Preliminary results of the study from the WHO and the European Observatory on Health Systems and Policies, Rehabilitation Services Financing and Organization: Learning from European Countries towards Strengthening Rehabilitation Care in Ukraine, has revealed that countries across Europe pursue different approaches to ensure equitable and sustainable access to rehabilitation services.

These findings have been presented at a policy dialogue in Kyiv, hosted by the WHO Country Office Ukraine together with the WHO Barcelona Office for Health Systems Financing and the European Observatory on Health Systems and Policies. Organized with the financial support of the European Union, the event has brought together national and regional authorities, clinical experts and international partners to discuss how to strengthen rehabilitation care financing in Ukraine, based on the experience and best practices from selected European countries, including case studies from Croatia, England, Estonia, Italy, Lithuania, Poland, Spain and Switzerland.

“Rehabilitation is more than just the restoration of physical function to the largest extent possible; it also includes attention to mental and psychosocial issues that often come with disabling conditions,” said Dr Natasha Azzopardi Muscat, WHO/Europe’s Director of Country Health Policies and Systems. “Of course, proper rehabilitation services need proper funding, and in the European Region spending on rehabilitation is still far too low. The preliminary findings we are releasing today are crucial to understand how countries—including Ukraine—can finance these services to meet people’s growing health needs.”

"The preliminary results of this study demonstrate how to improve rehabilitation care in Ukraine and other countries across Europe. By improving patient pathways and and finding  better ways to finance rehabilitation services, we can ensure that more people have affordable access to rehabilitation care here in Ukraine ," said Dr Jarno Habicht, WHO Representative in Ukraine.

“Thanks to the Observatory’s collaboration with country experts and the Health Systems and Policies Monitor (HSPM) network, we gathered valuable, country-specific policy data and insights about rehabilitation systems in selected European countries. These data allow us to understand each country’s system and compare how countries organize and finance rehabilitation services. Our findings generate a menu of policy options for Ukraine and other countries interested in building or improving the performance of their rehabilitation systems,” said Dr Ewout van Ginneken, Coordinator at the Berlin hub of the European Observatory on Health Systems and Policies at the Berlin University of Technology and its Director-elect (from January 2025). 

"The Ministry of Health is constantly working to improve the rehabilitation system. It is already possible to receive free inpatient rehabilitation care in 314 medical institutions throughout Ukraine. As of November 2024, the state has paid more than UAH 1.9 billion to medical institutions for this purpose. Outpatient rehabilitation is free of charge for patients in 470 medical facilities. In 2024, we differentiated the payment that medical institutions receive from the state for rehabilitation services. Now the amount directly depends on the severity of the injury and ranges from UAH 19,000 to UAH 41,0000 per cycle. Centers of Excellence are being created on the basis of progressive rehabilitation units, which function as training hubs for other rehabilitation teams and actively implement the latest practices that meet international standards. Rehabilitation services are critical to restoring the health of our citizens. We are grateful to our international partners for their help in shaping a modern approach to organizing this system. The interim results of the study give us a clear vision of the next steps to ensure the accessibility and quality of rehabilitation care in Ukraine," said Viktor Liashko, the Minister of Health of Ukraine.

“Efficient, modern, and science-based rehabilitation is very important for any country, and especially for a country being victim of military aggression. This is why we, together with the WHO, support strengthening of Ukraine’s rehabilitation system, which has faced unprecedented challenges and a steep increase of needs since the start of the Russian full-scale invasion,” said René Steiner, Counsellor for Migration and Home Affairs; Justice and Consumers; and Health and Food Safety, Delegation of the European Union to Ukraine.

The study is based on a cross-country comparison of the rehabilitation care systems of selected European countries. This was done through a jointly designed template that collected information from national experts on foundational aspects of countries’ rehabilitation systems. This information provides insights into the effectiveness and efficiency of different rehabilitation systems, including financing, organization and delivery, and their interplay with workforce strategies, and infrastructural supports.

The study focuses on 3 key areas:

• patient pathways and settings of care, particularly for conditions like stroke, back pain, and amputations;
• coverage, eligibility, and benefits offered to people; and
• the purchasing of services, including how different rehabilitation service providers are paid.

The study suggests that for improved service delivery, it is essential to integrate in- and outpatient care, and shift care to primary health care with a defined care coordinator, a clear hospital discharge process handing over care to the outpatient setting, rehabilitation professionals directly working in the primary health care (PHC) setting and with a broader set of responsibilities, such as diagnosis, treatment, prescribing, assessment.

The findings highlight that planning and purchasing value-for-money care requires setting clear eligibility criteria based on clinical guidelines with some flexibility for reassessment, setting budgets and purchase based on need predicted by population characteristics rather than based on services provided, promoting remote care when possible, limiting the activity or income of inpatient settings as well as planning and purchasing more care from outpatient settings.

Preliminary results also recommend that to control spending and avoid over- or under-provision, it is important to implement effective provider payment strategies. Such strategies could include:

• combining payments with different characteristics
• adjusting payments for severity
• setting budgets based on predicted needs, instead of past utilization or past spending

The policy dialogue, held in Kyiv, helps to shape the research with the final report planned for release in 2025.