Chapter 9 of 13 · ~1,570 words
9. Ukraine Today: How Care Is Organized
Who makes decisions and pays for treatment
Ukraine's current system combines national purchasing of health services with predominantly local hospital ownership. The Ministry of Health sets policy, standards, and regulatory requirements. The National Health Service of Ukraine (NHSU) contracts providers under the Medical Guarantees Program and pays for covered services. Regional councils and municipalities, as facility owners, make decisions about their networks and property; hospital management organizes staffing and clinical work. Social care, supported living, and employment assistance involve social protection authorities and local providers. [190, 191, 192]
The prewar starting point was strongly inpatient-oriented. WHO's situation analysis using 2020 data estimated that hospitals accounted for approximately 90% of mental health funding, with average stays of about 50 days. Reform shifts some work to primary care and community teams. Its policy sequence includes the 2017 concept through 2030, Ukraine's entry into WHO's Special Initiative in 2021, and the government's 2024 to 2026 plan. The first community teams studied began work in 2021. [193, 194, 195, 196]
Facility budgets and staff pay
Ukraine's 2026 state budget allocated UAH 258.6 billion to health care, including UAH 191.6 billion for the Medical Guarantees Program. A facility receives funds through its NHSU contract, prepares a financial plan, and distributes spending among wages, medication, food, utilities, and other needs. Its owner may provide additional funding for infrastructure and local programs. [197, 190]
In the first half of 2026, median gross physician pay at Medical Guarantees Program facilities was UAH 28,200 per month; department heads received UAH 31,200 and nurses UAH 19,300. Median facility-director pay was UAH 50,800, and junior health support staff pay UAH 12,100.14 Actual pay in a particular institution depends on revenue, staffing, workload, and management decisions. [198]
| Staff category | Monthly gross pay | After 18% personal income tax and 5% military levy |
|---|---|---|
| Physician, median | UAH 28,200 | UAH 21,714 |
| Department head, median | UAH 31,200 | UAH 24,024 |
| Nurse, median | UAH 19,300 | UAH 14,861 |
The tax model applies general deductions from gross salary. [199]
Average pay across all employees in Ukraine in June 2026 was UAH 32,783; in health care and social assistance, UAH 22,274. The cited median physician salary was therefore approximately 86% of the national average. This gap affects vacancy appeal, additional employment, and hospitals' ability to retain experienced teams. [200, 198]
From first presentation to a specialized team
A family physician, general internist, or paediatrician assesses symptoms, physical health, substance use, and self-harm risk, begins care within their competence, and arranges the next contact. mhGAP training provides a structured approach to common mental, neurological, and substance-related disorders. For the psychiatrist, this can mean receiving a referral with a history, medication list, and initial investigation results already assembled. [201, 190]
Specialized outpatient consultations are funded through the outpatient package. Mental health centres and mobile multidisciplinary teams operate under a separate package: they develop an individual treatment and rehabilitation plan with the patient, visit at home, and involve relatives. People may approach them directly or through a referral from a family or treating physician. After discharge, a team can continue follow-up where the person lives and takes medication. [190]
| Stage of care | Main work | Transition to the next stage |
|---|---|---|
| Primary care | Initial assessment, treatment of common conditions, physical health monitoring | Referral to a psychiatrist or team, agreed follow-up appointment |
| Specialized outpatient care | Diagnosis, psychopharmacotherapy, psychological care | Plan to monitor symptoms, tolerability, and functioning |
| Centre and mobile team | Team treatment, home visits, rehabilitation, family work | Links with primary care, social services, and inpatient services |
| Psychiatric inpatient care | Round-the-clock observation, diagnosis, and acute treatment | Discharge plan, prescription, handover to an outpatient clinician |
| Social support | Care, housing, assistance with daily life | Coordination of everyday needs with the medical plan |
During deterioration, the pathway accelerates: self-presentation, referral, emergency transport, or transfer from another hospital leads to inpatient assessment. Under additional purchasing conditions, the inpatient package covers intensive treatment of severe intoxication, alcohol withdrawal delirium, dangerous withdrawal syndromes, and other life-threatening conditions. Readiness to provide intensive care is reflected in funding. [190]
Electronic records, confidentiality, and reporting
Ukraine's electronic health care system, eHealth, has a central database to which facilities connect through medical information systems. Physicians record encounters, diagnoses, prescriptions, and results; electronic referrals and prescriptions accompany subsequent care. The NHSU uses entered information to verify contract performance and calculate payments under package rules. In inpatient psychiatry, the coded treated case affects payment, while other packages have their own units and formulas. [190, 202]
Patients may consult a psychiatrist or addiction specialist without an electronic referral at a facility with the appropriate NHSU outpatient contract. After consultation, the physician creates the necessary records, plan, and prescriptions. For someone who already knows their diagnosis and specialist, direct access shortens the path from deterioration to assessment. [203]
