Author: Tetiana Palamar

Primary medical care is provided on the basis of Article 35-1 of the Law of Ukraine “The fundamentals of the legislature of Ukraine concerning healthcare”. Every patient who has signed a declaration on choosing a family physician, a general practitioner, or a pediatrician, is entitled to free primary healthcare services included in the state-guaranteed medical benefits package. The healthcare provider will receive payment for such services on the basis of the contract concluded with the National Health Service of Ukraine (NHSU).

What you need to consider

Starting from April 1, 2021, primary healthcare is provided under the “Primary Healthcare” benefits package. The free primary healthcare benefits package includes a number of preventive check-ups and primary care. Thus, a family doctor can provide free of charge:

• Diagnostics and treatment of most common communicable and non-communicable diseases, trauma, poisoning, pathological, physiological conditions;
• Dynamic monitoring of chronic diseases according to the healthcare standards;
• Preventive checkup, with a medical certificate issued;
• Online referral to examination or consultation by specialist physicians;
• Health, nutrition, life-style advice;
• Vaccination according to the immunization schedule;
• Electronic prescription under the “Accessible medication” program.

The physician will define what scope of examinations is required for each individual patient, based on the patient’s complaints, lifestyle, and medical history.

Every patient who has signed a declaration on choosing a family physician, a general practitioner or a pediatrician, is entitled to a free state-guaranteed primary healthcare benefits package which includes the following tests:

• Total blood count with formula;
• Complete urinalysis;
• Total cholesterol count;
• Blood glucose test.

In primary healthcare facilities, patients can be offered free rapid tests for:

• pregnancy;
• troponin;
• HIV;
• Viral hepatitis;
• SARS-CoV-2 antigen.

This means that in primary healthcare facilities patients can take tests included in the primary healthcare benefits package. If other tests are required, the doctor will issue a referral to a specialized level of care, and the tests will be performed free of charge in healthcare facilities contracted by the NHSU for outpatient care.

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 in case of payment solicitation for primary healthcare or a refusal to provide such care.

• First of all, demand to remedy the violation of the right to free healthcare services included in the relevant benefit package referring to the availability of public funding received by the family doctor for providing such services.
• If, despite the expectations, these efforts were not successful (in fact, this is not common), you need to contact your municipal or oblast health department and submit a written report (complaint) demanding to remedy the violation of the right to healthcare. The health department must duly register the complaint and respond to it. Usually this is 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. 

• In case any questions regarding filing a complaint arise, call NHSU contact center toll-free at 16-77.
• If the client remains unsatisfied, he/she can file a complaint to court.

The REAct Project starts posting publications to inform what services are provided free of charge and guaranteed by the government, on what basis these services can be obtained, and how to ensure that the health facility receives the appropriate funding to provide the services, and how the patient should act in case his/her right to healthcare is violated.

The right to free healthcare in public and communal health facilities is secured by the legislature of Ukraine (Art. 49 of the Constitution of Ukraine), which is a well-known fact. However, in fact, cases are common when people seeking care face are rejected by healthcare providers. This is a violation of the right to healthcare resulting in misunderstandings and conflicts.

What you need to consider

First of all, you need to know that the Program of Medical Guarantees was approved by the Government and launched on April 1, 2020 in Ukraine. It guarantees patients a certain scope of free medical services. Healthcare providers have transitioned to the new healthcare funding system, including the vast majority of municipal, rayon and oblast policlinics contracted by the National Health Service of Ukraine (NHSU) for financing of medical service delivery. The Program of Medical Guarantees secures a clear scope of legally guaranteed services provided free of charge to patients (a guaranteed package, or a benefit package, according to international medical practice). The reason behind this reform of the existing free healthcare system was budget deficit and the so-called healthcare rationalization. The program of medical guarantees is based on the principle of prioritization. The Ministry of Health of Ukraine endorsed the Order on priority areas of healthcare sector development for 2020-2022. These areas were included in the Program of Medical Guarantees envisaging a number of state-guaranteed medical benefit packages. The provision of services included in these packages is funded by the Government.

Please note that Healthcare includes emergency care; primary healthcare; secondary (specialized) healthcare (outpatient); tertiary (highly specialized) healthcare (in most cases, inpatient); palliative care. Each patient is entitled to admission to any health facility of choice if is it justified by the patient’s condition and the facility has the capacities to ensure appropriate treatment. In context of free healthcare services, such treatment must be provided based on the content of the relevant medical benefit package.

