A complete list of PHC services covered by the state starting July 1, 2018
July 1st 2018 marks a significant step forward in the process of healthcare system transformation in Ukraine. The first PHC providers, both communal and private facilities, which have signed contracts with the National Health Service of Ukraine (NHSU), start operating under the new financing model based on the "money follows the patient" principle. At the meantime, all primary care facilities start providing services in full compliance with the Procedure for provision of primary care services (MoH Order No. 504), which defines a clear set of primary care services (the guaranteed benefit package) that will be covered by the state and paid by the NHSU.
DIAGNOSIS AND TREATMENT
General practitioners, pediatricians and family doctors are responsible for monitoring patients’ health and advising on healthy lifestyle, diagnosing and treating common diseases, injuries, poisoning, pathological, and physiological conditions.
If necessary, primary care doctors should refer patients to specialists of secondary or tertiary care (i.e. for specialized or highly specialized medical care) and issue health certificates or notes.
Primary care doctors can continuously treat patients with chronic diseases and conditions.
It is worth mentioning that family doctors can treat patients of all age groups, pediatricians can care for children from birth to the age of 18, and therapists – persons 18 years of age and older.
MEDICAL ANALYSIS AND TESTS
A clearly defined list of primary care services also includes the package of the most common medical analysis and tests, including:
- A general blood test (with leukocyte formula)
- A general urine test
- A blood glucose test
- A complete cholesterol test
- A blood pressure measurement
- An electrocardiogram (ECG or EKG)
- A measurement of body weight, height, waist circumference
- A rapid pregnancy test
- A rapid troponin blood test
- Rapid diagnostic tests for the detection of HIV, viral hepatitis
All other medical tests and analysis are to be performed by a specialist upon a referral from a primary care doctor.
ROUTINE MANAGEMENT OF UNCOMPLICATED PREGNANCY AND ESSENTIAL CARE FOR CHILDREN FROM BIRTH TO THREE YEARS OF AGE
By choice of a pregnant woman, a family doctor or therapist can provide routine care during an uncomplicated pregnancy (up to 12 weeks). When necessary, a family doctor refers a pregnant woman to a obstetrician-gynecologist. Primary physicians can consult a pregnant woman and other members of her family on matters related to the course of pregnancy and childbirth.
Routine essential care for children during the years from birth to age three includes scheduled examinations, even when the child is healthy: 16 health examinations (10 by a doctor and 6 by a nurse) during the first year of life, 2 health examinations during the second year and 1 during the third year.
Primary care physicians are responsible for identifying health risks in a timely manner and preventing diseases (including vaccination). A primary care doctor should ensure that children and adolescents aged up to 18 years receive vaccines according to the recommended immunization schedule. The Ukrainian government procures vaccines against the following life-threatening diseases: tuberculosis, poliomyelitis, diphtheria, pertussis, tetanus, measles, hepatitis B, hemophilic infection, rubella, and mumps.
MANDATORY PREVENTIVE MEDICAL EXAMINATIONS
The new Procedure for provision of primary care services envisages the practice of preventive medical examinations and analysis for seven at-risk groups – patients with risk factors for developing diabetes mellitus, HIV, tuberculosis, breast cancer, hypertonic disease and other cardiovascular diseases, colorectal cancer, and prostate cancer.
The role of a primary care doctor in preventing diseases is very important – from advising on a healthy lifestyle to identifying health risks in a timely manner.
Primary care doctors are also responsible for issuing correct prescriptions for medicines, including for those covered under the "Affordable Medicines" program.
HOME VISITS AND URGENT CARE
Primary care doctors do home visits, but it is now at the doctor's discretion (not patient’s or registrar’s anymore) whether a home visit is deemed necessary. Primary care doctor can visit a patient at home when this patient is confined due to illness or disability, or urgent treatment can be given more quickly by visiting. However, doctors will always encourage patients to come to the primary care facility when a home visit is not medically necessary, because this is where the best care can be provided.
Primary care physicians can also provide emergency care for an acute physical or mental disorder if a patient does not need an emergency, specialized or highly specialized care.
PALITIVE CARE AND MEDICAL NOTES
The competence of primary care physician includes certain palliative care services – care for people with serious illnesses, including prescription of medicines for management of physical symptoms, like pain.
Finally, primary care doctors can issue different types of medical notes, including sick notes, temporary disability leaves, referrals for a medical examination, etc.