Attitudes towards patient payments in Ukraine: is there a place for official patient charges?

Irena Gryga,

Tetiana Stepurko,

Andrii Danyliv,

Maksym Gryga,

Olga Lynnyk,

Milena Pavlova,

Wim Groot


The attitudes of health care system stakeholders towards official patient charges have not been studied in Ukraine although both the central and local governments have several times considered to introduce such charges. Instead, informal patient payments are widespread and wellestablished. Ukrainian patients pay either unofficially or quasi-officially (i.e. charitable contributions) to health care institutions. The reasonable solution for dealing with these types of payments would be the introduction of official patient charges. However, the legal base for such reform in Ukraine is ambiguous. The Constitution declares that health care provision is free-of-charge. Nevertheless, in our study,  representatives of stakeholders groups appear keen not only on discussing official charges but are also favor their introduction. The expectations regarding the possible objectives of these charges expressed by different  stakeholders are the focus of this paper.

Słowa kluczowe: oficjalne dopłaty pacjentów, ukraiński system opieki zdrowotnej, nieoficjalne opłaty pacjent

Moskalenko V., Principles of optimal health care system structure (in Ukrainian). Kiev 2008: 35.

Core Health Indicators.

OECD Health Data 2009: Statistics and indicators for 30 countries.,3343,en_2649_34631_12968734_1_1_1_37407,00.html.

Strategy of health care system development (in Ukrainian). Kiev 2009: 7.

Self-appraisal of health status and level of access to certain types of health care services in 2009, in: Statistical digest (in Ukrainian). Kiev 2010: 62–63.

Litvak A., Pogorilyj V., Tyshchuk M., Shade economy and future of the medical care in Ukraine (in Ukrainian). Vyd. TES, Odesa 2001.

Houseloner P., Berges B., Estimation of personal expenditures for health care in Lviv region, Ukraine/Lviv. Technical report, 1996; № 12.

Balabanova D., Mckee M., Pomerleau J., Rose R., Haerpfer C., Cross-country comparisons health service utilization in the former Soviet Union: evidence from eight countries. „Health Services Research”, 2004; 39(6): 1927–1950.

Levenets О., Unofficial patient payments at delivery houses in Kyiv: Masters’ thesis. Київ 2009: 41–42.

Lekhan V., Rudiy V., Nolte E., Health care systems in transition: Ukraine. WHO Regional Office for Europe on behalf of the European Observatory on Health Systems and Policies, Copenhagen 2004.

Ipatov A., Development of primary medical care reforms in Ukraine. Porogi, Dnipropetrovsk 2000.

Vynogradov O.V., State and the problems of the financial resources of health care in Ukraine (in Ukrainian). „Economica ta Derzhava” 2007; 12: 25–29.

Karamyshev D.V., Vashev Î.Ye., Nemchenko A.S., Volos B.O., State Policy of Public Health Service Financing in Ukraine (in Ukrainian). „Har RI NADU Derzhavne budivnytstvo” 2006; 1.

Constituion of Ukraine, pt. 2, art. XLIX.

Law of Ukraine, The legal basis of health care (1993).

Decree of the Cabinet of Ministers from 1996, The list of charged services in public health care facilities and higher educational medical establishments.].

The order of the Ministry of Health of Ukrainian Soviet Socialist Republic from 13.06.88 N 120 (v0120282-88) Approaches towards raising the dental care for the population. //

The order of the Ministry of Health of Ukrainian Soviet Socialist Republic from 30.07.87 N 526 (v0526282-87), Organization of anonymous treatment for drug addiction at the self-sustained organizations and approaches towards raising of the efficacy of organizational work.

The order of the Cabinet of Ministers of Ukraine from 17.09.96 №1146, Medical assistance for foreign citizents.

The order of the Cabinet of Ministers of Ukraine from 28.01.97 № 79 (79-97-п) Medical aid for foreign citizens, who temporarily live in Ukraine.

The Law of Ukraine, On charity and charitable activities (1997 p.)>.

The order of the Cabinet of Ministers of Ukraine from 4.08.2000 № 1222р., The order of getting charitable contributions from legal entities and private persons by budget entities, including the educational and health care institutions.

The order of the Cabinet of Ministers of Ukraine from 17.02.2010 № 208, Some issues regarding improvements of the health system.

On reforms of health care.

Bennett S., Ngalande-Banda E., Public and private roles in health: a review and analysis of experience in Sub-Saharan Africa. The World Health Organization/Division of Analysis, Research and Assessment, Geneva 1994.

Creese A., User charges for health care: a review of recent experiences. „Health Policy and Planning” 1991; 6: 309–319.

