Is there a place for the patient in the Ukrainian health care system? Patient payment policies and investment priorities in health care in Ukraine

Danyliv, Andriy; Степурко, Тетяна; Gryga, Irena; Pavlova, Milena; Groot, Wim

doi:10.1556/socec.34.2012.2.6

Cited by 26 publications

(23 citation statements)

References 5 publications

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“…Possibly, those respondents who had negative experiences with health‐care consumption and have less resistance towards paying informally (measured in undesirable perceptions), try to avoid visiting physicians. This also corresponds to under consumption in Ukraine and Romania as suggested by our results …”

Section: Discussionsupporting

confidence: 78%

To pay or not to pay? A multicountry study on informal payments for health‐care services and consumers’ perceptions

Степурко

Pavlova

Gryga

et al. 2014

Health Expectations

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Section: Discussionsupporting

confidence: 78%

To pay or not to pay? A multicountry study on informal payments for health‐care services and consumers’ perceptions

Степурко

Pavlova

Gryga

et al. 2014

Health Expectations

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“…This could explain why Bulgarian consumers most often reported small formal payments. In Lithuania, Romania and Ukraine, informal as well as quasi-formal payments (frequently requested by providers to compensate for insufficient public funding) are widespread, often imposing a double financial burden on patients 32 , 33 . These payments are largely outside the control of governments and thus not supported by measures to secure equity.…”

Section: Discussionmentioning

confidence: 99%

The inability to pay for health services in Central and Eastern Europe: evidence from six countries

Tambor

Pavlova

Rechel

et al. 2013

European Journal of Public Health

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Background: Out-of-pocket payments for health services constitute a major financial burden for patients in Central and Eastern European (CEE) countries. Individuals who are unable to pay use different coping strategies (e.g. borrowing money or foregoing service utilization), which can have negative consequences on their health and social welfare. This article explores patients’ inability to pay for outpatient and hospital services in six CEE countries: Bulgaria, Hungary, Lithuania, Poland, Romania and Ukraine. Methods: The analysis is based on quantitative data collected in 2010 in nationally representative surveys. Two indicators of inability to pay were considered: the need to borrow money or sell assets and foregoing service utilization. Statistical analyses were applied to investigate associations between the indicators of inability to pay and individual characteristics. Results: Patient payments are most common in Bulgaria, Ukraine, Romania and Lithuania and often include informal payments. Romanian and, particularly, Ukrainian patients most often face difficulties to pay for health services (with approximately 40% of Ukrainian payers borrowing money or selling assets to cover hospital payments and approximately 60% of respondents who need care foregoing services). Inability to pay mainly affects those with poor health and low incomes. Conclusion: Widespread patient payments constitute a major financial barrier to health service use in CEE. There is a need to formalize them where they are informal and to take measures to protect vulnerable population groups, especially those with limited possibilities to deal with payment difficulties.

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“…Yet, participation in the informal economy was so ubiquitous and fi gured so prominently in the everyday sensibilities of my respondents that it was necessary to investigate it. A study by Danyliv et al [2012] provides sociological confi rmation of these fi ndings, with 57% to 73% of patients reporting the use of out-of-pocket payments in obtaining treatment in a 'free-of-charge' system. Consider the view of Vitalina, who sometimes consults on pilot-certifi cation boards, and describes here the uncertainty and disorder in her fi eld: I will tell you this.…”

Section: Life 'With and In Ruins'mentioning

confidence: 94%

“…These feelings are not shared by everyone, but are by those doctors whose convictions, connections, and capital have helped them to be 'successful' in adapting to post-socialist uncertainties. I put 'successful' in quotation marks here, because to view these strategies as empowering or advantageous would obfuscate the risks that come with the lack of any formal accountability between patients and doctors [Danyliv et al 2012]. Until reforms in health care are introduced to mitigate the structural violence of the free market, physicians will likely continue to be involved in the 'economy of the bush … covert and insurgent … where claims to the right to wealth are being articulated and enacted … and the status of licit versus illicit practice … is the basis for the reconfi guration of governmental relationships' [Roitman 2004: 194, 197, 222].…”

Section: Life 'With and In Ruins'mentioning

confidence: 99%

Disorder and Civilization: The Future(s) of Ukrainian Medicine

Bazylevych¹

2014

Czech Sociological Review

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Post-socialist societies are full of uncertainty, fragmentation, and competing discourses on social justice [Steinberg and Wanner 2008;Zigon 2011]. This article focuses on how Ukrainian physicians envision the future, present, and past of the health-care system and make sense of social change in their professional lives and society more broadly. The Ukrainian healthcare system has remained largely untouched by post-socialist reforms, but it is nevertheless undergoing profound changes. These changes are occurring on the level of everyday practice and are shifting responsibility away from the state and onto the individual. The author traces how physicians navigate the persisting structures of the old system, and what hopes they carry for the present and the future. Post-socialist health care is bursting with competing interests, commitments, and notions of how health-care providers should relate to each other, their patients, administrations, and the state in general. This article therefore draws on physicians' narratives of the disorder in health care through the interpretive prism of 'ruination … as a process that weighs on the future and shapes the present' and that represents a 'vital reconfi guration' [Stoler 2008: 194]

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Is there a place for the patient in the Ukrainian health care system? Patient payment policies and investment priorities in health care in Ukraine

Cited by 26 publications

References 5 publications

To pay or not to pay? A multicountry study on informal payments for health‐care services and consumers’ perceptions

To pay or not to pay? A multicountry study on informal payments for health‐care services and consumers’ perceptions

The inability to pay for health services in Central and Eastern Europe: evidence from six countries

Disorder and Civilization: The Future(s) of Ukrainian Medicine

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