The WHO presented an analysis of the financing of rehabilitation services in Ukraine in 2023–2024 and provided recommendations for further reforms. Demand for assistance is growing due to the consequences of war, an ageing population and the spread of chronic diseases, but the system still faces a number of barriers.
Growing need for rehabilitation
In Ukraine, there’s a growing number of people who need to recover from injuries, strokes, chronic illnesses, and combat wounds. According to WHO data, more than 40% of stroke patients leave hospital with significant limitations, but only a small proportion of them receive rehabilitation. This indicates limited access to services and weak patient referral mechanisms.
Since 2014, and especially after the full-scale invasion in 2022, demand for rehabilitation has increased several times over. Along with war injuries, there has been an increase in the number of cases of stroke, musculoskeletal disorders and other conditions requiring long-term rehabilitation care.
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Funding: more money, but no clear priority
The share of rehabilitation in the Medical Guarantees Programme has increased from 1.2% in 2020 to a projected 4% in 2025. At the same time, resources are spent unevenly: significant funds are allocated to the treatment of mild musculoskeletal disorders, while patients with strokes or severe injuries remain underserved.
Access to services today is determined solely by diagnosis, without assessing a person’s functional limitations. This means that some patients do not receive help, even though they have significant health problems. The system records cases of manipulation of diagnosis codes to circumvent the rules.
Weak interaction between levels of assistance
Only 6% of patients continued outpatient rehabilitation after inpatient rehabilitation in 2024. The main reasons for this were unclear patient pathways and a lack of effective referral mechanisms. As a result, many people either interrupt their treatment or are forced to remain in hospital longer than necessary.
The role of rehabilitation at the community level, where services could be made available to a larger number of people, has not been defined. Primary health care has the potential to detect early signs of functional loss, but this resource is hardly used.
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Development of a network of establishments and new service models
Starting in 2023, the National Health Service introduced differentiated payment for inpatient and outpatient rehabilitation, as well as a system of treatment complexity levels. In 2025, services that can be provided by a single specialist (monoprofessional) were included in the Medical Guarantees Programme. This should reduce the burden on the team approach where it is not mandatory, but experts warn of the risk of fragmenting the system.
Despite progress, funding remains uneven. In 2024, about 3% of institutions received almost a fifth of the total budget for inpatient rehabilitation, including private clinics and sanatoriums outside the main hospital network. This calls into question the effectiveness of resource allocation and requires a review of contracting approaches.
How to change payment for services
Today, funding is based on payment for a treatment cycle lasting at least 14 days. This leads to excessive or insufficient provision of services. The WHO recommendation is to switch to payment for hospitalisation, adapting tariffs to the complexity of the case and actual costs.
It is also proposed to review complexity groups, establish fairer payment rates and take into account not only the human resources of the institution, but also the real needs of the population. An important step should be to expand funding for highly effective interventions, such as early rehabilitation after strokes.
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