Private provision of health services in Ukraine: A qualitative exploration of current policy challenges, and considerations for reform

Abstract

Background: The role of private healthcare providers (PHPs) in Ukraine has increased, despite the ongoing war. As the Government of Ukraine (GoU) continues health reforms, governance mechanisms for PHPs need further examination.

Objective: This study assesses the policy responses to the growth of PHPs in Ukraine, focusing on four key state functions: information generation, regulation, purchasing, and policy-making.

Methods: A qualitative approach was used, including interviews and document analysis, to explore the effectiveness of governance frameworks in managing the private healthcare sector.

Results: Regulations for PHPs are comprehensive but outdated and require stronger enforcement. The National Health Service of Ukraine (NHSU) has extensive purchasing agreements with PHPs but lacks policies to address equity and efficiency concerns. Many PHPs are not enrolled in the national health information system, limiting the GoU's ability to make evidence-based policy decisions. Strengthening the requirement for PHPs to enrol in the e-health system is needed, along with improved licensing and contractual specifications. Additionally, policy-making processes are vulnerable to influence by PHPs' commercial interests, highlighting the need for greater transparency and broader stakeholder engagement.

Conclusions: Enhancing regulatory enforcement, expanding e-health system participation, and improving policy processes are essential for the GoU to address challenges posed by private sector growth. Strengthening these governance mechanisms will support Ukraine's goals of equity, financial protection, and high-quality care, enhancing resilience to the multiple impacts of the war.

Keywords: Conflict of interest; Contracting; Delivery of health care; Facility regulation and control; Governance; Government regulation; Health information systems; Healthcare financing; Incentive; Participatory policy processes; Private sector; Reimbursement; Strategic purchasing; Ukraine.