Perspectives of implementation of partial state medical insurance in a form of provision with medicinal products and products of medical utility to general public

From January 1, 2016 it is proposed to implement medical insurance in a form of provision with medical products and products of medical utility to general public (as the first step of implementation of obligatory state social medical insurance) in Ukraine.

The respective draft of the Law of Ukraine № 4256а “On provision with medicinal products and products of medical utility” (hereinafter referred to as to as the “Draft Law”) has been registered in the Verkhovna Rada of Ukraine on July 7, 2014. In particular, it is proposed to provide insured people with medicinal products and products of medical utility from budget of Fund of medical insurance (hereinafter referred to as the “Fund”).

Initiators of the Draft Law defined quite a wide list of insured persons whom medicinal products and products of medical utilities will be obligatory given provided that insurance case occurs. In addition, state stipulates an opportunity for people, excluded from the mentioned list, to participate in an insurance program by voluntary entering into contract with the Fund.

However, it shall be noted that list of the insurance cases is quite limited and does not include, for instance: provision with quick, emergency, extra advisory medical assistance, health-resort assistance for tuberculosis patients, human organs and anatomical materials transplantation services, provision with medicinal products and products of medical utility which can be taken to insured persons within state target programs and measures of public character, medical immunobiological medicinal products for immunization, included to calendar of immunization, immunization with epidemic indicators etc.

In contrast, insurance cases include, in particular: health disorders (diseases, injuries and individual prevention of diseases, intoxication or other health disorder); prevention of exacerbation, transition of severe disease or other disorder into chronic or other acute stage; surgery; pregnancy and childbirth, pregnancy disruption, if medical conditions exist, and health deterioration due to childbirth.

It shall be noted that Fund’s budget consists of combined sources, in particular: insurance contributions of insurers, allocations from the State Budget of Ukraine and local budgets; charitable and voluntary contributions of enterprises, institutions, organizations and individuals; fines imposed for violations of the law; income generated from the placement of temporary surplus of the Fund, including reserves, deposits and other receipts that are not prohibited by law. Such an order of the fulfillment is an indisputable achievement of the Draft law as will ensure proper filling of the Fund and avoid further reduction of insurance. In addition, the positive aspects include excluding the Fund from the budget, which prevents its removal and allows the use only for the defined purpose.

One more positive aspect of the Draft Law is organization of the Fund management body and separate control body for implementation of insurance, Supervisory Board, on an equal basis from representatives of the state, persons and insurers that, taking into account competence of the Fund and its daily activities mechanism, prevents adoption of decisions in favor of a particular subject of insurance.

The Draft Law also stipulates that the list of the medicinal products and products of medical utility, provided within insurance program, is formed by the Fund. Nevertheless, it is not defined how the mentioned list will be formed in practice.

Finally, mechanism of Fund’s functioning at local territories is still undefined.