Are TB treatment services provided free of charge, which services are covered, and what to do if healthcare providers solicit payment for such services?

In Ukraine, the Law “On preventing tuberculosis disease” is in action. This law provides for state guarantees of measures aimed at preventing the dissemination of tuberculosis (Article 4) and sets forth the requirements for arrangements of medical care provided to patients with tuberculosis (Article 10). The medical services on TB diagnostics and treatment are covered by the Program of Medical Guarantees – the list of medical services guaranteed to patients by the Government. Under the Program of Medical Guarantees, TB patients are entitled to the following free services: laboratory and instrumental tests; outpatient and inpatient treatment; drugs from the National list of essential medications and drugs procured at the central level at the cost of the public budget.

What you need to consider

Starting from April 1, 2021, medical care for tuberculosis is provided under two state-guaranteed benefit packages, with a specific list of procedures defined for each package. To receive the service, one needs to select a facility contracted by the National Health Service of Ukraine (NHSU) for the provision of such services.

 The scope of free TB medical services which must be provided by health facilities includes:

1. Under benefit package “Follow-up and treatment of children and adults with TB at primary healthcare level”: directly observed treatment, monitoring, supervision, patient psychosocial support, including:
   1. Dynamic monitoring of the health status of people with tuberculosis (TB).
   1. Laboratory tests, including: 
2. Full blood panel;
3. Blood chemistry profile, bilirubin and fractions, creatinine, urea, uric acid;
4. Whole blood glucose or serum glucose;
5. Collection and transportation of biological samples for bacteriology tests;
6. Referral of TB patients to secondary (specialized), tertiary (highly specialized) care facilities for diagnostics, treatment of concomitant diseases aggravated by TB, or other services including medical rehabilitation.
7. Under benefit package “Outpatient and inpatient diagnostics and treatment of children and adults with TB”, including:

• Dynamic monitoring of the health status of people with tuberculosis (TB) at the outpatient treatment stage;
• Performing a broad range of required laboratory tests to confirm the diagnosis and monitor treatment progress;
• Performing the required instrumental investigations;
• Developing TB treatment and follow-up plan, including elaboration of an individual treatment plan for the outpatient / inpatient treatment stage, taking into account the patient’s concomitant diseases.

For the full scope of services under this benefit package, please access the NHSU website and select the specification under the relevant benefits package.

Conduct of the patient if healthcare providers solicit payment for medical service or refuse to provide the service.

• First of all, approach the chief physician of the healthcare facility, preferably with a written report (complaint), demanding to remedy the violation of right to free medical care under the relevant benefit package, referring to availability of public funding received by the healthcare facility for provision of such services. The complaint must be duly registered, with an incoming registration number assigned.
• If these efforts were not successful, you need to file a written report (complaint) to the oblast health department complaining about absence of response by the chief physician and demanding to remedy the violation of the right to healthcare. The healthcare department must duly register the complaint and respond to it. In fact, this is usually enough to correct the situation. 
• If the client remains unsatisfied, he/she can approach the National Health Service of Ukraine (NHSU) and submit a complaint using the online form on the NHSU website. 
• If a healthcare provider unreasonably refuses to provide medical care or solicits payment for the services covered by the NHSU under the Program of Medical Guarantees, this is a breach of the contract between the National Health Service and the facility. Usually, NHSU does not ignore such messages and may take measures up to terminating public funding provided to the health facility. Therefore, the administrations of health facilities try to avoid such complaints and prevent conflicts.
• The client has the right to file a complaint in court.