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Patient vs. system: 25% of Ukrainians cannot get medical care because of the war

The Ukrainian healthcare system is under extreme pressure amid the war. Despite the heroism of medical professionals, the situation remains difficult: underfunding, staff losses, low levels of trust, and new global threats, including antimicrobial resistance. Read about the main challenges facing medicine in the Komersant ukrainskyi article

War and underfunding: medicine in survival mode. Natalia Lisnevska, Deputy Minister of Health of Ukraine in 2014-2015, in an exclusive commentary Komersant ukrainskyi explained:

“In addition to the predictable answers that medicine needs more money and doctors need to raise their salaries, there is a clear trend: to complete or accelerate medical reform, improve the quality of doctors and medical services, and treat scientifically.”

According to her, 25% of patients report difficulties in accessing treatment due to air raids or power outages. Another 18% say that appointments or surgeries have been canceled, and 9.5% could not get to a doctor because he or she had traveled abroad or to another region.

“There is not enough money for medicine. And it will continue to be lacking. Healthcare expenditures in the State Budget for 2025 amount to UAH 219.6 billion (17.9% of all expenditures and 2.6% of the projected GDP). This is an 8% increase compared to the revised budget for 2024. And yes, of course, there is not enough money because the No. 1 priority is security and defense,” Lisnevska notes.

Funding system without accountability for results

Despite the reform and changes in funding approaches, there are still many problems.

“The NHSU finances the work of hospitals based on the number of declarations or services provided. But the outcome of treatment does not affect funding. This means that managers are more afraid of audits by the Audit and Control Department than of patient complaints or mortality,” emphasizes Lisnevska.

Problems of access to information and patients’ rights

Lisnevska also draws attention to the fact that both patients and doctors do not always understand how the reform works.

“Patients are still confused about what is happening. They are forced to sign declarations and are misled about the right to consultations. Doctors also do not have clear instructions. This is the result of a lack of communication, knowledge and trust,” she explains.

Antimicrobial resistance: a silent global threat

According to experts, the situation with antimicrobial resistance – bacteria that cannot be treated with conventional antibiotics – is no less dangerous.

“In 2021, antimicrobial-resistant bacteria claimed an estimated 1.14 million lives. By 2050, more than 10 million people will die every year,” microbiologist Dmytro Stepansky writes on social media.

He adds:

“We are facing a global infectious catastrophe – with chances of being left without a budget, without leadership, without antibiotics, without the ability to save lives. Superbugs do not respect borders and change faster than people make decisions.”

Natalia Bushkovska, commenting on the threat, adds:

“If we enter an era where antibiotics no longer work (and we are gradually moving there), then… it will not just be an inability to cure a sore throat. It will set medicine back decades.”

What’s next?

All experts agree: Ukrainian healthcare needs a systematic approach, an honest assessment of reality, raising awareness of patients and doctors, local reforms and international support.

“Perhaps it is necessary to increase treatment tariffs to a level where the money paid by the state is enough and patients do not have to buy medicines for the hospital. But during the war, the budget will not allow this to happen,” notes Natalia Lisnevska.

We should also not forget about inflation, which can “eat up” part of the money, Lisnevska adds. “And the fact that we have raised the minimum wage, and those who do not have enough money will have to add to it. Also, it is not uncommon for patients and doctors to have insufficient information about the new rules, so they cannot always defend their rights

In times of war, medicine, like the state as a whole, relies on people – doctors who continue to save lives and patients who are trying to survive in a system that is still learning to be fair.