WAYS TO IMPROVE HEALTH INSURANCE IN UKRAINE

Abstract

This article examines the current state and transformational challenges of Ukraine’s health insurance system under the conditions of full-scale war and substantiates strategic directions for its improvement. The analysis highlights the profound impact of wartime factors on the accessibility, quality, and financial stability of healthcare services, emphasizing the sharp increase in demand for medical, rehabilitation, and mental-health care amid significant damage to medical infrastructure. The system suffers from critical transformations due to the absence of a fully functional mandatory health insurance (MHI) system, the over-reliance of the Health Guarantees Program (HGP) on the state budget, and systemic vulnerability of e-health services. Drawing on comparative research of advanced international insurance models, including those implemented in EU countries, Taiwan, Canada, and Switzerland, the study identifies mechanisms that may be effectively adapted to Ukraine’s institutional and security environment. Particular attention is given to the need for a hybrid financing model that combines state budget resources (HGP), mandatory insurance components (MHI for higher-income workers, following the German model), and an expanded voluntary health insurance (VHI) sector. Furthermore, a three-year plan (e.g., 2026-2028) is suggested to restructure the HGP, expanding coverage to include critical areas such as psychosocial assistance, paid rehabilitation, and preventative medicine (Scandinavian model). The article also argues for developing state-supported war-risk coverage instruments. A key proposal is the creation of a State Insurance Reserve for War Risks, funded by the state budget (30%), insurers' mandatory contributions (50%), and international aid, which will function as a guarantor for private insurers, absorbing excessive losses. This reserve supports the introduction of War-Medical Policies designed to cover passive war risks (e.g., distant shelling effects). Methodological foundations include comparative, systemic, and analytical approaches, allowing the formulation of evidence-based recommendations to enhance the resilience, equity, and efficiency of Ukraine’s health insurance system.