HEALTH CARE FINANCING IN UKRAINE: CLASSIFICATION SYSTEMS AND FINANCIAL INSTRUMENTS

Abstract

The health care system is a key component of the infrastructure of any modern state, as it ensures the preservation of population health and contributes to social cohesion, national security, and economic development. In Ukraine, the issue of effective health care financing has gained particular relevance amid large-scale reforms launched in 2017. These reforms aimed to introduce the principle of "money follows the patient" and to integrate digital management tools. The COVID-19 pandemic and the full-scale war since 2022 have created additional challenges that require adaptation of financial mechanisms to emergency conditions and new system needs. The aim of this study is to provide a comprehensive scientific rationale for the classification systems and financial instruments applied in Ukraine’s health care sector, considering reform-driven changes, wartime challenges, and the need to enhance the efficiency, transparency, and sustainability of health financing. The study employs systemic and structural-functional approaches to analyse the financial architecture of the health care system in light of ongoing reforms and external shocks. The findings reveal a steady transformation toward increased transparency, efficiency, and patient-centeredness. The analysis covers the main financing channels, including the state budget via the Program of Medical Guarantees, expanded autonomy of local budgets, the critical role of international aid during wartime, and the underdevelopment of voluntary health insurance and public-private partnerships. The current expenditure structure remains dominated by inpatient care and pharmaceuticals, although there is a positive trend toward strengthening outpatient services, aligning with global best practices in resource optimization. The financing dynamics indicate a gradual shift from a centralized hospital-based model to a more diversified and decentralized system responsive to the realities of wartime. The study proposes recommendations for improving the classification of financial flows and optimizing funding instruments. The results emphasize the importance of enhancing the effectiveness, transparency, and resilience of health care financing, as well as the necessity of an interdisciplinary approach for the future development of financial models that ensure access and quality of health services in Ukraine.