The Humanitarian Media Hub continues its series of discussions on how patients can survive and protect their rights under the new healthcare system. In the second episode of the podcast “120 Beats per Minute,” journalist Nazar Onysko and executive director of the Patients of Ukraine charity fund Inna Ivanenko analyze the patient’s journey. This time, the focus is on how to distinguish between a polyclinic and a hospital, what the state should really pay for, and in what situations patients are forced to pay out of their own pockets.
Polyclinic or hospital: where does the road to recovery begin?
The search for medical care always begins with a clear understanding of the difference between a polyclinic and a hospital. Patients usually end up in the hospital in one of two ways: either through emergency care in a critical condition or through a planned referral for complex surgical or therapeutic interventions. Any minor deterioration in well-being that does not pose an immediate threat to life requires a visit to the family doctor.
The family doctor acts as the main coordinator. He or she determines whether a consultation with a specialist is necessary and issues the appropriate electronic referral. Help from a specialist without a referral can only be obtained in exceptional cases. This applies to visits to the dentist, gynecologist, psychiatrist, and phthisiatrician. In all other situations, an unauthorized visit to a specialist turns the service into a paid service for the patient.
“You are taken to the hospital, you go to the clinic when you feel slightly unwell and you understand that something needs to be done about it,” Inna Ivanenko explains the basic logic of the system.
The medical guarantee program and the real cost of services
The state medical guarantee program currently covers 46 service packages. They cover the vast majority of the population’s needs: from pregnancy and childbirth to complex oncological examinations and stroke treatment. However, there are clear boundaries where state obligations end and the patient’s personal responsibility begins.
Only services that are medically justified are free of charge. If a person wants to undergo an examination “just in case” without a doctor’s referral, they pay for it at the official rate of the institution. Services are a separate category. The state does not finance improved conditions in the ward, plastic surgery, orthodontics for adults, or the option to choose a specific doctor for childbirth outside the regular team.
The fight against extortion for medicines and anesthesia
One of the most pressing problems remains cases where inpatients are sent to pharmacies to buy medicines, sutures, or anesthesia. Inna Ivanenko emphasizes that such actions are a direct violation of the law. When a hospital signs a contract with the National Health Service of Ukraine for a specific package of services, the cost of all necessary medicines and consumables is already included.
“It is illegal to send you to a pharmacy to buy medicine for an operation,” emphasizes the executive director of the Patients of Ukraine Charitable Foundation.
If a patient finds themselves in a situation where they are being asked for money, or they have already spent their own funds on emergency treatment, there is a mechanism for protection. The first step should be to contact the head doctor of the facility and ask them to explain the reason for the lack of medication. If this does not help, you should call the NSZU hotline at 1677 or leave a written complaint on the service’s website. It is important to keep all fiscal receipts — they are the main evidence for further reimbursement or sanctions against the hospital.
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Digitalization as a safeguard against corruption and a control tool
Today, transparency is ensured by the e-health electronic healthcare system. Every procedure, every prescription, and every referral is recorded in digital format. This allows the National Health Service of Ukraine to see the actual volume of care provided and pay hospitals for the work actually performed, rather than for “bed days.”
Even in the event of blackouts or loss of communication, the system remains operational. Doctors are obliged to provide care even if the system is down. The doctor records everything on paper and later enters it into the system. Patients have the right to demand free treatment regardless of the technical difficulties of the facility, as funding continues to be provided on the basis of recorded electronic records.
Soviet legacy versus the needs of real patients
Ukraine is gradually moving away from the model of maintaining a huge number of half-empty hospitals left over from Soviet times. The problem with the current stage of reform is that many small institutions are trying to survive without enough patients and adequate equipment.
“We cannot afford to maintain these walls for the sake of maintaining them, to stay afloat,” says Inna Ivanenko.
The effectiveness of the system directly depends on a capable network. If a hospital performs only a few operations a year, the qualifications of doctors are lost, and maintaining the building becomes a burden on the budget. The reform encourages institutions to merge and specialize so that taxpayers’ money goes not to heating walls, but to quality medical services and decent salaries for staff. The main focus should be on the real needs of people living in a particular area, not on preserving an outdated structure.
Transparency and responsibility for the quality of services
An important aspect of interacting with a medical institution is understanding that funds for treatment follow the patient. This means that a person has the right to choose a hospital where they will receive the best care, provided that the institution has a contract with the National Health Service of Ukraine. If a hospital cannot provide a patient with the necessary equipment or medication, it does not have the right to accept this package of services for funding.
When a conflict arises, patients should not be afraid to stand up for their rights. Complaints help the system rid itself of unscrupulous managers and improve service. The podcast emphasizes that awareness is the first step toward receiving quality care without unnecessary expenses for one’s own budget.
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