• First of all, it is worthwhile to highlight to the offending social service provider that this is a violation of the right to social assistance guaranteed by the current legislature of Ukraine, demanding to respect this right.
• If this was not effective, you need to approach the head of the authority providing social services, better with a written complaint demanding to remedy the violation of the right to obtaining social services and assistance. Your report (complaint) must be duly registered, with an incoming registration number assigned.
• If, despite the expectations, these efforts were not successful, you need to submit a written report (complaint) to the municipal or oblast department of social protection about failure to react by the head of the local body. The report (complaint) must demand to remedy the violation of the right to receiving social services and assistance. The municipal or oblast authority must duly register the report and react to it. In fact, this is usually enough to correct the situation. 
• If the client remains unsatisfied, he/she can submit a complaint to the central executive authority responsible for social protection policy making, the Ministry of Social Policy of Ukraine, or apply to court. The legal action does not depend on the results of institutional appeal.

The right to healthcare and medical aid is guaranteed by the Ukrainian legislature (Art. 49 of the Constitution of Ukraine). However, unfortunately, cases occur when citizens face refusal by healthcare providers to deliver medical care, including hospitalization.

What do you need to remember and what shall you do in such situations?

1. First of all, you need to know the meaning of the term “healthcare”. According to Article 3 of the Law of Ukraine “The fundamentals of the legislature of Ukraine concerning healthcare” (the Fundamentals), healthcare means the activities of professionally trained healthcare providers aiming at prevention, diagnostics, treatment and rehabilitation in connection with diseases, trauma, poisoning and pathological condition and in connection with pregnancy and childbirth.
2. Healthcare includes emergency care; primary healthcare; secondary (specialized) healthcare (outpatient); tertiary (highly specialized) healthcare (inpatient); palliative care.
3. Each patient is entitled to admission to any health facility of choice if is it justified by the patient’s condition and the facility has the capacities to ensure appropriate treatment (Art. 38 of the Foundations).
4. In addition, according to the Law of Ukraine “On emergency medical care”, any person in need of emergency medical care has the right to seek emergency care in the closest emergency (urgent) medical care unit or another health facility able to provide such medical care.

According to the Law of Ukraine “On emergency medical care”, an emergency condition is a sudden deterioration of physical or mental wellbeing posing a direct and imminent threat to the life and health of the person or other people occurring as a result of a disease, trauma, poisoning or other intrinsic or external causes (Art.1 of the Law). A refusal to admit a patient in need of emergency medical care or untimely provision of emergency medical care to a patient in need of such care is unacceptable and will result in criminal charges against the healthcare provider whose duties include providing such care, for failure to provide medical care to a patient if the healthcare provider knows that this may have severe consequences for the patient (Art. 139 of the Criminal Code of Ukraine).

• A word about current (non-emergency) needs of hospital treatment. The Law of Ukraine “On freedom of movement and free choice of domicile in Ukraine” does not associate medical care provision by health facilities or provision of any services with the person’s registration or residence address. This means that a person who is registered at one address (for example, in a rayon center/in another oblast) and lives at another address (in the oblast center/another town), is not deprived of the right to seek medical care in a health facility at the person’s actual living address requesting qualified medical care. For that such a person should approach the chief physician of the health facility of choice with a written request of registration with the health facility at the place of actual residence which is their legal obligation.

 Conduct of the client whose right to healthcare is violated.

• First of all, it is worthwhile to highlight to the offending health professional that he/she is violating your right to healthcare guaranteed by the acting legislature of Ukraine (mentioned above) and demand respect of human rights.
• You can approach the chief physician of the health facility with a written statement (complaint) requesting to remedy the violation of the right to healthcare and medical services. The facility administration is obliged to register the complaint and issue it an incoming number.
• If, despite the expectations, these efforts were not successful (although such cases are not common in fact), you need to apply to the city or even oblast health administration: http://moz.gov.ua/regionalni-upravlinnja with a written report (complaint) about chief physician’s failure to react demanding to remedy the violation of your right to healthcare and medical services. The complaint must be duly registered and responded. Usually this is enough to correct the situation.
• If the client remains unsatisfied, he/she can complain to the Ministry of Health or apply to court.
• In case any consequences occur resulting from refusal to admit the patient requiring emergency medical care or untimely provision of emergency medical care to the patient in need of such care, a complaint can be submitted to the National Police of Ukraine based on Art. 139 of the Criminal Code of Ukraine for failure to provide care to a patient by a healthcare worker obliged to provide such care without a valid reason, if the healthcare worker is aware that such failure can result in severe consequences for the patient.

