2021). The main part of revenues will be tax revenues – UAH 1,169.1 billion. UAH 1.2 billion is expected to be received from official transfers (European Union, foreign governments, international organizations, donor institutions).

According to the Ministry of Health of Ukraine, the State Budget for 2022 provides funds to establish the basic level of salaries for doctors at 20 thousand UAH and 13.5 thousand UAH – for paramedics, as required by the decree of President of Ukraine Volodymyr Zelensky. Such salaries should be received by all physicians working under the Medical Guarantee Program (PMG). The budget provides for an increase in expenditures on SMP financing, procurement of medicines and medical equipment, development of the biocluster “Biosafety and development of biotechnological technologies”, transplants. Funds are also provided for vaccination of the population for the prevention of COVID-19 and others.

Expenditures envisaged by the State Budget for 2022 for the Ministry of Health of Ukraine include funding from the Ministry (UAH 36.7 billion), the State Service of Ukraine for Medicines and Drug Control (UAH 123.1 million) and the National Health Service of Ukraine (NHSU) UAH 157.6 billion), as well as national expenditures and lending (in the amount of UAH 2.4 billion). In total, health expenditures amounted to UAH 196.8 billion (3.7% of gross domestic product (GDP), an increase of 14.3% compared to the previous year).

Pilot projects on pharmaceutical insurance are being launched in Rivne, Sumy, Zaporizhia, Odesa, Kharkiv, and Kyiv. The relevant memorandum for their implementation was signed at the Ministry of Health of Ukraine on December 7.

“According to the Ministry of Health, Ukrainians leave about UAH 60 billion annually in pharmacies, and more than 50% of them spend on drugs without proven effectiveness and for unreasonable purposes.

The pilot project on pharmaceutical insurance is an opportunity to reduce the financial burden on the family budget through voluntary health insurance.

“There are medicines that are not included in the” Affordable Medicines “program, and the cost of which is not reimbursed under the reimbursement program, and it is thanks to voluntary insurance that you can get compensation for medicines prescribed during outpatient treatment,” said Health Minister Viktor Lyashko.

Doctors already have access to the pharmaceutical insurance system in the urban health facilities involved in the pilot projects. In order to participate in the project, the patient must purchase an insurance policy and notify their doctor. The patient will pay UAH 120 per month and will be able to use the sum insured of UAH 20,000 if he is prescribed drugs that are not included in the “Affordable Medicines” program and the cost of which is not reimbursed under the reimbursement program.

To receive medication under insurance in case of illness, the patient comes to the doctor, is examined, receives a prescription for medication. Drugs included in the pharmaceutical insurance program are automatically booked at the pharmacy. The patient receives a message with information about the pharmacy where you can pick up the medicine. Payment for medicines by the insurance company is automatic, without the involvement of a patient or doctor.

The project is controlled, prescriptions are issued only for international non-commercial names of drugs (INN). The choice of trade name is automated and operates on the principles of affordability and price. The conditions of the project make it impossible to prescribe drugs that are not provided for in clinical protocols.

To implement this project, the Ministry of Health, the Verkhovna Rada Committee on Nation Health, Medical Care and Health Insurance, the National Association of Insurers of Ukraine, the League of Insurance Organizations of Ukraine, the Insurance Business Association, and JSC PrivatBank concluded a memorandum of cooperation in the field of voluntary health insurance of expenditures related to the provision of medicines and medical devices.

A working group is currently being formed to work out issues and solutions that may arise during the project implementation.

The memorandum has an open form – it can be joined by other participants who are ready to develop medical services in Ukraine.

For reference: Since October 1, the Affordable Care Act has expanded to include 466 drugs for the treatment of cardiovascular disease, diabetes, prevention of stroke and heart attack, bronchial asthma, epilepsy, mental and behavioral disorders. This year, the Affordable Care Act has already reimbursed UAH 963 million for repaid prescriptions.

