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Must healthcare services be provided with the online referral number and what to do if healthcare workers refuse to provide services?

REAct project clients often report that heath facilities refuse to provide medical care. 

Clients report cases when they visit a specialist physician for a consultation showing the number of the online referral received from their family doctor or attending physician as a message on their smartphone. However, healthcare workers demand a paper copy of the referral as a mandatory requirement to deliver the healthcare services which certainly creates inconveniences. 

Let’s see if such a requirement is reasonable and what to do in such situations. 

Upon the healthcare reform and with the implementation of the Program of Medical Guarantees, the order of providing consultations by specialist physicians and conducting examinations has changed. An online referral is required to obtain such medical services. This document is issued by a physician upon his/her own initiative or upon the patient’s request if the physician needs findings of an examination to assess the patient’s health status. This can be either a primary care provider (a family doctor, a general practitioner, or a pediatrician) or the physician providing specialized care to the patient. 

No health facility contracted by the National Health Service of Ukraine (NHSU) can refuse to provide medical service to the patient for the absence of a paper copy of the referral, as long as the patient has a valid online referral number. 

According to the order, after an online referral is created, it is automatically registered in the central database of the Electronic Healthcare System (eHealth) designated to enable physicians from different facilities to access the referrals of their patients. Thus, a search inquiry for the referral is sent to the central database, and if a referral with such a number exists, it will appear in the informational system interface of the health facility.

The healthcare workers can only ask the patient to provide a printed copy of the electronic referral if it is possible, for example, in cases when the health professional cannot access eHealth from his/her office. In any case, this is not the reason to refuse to provide medical care upon referral! In case of such refusal, the patient needs to contact the chief physician or the deputy chief physician of the facility and to complain and demand delivery of the health service because the referral number is available. 

In general, referrals are designated to ensure delivery of inpatient or outpatient healthcare services; healthcare services delivered by mobile teams; laboratory, instrumental or functional tests.

Currently, online referrals break down into the following categories:

  1. Consultation
    1. Laboratory diagnostics 
    1. Diagnostic procedure 
    1. Procedure 
    1. Treatment and diagnostic procedure 
    1. Surgery
    1. Visualization 
    1. Hospitalization 
    1. Transfer to another health facility 

Is it possible to seek care in health facilities without a referral?

According to Order of the Ministry of Health # 586 as of 28.02.2020 “On endorsing the order of referring patients to health facilities and individual entrepreneurs duly licensed to run a healthcare practice who provide healthcare of the relevant type”, the referral is not mandatory in the following cases:

  • Seeking primary medical care;
  • Seeking secondary (specialized) outpatient medical care of obstetrician-gynecologist, psychiatrist, narcologist, dentist, pediatrician, TB specialist;
  • HIV counseling and testing;
  • Seeking paid medical services;
  • Other cases envisaged by legislature.

Specialized care is provided without referral to patients:

  • in an emergency (urgent) condition;
  • with chronic diseases on dispensary monitoring in this heath facility.

In other cases of seeking medical care without a referral in health facilities contracted by the NHSU for provision of healthcare services to the population, such medical care will not be free for the client (is not covered by the Program of Medical Guarantees) and must be paid for from other sources, for example, from the patient’s own money, based on the officially endorsed tariff in the health facility.