The Ukrainian legislature protects personal health information prohibiting its unlawful disclosure. However, in fact, cases of health professionals disclosing a person’s HIV status and thus directly violating the patient’s rights and breaching the law, are common.

What do you need to remember and what shall you do in such situations?

1. First of all, to act correctly, you need to know the following. No health facility employees (physicians, nurses, non-clinical staff) to whom your disease and the health status became known in performing their duties, have the right to disclose this information, except in cases envisaged by law.

Disclosing information about medical examination to detect human immune deficiency virus or acquired immune deficiency syndrome and its results incurs criminal liability based on Article 132 of the Criminal Code of Ukraine.

2. The fact of seeking medical care in a healthcare facility, along with the person’s health status and diagnosis, constitute medical secrecy according to Article 39-1 of the “The fundamentals of the legislature of Ukraine concerning healthcare” – the right to confidentiality of the health status.
3. Disclosing the information means that a person liable for ensuring confidentiality of the health information that became known to him or her, unlawfully reveals it to third parties or establishes conditions under which the medical information about a patient of a healthcare facility may become known to the third parties, especially if it relates to the patient’s HIV status. Information can be disclosed in many different ways: in talks with other people, for example, the patient’s neighbors, passing an invitation for the next visit to the AIDS Center with third parties, or giving documents containing confidential information, to third parties.
4. According to Article 15 of the Law of Ukraine “On preventing dissemination of diseases caused by human immune deficiency virus (HIV) and legal and social protection of people living with HIV”, people living with HIV are entitled to reparation of harm related to restriction of their rights due to publicization or disclosure of information about their positive HIV status.

Conduct of the client whose rights are violated by disclosure of HIV-positive status 

• If the victim of the offence (HIV status disclosure) is willing to hold the offending health professional to criminal liability, he/she shall file a complaint about the offence under Article 132 of the Criminal Code of Ukraine with the National Police of Ukraine.
• A person harmed by restrictions of his/her rights due to his/her HIV status publicization/disclosure, is entitled to take a civil legal action against the offender (a health professional or a health facility, depending on the case) demanding reparation of harm under Article 15 of the Law of Ukraine “On preventing dissemination of diseases caused by human immune deficiency virus (HIV) and legal and social protection of people living with HIV”.     

May people face violations of their rights in their day-to-day lives. To help you become more aware of your rights and understand the legislature, we are launching our “Know your rights” column with lawyer’s practical advice where you can ask your questions to get detailed answers. Now, our first question: what shall you do if your employer wants you to disclose your HIV status?

The Ukrainian labor law prohibits employers to request any personal information, including health information and HIV status, at conclusion of a labor agreement. However, in fact, unfortunately, cases when managers of companies or institutions request a certificate proving HIV-negative status, thus directly violating the labor law, are common.

What can you tell the employer in response to their demand for a test for HIV?

1. If an employee is demanded to take a test confirming his/her HIV-negative status, the employee should state that HIV testing is a right, not a liability referring to Article 6 of the Law of Ukraine “On preventing dissemination of diseases caused by human immune deficiency virus (HIV) and legal and social protection of people living with HIV” (further – the Law) which defines the right of people for testing to detect HIV, the terms and procedures of conducting the testing. The Article states that “testing shall be performed on voluntary basis, with confidentiality of personal data, including the data on the health status, ensured.”
2. The information on HIV test results is strictly protected, regardless of the status. The HIV test results are disclosed by the responsible employee of the facility which conducted the test only to the person who took the test, and in cases defined by the Law – to parents or other legal guardians (Article 7 of the Law), with confidentiality of information duly secured.
3. The Law guarantees protection of information about positive HIV status from publicizing and disclosure to the third persons (Article 13 of the Law). The information about HIV test results and HIV status is confidential and constitutes a medical secrecy which can be revealed to other third parties only upon court decision in cases defined by law.
4. Termination of employment, refusal of employment and restriction of other rights based on HIV status are prohibited. Unlawful actions of officials in this regard can be appealed administratively and in court. You should explain to the employer that you can and will appeal the employer’s refusal to hire you based on your HIV test in court.