The Ministry of Health, in collaboration with USAID ReLAB-HS and the World Health Organization, has begun work on a project office to implement rehabilitation reform.

“Currently, the system of rehabilitation of people with disabilities is not working at full capacity. Reform of this system is a requirement of time and an opportunity to get rid of outdated standards and approaches, because as a result of changes we will be able to comprehensively approach resource management, direct policies to restore and reduce disability, update the system of disability or functionality to determine the status of people with disabilities, etc. “, – said the Minister of Health Viktor Lyashko.

The Ministry of Health is currently working to establish an interagency working group that will shape the main priorities of the reform, as well as the reform support office itself. The Support Office will consist of experts in rehabilitation and public administration reform and will work on the implementation of the Rehabilitation Management System.

In particular, the functions of the office will be:

• analysis and development of the regulatory framework for reform;
• functional changes in the rehabilitation system, including the integration of disparate rehabilitation systems to form a holistic system;
• development of IT tools to assess the level of functioning of the person on the basis of the IFF;
• development of a model of social support/services and the establishment of disability and its implementation;
• training of existing specialists and formation of the legal framework for the modernization of rehabilitation curricula in higher education institutions.

On December 10, the Ministry of Health of Ukraine and Philips Medical Systems signed a memorandum of cooperation.

The memorandum between the Ministry of Health of Ukraine and Philips concerns cooperation and reciprocity in the following areas:

• Improving the quality of the oncology service of Ukraine, which includes the exchange of best practices in the planning of integrated cancer care and ways of treating patients based on modern methods of diagnosis, treatment planning, treatment, and monitoring of patients.
• Improve access to and management of digital personalized patient data and digital clinical images.
• Improving the quality and availability of secondary and special care, including health needs assessment, accurate planning of clinical services, development of strategic roadmaps, and patient-centered health care projects.
• Expanding access to modern technological services for diagnosis and treatment.

The document was signed by Oleksandr Komarida, First Deputy Minister of Health of Ukraine, and Philips Medical Systems Nederland B.V., Vice President for Global Relations with Public Authorities and the Public. Jan-Willem Scheigrond.

“The Ministry of Health is following the updates in diagnostic technologies and seeks to make high-tech medical services more accessible to Ukrainians. This is what our memorandum with Philips is dedicated to, as the company has significant experience and resources that will help achieve maximum results in the implementation of the main tasks of the Ministry, – said Alexander Komarida. “We are sincerely grateful to the Government of the Kingdom of the Netherlands and Philips Medical Systems for the excellent opportunity to develop healthcare in Ukraine and to implement best medical practices to improve the health of Ukrainians and improve their quality of life.”

The Cabinet of Ministers of Ukraine amended the resolution of 22.07.2020 № 641 and allowed budget managers to make advance payments for goods, services, and works necessary to counter COVID-19 (including from local budgets).

The adopted resolution clarifies the list of cases for which the period of quarantine is not prohibited by managers (recipients) of budget funds for prepayment of goods, works, and services purchased for budget funds.

In particular, we are talking about procurement:

• medicines, the list of which was approved by the Cabinet of Ministers of September 22, 2021, № 1012 coronavirus SARS-CoV-2 “,
• vaccines or other medical immunobiological drugs,
• consumables for medical care for patients with COVID-19,
• medical devices for vaccination from COVID-19,
• medical equipment for health care facilities that provide care to patients with COVID-19,
• medical gas supply systems,
• other goods and services necessary for the implementation of measures aimed at the prevention of coronavirus disease, which are accordingly purchased during the quarantine period in the manner prescribed for simplified procurement,
• work on providing health care facilities with medical gas supply systems (from the local budget).

The approved changes will allow prepayment of goods needed to combat COVID-19, which are purchased during the quarantine period in the simplified procurement procedure and for the implementation of budget programs, program codes of expenditure classification and local budget crediting which correspond to codes 2010 – 2152 and 7322.

