Ukraine’s parliament passed a legislative package in October 2017 to provide citizens with full payment of health care services and medications as required in its health care guarantees program.
As part of the forthcoming comprehensive health financing reforms, Ukraine’s Ministry of Health is implementing the use of Diagnosis-Related Groups (DRG) for provider payment. As an important part of this reform, the country has aspired to streamline its approach to the costing of health services.
After reviewing numerous costing methodologies, Ukraine is using one of the JLN’s earliest practical tools to assess the costing of health services. The Practical Manual for Costing of Health Services for Provider Payment, co-produced by seven JLN member countries, will not only save the Ukrainian government from reinventing the wheel but also provides tested costing methodologies based on the experiences of countries facing similar challenges.
“It’s been a long-awaited decision to implement a standardized approach to the costing of health care services. It was ideal for us to use this (JLN Costing) methodology, which has proved its effectiveness in many countries. We did not need to go through a long and painful process of deciding what to choose from the locally-produced manual,” shared Pavlo Kovtonyuk, Ukraine’s Deputy Minister of Health. Mr. Kovtonyuk is leading the effort to implement Diagnosis-Related Groups to finance hospitals based on the actual volume and complexity of services.
Ukrainian Government Approves JLN Costing Methodology
The Costing Manual, translated and adapted to Ukrainian context, was recently approved by the Government of Ukraine as the recommended approach to cost the health services provided by hospitals.
The decision to move forward with implementing the Costing Manual comes from the culmination of the World Bank’s support to the country for reforming its provider payment system and as part of a larger lending project aimed at improving health service delivery in Ukraine. The Ministries of Health and Finance were first introduced to the JLN costing methodology through the Global Flagship Course in 2016, followed by sharing the manual with a delegation and continued consultation on assessing top-down costing approaches.
The methodology is a product of efforts of many stakeholders, including the USAID Health Finance and Governance Project. After a working group within the Ministry of Health charged with making the decision engaged with the e-learning module for Costing of Health Services – an online course that breaks down the Costing Manual in bite-sized learning – they decided to move forward with the JLN’s costing methodology.
The experience with the Costing Manual has encouraged Ukraine to engage more deeply with the JLN.
“It’s time for us to consider becoming a more active member of the JLN network. We would like to have a more rigorous knowledge and experience exchange with countries facing similar problems,” Mr. Kovtonyuk said.
Ukraine submitted its application for JLN membership in April 2018 with an endorsement from its Ministry of Health. With the approval of JLN membership, Ukraine hopes to engage with the JLN as it implements health system reforms. In addition to the adoption of DRGs and other primary health care reforms, Ukraine’s current priorities include developing a National Health Service – modeled after the system in the United Kingdom, moving from a line-item approach to output-based financing, setting systematic priorities for resource allocation and designing benefits packages.
Catalyzing the Implementation of Global UHC Knowledge
The Practical Manual for the Costing of Health Services for Provider Payment, co-produced by JLN’s Costing collaborative, is one of the JLN’s most widely implemented knowledge products. In another recent example, Egypt implemented the Costing Manual to develop a unified costing system for its health services. The manual bridges costing theory — what practitioners should do — with practical, step by step guidance on what practitioners can do to address challenges related to costing for provider payment in low- and middle-income countries, including data constraints, different concerns of public and private providers and weak collaboration between institutions. Based on the experiences of a network of practitioners from different countries, the manual’s tools and templates are adaptable to a variety of contexts.
Ukraine’s decision to implement the JLN’s Costing Manual highlights the potential of online learning modules in facilitating and catalyzing the uptake of practical knowledge products that will accelerate universal health coverage. The e-Module for Costing of Health Services, developed by the World Bank’s Open Learning Campus as a digital companion to the Costing Manual, integrates instructional technology with a concise and interactive version of the manual. The JLN’s first online learning tool could spark development of more such tools in the future.
Access the Costing Manual and e-Module