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On April 1, 2020, the second stage of medical reform began, as a result of which a program of medical guarantees, a package of free services from the state, was launched for the first time. Read about the role of the National Health Service of Ukraine in this process and what tools help it to purchase medical services for Ukrainians in health care institutions, in our material with Tetiana Boiko, Director of the Communications Department of the NHSU, and Yurii Marynovskyi, Head of the Development Department and maintenance of systems of the Department of Information Technologies of the NHSU.

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Tetiana Boiko: Starting in 2020, specialized medical institutions switched to a new financing system and began to receive money for the services provided to patients, and not just for the availability of beds, as it was before.

The National Health Service of Ukraine is responsible for the strategic procurement of medical services and medicines for the patients benefit. Simply put, we assess the health care needs of the population, select those providers who can provide safe and quality health care, and determine payment methods.

The NHSU operates with state budget funds through the Medical Guarantee Program (hereinafter – MGP) – for the first time, it was fully operational in Ukraine on April 1, 2020. The MGP consists of packages of services defined based on priorities in healthcare, which are approved by the Ministry of Health of Ukraine.

This is how the principle “money follows the patient” is implemented in practice (when the state pays hospitals for specific medical services rendered to patients). The transformation of healthcare financing is a game-changer in healthcare. What does it give:

- transparent and understandable guarantees of the state regarding the volume of free medical care;
- financial protection of patients in case of illness;
- efficient and fair distribution of public funds;
- an incentive to improve the quality of medical care by health care institutions of all forms of ownership.

Tetiana Boiko: The Medical Guarantee Program allows citizens to receive the services of doctors free of charge even in private clinics.

The Medical Guarantee Program became fully operational in 2020. It is a clear list of services that a patient can receive for free, subject to certain rules. We are talking about primary, emergency care, consultations, diagnostics, hospitalizations, operations, rehabilitation, and palliative care.

The Medical Guarantee Program is a flexible tool that can be quickly adapted to the situation to respond effectively to calls. For example, since the beginning of the coronavirus pandemic, the NHSU has promptly expanded the MGP to include additional packages related to providing care to patients with and suspected COVID-19. At the end of 2020, more than UAH 13.2 billion were paid for these packages.

The new Medical Guarantee Program will start on April 1, 2021. In it, we detail medical service packages based on patient needs. For citizens, this expansion of the MGP will mean a more convenient and understandable route for these services. In the first quarter, the 2020 MGP is still in effect with minor changes.

Tetiana Boiko: In 2020, almost all healthcare institutions in Ukraine joined the medical guarantees program. 21% are non-state providers of medical services.

Since April 1, 2020, despite various unforeseen events and the COVID-19 pandemic, almost all municipal specialized agencies began to work under an agreement with the NHSU. District and rural, regional and city hospitals began to receive transparent payments from the NHSU for the medical care provided to patients, instead of a subvention for the maintenance of walls and beds, as it was before.

For a patient, this means the opportunity to receive medical services from a family doctor or a specialized medical institution, regardless of the place of registration or residence – the main thing is that the hospital where the required specialist works has an agreement with the NHSU. Patients can conclude declarations with a family doctor and be treated in private institutions for state money – that is, for money paid from their taxes. Since April 2020, in some private clinics in Ukraine, you can also receive specialized medical care for free.

In total, in 2020, the NHSU signed more than 3,800 contracts with 1,675 medical institutions that provide specialized and emergency medical care – all of them were concluded through SmartTender.biz. The amount of payments under these contracts amounted to almost 52 billion hryvnia.

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I would like to draw your attention to the fact that an agreement with the NHSU can be concluded not only by state institutions but also by private institutions and doctors who are sole proprietors. In 2020, 21% of the total number of contracts were concluded specifically with non-state suppliers:

- 401 – with private entrepreneurship doctors (397 of them work at primary care);
- 231 – with private medical institutions (212 of them work in primary care).

The fact that the data is now stored in the Electronic Health Care System (hereinafter – EHCS) guarantees their transparency and openness. We visualize the data in the form of interactive dashboards on the NHSU website, so that the patient immediately sees with which doctor and in which institution a declaration can be concluded, as well as in which institution he can receive the service in his electronic referral, and in the pharmacy – available medicines.

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Dashboard "Overview of Filed Declarations of Primary Care Physician Choice"

Yurii Marynovskyi: To automate the acceptance of applications from healthcare institutions and conclude agreements with them, we use ready-made tools of the electronic platform.

When the NHSU was preparing to conclude contracts for the first time with institutions that provide specialized assistance, it was important for us to find a ready-made tool that would ensure a quick contact process. We researched the market and decided to choose the SmartTender.biz, since its functionality, price, and speed of preparing the contacting process met the list of our requirements.

We have identified the following advantages of the site:

1. Convenient work with contracts – the ability to form requests for the conclusion of contracts, the choice of parameters, and the contract management module.
2. Automated processes for data exchange – when the NHSU receives an offer from a healthcare institution (hereinafter – HCI), we can check it directly on SmartTender.biz and calculate the amount of the contract. We have a Data Warehouse, where applications from the site are transferred, where our specialists verify the information from the institution with the data of the EHCS. Further, the contract is formed automatically and goes through the process of internal approval.
3. The cost of the license includes technical support and functional adjustments by the site specialists. If there is a need for additional functionality, we will quickly get it.
4. The site has a separate service for the exchange of legally documents significant – Signy. When the contract is ready for signing, the service notifies HCI that it has received a document for signing. And we, in turn, immediately see when the agreement was signed.

Yurii Marynovskyi: To conclude a contract with us on medical care, providers of medical services must first fulfill the necessary conditions.

Any institution, regardless of its form of ownership, can enter into an agreement on medical services for the population. To do this, they just need to fulfill the following conditions:

- become autonomous (a prerequisite for government agencies);
- join the Electronic Health Care System (EHCS);
- have the necessary equipment;
- submit an application (proposal) to the NHSU;
- sign an agreement.

A healthcare provider may submit an offer when we open contract advertisements. We conclude all contracts electronically:

1. Primary care providers and pharmacies contract the EHCS through their health information systems.
2. Specialized help providers use the SmartTender.biz platform.

NHSU concludes contracts with medical institutions until the end of the year. We form the need for medical services, and, guided by it, as well as by regulatory legal acts, we open an ad at certain periods. Now we are preparing to conclude contracts for the 2021 medical guarantees program, which will start working on April 1.

Yurii Marynovskyi: It is important that representatives of medical institutions carefully prepare the necessary package of documents for applying for an agreement with the NHSU.

Most HCI conduct purchases, so they are already familiar with the functionality of trading platforms. Difficulties usually arise with the preparation of the necessary documents. The percentage of proposals accepted by us directly depends on the packages of services, and more specifically, on the conditions of purchase and the specification of each package of medical services. For example, to submit a proposal for some packages of an institution, it is enough to fill out a few points of the specification, add a license for medical practice and impose a QES. Such an offer is processed by our specialist within 5-7 minutes. But the share of incorrectly submitted proposals the first time, even for such packages, is quite large.

For healthcare institutions to quickly submit their application, we have developed a site instruction manual. For some establishments, we additionally create test lots so that they have the opportunity to practice. This is necessary so that later they could easily complete their application, and in the future conclude an agreement and receive payments from the National Health Service of Ukraine.