The Cabinet of Ministers of Ukraine extended the adaptive quarantine on the territory of Ukraine until March 31, 2022.

Relevant amendments to Resolution №1236 were adopted during the Government meeting on December 15.

We will remind, since December 6 new quarantine norms began to operate. They apply primarily to unvaccinated citizens. At the yellow level of epidemic danger, at least one vaccination against COVID-19, a valid negative test or a certificate of recovery is required to visit and operate public facilities, restaurants, sports centers, entertainment venues, participate in public events, etc.

In addition, the validity of the single dose of COVID-19 vaccine document was reduced: the “yellow” COVID certificate and the 063-O certificate. Previously, they were valid for 120 days, and from December 6, their validity is 30 days. If a person has not given a second dose of the vaccine within 30 days, their document will no longer be valid.

The Cabinet of Ministers of Ukraine has allocated funds for the purchase of 84 X-ray machines for health care facilities. These are regional medical institutions that are involved in measures to prevent the spread of coronavirus disease.

The relevant decision was made during a meeting of the Government on December 15.

UAH 210 million was allocated for the purchase of devices. The funds will be redistributed within the subvention to local budgets. Thus, hospitals in the regions will be able to receive new diagnostic equipment.

The Ministry of Health continues to prepare a draft Health Development Strategy 2030. To finalize the comprehensive document, the Ministry is holding public consultations with the public with the assistance of the National Democratic Institute, the Coalition Resuscitation Reform Package and the Republic Institute. As part of public consultations, meetings are organized with all stakeholders involved in the field of medicine: community experts. doctors, patients, scientists, government officials, etc.

On December 15, representatives of the Ukrainian medical business provided suggestions and ideas for improving the quality of health care.

The goal of the new Ministry of Health Strategy is to promote the healthy well-being of citizens by ensuring fair access to the quality of health services and building sustainable health care systems.

“Today, at the stage of forming the Strategy, we want to hear your opinion, your vision. The purpose of our meeting is to try to think about the key areas of cooperation between the Ministry of Health and business. – explained the moderator of the event, coordinator of campaigns of the Institute “Republic” Vitaly Glizhynsky.

Roman Lansky, Adviser to the Minister of Health on Digitalization, explained that the Strategy will for the first time highlight specific values ​​and vision instead of stating the policy documents:

“The Strategy for 2015-2020 outlined the main directions of health care reform, the updated Strategy should work in the same vector. This document is about equal access to medicines, updated quality of medical services, protection of health workers. For the first time, we are starting to talk about the Strategy as a visionary thing, not the adoption of conditional documents. ”

“We need to reach a common agreement on those issues whose answers are relevant to both the state and business.” – added the adviser to the head of the Ministry of Health.

It will be recalled that the Ministry has identified the following key priorities in its 10-year Strategy:

Health governance
Universal health coverage
Public health, preparedness and response to emergencies
Involvement of people and communities
Human resources of the health care system (CROC)

During the expert discussion, proposals were received to expand the pool of key priorities of the Strategy, assess the involvement of Ukrainian pharmaceutical business in the EU system and clear boundaries of funding for the sector by the state and business.

Business representatives expressed their hopes that the Strategy will not only work as a policy document, but will also be used properly, taking into account the interests of all stakeholders and a clear KPI.

The recommendations prepared during the public consultations will be submitted to the Ministry for consideration in the Strategy and will be published in the general report on the results of the meetings.

It will be recalled that public consultations on universal coverage of health services, public health, governance and human resources of the health care system were held earlier.

The public consultation was made possible by the generous support of the British people through the Office of Foreign Affairs, Commonwealth and Development.

On December 17, the Ideaton on “Creating a Biocluster for the Development of Medical Biotechnology in Ukraine” started at the UNIT.City Innovation Park.

The opening ceremony was attended by Minister of Health Viktor Lyashko and Deputy Head of the Office of the President of Ukraine Yulia Sokolovska.