Rubin R.J., Mendelson D.N., A framework for cost sharing policy analysis. „PharmacoEconomics” 1995; 10 (Suppl. 2): 56–67.

Sepehri A., Chernomas R., Are user charges efficiency- and equity-enhancing? A critical review of economic literature with particular reference to experience from developing countries. „Journal of International Development” 2001; 13: 183–209.

Baschieri A., Falkingham J., Formalizing informal payments: the progress of health reform in Kyrgyzstan. „Central Asian Survey” 2006; 25(4): 441–460.

Bennett S., The impact of the increase in user fees: a preliminary investigation. „Lesotho Epidemiological Bulletin” 1989; 4: 29–37.

Falkingham J., Poverty, out-of-pocket payments and access to health care: evidence from Tajikistan. „Social Science and Medicine” 2004; 58: 247–258.

Gotsadze G., Bennett S., Ranson K., Gzirishvili D., Health care-seeking behaviour and out-of-pocket payments in Tbilisi. „Georgia. Health Policy and Planning” 2005; 20: 232–242.

Kim J., Ko S., Yang B., The effects of patient cost sharing on ambulatory utilization in South Korea. „Health Policy” 2005; 72: 293–300.

Kupor S.A., Liu Y,-C., Lee J., Yoshikawa A., The effect of copaments and income on the utilization of medical care by subscribers to Japan’s national health insurance system. „International Journal of Health Services” 1995; 25(2): 295–312.

Manning W.G., Newhouse J.P., Duan N., Keeler E.B., Leibowitz A., Marquis M.S., Health insurance and the demand for medical care: evidence from a randomized experiment. „American Economic Review” 1987; 77: 51–277.

Newhouse J.P., Free for all? Lessons from the RAND health insurance experiment. Harvard University Press, Harvard 1993.

O’Grady K.F., Manning W.G., Newhouse J.P., Brook R.H., The impact of cost sharing on emergency department use. „The New England Journal of Medicine” 1985; 313: 484–490.

Schneider P., Hanson K., Horizontal equity in utilisation of care and fairness of health financing: a comparison of micro-health insurance and user fees in Rwanda. „Health Economics” 2006; 15(1): 19–31.

Selby J.V., Fireman B.H., Swain B.E., Effect of a copayment on the use of the emergency department in a health maintenance organization. „The New England Journal of Medicine” 1996; 334: 635–641.

Waddington C.J., Enyimayew K.A., A price to pay, part 2: the impact of user charges in the Volta region of China. „International Journal of Health Panning and Management” 1990; 5(4): 287–312.

Yoder R.A., Are people willing and able to pay for health services? „Social Sciences and Medicine” 1989; 29(1): 35–42.

Gertler P., van der Graag J., The willingness to pay for medical care: evidence from two developing countries. The World Bank, Washington DC 1990.

McPake B., User charges for health services in developing countries: a review of the economic literature. „Social Science and Medicine” 1993; 36(11): 1397–1405.

Pavlova M., Groot W., van Merode G., Willingness and ability of Bulgarian consumers to pay for improved public health care services. „Applied Economics” 2004; 36: 1117–1130.

Akashi H., Yamada T., Huot E., Kanal K., Sugimoto T., User fees at a public hospital in Cambodia: effects on hospital performance and provider attitudes. „Social Science and Medicine” 2004; 58: 553–564.

Bazylevych M., Who is responsible for our health? Chang­ing concepts of state and the individual in post-Soviet Ukraine. „The anthropology of East Europe Review” 2009; 27(1): 65–75.

Pryhod’ko O., Is Ukrainian health care system privatised? (in Ukrainian). „Dzerkalo tyzhnia (Newspaper)” 2009, 758. (

Gryga I., No free lunch (publication of web-page)

Pavlova M.,Patient payments in the Bulgarian public health care sector. Are they feasible? 2002; 1–143.

Lagarde M., Palmer N., The impact of user fees on health service utilization in low- and middle-income countries: how strong is the evidence? „Bulletin of the World Health Organization” 2008; 86: 839–848.

Audibert M., Mathonnat J., Cost recovery in Mauritania: initial lessons. „Health Policy and Planning” 2000; 15(1): 66–75.

Creese A., Kutzin J., Lessons from cost recovery in health.World Health Organization, Geneva 1995.

Deininger K., Mpuga P., Economic and welfare impact of the abolition of health user fees: evidence from Uganda. „Journal of African Economies” 2005; 14: 55–91.

Fafchamps M., Minten B., Public service provision, user fees and political turmoil. „Journal of African Economies” 2007; 16(3): 485–518.

Litvack J.I., Bodart C., User fees and improved quality of health care equals improved access: results from a field experiment in Cameroon. „Social Science Medicine” 1993; 37: 369–383.

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