Additional sensitive-data access rules apply to mental health records in eHealth. Public eHealth guidance describes granting another physician access with the patient's written consent. In psychiatric practice, this requires agreement on what to share with the family physician: medication and dose, required tests, interaction risks, and follow-up date. Such exchange combines confidentiality with treatment of physical illnesses. [202, 204]
Separately, facilities complete annual Form No. 10, "Report on Psychiatric Care Provided to the Population," approved by Ministry of Health Order No. 1504. Its instructions cover specialized institutions, departments, and licensed providers of all ownership types that provided psychiatric care, including for substance use disorders. The electronic record describes individual encounters; the aggregate form describes the volume and structure of care over a year. [205]
Involuntary hospitalization creates another documentary pathway: examination by a panel of psychiatrists within 24 hours and, where continued hospitalization is justified, an application by the facility to the court within the statutory period. The clinical description and justification for inpatient care become materials for judicial oversight. [204]
The network and actual service use in 2026
From January through May 2026, the NHSU registered 586,769 recipients of mental health services, including 84,139 children and adolescents. Outpatient consultations reached 378,523 people; centres and mobile teams served 87,314; more than 97,000 received primary mental health care and almost 98,000 inpatient care.16 The largest numbers were registered in Dnipropetrovsk region, Kyiv, and Lviv, Odesa, and Kharkiv regions. [206]
As reported by the NHSU on June 19, the network included 2,591 primary care providers, 1,078 outpatient providers, 194 centre and mobile-care providers, and 138 inpatient providers. Primary care employed 22,901 physicians at 7,388 service locations. This geographically extensive level handles early recognition, repeat contacts, and physical health care, while specialized teams concentrate on more complex conditions. [206]
The planned budget for the inpatient psychiatric package in 2026 was UAH 5.6 billion. Payment relies on treated cases, diagnostic weights, and readiness to provide the relevant scope of care. For a clinic, this links documentation, its patient mix, and available treatment capabilities to its financial plan. [207, 190]
Medication and treatment of opioid dependence
Outpatient medication provision follows a separate structure. The Affordable Medicines program reimburses specified medicines for mental and behavioural disorders and epilepsy. A psychiatrist or neurologist establishes the relevant diagnosis and treatment plan; a family physician may continue prescribing under that plan. An electronic prescription links the clinical decision with dispensing at a contracted pharmacy, while the current register determines brand availability and copayment. [208]
Opioid dependence is treated with maintenance substitution therapy using methadone or buprenorphine. A separate NHSU package funds treatment and support; the Public Health Centre maintains information on access points, transfer rules, and access during displacement. Daily dose stability, dispensing hours, travel to the site, and coordination with HIV, hepatitis, or tuberculosis treatment become part of long-term clinical care. [190, 120]
Patients' out-of-pocket costs
Public funding of psychiatric consultations and medication coexists with a private market. A Ukrainian review of WHO Mental Health Atlas 2024 data estimates mental health at approximately 2.7% of government health spending. It places patient out-of-pocket payments for outpatient care and psychological therapy in the 21% to 50% category, and inpatient care and psychotropic medication at up to 5%.15 [209]
Private appointments allow patients to choose a professional and time using their own budget. In October 2026, a consultation with one psychiatrist in Kyiv's Dobrobut network cost UAH 2,460; an initial consultation at Veselka in Lviv cost UAH 1,680, and a follow-up UAH 1,300. Family costs include repeated meetings, medication, travel, and, where needed, regular psychotherapy. [210]
Legislation and professional responsibility
Law No. 1489-III, "On Psychiatric Care," regulates psychiatric assessment, consent, confidentiality, hospitalization, and judicial oversight. Law No. 4223-IX, "On the Mental Health Care System in Ukraine," adopted January 15, 2025, and brought into operation February 7, 2026, encompasses a broader group: medical and psychological professionals, social services, education, employers, and communities. It establishes arrangements for prevention, psychosocial support, professional certification, and coordinated care. [191, 204]
Resolution No. 288 of March 4, 2026, established certification and continuing professional development procedures for mental health professionals; Resolution No. 681 of May 27 initiated formation of the National Commission. Alongside these new mechanisms, everyday clinical responsibility remains personal: the physician formulates a diagnosis, justifies treatment, records consent or the legal basis for intervention, and arranges follow-up. [211, 212, 204]
Section Footnotes
- Data cover all physicians in Medical Guarantees Program facilities; the cited publication does not identify psychiatrists separately. The source is a secondary account of NHSU figures in Farmatsevt Praktyk, dated October 2, 2026. Category medians and economy-wide average salaries have different statistical definitions. [198, 200]↩
- The Atlas gives out-of-pocket payment categories, not a cash total of all Ukrainian household spending. The Ukrainian review presents the 2024 round of data; the individual clinic prices cited are dated October 2026. [209, 210]↩
- One person could receive care at several levels; counts by service type overlap. [206]↩