Deputy Minister of Finance of Ukraine Roman Yermolychev: how the Government supports the medical industry during the war

Deputy Minister of Finance of Ukraine Roman Yermolychev talks about the Medical Guarantee Program, state financing of certain branches of medicine during martial law, and tax relief for non-profit organizations in an interview with the Ufund.

Roman Volodymyrovych, tell me which fields of medicine are currently the most prioritized for financing? What are the prospects for state budgeting regarding the issues of cardiology in Ukraine within the limits of this budget? There is information that funding from the state budget is not enough for the full purchase of endovascular equipment. Is it possible to implement a program that would cover these needs, at least for children and the military?

The state budget (with transfers) for health care for 2023 provides 178.3 billion hryvnias. Of course, one of the main priorities for financing from the state budget is the Medical Guarantee Program, for the implementation of which UAH 142.5 billion is allocated, which covers all basic types of medical care.

It is expected that about 70% of the expenses under the medical guarantee program will be covered by attracting international financial aid, which will allow for stable financing of medical services and, accordingly, timely payment of salaries to employees of medical institutions.

Thus, the state finances medical services caused by the demand of citizens, with the aim of guaranteeing their quality and availability, as well as preventing cases of double payment for the same services - from the state budget and "from the patient’s pocket". Our task is to provide people with appropriate medical services as much as possible, because, in fact, this is what the health care system exists for and citizens pay taxes for.

It is worth noting that the provision of treatment of cardiovascular diseases is also provided for in the medical guarantee program. For example, the state allocates 1.8 billion hryvnias for medical care in case of an acute cerebral stroke, and 1 billion hryvnias for acute myocardial infarction.
The largest volume of expenses is directed to surgical operations for adults and children in inpatient conditions, in inpatient conditions of one day, or inpatient care for adults and children without surgical operations. 41.4 billion hryvnias have been earmarked for these purposes.

The state also took care of financing prevention, diagnosis, observation and treatment in outpatient settings and allocated 15.9 billion hryvnias for this.
In view of the high cost of medicines for patients, the Medical Guarantee Program provides for their reimbursement (reimbursement of the cost of medicines) during outpatient treatment of persons (a total of UAH 4.7 billion), in particular those suffering from cardiovascular and cerebrovascular diseases.
We draw your attention to the fact that the treatment of cardiovascular diseases is provided by national health care institutions that are under the management of the Ministry of Health, the National Academy of Medical Sciences and the State Administration of Affairs.

In particular, two specialized research institutes of the National Academy of Medical Sciences, namely the National Institute of Cardiovascular Surgery named after M. M. Amosov and the National Research Center "Institute of Cardiology, Clinical and Regenerative Medicine named after Academician M. D. Strazhesk", receive funding for specialized expensive cardiac services within the new mechanism of financial support for the provision of specialized medical care.
Thus, in 2023, the state allocated UAH 420.7 million to finance more than 13,000 cardiology services at these institutes, of which UAH 306 million was allocated to the M. Amosov Institute; Institute of M. Strazhesk - 114.7 million hryvnias.
In addition, UAH 10 billion for the centralized purchase of medicines and medical devices to provide treatment for patients with cardiovascular and cerebrovascular diseases, as well as for the purchase of high-value medical equipment, is provided to the Ministry of Health.

Are there any changes to the Medical Guarantee Program in 2023? What directions are the most prioritized at the moment?

The Ministry of Health determines the priority directions for the development of the health care sector for the corresponding year for the formation of the medical guarantee program, taking into account the need to ensure the basic needs of the population in medical services.

Currently, within the framework of the medical services program, 42 packages of medical services for the population are provided. Of course, the Government responds to the challenges of wartime, and therefore directs UAH 3.8 billion to the development of rehabilitation services and psychological support services, as well as UAH 4.7 billion to the expansion of the reimbursement program for medicines and medical devices.

Which areas of health care will not be financed in 2023 in whole or in part compared to previous years?

Medicine, as one of the main priorities of the state policy, is properly funded, taking into account the capacity of the state budget, and it is expected that all health care expenditures will be fully financed.