Victor Lyashko noted that this is the first time that the state has gathered representatives of research institutes, startups, pharmaceutical companies, international partners to develop ideas for creating a biocluster.

“We want to hear what is needed for the development of biotechnology, and to create an ecosystem conducive to innovation, where you can test a scientific idea, find like-minded people, conduct research, laboratory experiments, and most importantly – bring developments to market. The biocluster will be able to become the same platform for research and testing, which is currently lacking for our scientists, “said Viktor Lyashko.

Yulia Sokolovska thanked everyone for their participation in the development of biotechnology and noted that the state is ready to support the development of medical biotechnology, because it is a matter of time. The Deputy Head of the Office of the President stressed the importance of implementing all the ideas and opinions that will be developed during the Ideaton.

The ideaton will last for two days. The program of the event includes work in teams on the mission and values ​​of the biocluster, creating a value chain for each of the stakeholders, presentation of foreign practices of creating bioclusters and more.

The results of the work within the framework of Ideaton will be used to create a biocluster in Ukraine.

Certificate:

A biocluster is a group of interconnected organizations that work together to implement scientific innovations in the medical, pharmaceutical, and biotechnological fields. The creation of a biocluster is a successful international practice, the purpose of which is to start biotechnological production in the country.

According to the results of the competition of scientific developments in 2021, the list of winners who will develop test systems has been determined. In particular, the development of a set of reagents for serological diagnosis of brucellosis, diagnostic test system for the detection of IgM antibodies to measles vypycy by ELISA, enzyme-linked immunosorbent assay for the detection of IgG antibodies to Borrelia burgdorferi in human serum or plasma, human blood plasma to determine the variation of SARS-CoV-2 virus by PCR and the test system to determine Orthohantavirus genus by PCR.

Draft Law of Ukraine “On Amendments to the Law of Ukraine“ On Public Procurement ”and other laws of Ukraine on procurement of medicines, medical devices and their aids by a person authorized to procure in the field of health care and with the involvement of specialized organizations, who procure ”(hereinafter – the Bill) is designed to successfully continue the experience of providing patients of Ukraine with vital effective, safe and high-quality medicines and medical devices at the expense of the state budget with the involvement of international specialized organizations that procure.

The draft law was developed by the Ministry of Health of Ukraine (hereinafter – the Ministry of Health) on its own initiative.

Since 2015, the Ministry of Health has been procuring medicines and medical devices with the participation of specialized procurement organizations (such as the United Nations Development Program (UNDP), Crown Agencies Limited, the United Nations Children’s Fund in Ukraine (UNICEF)).
Such international procurement organizations have many years of experience in implementing projects for the procurement of goods and services on behalf of individual states or organizations, and their activities are strictly regulated in terms of the control system, procurement processes, and procedures.

World experience shows that the involvement of international procurement organizations in the process of purchasing medicines and medical devices at public expense provides a number of benefits for both patients and health care in general, as well as provides significant budget savings. In particular, such advantages are:

• reduction of the supply chain of medicines and medical devices (in particular, many medicines and medical devices are purchased by international procurement organizations under direct agreements with manufacturers, which allows obtaining the best price and quality guarantees);
• ensuring the procurement of high-quality medicines and medical devices due to the strict requirements for medicines;
• ensuring the speed of procurement through procurement from suppliers qualified by international procurement organizations (ie suppliers that have been tested by an international procurement organization for financial viability, as well as compliance with ethical requirements and applicable law);
• conducting procurement in accordance with transparent and open rules and procedures of international procurement organizations;
• the possibility of purchasing medicines and medical devices at low prices due to the large volumes of procurement carried out by international procurement organizations, as well as due to the conclusion of long-term framework agreements with suppliers by international procurement organizations.

The experience of procurement of these organizations has proven its success, providing the population for many years with the supply of quality and safe medicines and medical devices while significantly saving budget funds.

