Overview
Ukrainian healthcare should be free to citizens according to law, but in practice patients contribute to the cost of most aspects of healthcare. The system is funded mainly from state and local budgets. Medical staff in the state sector have very low salaries. The healthcare system in Ukraine is now being reformed to move towards an insurance-based system. However, the situation with diabetes mainly remains the same.
Medical insurance is not developed well, with insurance companies offering medical coverage but not many people being able to use it. If someone has a chronic condition, such as diabetes, companies may refuse to provide coverage or set very high fees. The healthcare system covers basic needs of public clinics, and only essential medicines are provided by the government. That means medical services are expensive in both public and private clinics.
What happens if you need to see a doctor?
Except in emergencies, if one wants to consult a doctor they need to make appointment first. A person may need to wait from several hours to a few weeks before they have their appointment, depending on the clinic and a doctor. To see an endocrinologist, it usually takes few days to get an appointment. When you visit your endocrinologist, they can give you a prescription for insulin.
Who decides what doctors can prescribe?
Doctors can only prescribe medicines officially registered in Ukraine. The medicine registries are the responsibility of the State Service on Medicines and Drugs Control. If a doctor decides you have to switch to another insulin, you have to be admitted to a hospital where the other doctor must decide the new treatment regime and dosage. If a person with diabetes wants to have his/her insulin costs covered by the government, only prescriptions from certain clinics are valid.
Practically, what is it like to live with type 1 diabetes in Ukraine?
Insulins are mostly free for people with diabetes and covered by government. Those that use insulin analogs or get insulin in pens or cartridges must show good diabetes management (HBA1c less than 7.5%) in order to receive it. Certificates must be presented to doctors every 3 months or else a person with diabetes will need to make a co-payment (usually, 10 - 30% of insulin cost). Blood tests and test-strips for glucometers are not free. There are some programs for children (under 18 years) and pregnant women with diabetes, that provide free test-strips, but they are not ongoing.
Living with type 1 diabetes in Ukraine is a challenge, because you do not have a lot of support from the government. All you can do is rely on yourself and on the social or charitable organizations that provide people with information, social and emotional support, and things like test strips and glucometers. The cost of insulin pumps, CGMs and their supplies must be paid for by people with diabetes. As of today, only the Medtronic CGM is officially registered in Ukraine.
On other hand, living with diabetes in Ukraine does have its advantages. For example, each person with diabetes has the right to get monthly monetary allowance and discounts for some medicine and free public transport tickets. You can buy a cheaper ticket to the cinema or to the zoo if you have the document that confirms your disability. To get this document, a person with diabetes has to do the confirmation of disability every year, which takes a lot of time.
What about getting admitted to hospital?
When a person with diabetes needs to be admitted to a hospital, their doctor refers them to a clinic. The admission can be both for emergency care or for a less urgent examination. The admission is not free, even at public clinics. Patients must pay for meals, most medications they take while in hospital, and sometimes they even pay for supplies (syringes, infusion systems etc.). In general, doctors advise people with diabetes to be admitted to a hospital at least once a year for complication prevention and for general examination.
How does diabetes care vary throughout Ukraine?
Diabetes life and care is different in regions throughout Ukraine. In big cities, the availability of insulin, glucometers and test strips is much higher than in rural areas. People also generally have higher income in urban areas. If you live in the countryside, it is much harder to manage diabetes because the rural areas are very poor and usually do not have professional doctors (even in primary care) that work on diabetes. In big cities, more and more private clinics that have very smart professionals that are young and skilled in managing diabetes are starting to appear.
We really appreciate the help of Roman Vlasenko and Olena Ginzburg, who provided information about diabetes in their country.