Will state financing of compensation for hearing loss of children be fully implemented in 2023? Are there any difficulties in this direction now?

Despite the state of war and the need to strengthen the security and defense of the country, the Ministry of Finance is doing everything possible to ensure stable financing of priority areas, which is definitely the field of health care, in particular the provision of medical assistance to persons with hearing impairments by the method of cochlear implantation, as well as the effective use of budget funds.

I will say that I took care of this issue personally. I am convinced that children and adults have the right to fully live and enjoy all the benefits of society. At the same time, cochlear implantation is not cheap for patients, and therefore the Ministry of Finance did and continues to do everything to make hearing loss compensation affordable and patients to undergo rapid rehabilitation.

Thus, for the fifth year in a row, our Ministry consistently and systematically takes care of the health of people with hearing impairments, provides funding for medical assistance to children and adults with hearing impairments by the method of cochlear implantation at the Institute of Otolaryngology named after Prof. O. S. Kolomiichenko, which is a leading specialized research institution of the National Academy of Medical Sciences.

In particular, the state provides sufficient financial resources for the purchase of cochlear implants, bone conduction systems, speech processors, necessary for the surgical intervention of medicines and medical devices, modern medical equipment, etc.
I note that thanks to this, the patient’s waiting period for such assistance is currently measured only by the period necessary for preparatory measures of an organizational nature and medical diagnosis (for example, a few years ago, the queue for hearing prosthesis surgery was about 400 - 450 children, and waiting for the operation had to do for years, and there was no question of providing free hearing aids for adults at all).

In 2023, more than UAH 360.7 million is provided in the state budget to ensure the provision of these specialized medical services to patients and the purchase of necessary medical products, of which UAH 230.1 million the O. Kolomiychenko Institute plans to allocate to the purchase of cochlear implantation systems and speech processors.
This will make it possible to receive more than 16,000 completely free highly specialized otolaryngological services for patients, and these are not only services for cochlear implantation, but also services related to severe oncological, neurological and other pathologies of the ear, throat, nose.
The Ministry of Finance illustrates everything in the language of numbers, which is why, on average, the state pays more than 20,000 hryvnias for one such service.
Regarding cochlear implantation services, I note that in 2023, patients are scheduled to undergo 207 cochlear implant surgeries and install (replace) 207 speech processors.

In particular, as of April 1, 2023, 71 people with hearing impairments have already received medical services for cochlear implantation at the O. Kolomiichenko Institute, namely, 36 children and 13 adults were operated on, 16 speech processors were installed (replaced) for children and 6 adults.
On average, the state pays about 350,000 hryvnias for the installation of a speech processor, and 770,000 hryvnias for a hearing prosthesis operation (implantation of a cochlear implant). Agree that very few patients can pay for such services themselves, so the Government took care of it.

The cost includes both special medical equipment – a cochlear implant and a speech processor – and medicines and medical products necessary for surgical intervention, as well as the patient’s stay in a hospital, the payment of medical staff and other expenses of the institution necessary to ensure the provision of such medical care. It is important for us that people know that the state pays for it.

Does the Ministry of Finance plan to consider the issue of tax relief for non-commercial (charitable) organizations?

One of the main conditions for the non-profit status of a charitable organization is that the income of such a charitable organization must be used exclusively for financing expenses for the maintenance of such a non-profit organization and the realization of the purpose (goals, tasks) and directions of activity of such an organization.

However, the war made adjustments to this rule. For non-profit organizations, legislative changes were made to the Tax Code of Ukraine, which determined that during the period of martial law, it is not considered a violation of the goals of using the income of a non-profit organization if its funds, services, property are voluntarily transferred (provided, transferred) to military formations that protect the country

Therefore, today, non-profit organizations, regardless of their type (charitable foundation, public association, trade union, etc.), which in the pre-war period had their own founding goals not related to state support, are given the opportunity to provide such support during martial law without tax consequences, which is a significant relaxation for non-profit organizations from the state.

Author Ksenia Anniuk
Photo by Maria Duka