It should be noted that procurement with the involvement of specialized organizations since 2015 has been forced to strengthen the Ministry of Health’s own institutional capacity to procure medicines and medical devices through a national strategic purchaser.

This is due to the fact that the procurement of medicines and medical devices must be carried out within the deadlines set by law and are urgent, and the current system of centralized public procurement proved ineffective and posed risks of restricting patients’ access to essential medicines. temporary mechanism (for the period of reforming this area) with the involvement of proven world experience in the procurement of medicines and medical devices for budget funds.

Such a national strategic purchaser was the state enterprise “Medical Procurement of Ukraine”, which applies the leading practices and mechanisms of specialized organizations and continues the successful experience of specialized organizations.

According to each year, the list of medicines and medical devices procured with the involvement of international specialized organizations decreases, and the relevant areas of procurement are procured by the state enterprise “Medical Procurement of Ukraine” as a person authorized to procure health care for programs and implementation of centralized health care measures.

However, as the practice of procurement of medicines and medical devices by the state enterprise “Medical Procurement of Ukraine” in the period
2020-2021, there is a need to continue the temporarily introduced mechanism of parallel use for procurement of both international specialized organizations and the person authorized to conduct procurement in the field of health to implement programs and implement centralized health measures for another year.

Continuing to engage specialized organizations is also in line with the Sustainable Development Goals, including Goal 3, “Strong Health and Well-Being”, which is a bold commitment to tackling AIDS, tuberculosis, malaria, and other communicable diseases by 2030 by universal health coverage and providing access to safe and affordable medicines and vaccines.

In addition, the need to continue to involve specialized organizations in procurement procured to ensure the purchase of COVID-19 vaccines and COVID-19 vaccines from leading manufacturers of drugs with which specialized organizations have long-term contracts in 2022-2023.

At present, the conditions for the involvement of the Ministry of Health of international specialized organizations for the procurement of medicines and medical devices for budget funds are limited in time, namely:
– The Law of Ukraine “On Amendments to Certain Laws of Ukraine on Ensuring Timely Access of Patients to Necessary Medicines and Medical Devices through Public Procurement with the Involvement of Specialized Procurement Organizations” is valid until April 30, 2022;
Part 7 of Article 33 of the Law of Ukraine “On Ensuring the Functioning of the Ukrainian Language as the State Language” health, with specialized organizations that carry out procurement, valid until April 30, 2022;
– paragraph 19 of the fifth part of Article 3 of the Law of Ukraine “On Public Procurement”, which states that this Law does not apply to cases where the subject of procurement are goods and services to be procured in accordance with procurement agreements concluded by the central executive body the authorities of Ukraine, which ensures the formation and implementation of state policy in the field of health care, with specialized organizations that carry out procurement, valid until March 31, 2022;
– the validity of registration certificates for medicinal products subject to procurement as a result of a procurement procedure conducted by a specialized procurement organization for the implementation of a procurement agreement between the central executive body that ensures the formation and implementation of state health policy, and the relevant specialized organization conducting procurement valid until March 31, 2020, extended until March 31, 2022, and the fifth paragraph, the third sentence of the tenth paragraph of subparagraph 2, subparagraph 3, paragraphs five and seven of subparagraph 4, paragraphs two – the fourth sub-item 5, sub-item 6 of item 2, item 3, the third paragraph of item 4 of section I of the Law of Ukraine “On Amendments to Certain Laws of Ukraine Aimed at Improving the Availability of Medicines, Medical Devices and Auxiliaries for procurement in the field of health care “are in force until March 31, 2022.

The draft law proposes to extend the validity of the listed norms, which are in a systemic connection with the involvement of international specialized organizations in procurement, until April 30, 2023.

Adoption of the amendments proposed by this Bill will create favorable conditions for the further functioning of the procurement system in the field of health care, taking into account the unique specifics of international specialized organizations, and increase the availability of medicines and medical devices to patients.